10-00600 Bonding Forms.pdf

SECTION 00600

BONDING FORMS DIVISION 0

West Branch Regional Authority 00600-1 January 2026 Route 54 Sanitary Sewer Extension Project Bonding Forms Contract No. WB-1

INSTRUCTIONS FOR EXECUTING BONDS

1. The full name and residence of each individual party to the Bond must be inserted in the first paragraph.

2. If Contractor is a partnership, the full names of all partners must be inserted in the first paragraph, which must recite they are partners composing the partnership (to be named) and all partners must execute the Bond or Bonds as individuals.

3. The State of incorporation of each corporate party to the Bond must be inserted in the first paragraph and the Bond must be executed under the corporate seal of said party, attested by its Secretary or other appropriate officer.

4. The date of the Performance and Payment Bonds must not be prior to the date of the Agreement.

5. The Power-of-Attorney-in-Fact who executes the Bond for Surety Company must be attached to the

Bond.

6. All Bonds shall be executed by such Sureties as are named in the current list of "Companies Holding

Certificates of Authority as Acceptable Sureties on Federal Bonds and as Acceptable Reinsuring Companies" as published in Circular 570 (amended) by the Audit Staff Bureau of Accounts, U.S.

Treasury Department and be authorized to transact business in the Commonwealth of Pennsylvania.

7. Surety executing bonds must be licensed in the Commonwealth of Pennsylvania to transact surety insurance. Corporate seals must be affixed, a power of attorney must be attached, and a Pennsylvania resident agent must sign or countersign.

West Branch Regional Authority 00600-2 January 2026

BID BOND

KNOW ALL MEN BY THESE PRESENTS, that we, , as Bidder (the “Bidder”), and , a corporation organized and existing under laws of the of as Surety (the “Surety”), are held and firmly bound unto the

WEST BRANCH REGIONAL AUTHORITY, as Owner (the “Owner”), as hereinafter set forth, in the full and just sum of Dollars

($ . ), lawful money of the United States of America, for the payment of which we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.

WITNESSETH THAT:

WHEREAS, the Bidder heretofore has submitted to the Owner a certain bid, dated February 16, 2026, (the “bid”), to perform certain Construction work for the Owner, in connection with the Route 54 Sanitary Sewer

Extension Project pursuant to plans, specifications and other related documents, which are incorporated into the bid by reference (the “Contract Documents”), as prepared by LEVINE ENGINEERING, LLC, ALTOONA, PENNSYLVANIA; and it is a condition of the Owner's receipt and consideration of said bid that the bid be accompanied by bid security to be held by the Owner on terms embodied herein.

1. Bidder and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors and assigns to pay to Owner upon default of Bidder the penal sum set forth on the face of this Bond.

2. Default of Bidder shall occur upon the failure of Bidder to deliver within the time required by the Bidding

Documents, the executed Agreement required by the Bidding Documents and any performance and payment bonds required by the Bidding Documents and Contract Documents.

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3. This obligation shall be null and void if:

3.1. Owner accepts Bidder's bid and Bidder delivers within the time required by the Bidding

Documents (or any extension thereof agreed to in writing by Owner) the executed Agreement required by the Bidding Documents and any performance and payment bonds required by the

Bidding Documents and Contract Documents, or

3.2 All bids are rejected by Owner, or

3.3 Owner fails to issue a Notice of Award to Bidder within the time specified in the Bidding

Documents (or any extension thereof agreed to in writing by Bidder and, if applicable, consented to by Surety when required by paragraph 5 hereof).

4. Payment under this Bond will be due and payable upon default of Bidder and within thirty (30) calendar days after receipt by Bidder and Surety of written notice of default from Owner, which notice will be given with reasonable promptness, identifying this Bond and the Project and including a statement of the amount due.

5. Surety waives notice of and any and all defenses based on or arising out of any time extension to issue notice of award agreed to in writing by Owner and Bidder, provided that the time for issuing notice of award including extensions shall not in the aggregate exceed 120 days from Bid Due Date without

Surety's written consent.

6. No suit or action shall be commenced under this Bond prior to thirty (30) calendar days after the notice of default required in paragraph 4 above is received by Bidder and Surety, and in no case later than one (1) year after Bid Due Date.

7. Any suit or action under this Bond shall be commenced only in a court of competent jurisdiction located in the state in which the Project is located.

