PAYMENT BOND ey NU AE OUTED Watts sone ciaerins# 22241 Ona Control Number: 9000-0045 (See instructions on reverse) ARRAIGNMENT DATE Expiration Date: 7/31/2019 Faseraer Roaicion Ac Gatornt- The iWormatoncaloion nates roguvarens 14 USO § SGOT. ae avandoa by socion Poe Pasarwar: Redicion Ae oF {885."You do noi nee o answer fess questons unless ws Sofay a vid Ofice Manageme and Budget (OMB) ora mune. The OM corto number ers calecton 9000-0085 Wo oeumto thc Kl ae CO mis read to hstutons, gtr to fact, and snewor tw qustons. Sard ony oman relay our ie eeumate nel ‘iggestons for eduring ths Cursen, or any She aepcis sth coleston er mfamraton for General Sorvaes hemnaatan, Raguntnry Secret Dies (UV ICS) 10 F ‘Steck NA vlgzingi be 20408, FPRINGIPAL (Logo! name ana basa ome) TPE GF ORGANZATION /X ono), FIRST MIDDLE LAST wowiouat — Jparmersiie [ow venture. 1234 YOUR ADDRESS ST. or [oorrorarion [Jom pect) 1234 JAIL ADDRESS ST. CITY / TOWN, ST 12345 TATE RED OAH YOUR STATE Birth Cert. xxuxxxzx ‘SURETYIES) (Ramee) and bisress aes) PENAL SUM OF BOND FIRST MIDDLE LAST THLUONS) — | FHOUSANDIS) RUNOREDIS) [CENTS DEPOSITORY TRUST COMPANY x x 55 WATER ST., ist Floor CORTRAETOATE , foounecrpougen NEW YORK, NY 10041 BIRTH CASENUMBERXX OBLIGATION: Wo, the Principal and Surety(ies), are firmly bound to the United States of America (hereinafter called the Government) in the above penal sum. For payment of the penal sum, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally. However, ‘whore the Sureties are corporations acting as co-sureties, we, the Sureties, bind ourselves in such sum “Jointly and soveraliy” as well as, "severally" only for the purpose of allowing a joint action or actions against any or all of us. For all other purposas, each Suraty binds itself, Jointly ane severally withthe Principal, for the payment ofthe sum shown opposite the name of the Surety. If no limit is indicated, the limit of liability isthe full ammount of the penal sum, CONDITIONS: The above obligation is void ithe Principal promplly makes payment to all persons having a direct relationship withthe Principal or a subcontractor of tne Princjpal for furnishing labor, material or oth in the prosecution of the work provided for in the contract identifies above, ‘and any authorized modifications of the contract that subsequently are made. Notice of these modifications to the Surety((es) are waived. WITNESS: ‘The Principal ang Suretylies} executes this payment bond and affixes their seals on the above date, PRINCIPAL 7 B 5 sionavunes} | By: Dinue ally naa som | Corporate wuese [Riese middie Last,” Seal ime ‘as surety INDIVIDUAL SURETY(IES) i a seowaruneisy |" By: Gisue Mlle ay eel tsa ines 7 fz tome FIRST MIDDLE LAST ‘CORPORATE SURETYIES) aes state OF NCORRORATON LARLY LRT <| anes k | stonarurers)|" a Corporate g Seal TERE a) Sie |" P ‘ped AUTHORIZED FOR LOCAL REPRODUCTION STANDARD FORM 25A (REV. 8/2016) Previous editor 1s NOT usable Preserbed ty GSA-FAR (48 GFR} 53.2228(c)‘CORPORATE SURETY(IES) (Continued) Be Frac orncorronnon [RSUTYERT | Swed E § [scurenes)" P Corporate e Seal Bl Nawesya | 2, ey Tie ray SEO RRR [RSTO o| Bae E & | owsruncis| P Corporate z Seal a) are |! P Tied rate ao RT TTT o| Sires k & | sexarunssi|" a Corporate « Seal aap P wey Iie EE EORTC w| SHES ; | stonaturets)|' 2 Corporate z Seal a) HES i — ETT | ores H 5 ; Corporat | stonaturess) orporate: £ Seal a) nage |r a ey (tie raat EO OAT | ES H § [scuruness|" F Corporate z Seal a] satis te INSTRUCTIONS 1. This frm, fr the protection of persons supplying labor and matanal, is usad when a payment bond is required undar 40 USC Chapter 3, Subchapler I Bonds. Ary deviation from tvs form val requir the writen approval ef the Aciinisralor of General Services, 2. Insert the fll legal name and business adress ofthe Pincipalin the space designated "Pancipa”on the face of the form. An authorized persen shall sign the bond. Any person signing in a representative capaci (e.., an altomeyi-fac) must furnish evidence of authonty that representatives not 3 member ofthe firm, parinarship or onl venture, or an oficer ofthe corpration involve 3. (a) Corporations executing the bond as sureties must appear on the Depariment ofthe Treasury’ Iistof approved surstes and must act wih the Ilations Isled theren. The value pul nis the LIABILITY LIMIT block s the penal sum (.2, the face value) ef the bond, unless 2 co-surely arrangement is proposed (0) When ruliple corporate sureties ae involved, their names and adresses shall appear inthe spaces (Surety , Surat B, el.) headed "CORPORATE 'SURETY(IES)” In the space designated "SURETY IESY on the face ofthe form, inser ont the leer Kenifier corresponcite to each af he suraties. Moreaver when co-surely arrangements est, he parties may allocate ther respecte Imialions of labiliy urder the honds, provided that the sum tla of thai labiity ‘equals 100% of the bond penal sum, {0} When individual sureties are involved. a completed Affidavit of Individual Surety (Stancard Form 28) fr each incvicual surety shall accompany the bond. ‘The Government may require the surety te furnish adsitonal substantiating information concoming it nancial capably 4, Corporations executing the bond shall affix heir coporaie seals. Inviduls shall exocuto the Lond opposite the words "Corporate Seal’, end shall fix an achiesive sea f executed in Maine, New Hampshire, or any other jnsdicion requFing adhesive seals. ‘5. Type the name and ile of each person sizing ths bond inte space provided, ‘STANDARD FORM 25A (REV. 872016) BACK