Form 3809-1 Surface Management Surety Bond

UNITED STATES
DEPARTMENT OF THE INTERIOR

Form 3809-1
(January 2004)

BUREAU OF LAND MANAGEMENT

FORM APPROVED
OMB NO. 1004-0194
Expires: January 31, 2007

SURFACE MANAGEMENT SURETY BOND
Act of May 10, 1872, as amended (30 U.S.C. 22-54)
Act of December 29, 1916, as amended (39 Stat. 862)
Act of October 21, 1976, as amended (43 U.S.C.1732-35, 1782)
Act of September, 13, 1982 (31 U.S.C. 9301 et seq.)
Act of September 27, 1988 (102 Stat. 1776)
Act of April 16, 1993 (43 U.S.C. 299)
Individual

Surety Bond Number

; or Statewide
(Enter BLM Serial No.)

; or Nationwide
(Enter “Yes,” if applicable)

(Enter Name of State, if applicable)

KNOW ALL BY THESE PRESENTS, THAT:
(name)

of
(address)

as principal; and

of

(name)

(address)

as surety; are held firmly bound unto the United States of America in the
sum of
U.S. dollars ($

),

lawful money of the United States, which may be increased or decreased by a rider hereto executed in the same manner as this bond, for the payment of
which sum the principal and surety bind themselves successors, and assigns, jointly and severally, by these presents.
The principal/surety will apply this bond for the faithful performance of any and all of the conditions and stipulations as set forth in this bond, the plan of
operations/notice cited above, and the regulations cited at CFR 3802 and 43 CFR 3809. In the case of any default in the performance of the conditions and
stipulations of such undertaking, it is agreed that the surety/principal will apply the bond or any portion thereof, to the satisfaction of any damages,
reclamation, assessments, penalties, or deficiencies arising by reason of such default.

BOND CONDITIONS
1. WHEREAS, the principal has an interest in a mining claim(s), mill site(s), or tunnel site(s) and/or responsibility for operations on those mining claim(s),
mill site(s), tunnel site(s) or public lands under the Acts cited in this bond; and
2. WHEREAS, the principal has filed an acceptable notice with the United States Department of the Interior, Bureau of Land Management (BLM) and/or
received approval from the BLM of the plan of operations cited above, and said plan of operations/notice contains certain stipulations and conditions;
and
3. WHEREAS, the principal has promised to deliver to the United States a bond substantially in the form hereof upon the approval and/or acceptance of
the above referenced plan of operations and/or notice by the BLM to secure the performance of the terms and conditions contained in said plan of
operations/notice and/or associated reclamation plan.
4. WHEREAS, the principal and surety agree that, with notice to the surety, the coverage of this bond, in addition to the present holdings of and/or
authorization(s) granted to the principal, shall extend to and include:
a. Any transfer of operating rights under the plan of operations and/or notice hereafter entered into or acquired by the principal affecting mining
claim(s), mill site(s), tunnel site(s), or public lands; and
b. Any activity subsequent hereto of the principal as operator under a plan of operations and/or notice issued pursuant to the Acts cited in this bond;
Provided, that for Statewide and Nationwide bonds only, the surety may elect to terminate the additional coverage authorized under this paragraph.
Such termination will become effective 30 days after the BLM receives notice of the election to terminate. After the termination becomes effective,
the additional interests identified in this paragraph will not be covered by this bond; and
5. WHEREAS, the principal and surety agree that with notice to the surety this bond shall remain in full force and effect notwithstanding: Any
assignment(s) of an undivided interest in any part or all of the mining claim(s) mill site(s), tunnel site(s), or public lands covered by the plan of
operations/notice in which event the assignee(s) shall be considered to be coprincipal(s) on this bond as fully and to the same extent as though their
duly authenticated signatures appeared thereon; and
6. WHEREAS, the principal/surety hereby waives any right to notice of, and agrees that this bond will remain in full force and effect notwithstanding:
a. Any transfer(s) in whole or in part, of any or all of the land covered by the plan of operations and/or notice and further agrees to remain bound
under this bond as to the interests in the plan of operations and/or notice retained by the principal; and
b. Any modification of the plan of operations/notice or obligations thereunder as provided in paragraph 4 herein; and
7. WHEREAS, the principal and surety hereby agree that notwithstanding the nullity, relinquishment, abandonment or forfeiture of any mining claim(s),
mill site(s), or tunnel site(s) covered by this plan of operations and/or notice, whether by operation of law or otherwise, the bond will remain in full
force and effect as to the terms and conditions of the plan of operations and/or notice and obligations covered by this bond; and
Title 18 U.S.C. Section 1001 and Title 43 U.S.C. Section 1212 make it a crime for any person knowingly and willfully to make to any department or
agency of the United States any false fictitious, or fraudulent statements or representations as to any matter within its jurisdiction.
(Continued on page 2)