8. Notice required hereunder shall be in writing and sent to Bidder and Surety at their respective addresses shown on the face of this Bond. Such notices may be sent by personal delivery, commercial courier or by United States Registered or Certified Mail, return receipt requested, postage pre-paid, and shall be deemed to be effective upon receipt by the party concerned.

9. Surety shall cause to be attached to this Bond a current and effective Power of Attorney evidencing the authority of the officer, agent or representative who executed this Bond on behalf of Surety to execute, seal and deliver such Bond and bind the Surety thereby.

West Branch Regional Authority 00600-4 January 2026

10. This Bond is intended to conform to all applicable statutory requirements. Any applicable requirement of any applicable statute that has been omitted from this Bond shall be deemed to be included herein as if set forth at length. If any provision of the Bond conflicts with any applicable provision of any applicable statute, then the provision of said statue shall govern and the remainder of this Bond that is not in conflict therewith shall continue in full force and effect.

11. The term “bid” as used herein includes a bid, offer or proposal as applicable.

IN WITNESS WHEREOF, the Principal and the Surety cause this Bond to be signed, sealed and delivered this day of , 20 .

(Individual Bidder)

(Name of Business)

(Address)

Witness:

By: (SEAL)

West Branch Regional Authority 00600-5 January 2026

(Partnership Bidder)

(Name of Partnership)

By: (SEAL)

(Partner)

By: (SEAL)

(Partner)

By: (SEAL)

(Partner)

(Partner)

(Corporation or Limited Liability Company Bidder)

(Name of Corporation)

Attest:

By:

(Assistant) Secretary (Vice) President

(CORPORATE SEAL)

West Branch Regional Authority 00600-6 January 2026

(Corporation Surety)

**By: (SEAL)

(Attorney-in-Fact)

**Attach an appropriate power of attorney, dated as of the same date as the Bond, evidencing the Authority of the Attorney-in-Fact to act on behalf of the Corporation.

West Branch Regional Authority 00600-7 January 2026

PERFORMANCE BOND

(INCLUDING A ONE (1) YEAR EXTENDED MAINTENANCE AND WARRANTY PERIOD PROVISION)

, as Contractor (the “Contractor”), and

, a corporation organized and existing under laws of the of as Surety (the “Surety”), are held and firmly bound unto the WEST BRANCH REGIONAL AUTHORITY, as Owner (the “Owner”), as hereinafter set forth, in the full and just sum of

Dollars ($ . ), lawful money of the United States of America, for the payment of which we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.

WITNESSETH THAT:

WHEREAS, the Contractor heretofore has submitted to the Owner a certain bid, February 16, 2026, (the

“Proposal”), to perform Contract No. WB-1 (the “Construction Contract”) by Agreement dated , 2026 for the Owner, in connection with the Route 54 Sanitary Sewer Extension Project pursuant to plans, specifications and other related documents, which are incorporated into the Proposal by reference (the

“Contract Documents”), as prepared by LEVINE ENGINEERING, LLC, ALTOONA, PENNSYLVANIA; and

WHEREAS, the Owner is a “Contracting Body” under the provisions of Act No. 385 of the General

Assembly of the Commonwealth of Pennsylvania, approved by the Governor on December 20, 1967, known and cited as the “Public Works Contractors' Bond Law of 1967” (the “Act”); and

WHEREAS, the Act, in Section 3(a), requires that, before an award shall be made to the Contractor by the Owner in accordance with the Proposal, the Contractor shall furnish this Bond to the Owner, with this Bond to become binding upon the award of a Construction Contract to the Contractor by the Owner in accordance

West Branch Regional Authority 00600-8 January 2026 with the Proposal; and

WHEREAS, it also is a condition of the Contract Documents that this Bond shall be furnished by the

Contractor to the Owner; and

WHEREAS, under the Contract Documents, it is provided, inter alia, that if the Contractor shall furnish this Bond to the Owner, and if the Owner shall make an award to the Contractor in accordance with the

Proposal, then the Contractor and the Owner shall enter into a Construction Contract with respect to performance of such Construction Contract, the form of which said Construction Contract is set forth in the

Contract Documents.

NOW, THEREFORE, the terms and conditions of this Bond are and shall be that:

1. The Contractor and the Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors and assigns to the Owner for the performance of the Construction

Contract, which is incorporated herein by reference, for a period of two (2) years.

2. If the Contractor performs the Construction Contract, the Surety and the Contractor shall have no obligation under this Bond, except to participate in conferences as provided in

Subparagraph 3.1.

