SBA Form 991 Surety Bond Guarantee Aagreement Addenum

OMB Control No: 3245-0007

Expiration Date: 01-31-2010

U.S. SMALL BUSINESS ADMINISTRATION

SURETY BOND GUARANTEE AGREEMENT ADDENDUM

Business Name

Business Trade Name SBG Number

Instructions: If work has begun on the project, the small business must complete this form and submit it to the surety agent of choice.

When the work under a contract has actually begun, an SBA official having delegated authority to approve the bond in question (see 13 CFR part 101), may nevertheless guarantee a bond or bonds pursuant to Part 115 of 13 CFR, upon receipt, satisfactory to SBA, of all the items below.

1. Evidence (certified copy of contract or sworn affidavit) from Principal that the surety bond requirement was contained in the original job contract, or documentation, satisfactory to SBA, as to why a surety bond was not previously secured and is now being required is attached hereto.

2. In the spaces below the Principal has certified that all suppliers and subcontractors are paid to date. If additional spaces are needed attach hereto. A waiver of lien from each, or an explanation satisfactory to SBA why such certification cannot be produced, is attached hereto.

Waiver of

Bill to Paid to Lien Attached

Suppliers date date hereto

1. _________________________________ ______________ ________________ _______________

2. _________________________________ ______________ _______________ _______________

3. _________________________________ ______________ ________________ _______________

4. _________________________________ ______________ ________________ _______________

5. _________________________________ ______________ ________________ _______________

Subcontractors

1. _________________________________ ______________ ________________ _______________

2. _________________________________ ______________ ________________ _______________

3. _________________________________ ______________ ________________ _______________

4. _________________________________ ______________ ________________ _______________

5. _________________________________ ______________ ________________ _______________

3. Certifications by Principal and Obligee.

By signing below, I certify on behalf of the Principal or Obligee that all information provided in connection with the application for a surety bond guaranty from SBA is true, correct and complete to the best of my knowledge. I understand that knowingly making a false statement is a violation of Federal law and could result in criminal prosecution or civil penalties under 18 U.S.C. §§ 287, 371, 1001, 15 U.S.C. § 645, or 31 U.S.C. § 3729. The Principal also hereby certifies that all taxes and labor costs in connection with this job are current. The Obligee also hereby certifies that all payments due under the contract to present status have been made and that the job has been satisfactorily complete to present status. Please provide reason why bond was not required prior to job starting.

______________________________________ ___________________________________ ___________________

Signature of Principal Type or Print Name Date

_______________________________________ ___________________________________ ___________________

Signature of Obligee Type or Print Name Date

4. All documents required from the Principal and Obligee are attached hereto and all items on this form have been certified to the SBA’s satisfaction.

______________________________________________________________ _________________

SBA Signature Date

PLEASE NOTE: The estimated burden for completing this form is 10 minutes per response. You are not required to respond to any collection of information unless it displays a currently valid OMB approval number. Comments on the burden should be sent to U.S. Small Business Administration, Chief, AIB, 409 3^rd St., S.W., Washington, D.C. 20416 and Desk Officer for the Small Business Administration, Office of Management and Budget, New Executive Office Building, Room 10202, Washington, D.C. 20503. OMB Approval (3245-007). PLEASE DO NOT SEND FORMS TO OMB

FORM 991 (11-09) Previous Editions are Obsolete