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LIST OF SUBCONTRACTORS
(to be submitted after bid opening)

Within two hours after the completion of the opening of the bids, the general contractors who
submitted the three lowest bids must provide a list of each subcontractor who will provide labor or a
portion of the work or improvement to the contractor for which the subcontractor will be paid an amount
exceeding one percent (1%) of the prime contractor's bid or $50,000, whichever is greater, and the
number of the license issued to the subcontractor. If a general contractor fails to submit such a list
within the required time, the bid shall be deemed not responsive. To be deemed a responsive bid, this
form must be submitted even if no subcontractors are required to be listed. In that case, the bidder should
state “None” (or similar language stating that no subcontractors need to be listed) in the space below.
(Refer to General Condition 6.09.H.)

Dollar Value and
Subcontractor/Address description of work

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Bid Form

BID BOND
PENAL SUM FORM

BIDDER (Name and Address):
DL King and Associates, Inc. 27 Tanglewood Dr. Nashua, NH

SURETY (Name and Address of Principal Place of Business):
The Ohio Casualty Insurance Company

OWNER (Name and Address):
_ City of Nashua 9 Riverside Street Nashua, NH 03062

BID
BID DUE DATE:_3/31/2016
PROJECT (Brief Description Including Location):
Construct accessible playground at Labine Field located Cleveland Street and intersection of

Fairview Avenue

BOND
BOND NUMBER:___©972429
DATE: (Not later than Bid Due Date): _3/31/2016
PENAL SUM: Five Percent of Contract Price 5%

(Words) (Figures)

IN WITNESS WHEREOF, Surety and Bidder, Intending to be legally bound hereby, subject to
the terms printed on the reverse side hereof, do each cause the Bid Bond to be duly executed

on its behalf by its authorized officer, agent, or representative.

BIDDER SURETY

DL King and Associates, Inc. (Seal) The Ohio Casualty Insurance Compgay})

Bidder’s Name and Corporate.Seal
\ Gg — L
By: Adiezce lta - (A hate devt
agente ey Title

A Attest: Tee \K\ “Falle i “|

UN ks and Title

Note: (1) Above addresses are to be used for giving required notice.
(2) Any singular reference to Bidder, Surety, OWNER or other party shall be considered plural where

applicable.

Not valid for mortgage, note, loan, letter of credit,

currency rate, interest rate or residual value guarantees.

4

THIS POWER OF ATTORNEY IS NOT VALID UNLESS IT IS PRINTED ON RED BACKGROUND.
This Power of Attorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated.
Certificate No. 6972429

American Fire and Casualty Company Liberty Mutual Insurance Company
The Ohio Casualty Insurance Company West American Insurance Company
POWER OF ATTORNEY

KNOWN ALL PERSONS BY THESE PRESENTS: That American Fire & Casualty Company and The Ohio Casualty Insurance Company are corporations duly organized under the laws of
the State of New Hampshire, that Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts, and West American Insurance Company
is a corporation duly organized under the laws of the State of Indiana (herein collectively called the “Companies’), pursuant to and by authority herein set forth, does hereby name, constitute
and appoint, _ Ann Lafond; Harriet Hoffmann; John Bernardin; Michael J. Regan; William J. Cleary

all of the city of Boston _ state of MA each individually if there be more than one named, its true and lawful attorney-in-fact to make, execute, seal, acknowledge
and deliver, for and on its behalf as surety and as its act and deed, any and all undertakings, bonds, recognizances and other surety obligations, in pursuance of these presents and shall
be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper persons.

IN WITNESS WHEREOF, this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this_1st day of _ May , 2015

American Fire and Casualty Company

The Ohio Casualty Insurance Company

Liberty Mutual Insurance Company

ie Insurance Company
By: LEAT hoor

David M. Carey“Assistant Secretary

STATE OF PENNSYLVANIA ss
COUNTY OF MONTGOMERY

On this _1st___ day of May 2015 | before me personally appeared David M. Carey, who acknowledged himself to be the Assistant Secretary of American Fire and
Casualty Company, Liberty Mutual Insurance Company, The Ohio Casualty Insurance Company, and West American Insurance Company, and that he, as such, being authorized so to do,
execute the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer.

