Agenda

Schedule A —List of Major Engineered Construction Projects Completed in the Past Five (5) Years

Name, Location and

Schedule A —List of Major Engineered Construction Projects Completed in the Past Five (5) Years

Name, Location and

This Page Intentionally Left Blank

CQ -40f7

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

CQ -3of7

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

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

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
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Evgnt Hondre a WEE ore and zy f
Sixty ttre Forty Cents
Contractor:

Authorized Signature:

BS - 3 of 3

City of Nashua, New Hampshire
Diviston of Public Works

Legacy Playground at Labine Park

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

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