SCHEDULE 1
to
MOULISON, LLC
LIMITED LIABILITY COMPANY AGREEMENT
Name Mailing Address
SC Holdings, Inc. 378 Bennoch Road
P.O. Box 435
Stillwater, ME 04489
{RIGH7112 $7989-072080 } 13
TE/CMAQ Program
Construction Proposal
It us proposed:
To execute the Contract and begin work within 10 days from the date specified in the “Notice to Proceed” and to
prosecute said work so as to complete the and its appurtenances on or
before
To furnish a Contract Bond in the amount of 100 per cent of the Contract award, as security for the construction and
completion of the and its appurtenances in accordance with the
Plans, Specifications and Contract. The Conteacior’s attention is called to Section 103.05 of the NHDOT Standard
Specifications for coad and bridge construction which provides the following guidance: unless specifically waived in the
Proposal, upon execution of the Contract, the successful Bidder shall furnish the Agency a surety bond or bonds equal
to the sum of the Contract amount. The form of the bond(s) shall be acceptable to the Agency and the bonding
Company issuing the bond{s) shall be licensed to transact business in the State of New Hampshire, and ...
To certified that the Bidder, in accordance with the requirements of 103.06 and 108.01, intends to sublet, assign, sell,
transfer or otherwise dispose of one or more portions of the work and (1) has contacted the appropriate listed
disadvantaged businesses and afforded such disadvantaged businesses equal consideration with non-disadvantaged
business for all work the Bidder currently proposes to sublet, assign, sell, transfer or otherwise dispase of, (2) may
contact additional appropnate disadvantage businesses and will afford such businesses equal consideration with
non-disadvantaged businesses for all work the Bidder in the future proposes to sublet, assign, sell, transfer or otherwise
dispose of, and (3) will complete enclosed “DISADVANTAGED BUSINESS ENTERPRISE COMMITMENT
FORM” and Letters of Intent for each disadvantaged business. The name of the person in the Bidder’s organization
who has been designated as the liaison officer to administer the disadvantaged business enterprise program is,
(To be completed by the Bidder)
To guarantee all of the work performed under this Contract to be done in accordance with the Specifications and in
good and workmanlike manner, and to renew or repairs any work which may be rejected, due to defective materials or
workmanship, prior to final completion and acceptance of the project.
Enclosed herewith find certified check or bid bond in the amount of
dollars (§ ), made payable to the Agency
as a proposal guarantee which it is understood will be forfeited in the event the Contract is not exeanted, if awarded by
the Agency to the undersigned.
rtification Regarding Debarment, Suspension, and Other nsibility Matters - Primary Covered
Transactions.
(1). The prospective primary participant certifies to the best of its knowledge and belief, that it and all its
principals: (a) Are not presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from covered transactions by any Federal department or agency; (b) Have not within a
three-year period preceding this proposal been convicted of or had a civil judgment rendered against them for
commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a
public (Federal, State or Local) transaction or contract under a public transaction; violation of Federal or State
antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of
records, making false statements, or receiving stolen property; (c) Arc not presently indicted for or otherwise
criminally or civilly charged by a governmental entity (Federal, State or Local) with commission of any of the
offenses enumerated in Paragraph (1) (b) of this certification and (d) Have not within a three-year period
preceeding this application/ proposal had one os more public transactions (Federal, State or Local) terminated
for cause or default. (2), Where the prospective primary participant is unable to certify to any of the
statements in this certification, such prospective participant shall attach an explanation to this proposal.
Contract Affidavit
I/We declare under penalty of perjury under the laws of the United States and the State of New
Hampshire that, in accordance with the provisions of Title 23 USC, Section 112(c), have not either directly or
indirectly entered into any agreement, participated in any collusion or otherwise taken any action in restraint
of free competitive bidding in connection with this Proposal,
Dated:
(if'a firm or individual)
Signature of Bidder
By.
Address of Bidder
Names and Addresses of Members of the Firm:
(If a Corporation)
Signature of Bidder
Tule
By
Business Address
Incorporated under the laws of the State of
Names of Officers:
President
Name Address
Secretary
Name Address
Treasurer.
Name Address
SICMAQATEWroposal doc
CHANGE ORDER
No.
