OMB Control No: 3245-0007
Expiration Date: XX/XX/XXXX
U .S. SMALL BUSINESS ADMINISTRATION
SURETY BOND GUARANTEE AGREEMENT ADDENDUM
If work has begun on the project, the small business must complete this form and submit it to the surety agent of choice with the application. 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.
|
||||||
|
|
|||||
In the spaces below, the Principal certifies that all suppliers and subcontractors are paid to date. If additional space is needed, attach an additional sheet. The Principal must provide a waiver of lien from each supplier and subcontractor, or an explanation satisfactory to SBA why such certification cannot be produced, is attached hereto. |
||||||
|
Bill to Date |
Paid to Date |
Waiver of Lien Attached Hereto |
|||
Check here if not applicable ☐ |
||||||
Click or tap here to enter text. |
|
|
|
|||
Click or tap here to enter text. |
|
|
|
|||
Click or tap here to enter text. |
|
|
|
|||
Click or tap here to enter text. |
|
|
|
|||
|
Bill to Date |
Paid to Date |
Waiver of Lien Attached Hereto |
|||
Check here if not applicable ☐ |
||||||
Click or tap here to enter text. |
|
|
|
|||
Click or tap here to enter text. |
|
|
|
|||
Click or tap here to enter text. |
|
|
|
|||
Click or tap here to enter text. |
|
|
|
|||
|
||||||
By signing below, I certify on behalf of the Principal 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 or submitting false information 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. |
||||||
Click or tap here to enter text. |
Click or tap here to enter text. |
Click or tap to enter a date. |
||||
|
||||||
The Obligee hereby certifies that all payments due by Principal under the contract to present status has not been reported to the Obligee to be delinquent, under investigation or in dispute, and that the job has been satisfactorily completed to present status. I understand that knowingly making a false statement or submitting false information 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. |
||||||
Click or tap here to enter text. |
Click or tap here to enter text. |
Click or tap to enter a date. |
||||
|
||||||
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. |
||||||
Click or tap here to enter text. |
Click or tap here to enter text. |
Click or tap to enter a date. |
||||
SUBMISSION INSTRUCTIONS: The completed form must include the signatures of the Principal and Obligee. This form may be completed electronically in the Capital Access Financial System (CAFS) located at located at https://www.sba.gov/partners/surety-bond-partners-agents/operate-surety-partner-or-agent. If the form is prepared electronically, the completed form must be printed, signed and then uploaded into CAFS. If CAFS is unavailable, a paper copy of the form is available on the Office of Surety Guarantees (OSG) website at https://www.sba.gov/document/sba-form-991-surety-bond-guarantee-agreement-addendum where it may be printed, completed, signed and mailed to the OSG office at 409 3rd St., S.W. Suite 8600 Washington, D.C. 20416. When the work under a contract has actually begun, an SBA official having delegated authority to approve the bond in question (see Part 101 of 13 CFR) may nevertheless guarantee a bond or bonds pursuant to Part 115 of 13 CFR, upon receipt, satisfactory to SBA, of all the items below. |
||||||
PLEASE NOTE: The estimated burden for completing this form is approximately 10 minutes per response. You are not required to respond to any collection of information unless it displays a currently valid OMB Control number (3245-0007). Comments on the burden should be sent to U.S. Small Business Administration, Director, Records Management Division, 409 3rd 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. PLEASE DO NOT SEND COMPLETED FORMS TO OMB. |
FORM
991 (09/22) Previous Editions are Obsolete
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Subject | Surety Bond Guarantee Agreement Addendum |
Author | [email protected] |
File Modified | 0000-00-00 |
File Created | 2022-09-29 |