IN WITNESS WHEREOF, | have hereunto subscribed my name and affixed my notarial seal at Plymouth Meeting, Pennsylvania, on the day and year first above written.
COMMONWEALTH OF PENNSYLVANIA

Notarial Seal Gg. £ Z f f
Teresa Pastella, Notary Public By:

Plymouth Twp., Montgomery County Teresa Pastella, Notary Public
My Commission Expires March 28, 2017

Member, Pennsylvania Association of Notaries

This Power of Attorney is made and executed pursuant to and by authority of the following By-laws and Authorizations of American Fire and Casualty Company, The Ohio Casualty Insurance
Company, Liberty Mutual Insurance Company, and West American Insurance Company which resolutions are now in full force and effect reading as follows:

ARTICLE IV - OFFICERS — Section 12. Power of Attorney. Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President, and subject
to such limitation as the Chairman or the President may prescribe, shall appoint such attorneys-in-fact, as may be necessary to act in behalf of the Corporation to make, execute, seal,
acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys-in-fact, subject to the limitations set forth in their respective
powers of attorney, shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so
executed, such instruments shall be as binding as if signed by the President and attested to by the Secretary. Any power or authority granted to any representative or attorney-in-fact under
the provisions of this article may be revoked at any time by the Board, the Chairman, the President or by the officer or officers granting such power or authority.

ARTICLE XiIll - Execution of Contracts - SECTION 5. Surety Bonds and Undertakings. Any officer of the Company authorized for that purpose in writing by the chairman or the president,
and subject to such limitations as the chairman or the president may prescribe, shall appoint such attorneys-in-fact, as may be necessary to act in behalf of the Company to make, execute,
seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety obligations. Such attorneys-in-fact subject to the limitations set forth in their
respective powers of attorney, shall have full power to bind the Company by their signature and execution of any such instruments and to attach thereto the seal of the Company. When so
executed such instruments shall be as binding as if signed by the president and attested by the secretary.

Certificate of Designation — The President of the Company, acting pursuant to the Bylaws of the Company, authorizes David M. Carey, Assistant Secretary to appoint such attorneys-in-

fact as may be necessary to act on behalf of the Company to make, execute, seal, acknowledge and deliver as surety any and all undertakings, bonds, recognizances and other surety

832-8240 between 9:00 am and 4:30 pm EST on any business day.

To confirm the validity of this Power of Attorney call

1-610

obligations.

Authorization - By unanimous consent of the Company's Board of Directors, the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company, wherever appearing upon a certified copy of any power of attorney issued by the Company in connection with surety bonds, shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
|, Gregory W. Davenport, the undersigned, Assistant Secretary, of American Fire and Casualty Company, The Ohio Casualty Insurance Company, Liberty Mutual Insurance Company, and
West American Insurance Company do hereby certify that the original power of attorney of which the foregoing is a full, true and correct copy of the Power of Attorney executed by said
Companies, is in full force and effect and has not been revoked. \\y \

day of Hut hy 20\\y

sr
IN TESTIMONY WHEREOF, | have hereunto set my hand and affixed the seals of said Companies this \
Zi ea Ds
By: —

Gregory W. Cavenport, Assistant Secretary

26 of 100
LMS_12873_122013

Firm Name

ItemNo. Quantity Units

214,

304.2

304.3

403.12

870.95

602.

Estimated

1300

200

100

1200

610

3240

52

3600

City of Nashua, New Hampshire

Division of Public Works
Legacy Playground at Labine Park
Bid Schedule
Item Description & Unit Price Unit Price Total Price
(fn both words and numerical) In numerals in numerals
u FINE GRADING
Five thousand seven hundered fifty (5750Poliars and We apie
_no(0) Cents §5.750,00 $5,750.00
CY GRAVEL (F) 6 (GEE
—Twenty Six(26) Dollars and &S4 008 °
t Cents $26.16
__ Sixteen (16) $34,014.25— @® aha Ne
cy CRUSHED GRAVEL (F) a Mee
Twenty Six (26) Dollars and 45;348-
__Seventy four (74) Cents 26.74 Bo
TON —_ HOT BITUMINOUS PAVEMENT, HAND METHOD
Two Hundred Thirty (230) Dollars and
No (0) Cents $230.00 $23,000.00
LF ine SAFETY FENCE
Five(5) Dollars and
Seventy Five (75) Cents _ $5.75 $6,900.00
U MOBILIZATION
Pifty Thousand Seven Hundred fifteen (50,715 Dollars and
TO BE PAID ON PERCENT COMPLETE BASIS Cents _ $50,715.00 $50,715.00
STAMPED CONCRETE WALKWAY (6" DEPTH) ge.
SF (COBBLESTONE PATTERN)
Twelve (12) Dollars and 4 6,462 10 GbR
Eight (8) Cents $12.08 t b
SF STONE DUST PATHWAY (4" DEPTH) @ 4h alt
One (I Dollars and 4 1310-40
—Fourty Four (44) Cents $3.44 $b 30843 | j J
4
SY LOAM AND SEED (4" DEPTH) Alt
No (0) Dollars and 4 583 8° eae
—Fifty Eight (58) _ Cents 50.58 $4063.00
EA ELEMENT FOOTING (SIZE VARIES)
1 Dollars and
Seventy ihe 5) Cents __ $258.75 $13,445.00 Y A A | ib
SF PROTECTIVE SURFACING
_—Seventeen (17) Doliers and 61,63) °9
Twelve (12) Cents $17.12 S64
$210,504 40

