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CHANGE ORDER

PROJECT:

OWNER’S CONTRACT NO:

EXECUTED CONTRACT DATE:

DATE OF ISSUANCE: EFFECTIVE DATE: Upon City Approval
OWNER: City of Nashua, NH

OWNER’s Purchase Order NO.:

CONTRACTOR:

ENGINEER:

‘You are directed to make the following changes m the Contract Documents:

Description:

Change Order # 1 of 2

Summary

CHANGE IN CONTRACT PRICE:
Original Contract Price

$

CHANGE IN CONTRACT TIMES:
Original Contract Times

Final 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

Final completion:
Ready for final payment:

Net Increase (decrease) 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

$ Final completion:
Ready for final payment:
RECOMMENDED: ACCEPTED: APPROVED:

By: By: By:

Engineer Name Mayor Jim Donchess
Contractor Owner
{Authorized Signature) (Authorized Signature)
(Authorized Signature}
Date:
Date: Date:
Change Order # 2 of 2

CERTIFICATE OF SUBSTANTIAL COMPLETION

PROJECT:

OWNER’S CONTRACT NO:

DATE OF ISSUANCE:
OWNER: City of Nashua, NH

OWNER’s Purchase Order NO.:

CONTRACTOR:

ENGINEER;

The Work to which this Certificate applies has been inspected by authorized representative of OWNER,
CONTRACTOR, and ENGINEER, and that Work is hereby declared to be substantially complete in
accordance with the Contract Documents on

(DATE OF SUBSTANTIAL COMPLETION)

A Tentative list of items to be completed or corrected is attached hereto. This list may not be all-
inclusive, and the failure to include an item in it does not alter the responsibility of CONTRACTOR to
complete all the Work in accordance with the Contract Documents. The items in the tentative list shall
be completed or corrected by CONTRACTOR within days of the above date of
Substantial Completion.

This certificate does not constitute an acceptance of Work not in accordance with the Contract
Documents nor is it a release of CONTRACTOR’s obligation to complete the Work in accordance with
the Contract Documents.

EXECUTED BY ENGINEER: ACCEPTS THIS CERTIFICATE OF SUBSTANTIAL ACCEPTS THES CERTIFICATE OF SUBSTANTIAL
COMPLETION: COMPLETION:
By: By: By:

Daniel Hudson, P.E.

(Authorized signature) Owner Representative Contractor (Authorized Signature)

Title: Title: City Engineer, City of Nashua Title:

Date: Date: Date:

CERTIFICATE OF FINAL COMPLETION

PROJECT:

OWNER’S CONTRACT NO;

DATE OF ISSUANCE:

OWNER:

OWNER’s Purchase Order NO.:

CONTRACTOR:

City of Nashua, NE

ENGINEER:

The Work to which this Certificate applies has been inspected by authorized representative of OWNER,
CONTRACTOR, and ENGINEER, and that Work is hereby declared to be substantially complete in
accordance with the Contract Documents on

(DATE OF FINAL COMPLETION)

This certificate does not constitute an acceptance of Work not in accordance with the Contract
Documents nor is it a release of CONTRACTOR’: obligation to complete the Work in accordance with
the Contract Documents. The Warranty for all Work completed expires one year from the date of this

Final Completion.

EXECUTED BY ENGINEER:

ACCEPTS THIS CERTIFICATE OF FINAL
COMPLETION:

By: By:
Daniel Hudson, P.E.
(Authorized signature) (Owner Representative)
Title: Title: — City Engineer, City of Nashua
Date: Date:

ACCEPTS THIS CERTIFICATE OF FINAL
COMPLETION:

By:

Contractor (Authorized Signature}

Title:

Date:

CONSENT OF SURETY FOR FINAL PAYMENT

OWNER's Project No.:
Project:
Amount of Contract (including
Type of Contract: Change Orders):
CONTRACTOR:
Contract For: Contract Date:

In accordance with the provisions of the above named contract between the OWNER and the
CONTRACTOR, the following named Surety Company:

On the Payment Bond of the following named CONTRACTOR:

Hereby approves of final payment to the CONTRACTOR, and further agrees that said final payment to
the CONTRACTOR shail not relieve the Surety Company named herein of any of its obligations to the
following named OWNER; as set forth in said Surety Company’s bond:

IN WITNESS WHEREOF, the Surety Company has hereunto set its hand and seal
this day of , of 20