BOND CONDITIONS (Continued)
8. WHEREAS, should the surety elect to cancel this bond, the surety agrees to give the principal and the BLM 90 days written notice by certified mail,
return receipt requested, at their respective addresses as stated herein. The address for service to BLM concerning this bond
is the BLM _______________________ State Office located at ____________________________________________________________________
_______________________________________________________________________________________________________________________.
The surety further agrees that in the event of such cancellation this bond will remain in full force and effect as to all areas within the plan of
operations/notice disturbed prior to the effective date of such cancellation, unless and until the principal should file a substitute bond or other
acceptable instrument to protect the interests of the BLM and such bond or instrument is accepted by the BLM; and
9. WHEREAS, the principal and surety agree that in the event of any default under the plan of operations and/or notice, the bond may be forfeited and,
the United States, through the BLM, may commence and prosecute any claim, suit, or other proceeding against the surety and principal, or either of
them, without the necessity of joining the owner(s) of the mining claim(s), mill site(s), or tunnel site(s) covered by the plan of operations and/or
notice; and
10. WHEREAS, if the principal fails to comply with the provisions of 43 CFR 3802 and 43 CFR 3809, the principal will be subject to the applicable
provisions and penalties of Sections 303 and 305 of the Federal Land Policy and Management Act of 1976, as amended, (43 U.S.C. 1733 and 1735).
This provision should not be construed to prevent the exercise by the United States of any other legal and equitable remedy, including waiver of the
default; and
11. WHEREAS, on the faith of the foregoing promises, representations, and appointments and in consideration of this bond, the United States has received
a notice or approved the plan of operations referenced herein.
12. NOW, THEREFORE, the condition of this obligation is that if said principal, heirs, executors, administrators, successors, or assignees will, in all
respects, faithfully comply with all of the provisions of the plan of operations and/or notice, and any amendments thereto, and the regulations at 43
CFR 3802 and 43 CFR 3809, then this obligation will be null and void; otherwise it will remain in full force and effect.
Executed this

day of

, 20

:

Surety

Principal
By

(Print Name)
Title
Business Address

Attorney-in-Fact
(Print name)
Signature

Business Address

(TIN or SSN, if applicable)

( TIN )

This bond must bear the seal of the surety company. If this bond is signed by a corporation, it should bear the seal of the corporation, if
applicable.
NOTICE
The Privacy Act of 1974 and the regulation in 43 CFR 2.48(d) provide that you be furnished the following information in connection with information
required by this application.
AUTHORITY: 30 U.S.C. 22 et seq.; 43 U.S.C. 1732[b] and 1782[c]; 31 U.S.C. 9301 et seq.; 43 CFR 3802 and 43 CFR 3809.
PRINCIPAL PURPOSE: Information is being used to establish financial responsibility for surface disturbance on public lands.
ROUTINE USES: BLM will only disclose the information according to the regulations at 43 CFR 2.56(d).
EFFECT OF NOT PROVIDING INFORMATION: Disclosure of the information is necessary to receive a benefit. Failure to disclose this information may
result in BLM’s rejection of your application.
The Paperwork Reduction Act of 1995 requires us to inform you that:
BLM collects this information to grant the right to conduct exploration and mining activities on public lands.
Response to this request is required to obtain a benefit.
BLM would like you to know that you do not have to respond to this or any other Federal agency-sponsored information collection unless it displays a
currently valid OMB control number.
BURDEN HOURS STATEMENT
Public reporting burden for this form is estimated to average 8 minutes per response, including the time for reviewing instructions, gathering and
maintaining data, and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of this form to U.S.
Department of the Interior, Bureau of Land Management (1004-0194), Bureau Information Collection Clearance Officer (WO-630), 1849 C Street, N.W.,
Washington, D.C. 20240.
(Form 3809-1, page 2)