3. If there is no Owner Default, the Surety's obligation under this Bond shall arise after:

3.1 The Owner has notified the Contractor and the Surety at its address described in

Paragraph 10 below, that the Owner is considering declaring a Contractor Default and has requested and attempted to arrange a conference with the Contractor and the

Surety to be held not later than fifteen (15) days after receipt of such notice to discuss methods of performing the Construction Contract. If the Owner, the Contractor and the Surety agree, the Contractor shall be allowed a reasonable time to perform the

Construction Contract, but such an agreement shall not waive the Owner's right, if any, subsequently to declare a Contractor Default; and

3.2 The Owner has declared a Contractor Default and formally terminated the

Contractor's right to complete the contract. Such Contractor Default shall not be declared earlier than twenty (20) days after the Contractor and the Surety have received notice as provided in Subparagraph 3.1; and

West Branch Regional Authority 00600-9 January 2026

3.3 The Owner has agreed to pay the Balance of the Contract Price to the Surety in accordance with the terms of the Construction Contract or to a contractor selected to perform the Construction Contract in accordance with the terms of the contract with the Owner.

4. When the Owner has satisfied the conditions of Paragraph 3, the Surety shall promptly and at the Surety's expense take one of the following actions:

4.1 Arrange for the Contractor, with consent of the Owner, to perform and complete the

Construction Contract; or

4.2 Undertake to perform and complete the Construction Contract itself, through its agents or through independent contractors; or

4.3 Obtain bids or negotiated proposals from qualified contractors acceptable to the

Owner for a contract for performance and completion of the Construction Contract, arrange for a contract to be prepared for execution by the Owner and the Contractor selected with the Owner's concurrence, to be secured with performance and payment bonds executed by a qualified surety equivalent to the bonds issued on the

Construction Contract, and pay to the Owner the amount of damages as described in

Paragraph 6 in excess of the Balance of the Contract Price incurred by the Owner resulting from the Contractor's default; or

4.4 Waive its right to perform and complete, arrange for completion, or obtain a new

Contractor and with reasonable promptness under the circumstances:

1. After investigation, determine the amount for which it may be liable to the

Owner and, as soon as practicable after the amount is determined, tender payment therefore to the Owner; or

2. Deny liability in whole or in part and notify the Owner citing reasons therefore.

5. If the Surety does not proceed as provided in Paragraph 4 with reasonable promptness, the

Surety shall be deemed to be in default on this Bond fifteen (15) days after receipt of an additional written notice from the Owner to the Surety demanding that the Surety perform its obligations under this Bond, and the Owner shall be entitled to enforce any remedy available to the Owner. If the Surety proceeds as provided in Subparagraph 4.4 and the Owner refuses the payment tendered or the Surety has denied liability, in whole or in part, without further notice the Owner shall be entitled to enforce any remedy available to the Owner.

West Branch Regional Authority 00600-10 January 2026

6. After the Owner terminated the Contractor's right to complete the Construction Contract, and if the Surety elects to act under Subparagraph 4.1, 4.2 or 4.3 above, then the responsibilities of the Surety to the Owner shall not be greater than those of the Contractor under the

Construction Contract, and the responsibilities of the Owner to the Surety shall not be greater than those of the Owner under the Construction Contract. To the limit of the amount of this

Bond, but subject to commitment by the Owner of the Balance of the Contract Price to mitigation of costs and damages on the Construction Contract, the Surety is obligated without duplication for:

6.1 The responsibilities of the Contractor for correction of defective work and completion of the Construction Contract:

6.2 Additional legal, design professional and delay costs resulting from the Contractor's

Default, and resulting from the actions or failure to act of the Surety under Paragraph

4; and

6.3 Liquidated damages, or if no liquidated damages are specified in the Construction

Contract, actual damages caused by delayed performance or non-performance of the

Contractor.

7. The Surety shall not be liable to the Owner or others for obligations of the Contractor that are unrelated to the Construction Contract, and the Balance of the Contract Price shall not be reduced or set off on account of any such unrelated obligations. No right of action shall accrue on this Bond to any person or entity other than the Owner or its heirs, executors, administrators, or successors.

8. The Surety hereby waives notice of any change, including changes of time, to the Construction

Contract or to related subcontracts, purchase orders and other obligations.

