Finance Committee

Certification Regarding Debarment, Suspension,
Ineligibility and Voluntary Exclusion
- Lower Tier Covered Transaction

(1) The prospective lower tier participant certifies, by submission of this bid or proposal, that neither it
nor its "principals” [as defined at 49 CFR § 29.105(p)] is presently debarred, suspended, proposed
for debarment, declared ineligible, or voluntarily excluded from participation in this transaction by
any Federal department or agency.

Federal Motor Vehicle Safety Standards

The Proposer and (if selected) Contractor shall submit (1) manufacturers FMVSS self-certification sticker
information that the vehicle complies with relevant FMVSS or (2) manufacturer's certified statement that the
contracted buses will not be subject to FMVSS regulations.

Company name:
Name of signer:
Title:

Authorized signature Date

BUY AMERICA CERTIFICATE OF COMPLIANCE WITH FTA
REQUIREMENTS FOR BUSES, OTHER ROLLING STOCK,
OR ASSOCIATED EQUIPMENT

(To be submitted with a bid or offer exceeding the small purchase threshold for Federal
assistance programs, currently set at $150,000.)

Certificate of Compliance

The bidder hereby certifies that it will comply with the requirements of 49 U.S.C.
Section 5323(j)(2)(C), Section 165(b)(3) of the Surface Transportation Assistance
Act of 1982, as amended, and the regulations of 49 CFR 661.11:

Date:

Signature:

Installation of vehicle body ontc chassis frame

Mounting of front and rear caps

Installation and interconnection of heat and air conditioning equipment
installation of floor decking and floor covering

Installation of electrical system and lighting

Instailation of passenger seats, stanchions and grab rails

installation of doors and windows

Installation of customer selected options such as destination signs, lifts, etc.
Water testing of completed vehicle

Road testing of completed vehicle

CHAMPION’

A -GROUP

BUY AMERICA
DOMESTIC CONTENT WORKSHEET

NASHUA, NH

More than 855 of the material cost of tve Champion bes is U.S. domestic content

DOMESTIC CONTENT ASA
FINSL PERCENTAGE OF TOTAL

CERTIFICATE OF
TVM DBE

COMPLIANCE

(TO BE FILLED OUT BY MANUFACTURER'S OF ROLLING STOCK ONLY)

In connection with the contract to be awarded as a result of the invitation to bid issued by the Nashua Transit
System:

| hereby certify that the (name of company) has complied with
the requirements of 49 CFR 26, participation by Disadvantage Business in DOT Programs, and that our goals
have not been disapproved by the Federal Transit Administration.

Name of Company

Signature of Authorized Official

Date:

Firm:

FTA BUS TESTING CERTIFICATION

I. NEW BUS MODEL TO BE TESTED

EXHIBIT D - FORMS

THE FOLLOWING PAGES MUST BE FILLED

contractors for federally financed or assisted construction, the recipient shall cancel,
terminate or suspend this contract.

8. Other Contract Requirements

To the extent not inconsistent with the foregoing Federal requirements, this contract shall
also include those provisions attached hereto, and shall comply with the recipient’s
Procurement Guidelines, available upon request from the recipient.

9. Compliance with Federal Regulations

Other Federal Requirements

1. Full and Open Competition In accordance with 49 U.S.C. § 5325(a) all
procurement transactions shall be conducted in a manner that provides full and open
competition.

2. Prohibition Against Exclusionary or Discriminatory Specifications

Apart from inconsistent requirements imposed by Federal statute or regulations, the
contractor shall comply with the requirements of 49 USC 5323(h)(2) by refraining from
using any FTA assistance to support procurements using exclusionary or discriminatory
specifications.