Finance Committee

DISCLOSURE OF LOBBYING ACTIVITIES

The undersigned [Contractor] certifies, to the best of his or her knowledge and belief, that:

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) Seller shall submit (1) manufacturer's 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

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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:

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 C - FORMS

THE FOLLOWING PAGES MUST BE FILLED

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imsurance and/or an adequately funded self-insurance program will constitute
a material breach in of this Contract.

Occurrence Coverage — Insurance shall be provided on an occurrence basis and not
a claim-made basis.
Deductibles and Retentions — Seller shall be responsible for payment of any

deductible or retention on Contractor’s policies without right of contribution
from. the City of Nashua.

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capacity, and their successors and _assignees, as they now, or as they may
hereafter be constituted , singly, jointly or severally.

e Cross Liability or Severability of Interests Clause.
@ Primary and Non-Contributory wording.
@ Waiver of Subrogation.

Product Liability for products and completed operations coverage of at least
$10 million for a period of five (5) years after acceptance of the last Low
Floor Cutaway Van delivered under this contract.