9. Any proceeding, legal or equitable, under this Bond may be instituted in any court of competent jurisdiction in the location in which the work or part of the work is located and shall be instituted within one (1) year after Contractor Default or within one (1) year after the

Contractor ceased working or within one (1) year after the Surety refuses or fails to perform its obligations under this Bond, whichever occurs first. If the provisions of this Paragraph are void or prohibited by law, the minimum period of limitation available to sureties as a defense in the jurisdiction of the suit shall be applicable.

10. Notice to the Surety, the Owner or the Contractor shall be mailed or delivered to the address shown on the signature page.

West Branch Regional Authority 00600-11 January 2026

11. When this Bond has been furnished to comply with a statutory or other legal requirement in the location where the construction was to be performed, any provision in this Bond conflicting with said statutory on legal requirement shall be deemed deleted herefrom and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein.

The intent is that this Bond shall be construed as a statutory bond and not as a common law bond.

12. Definitions.

12.1. Balance of the Contract Price: The total amount payable by the Owner to the

Contractor under the Construction Contract after all proper adjustments have been made, including allowance to the Contractor of any amounts received or to be received by the Owner in settlement of insurance or other claims for damages to which the Contractor is entitled, reduced by all valid and proper payments made to or on behalf of the Contractor under the Construction Contract.

12.2. Construction Contract: The agreement between the Owner and the Contractor identified on the recitation page, including all Contract Documents and changes thereto.

12.3. Contractor Default: Failure of the Contractor, which has neither been remedied nor waived, to perform or otherwise to comply with the terms of the Construction Contract.

12.4. Owner Default: Failure of the Owner, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contract or to perform and complete or comply with the other terms thereof.

West Branch Regional Authority 00600-12 January 2026

(Individual Principal)

(Partnership Bidder)

By: (SEAL)

(Partner)

By: (SEAL)

(Partner)

West Branch Regional Authority 00600-13 January 2026

(Corporation or Limited Liability Company Principal)

(Corporation Surety)

**By:

West Branch Regional Authority 00600-14 January 2026

**Attach an appropriate power of attorney, dated as of the same date as the Bond, evidencing the Authority of the Attorney-in-Fact to act on behalf of the corporation.

(FOR INFORMATION ONLY - Name, Address and Telephone)

AGENT OR BROKER: OWNER'S REPRESENTATIVE:

Levine Engineering, LLC 2703 Washington Avenue Altoona, PA 16601 Phone: (814) 935-1928 Fax: (814) 941-2630 Email: tmlevine81@gmail.com

West Branch Regional Authority 00600-15 January 2026

PAYMENT BOND

, as Contractor (the “Contractor”), and

, a corporation organized and existing under laws of the of as Surety (the “Surety”), are held and firmly bound unto the

WEST BRANCH REGIONAL AUTHORITY, as Owner (the “Owner”), as hereinafter set forth, in the full and just sum of Dollars

($ . ), lawful money of the United States of America, for the payment of which we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.

WITNESSETH THAT:

WHEREAS, the Contractor heretofore has submitted to the Owner a certain bid, dated February 16, 2026, (the “Proposal”), to perform Contract No. WB-1 (the “Construction Contract”) by agreement dated

, 2026 for the Owner, in connection with the Route 54 Sanitary Sewer Extension Project pursuant to plans, specifications and other related documents, which are incorporated into the Proposal by reference (the

“Contract Documents”), as prepared by LEVINE ENGINEERING, LLC, ALTOONA, PENNSYLVANIA; and

WHEREAS, the Owner is a “Contracting Body” under the provisions of Act No. 385 of the General

Assembly of the Commonwealth of Pennsylvania, approved by the Governor on December 20, 1967, known and cited as the “Public Works Contractors' Bond Law of 1967” (the “Act”); and

WHEREAS, the Act, in Section 3(a), requires that, before an award shall be made to the Contractor by the Owner in accordance with the Proposal, the Contractor shall furnish this Bond to the Owner, with this Bond to become binding upon the award of a Construction Contract to the Contractor by the Owner in accordance with the Proposal; and

West Branch Regional Authority 00600-16 January 2026

WHEREAS, it also is a condition of the Contract Documents that this Bond shall be furnished by the

Contractor to the Owner; and

WHEREAS, under the Contract Documents, it is provided, inter alia, that if the Contractor shall furnish this Bond to the Owner, and if the Owner shall make an award to the Contractor in accordance with the

Proposal, then the Contractor and the Owner shall enter into an a Construction Contract with respect to performance of such Construction Contract, the form of which said Construction Contract is set forth in the

Contract Documents.

