PROJECT CLOSE-OUT FORMS
CERTIFICATE OF FINAL COMPLETION OF WORK
(page 1 of 2)
OWNER'S CONTRACT NO.:: ENGINEER’ PROJECT NO.:
AGREEMENT DATE:
CONTRACT TITLE:
FINAL COMPLETION DATE PER AGREEMENT AND CHANGE ORDERS:
ACTUAL DATE OF FINAL COMPLETION:
FINAL CERTIFICATION OF CONTRACTOR
I hereby certify that the Work as identified in the Final Payment Request dated
PROJECT CLOSE-OUT FORMS
CONTRACTOR'S FINAL LIEN WAIVER
(page 2 of 2)
From: (Contractor)
Authorized Representative Signature
Name and Title (printed)
NOTARY:
Then personally appeared the above named ; and
acknowledged the foregoing to be the free act and deed of the above-named Contractor, before
me.
Subscribed and sworn to on the day of , 20
Notary Public:
My Commission Expires:
9/07
PROJECT CLOSE-OUT FORMS
CONTRACTOR'S FINAL LIEN WAIVER
(page 1 of 2)
OWNER'S CONTRACT NO:: ENGINEER’ PROJECT NO.:
AGREEMENT DATE:
CONTRACT TITLE:
To: (Owner)
APPLICATION FOR FINAL PAYMENT
PROJECT CLOSE-OUT FORMS
CONSENT OF SURETY COMPANY
TO
FINAL PAYMENT
OWNER'S CONTRACT NO.: ENGINEER' PROJECT NO.:
AGREEMENT DATE:
BOND NUMBER:
CONTRACT TITLE:
To: (Owner)
From: (Contractor)
In accordance with the provisions of the Contract between the Owner and the Contractor as
indicated above, the (Surety) on the bond of
Summary
CHANGE IN CONTRACT PRICE:
Original Contract Price
$
CHANGE IN CONTRACT TIMES:
Original Contract Times
Substantial 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
Substantial completion:
Ready for final payment:
Net Increase (deerease) of this Change Order
$
Net Increase (decrease) of this Change Order
CHANGE ORDER
No.
PROJECT: Safe Routes to School Birch Hill Elementary Variable Message Speed Feedback Signs
OWNER’S CONTRACT NO:__IFB STATE No._40683 FEDERAL No. A004(467)
EXECUTED CONTRACT DATE:
DATE OF ISSUANCE: _. EFFECTIVE DATE: Upon City Approval
OWNER: City of Nashua, NH
OWNER’s Purchase Order NO.:
CONTRACTOR:
You are directed to make the following changes in the Contract Documents:
Description:
Justification:
Change Order # 1 of 2
Contract Affidavit
I/We declare under penalty of perjury under the laws of the United States and the State of New
Hampshire that, in accordance with the provisions of Title 23 USC, Section 112(c), have not either directly or
indirectly entered into any agreement, participated in any collusion or otherwise taken any action in restraint
of free competitive bidding in connection with this Proposal,
Dated:
(if'a firm or individual)
Signature of Bidder
TE/CMAQ Program
Construction Proposal
It us proposed:
To execute the Contract and begin work within 10 days from the date specified in the “Notice to Proceed” and to
prosecute said work so as to complete the and its appurtenances on or
before
SCHEDULE 1
to
MOULISON, LLC
LIMITED LIABILITY COMPANY AGREEMENT
Name Mailing Address
SC Holdings, Inc. 378 Bennoch Road
P.O. Box 435
Stillwater, ME 04489
{RIGH7112 $7989-072080 } 13
reference in this Agreement to any law, rule or regulation shall be construed as reference to the
law, rule or regulation as it may have been, or may from time to time be, amended, revised
or reenacted and any successor thereto. The headings of sections in this Agreement are intended
for reference purposes only and shall be given no substantive meaning or any interpretive force.
IN WITNESS WHEREOF, the undersigned has duly executed this Limited Liability Company
Agreement as of the day and year first aforesaid,
Name:
Title:
President
