Form 5-5423 Performance Bond (Surety)

Form 5-5423

UNITED STATES DEPARTMENT OF THE INTERIOR BUREAU OF INDIAN AFFAIRS PERFORMANCE BOND

OMB. No. 1076-0157 Expires: ##/##/####

Date Bond Executed:

Principal			Surety
Lease/Permit Number	Date of Lease/Permit	Purpose of Bond		Penal Sum
Total Bond Amount				$

OBLIGATION

We, the PRINCIPAL and SURETY above named, are firmly bound unto the United States of America (hereinafter called the Government) in the penal sum of the amount stated above. For the payment of the penal sum, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally.

CONDITIONS

The Principal has entered into the Lease/Permit(s) listed and dated above; and

The principal and surety agree that the neglect or forbearance of the Government or landowner in enforcing against the lessee or permittee the payment of rentals or the performance of any other covenant or condition of the agreement, shall not in any way release the principal and surety, or either of them, from any liability under this bond; and

The principal and surety agree that in the event of any default under such lease/permit, the Government or landowner may prosecute any claim, suit, action, or other proceeding against either the principal or surety without the necessity of joining the other.

THEREFORE

If the principal shall well and truly perform and fulfill all the undertakings, covenants, terms, and conditions of said agreement during the original term of said agreement and any duly authorized extensions thereof, with or without notice to the surety, and during the life of any guaranty required under the agreement, and shall also well and truly perform and fulfill all the undertakings, covenants, terms, and conditions of any and all duly authorized modifications to said agreement that may hereafter be made, notice of which modifications to the surety being hereby waived, then, this obligation is void; it otherwise remains in full force and virtue.

IT IS FURTHER UNDERSTOOD AND AGREED between all parties hereto, that, if the Surety shall so elect, this bond may be cancelled by giving at least forty-five (45) days advance notice in writing to both the Principal and the Superintendent or other officer in charge of the Indian Agency or field office concerned, and this bond shall be deemed cancelled as of the date specified on such notice, the said Surety remaining liable for all acts covered by this bond which may have been committed by the Principal up to said date under the terms, conditions, and provisions of this bond.

WITNESS

The Principal and Surety(ies) have executed this performance bond on the above date, the name and corporate seal of each corporate party being hereto affixed, and these presents duly signed by its undersigned representative, pursuant to authority of its governing body.

IN PRESENCE OF:

WITNESS INDIVIDUAL PRINCIPAL

1. ________________________________________ as to _____________________________________________

2. ________________________________________ as to _____________________________________________

3. ________________________________________ as to _____________________________________________

WITNESS INDIVIDUAL SURETY

1. ________________________________________ as to _____________________________________________

2. ________________________________________ as to _____________________________________________

Attest: ____________________________________________ ____________________________________________ Attest: ____________________________________________ ____________________________________________

Corporate Principal____________________________ ____________________________________________ Business Address ___________________________________________ By ___________________________________________ Title AFFIX CORPORATE SEAL ____________________________________________ Corporate Surety ____________________________________________ Business Address ___________________________________________ By ___________________________________________ Title AFFIX CORPORATE SEAL

Paperwork Reduction Act Statement: This form is covered by the Paperwork Reduction Act.  It is used to establish the respective rights and responsibilities of the respondent and the Federal government. The information is provided by respondents to obtain or retain a benefit.  In compliance with the Paperwork Reduction Act of 1995, as amended, the collection has been reviewed by the Office of Management and Budget and assigned a number and an expiration date.  The number and expiration date are at the top right corner of the form.  An agency may not sponsor or conduct, and a person is not required to respond to, a request for information collection unless it displays a currently valid OMB Control Number.  The public reporting burden is estimated to average 20 minutes per respondent.  This includes the time needed to understand the requirements, gather the information, complete the form, and submit it to the Department.  Comments regarding the burden or other aspects of the form may be directed to the Indian Affairs Information Collection Clearance Officer, Office of Regulatory Affairs – Indian Affairs, 1849 C Street, NW, MS-4141, Washington, DC 20240.

Form 5-5423, Performance Bond, Page 1 of 2

Permittee Initial ______