PROJECT: Safe Routes to School Birch Hill Elementary Variable Message Speed Feedback Signs
OWNER’S CONTRACT NO:__IFB STATE No._40683 FEDERAL No. A004(467)
EXECUTED CONTRACT DATE:
DATE OF ISSUANCE: _. EFFECTIVE DATE: Upon City Approval
OWNER: City of Nashua, NH
OWNER’s Purchase Order NO.:
CONTRACTOR:
You are directed to make the following changes in the Contract Documents:
Description:
Justification:
Change Order # 1 of 2
Summary
CHANGE IN CONTRACT PRICE:
Original Contract Price
$
CHANGE IN CONTRACT TIMES:
Original Contract Times
Substantial completion:
Ready for final payment:
Net changes from previous Change Orders
$
Net change from previous Change Orders
Contract Price prior to this Change Order
$
Contract Times prior to this Change Order
Substantial completion:
Ready for final payment:
Net Increase (deerease) of this Change Order
$
Net Increase (decrease) of this Change Order
Contract Price with all approved Change Orders
Contract Times with all approved Change Orders
Substantial completion:
Ready for final payment:
$
RECOMMENDED: ACCEPTED:
By By:
City Project Manager Name
Contractor
(Authorized Signature)
Date: Date:
(Authorized Signature)
APPROVED:
Mayor Jim Donchess
Owner
(Authorized Signature)
Change Order #
2 of 2
PROJECT CLOSE-OUT FORMS
CONSENT OF SURETY COMPANY
TO
FINAL PAYMENT
OWNER'S CONTRACT NO.: ENGINEER' PROJECT NO.:
AGREEMENT DATE:
BOND NUMBER:
CONTRACT TITLE:
To: (Owner)
From: (Contractor)
In accordance with the provisions of the Contract between the Owner and the Contractor as
indicated above, the (Surety) on the bond of
(Contractor) hereby approves of the final payment to the Contractor, and agrees that final
payment to the Contractor shall not relieve the Surety Company of any of it's obligations to the
(Owner) as set forth in the said Surety Company's Bond.
IN WITNESS WHEREOF, the Surety Company has hereunto set its hand this _ day of
520.
Surety Company
Signature of Authorized Representative
Attest: (Seal) Name & Title
Note: Power of Attorney should be attached in instances where same applies.
9/07
PROJECT CLOSE-OUT FORMS
CONTRACTOR'S FINAL LIEN WAIVER
(page 1 of 2)
OWNER'S CONTRACT NO:: ENGINEER’ PROJECT NO.:
AGREEMENT DATE:
CONTRACT TITLE:
To: (Owner)
APPLICATION FOR FINAL PAYMENT
The undersigned hereby certifies that the amount owed set forth below constitutes the entire
value of all work performed and services rendered by, through or under the undersigned with
respect to the project not heretofore paid for up to and including the period covered by the above
Application for Final Payment; that all work covered by such Application has been incorporated
into the project and title thereto has passed to the Owner free and clear of all liens, claims,
security, interests or encumbrances; and that no work covered by such Application has been
acquired subject to an agreement under which any interest therein or an encumbrance thereon is
retained by the seller or any other person. In consideration of payment of the requisition, the
undersigned hereby releases the Owner from all claims of lien which the undersigned has
regarding the Project.
The undersigned, in order to induce the Owner to pay the requisition, hereby represents that it has
paid or will pay from the proceeds of the requisition all sums due to those parties who have
performed work or provided materials to the undersigned in connection with the Project, and that
it will on request of the Owner provide written evidence of the discharge by the undersigned of
its obligations to such parties.
Executed under seal as of this day of , 20
Amount Owed to Contractor by Owner as Final Payment:
$ (total value of project including change orders)
Amount Unpaid From Previous Application for Payment:
$
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PROJECT CLOSE-OUT FORMS
CONTRACTOR'S FINAL LIEN WAIVER
(page 2 of 2)
From: (Contractor)
Authorized Representative Signature
Name and Title (printed)
NOTARY:
Then personally appeared the above named ; and
acknowledged the foregoing to be the free act and deed of the above-named Contractor, before
me.
Subscribed and sworn to on the day of , 20
Notary Public:
My Commission Expires:
9/07
PROJECT CLOSE-OUT FORMS
CERTIFICATE OF FINAL COMPLETION OF WORK
(page 1 of 2)
OWNER'S CONTRACT NO.:: ENGINEER’ PROJECT NO.:
AGREEMENT DATE:
CONTRACT TITLE:
FINAL COMPLETION DATE PER AGREEMENT AND CHANGE ORDERS:
ACTUAL DATE OF FINAL COMPLETION:
FINAL CERTIFICATION OF CONTRACTOR
I hereby certify that the Work as identified in the Final Payment Request dated
for the above-noted construction Contract represents full compensation for the actual
value of work completed. Additionally, all work completed conforms to the terms of the
Agreement and authorized changes.
CONTRACTOR Date
Authorized Representative’s Signature
Name & Title
FINAL CERTIFICATION OF ENGINEER
I have reviewed the Contractor's Final Payment Request dated and hereby
certify that to the best of my knowledge, the cost of the work identified on the Final Payment
Request represents full compensation for the actual value of work completed and that the work
has been completed in accordance with the terms of the Agreement and authorized changes.
ENGINEER Date
Authorized Representative’s Signature
Name & Title
9/07
PROJECT CLOSE-OUT FORMS
CERTIFICATE OF FINAL COMPLETION OF WORK
(page 2 of 2)
FINAL ACCEPTANCE OF OWNER
I, as representative of the Owner, accept the above Final Certifications and authorize Final
Payment in the amount of $ and direct the Contractor's attention to the
General Conditions. The guaranty for all Work completed subsequent to the date of Substantial
Completion, expires year from the date of this Final Acceptance.
At a meeting of the (Town Council/Selectmen/Alderman), the Owner,
(Name of the community) has accepted the constructed project.
OWNER Date
Authorized Representative’s Signature
Name & Title
END OF SECTION
9/07
