240G-09
PrreyXD) rrp wey
SU0Ud 2 SSAIPpy °F Idd }0e1jU0y pajajdwog ajeg JaoulBug ubiseg J3UMCO yoafoig jo UONdIUISeq
pyORJUOD/BoUaIBjayY pue uonjeso7] ‘awey
S189, (§) dAlJ JS€d OU) Ul pojyojdUloD S}odlO1g UOljoN1jJSUOD PolooU DU] JOleyy JO JST] — Y ajnpayss
This Page Intentionally Left Blank
CQ -40f7
] hereby certify that the information submitted herewith, including any attachment is true to the best of
my knowledge and belief.
_ lav ine, Cov Dove NAV)
Title: Fre sichon &
Dated: ArLuwnny. / a” | Of G
CQ -3 of 7
10.
12.
14,
Does your organization now have any legal suits or arbitration claims pending or outstanding
against it or any officers?
[Yes [No
If yes, describe circumstances and provide details on attachment. Ww \ 4
Has your organization had a contract partially or completely terminated for default (cause) within
the past five years?
L]Yes IXINo
If yes, describe circumstances and provide details on attachment. \\a
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.
Not valid for mort
gage, note, loan, letter of credit,
currency rate, interest rate or residual value guarantees.
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.
Liberty Liberty Mutual Insurance Company
Mutual. The Ohio Casualty insurance Company Certificate No: 8198086-968046
West American insurance Company
SURETY
POWER OF ATTORNEY
. EICDCS PENAL SUM FORM
SOO OMERTS Consarctrn
1. Bidder and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors, and
assigns to pay to Owner upon default of Bidder the penal sum set forth on the face of this Bond. Payment of the penal
sum is the extent of Bidder’s and Surety’s liability. Recovery of such penal sum under the terms of this Bond shall be
Owner's sole and exclusive remedy upon default of Bidder.
x
EICDCS PENALSUM FORM
LATA MoM MITES
BID BOND
Any singular reference to Bidder, Surety, Owner or other party shall be considered plural where applicable.
BIDDER (Name and Address): SUNSHINE PAVING CORPORATION
29 Constitution Drive
Hudson, NH 03051
SURETY (Name, and Address of Principal Place of Business): THE OHIO CASUALTY INSURANCE COMPANY
Agency: P.O. Box 511
Concord, NH 03302-0511
OWNER (Name and Address): CITY OF NASHUA
229 Main Street
Nashua, NH 03060
LIST OF SUBCONTRACTORS
(to be submitted after bid opening)
LIST OF SUBCONTRACTORS
(to be submitted with bid)
The name and address of each subcontractor who will be paid at least five percent (5%) of the prime
contractor's total bid shall be listed below. 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)
Name Address of aS Portion of Work
d Peters pc\