BS -10f3

SUBTOTAL BS-1 $O562.69

Ap dlialie

City of Nashua, New Hampshire
Diviston of Public Works

Legacy Playground at Labine Park

_DL King and Associates Inc
Firm Name Bid Schedule
Estimated Item Description & Unit Price Unit Price
Jtem No, Quantity Units (in both words and numerical) in numerals
+ F “246- er ENGINEERED WOOD CHIPS [12" DEPTH)
—Fifty. Ope (6) ————___Dotiers-and
‘ i275) ls $5475
H 1 Ls PLAYGROUND ELEMENTS (CONTRACTOR BUILO}
Thirteen Thousand Three Hundred Forty (13,340) Dollars and
Na (po) Cents __ $13,340.00
a 440 LF 8°X8" LANDSCAPE TIMBER BORDER
_Sixteen (16) Dollare and
—Ten (10) Cents _ $16.10
L 1 LS IRRIGATION DESIGN AND INSTALLATION
Two Thousand Eight Hundred Sevnety Five (2.875)ollars and
__No (0) Cents $2,875.00
SUBTOTAL BS-2

# Cety will sepply

BS - 2 of 3

cer Nick Caggiano

qh
$6 yj fle
24060

ney IW)
8 TOBY eC Wis all

H35,119 % Bes

“weg AZ

City of Nashua, New Hampshire

Division of Public Works
D1 King & Associates, Inc Legacy Playground at Labine Park
Firm Name Bid Schedule )
Ch
SUMMARY of Each Bid Shest
$710,504. yo PZ
SUBTOTAL of Page BS-1
SUBTOTAL of Page BS-2 soso700. SA 8,294.00
UM
f
TOTALBIDPRICEFIGURES | -getsuste> S 233,803.40 |
Uy Mb
TOTAL
ramos wh
—FerrHesrdred Satyr
Ue
Evgnt Hondre a WEE ore and zy f
Sixty ttre Forty Cents
Contractor:

Authorized Signature:

BS - 3 of 3

CONSTRUCTION CONTRACTOR’S
QUALIFICATION STATEMENT

On Schedule A, attached, list major engineered construction projects completed by this
organization in the past five (5) years. (If joint venture, list each participant’s projects separately).

On Schedule B, attached, list current projects under construction by this organization, (If joint
venture, list each participant’s projects separately).

Name of surety company and name, address, and phone number of agent.
The Ohio Casualty Insurance Company
Regan Cleary Insurance & Bonds

226 Causeway St. Boston, MA 617-305-0346

Is your organization a member of a controlled group of corporations as defined in I.R.C. Sec.
1563?

[_] Yes No

If yes, show names and addresses of affiliated companies.

Furnish on Schedule C, attached, details of the construction experience of the principal
individuals of your organization directly involved in construction operations.

Has your organization ever failed to complete any construction contract awarded to it?

[] Yes [4 No

If yes, describe circumstances and provide details on attachment.

Has any Corporate officer, partner, joint venture participant or proprietor ever failed to complete
a construction contract awarded to him or her in their own name or when acting as a principal of
another organization?

[_] Yes No

If yes, describe circumstances and provide details on attachment.

In the last five years, has your organization ever failed to substantially complete a project in a
timely manner?

[] Yes [xX] No

If yes, describe circumstances and provide details on attachment.

Does your organization now have any legal suits or arbitration claims pending or outstanding
against it or any officers?

[|] Yes [X] No

If yes, describe circumstances and provide details on attachment.

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ll.

12.

[3s

14.

Has your organization had a contract partially or completely terminated for default (cause) within
the past five years?

[_] Yes No

If yes, describe circumstances and provide details on attachment.

List the licensed categories of work that your company normally performs with its own
workforce. N/A

If required, can your organization provide a bid bond for this project?

[% Yes C] No

What is your approximate total bonding capacity?
[-] $500,000 to $2,000,000

[4] $2,000,000 to $5,000,000

[] $5,000,000 to $10,000,000

[_] $10,000,000 or more

Describe the permanent safety program you maintain within your organization. Use attachment if

necessary.
Registered with State of NH - Slip and falls, electrical

safety, Hazardous waste/material handling, carpenter

safety issues.

Furnish the following information with respect to an accredited banking institution familiar with
your organization.

Name of Bank Citizens Bank

Address 122 Northeastern Blvd.
Nashua, NH 03062

Account Manager Jeanine Briggs

Télsphions 603-305-6688

CQ -2of7

I hereby certify that the information submitted herewith, including any attachment is true to the best of

my knowledge and belief. J ‘

By: Donna L. King

Title: President

Dated: March 31,2016

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This Page Intentionally Left Blank

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