(Name of Surety Company)

(Signature of Authorized Representative)

(Title)
(Affix corporate seal here}

1 of 1
Consent of Surety

: Account: CITY OF NASHUA
SmartShopper Program Date: 07/01/19

May 2022 Performance Report

aaa }OP Procedure Summary (Jun 2021 - May 2022)

Top Shopping Procedures Top Savings Summary

Lab/Blood Work [I 56 Specialty Rx $38,716

Mammogram a: Lab/Blood Work $27,936

Colonoscopy a:

Physical Therapy $23,306

Colonoscopy $9,745

Physical Therapy | Shoulder Surgery $9,681
Specialty Rx [BB9 MRI| $8,823
X-Ray fz Upper GI | $3,549
Ultrasound | Mammogram | $2,989
ctscan ffi Bone Density {$1,085
Upper GI fio Ultrasound [$753

aaa Missed Opportunity Procedure Summary (Jun 2021 - May 2022)

Top 10 Missed Opportunity Claims Top 10 Missed Opportunity Savings
Lab/Blood Work [nS 392 Lab/Blood Work $1,353,985
X-Ray BR: 304 Physical Therapy $789,506
Ultrasound Moss Colonoscopy $300,646
CT Scan sss Sinus Surgery $260,957
Physical Therapy [515 SpecialtyRx $250,138
mri 511 CTScan $221,393
Colonoscopy 286 MRI $209,749
Specialty Rx |188 Ultrasound — $152,500
Sinus Surgery 77 OB/Gyn $138,624
OB/Gyn [24 X-Ray $129,983

Page 3 of 6

CONTRACTOR'S AFFIDAVIT

STATE OF:

COUNTY OF:

Before me, the undersigned, a

(Notary Public, Justice of Peace, Alderman)
in and for said County and State personally appeared,

(Individual, Partner or duly authorized representative of corporate contractor)
who being duly sworn according to law deposes and says that the cost of all the Work, and
outstanding claims and indebtedness of whatever nature arising out of the performance of the
contract between

City of Nashua, New Hampshire of 229 Main Street, Nashua, NH 03060
(Owner) (Address)
and
of
(Contractor) (Address}
Dated for the construction of the

and necessary appurtenant installations have been paid in full.

(Individual, Partner or duly authorized representative of corporate contractor}

(Title)

(Individual, Partner, or duly authorized representative of corporate contractor)

Sworn to and subscribed before me this day of , 2020

{Notary Public}

Rada

CONTRACTOR'S FINAL RELEASE AND WAIVER OF LIEN

Project:

Owner Contractor

Owner:_City of Nashua, New Hampshire Name:

Address:_229 Main Street Address:

Nashua, New Hampshire 03060

City State Zip City State Zip

Contractor License:
Contract Date:

TO ALL WHOM IT MAY CONCERN:

For good and valuable consideration, the receipt and sufficiency of which is hereby
acknowledged, the undersigned Contractor hereby waives, discharges, and releases any and all
liens, claims, and rights to liens against the above-mentioned project, and any and all other
property owned by or the title to which is in the name of the above-referenced Owner and against
any and all funds of the Owner appropriated and available for the construction of said project,
and any and all warrants drawn upon or issued against any such funds or monies, which the
undersigned Contractor may have or may hereafter acquire or process as a result of the
furnishing of labor, materials, and/or equipment, and the performance of Work by the Contractor
on or in connection with said project, whether under and pursuant to the above-mentioned
contract between the Contractor and the Owner pertaining to said project or otherwise, and
which said liens, claims or rights of lien may arise and exist.

The undersigned further hereby acknowledges that the sum of

Dollars ($ } constitutes the entire wupaid balance due the undersigned in
Connection with said project whether under said contract or otherwise and that the payment of
said sum to the Contractor will constitute payment in full and will fully satisfy any and all liens,
claims, and demands which the Contractor may have or assert against the Owner in connection
with said contract or project.

Dated this day of 20

Contractor
Witness to Signature

By Title

DIVISION 9

TECHNICAL SPECIFICATIONS

A. NHDOT Supplemental Specifications (2016 Edition) — updated July 6, 2018
B. ‘Technical Specifications

NHDOT SUPPLEMENTAL SPECIFICATIONS
(2016 EDITION) —- UPDATED JULY 6, 2018