ࡱ> IKH3 bjbj΃ 8P*l8 L(<<<K M M M C ` +` PL$M ONtL"tL <<UL |8<<K K j ' ' < ` D&/ @' ' $L0L' Oo NO'  X Bureau of Highway Design X Room 200 X Tel. (603) 271-2171 ( ) Fax (603) 271-7025 [FORCE ACCOUNT/SUPPLEMENTAL/AMENDMENT AGREEMENT COVER LETTER _______________] current date X X X X X Dear X: The Department has received your letter dated _____________, along with the estimate for the installation of ________________________________ on the above noted State project in the {City|Town} of _________________, New Hampshire. The estimate has been reviewed by this office and it appears to be acceptable in the amount of $__________. Enclosed is the original {Force Account|Supplemental|Amended} Agreement in duplicate, executed by the State. If this Agreement is satisfactory, please have both signed and dated for the {City|Town|Company|District|Precinct} and return one (1) to {Lennart D. Suther|Steven J. Swana}, P.E., Utilities Engineer, New Hampshire Department of Transportation, 7 Hazen Drive, PO Box 483, Concord, NH, 03302-0483. Please encumber an escrow payment (which includes construction engineering) in the amount of $______________. Request for payment to the Treasurer, State of New Hampshire through Mr. Leonard Russell, Financial Reporting Administrator, Bureau of Finance and Contracts, New Hampshire Department of Transportation, 7 Hazen Drive, PO Box 483, Concord, NH 03302-0483 will be sent upon receipt of the Bids and determination of the lowest responsible bidder. Should funds not be provided, the _______________________work will be deleted from the contract. {Please encumber funds for payment (which includes construction engineering) in the amount of $________ which is __% of the full Force Account agreement payment estimated amount of $__________. Request for payment to the Treasurer, State of New Hampshire through Mr. Leonard Russell, Financial Reporting Administrator, Bureau of Finance and Contracts, New Hampshire Department of Transportation, 7 Hazen Drive, PO Box 483, Concord, NH 03302-0483 will be sent upon receipt of the Bids and determination of the lowest responsible bidder. The remaining __% of the contract bid amount plus construction engineering shall be submitted by _______________. Should funds not be provided, the ________________ work will be deleted from the contract.} Please note that it is important that the Department have sufficient backup information when invoices are submitted for payment in addition to the Utility Reports as stated in the Force Account Agreement. Backup information must include quantities and costs of labor, material and equipment, subcontractor expenses, overhead and other costs associated with the project. These costs must be presented in a detailed manner so that the rational basis of the invoiced amount is clearly understood. Invoices that are presented with insufficient backup information will be returned to the company. Please forward a copy of this letter to the appropriate accounts payable individual(s) in order to assure this requirement is met. Upon (approval of the executed Agreement by the Federal Highway Administration|receipt of the signed, executed Agreement by the Department}, we will notify you in writing of authorization to proceed with the work covered by the Agreement. If you have any questions, please contact ________________ of this office at 271- ________. Sincerely, Charles R. Schmidt, II, P.E. Chief of Design Services CRS/___/___ Enclosures cc: , Construction, {Consultant Design,|Final Design,| Preliminary Design,} Finance & Contracts-Mary Dubey, {{City|Town} of _________,} {Project Programming,} {Turnpikes,} Utilities PAGE 2  FILENAME \p Document1 DRAFT  % 4 3 4  '7oPQWXYZ[^_lmvwxz B*ph B*CJHphCJmHnHuCJ jCJU0JmHnHu0J j0JU5CJ@CJCJCJjUmHnHu$*@XY$`a$$ a$$a$$ Pa$$  a$  $ a$Pz    '(4567Uop|}$$a$ $  $$ a$ $$ a$ $$ a$ $$`a$`$`a$P[\]^xyz&`$ 0^`0a$ 6 00"PP&PP/ =!"#$`%` i@@@ Normal5$7$8$9DH$_HmH sH tH 6@6 Heading 1$$@&a$CJ<A@< Default Paragraph Font,@, Header  !&)@& Page Number, @, Footer  !0B@"0 Body Text$a$CJ  *@XY  ' ( 4 5 6 7 U o p | } P[\]^xyz0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0m @0m @0m @0m @0m 0@0@0@0@0@0@0 00@0  ),    &,!8@ (  r  68c? 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