PAYMENT BOND FOR OTHER THAN [DATEOoND EXECUTED fasnatewmre=n 50 [OMB Control Number: 0000-0048 CONSTRUCTION CONTRACTS, evening cate) expiration Date: 7/34/2019 (See instructions on reverse) ARRAIGNMENT DATE ‘aporno Reaon fat Sataoat = Tie ivoatoncoleion Tats TeqaFaTans oF US § SST, be aTanGe by saan 2 ofthe Papasan ROGAN AT TOS YOuae ‘ofneod anwar ve gusto urls we diay 3 vad Offs of Vonage Stegel(OUB} atl rumbe.Te OME cro uma for is elon S000 088, We ‘strate hat ake 25 minis lea he etios, gather facts, and ansuer the quesions. Sen oy coneents etn carte extra, cdg suggestions fer ‘esucrg ieSucen er anyother anor of hie cleo st eemeon General Senices ariaeaton,RogUsery Secreta Disien (MIVICS) 180 F Set. NW. "PRINCIPAL Lag er Ge BURG SET) [NPE OF ORGANIZATION Po) FIRST MIDDLE LAST Ti nowoun Cearmiensne 1234 YOUR ADDRESS ST. oy (CJaoesr venrure Ci coronation 1234 JAIL ADDRESS sv, ———— CITY / TOWN, ST 12345 STATE OF BIRTH STATE "SURETV(ES) Nae) and piss ono) (rade PCH) PENAL SUM OF BOND. FIRST MIDDLE LAST JMLLIONsy THOUSANDS) )HUNDREDIS) [GENTS DEPOSITORY TRUST COMPANY x x 55 WATER ST., 1st Floor Date OF =| BIRTE GERD. NEW YORK, NY 10041 BIRTH NUMBER We, the Principal and Surely(/es), are fimly bound to the United States of America (hereinafter called the Goverment) in the above penal sum. For payment of the penal sum, we bind ourselves, our heirs, executors, administrators, and successors, joinly and severally. However, where the Suretes are corporations acting as co-sureties, we, the Sureties, bind ourselves in such sum "jointly and severally" as wall 9 “severally” ‘only for tha purpose of allowing a joint action o° actions against any or all of us. For all other purposes, each Surety binds isa, jointy and ‘severally with the Principal, forthe payment of the sum shown opposite the name of the Surely. ino limit of abi is indicated, the mit of Tabilty is the ful amount of the penal sum. ‘CONDITIONS: The Principal has entered into the contract identified above, ‘THEREFORE: {a} The above obligation is void i the Principal promptly makes payment to all persons (claimants) having a contract relationship with the Principal or a subcontractor of the Principal for fumishing labor, matorial of Boi in tho prosecution of tho work providad for in the contract Identified above and any duly authorized modifications thereof. Notice of those modifications ta the Suretyiies) are waved, (0) The above obligation shall remain in full force if the Principal does not promplly make payments to all persons (claimants) having a ‘conlract relationship with the principal or a subcontractor of the Principal for furnishing labor. material or both in the prosecution of the contract idontiied above. In those casos, persons not paid in full bfore tho expiration of ninoly (20) days ator the date of which the last labor was Belemnec ormatealfunishing, have a dec it of action again he pcipal and Surety(es) on is bond forte um or sums sty de, he claimant, however, may not bring a sull or any action - (1) Uniess claimant, other than one having & direct contract with the Principal, had given written notice to the Principal lthin ninety (90) ‘days aller the claimant did or performed the last ofthe work or labor. or furnished or supplied the lst of the materials for which the claim is, ace. The notice s to state with Substantel accuracy the amount claimed and the name of the pary to wham the materials were furnishes or ‘supplied, or for whom the work or labor was done or performed. Such notica shail be served by mailing the same rogistarad or certifad mall, postage prepaid, in ah envelope addressed to the Principal at any place where an office is regularly maintained for the transaction of business, ‘oF served in any manner in which legal process is served inthe stale in which the contract is being performed, save thal Such service need nol be made by a public offcar. (2) Aer the expiration one (1) year following the date on which claimant did or performed the last ofthe work or labor, or fumished or ‘supplied the last of the materials for which the sults Brought, (3) Other than in the United States District court forthe distil in which the contract, or any part thereof, was performed and executed, and not elsewnere, WITNESS: The principal and Surety(ies) executed this bid bond and affixed their seals on the above date. ‘RURORIZED FOR LOCAL REPROSUGTION "STANDARD FORM 1416 jv 1050) Previous aon no wean Prosenbesby GEAAR (48 CFR) 53.228)PRINCIPAL. r E x sronarures) | By: Fue 5 ‘sea (S000 (seal) Comporate a Ez z Seat Nig «First Middle Last. ‘Tive0 as surety INDIVIDUAL SURETY(ES) stonaTunes) |" By: Fine ‘seas ~ nese fF FIRS? MIDDLE” LAST G ‘CORPORATE SURETYUES) Nae [STATE OF NCORFORATION [UAB UNIT | aboess a murs" 2 Corporate i er 2) ET z me) (ree NAME & SERTEGF ROOREORATON UAB OMT | abosess a § lscramrets P Comprate @ Soal a) NERS | ze met INSTRUCTIONS 1. This forms authorized for use when payment bonds are requtad under FAR (48 CFR) 28.103-3, Le. payment bonds for other than constuction contracts, Ay devialon Irom ins form wil require the willan aopreval oi tho Admnisrator of General Soros. 2. Inger the fal egal name and business adress ofthe Principal in the space designated "Principal onthe face ofthe form, &n authorized person shal sign the bang. Any person signing in a represortative eapaciy(e 9..an altorney-vfac!) must fum'sh evidence of authoily hat repracentatve Is Pata rmembor ofthe fr, parnorship, oF jin venture, or an ofcor othe corporation Involve. 3. a} Corporations executing the bond as sureties must appest on the Department of the Tressury ist of approved sureties ancl must act within the imation sted therein. Were more than one corporate surely is vowed, thelr names and addresses shall appear inthe spaces (Sutaly A. Surely, etc.) headed "CORPORATE SURETY\IES)" In the space designeted "SURETV(IES}" on the face ofthe ‘erm, insert only the leer Kletifcation ofthe sureties {(b) Whoro individual Suretes aro involved, a completed Affelavi of Individual Surety (Standard Form 26) for each individual surety, shall accompany the boned The Governmant may require the surety Yo furs acional substantang information conceining ts franca expat 4, Corporations execuitng the bond shall afk thelr corporate seas. Indlviduals shell exacue the bond apposite the word "Corporate Sea" ard shall ax an adtosve soal foxccutod in Maina, Now Hampsito, o any cor jursdicbon roguing adhesive soaks, 5, Type the name and tie ofeach person sigring tis bond in the space provides ‘STANDARD FORM 1416 (nev 1096) BACK