NOW THEREFORE, the terms and conditions of this Bond are and shall be that:

1. The Contractor and the Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors and assigns to the Owner to pay for labor, materials and equipment furnished for use in the performance of the Construction Contract, which is incorporated herein by reference.

2. With respect to the Owner, this obligation shall be null and void if the Contractor:

2.1 Promptly makes payment, directly or indirectly, for all sums due Claimants, and

2.2 Defends, indemnifies and holds harmless the Owner from all claims, demands, liens or suits by any person or entity who furnished labor, materials or equipment for use in the performance of the Construction Contract, provided the Owner has promptly notified the Contractor and the Surety (at the address described in Paragraph 12) of any claims, demands, liens or suits and tendered defense of such claims, demands, liens or suits to the Contractor and the Surety, and provided there is no Owner

Default.

3. With respect to Claimants, this obligation shall be null and void if the Contractor promptly makes payment, directly or indirectly, for all sums due.

4. The Surety shall have no obligation to Claimants under this Bond until:

4.1 Claimants who are employed by or have a direct contract with the Contractor have given notice to the Surety (at the address described in Paragraph 12) and sent a copy, or notice thereof, to the Owner, stating that claim is being made under this

Bond, and with substantial accuracy, the amount of the claim.

West Branch Regional Authority 00600-17 January 2026

4.2 Claimants who do not have a direct contract with the Contractor:

1. Have furnished written notice to the Contractor and sent a copy, or notice thereof, to the Owner, within ninety (90) days after having last performed labor or last furnished materials or equipment included in the claim stating, with substantial accuracy, the amount of the claim and the name of the party to whom the materials were furnished or supplied or for whom the labor was done or performed; and

2. Have either received a rejection in whole or in part from the Contractor, or not received within thirty (30) days of furnishing the above notice any communication from the Contractor by which the Contractor has indicated the claim will be paid directly or indirectly; and

3. Not having been paid within the above thirty (30) days, have sent a written notice to the Surety (at the address described in Paragraph 12) and sent a copy, or notice thereof, to the Owner, stating that a claim is being made under this Bond and enclosing a copy of the previous written notice furnished to the Contractor.

5. If a notice required by Paragraph 4 is given by the Owner to the Contractor or to the Surety that is sufficient compliance.

6. When the Claimant has satisfied the conditions of Paragraph 4, the Surety shall promptly and at the Surety's expense take the following actions:

6.1 Send an answer to the Claimant, with a copy to the Owner, within forty-five (45) days after receipt of the claim, stating the amounts that are undisputed and the basis for challenging any amounts that are disputed.

6.2 Pay or arrange for payment of any undisputed amounts.

7. The Surety's total obligation shall not exceed the amount of this Bond, and the amount of this

Bond shall be credited for any payments made in good faith by the Surety.

8. Amounts owed by the Owner to the Contractor under the Construction Contract shall be used for the performance of the Construction Contract and to satisfy claims, if any, under any

Construction Performance Bond. By the Contractor furnishing and the Owner accepting this

Bond, they agree that all funds earned by the Contractor in the performance of the

Construction Contract are dedicated to satisfy obligations of the Contractor and the Surety

West Branch Regional Authority 00600-18 January 2026 under this Bond, subject to the Owner's priority to use the funds for the completion of the work.

9. The Surety shall not be liable to the Owner, claimants or others, or obligations of the

Contractor that are unrelated to the Construction Contract. The Owner shall not be liable for payment of any costs or expenses of any Claimant under this Bond and shall have under this

Bond no obligations to make payments to give notices on behalf of or otherwise have obligations to Claimants under this Bond.

10. The Surety hereby waives notice of any change, including changes of time, to the Construction

Contract or to related subcontracts, purchase orders and other obligations.

11. No suit or action shall be commenced by a Claimant under this Bond other than in a court of competent jurisdiction in the location in which the work or part of the work is located or after the expiration of one (1) year from the date (1) on which the Claimant gave the notice required by Subparagraph 4.1 or Clause 4.2 (iii) or (2) on which the last labor or service was performed by anyone or the last materials or equipment were furnished by anyone under the Construction

Contact, whichever of (1) or (2) first occurs. If the provisions of this Paragraph are void or prohibited by law, the minimum period of limitation available to sureties as a defense in the jurisdiction of the suit shall be applicable.

12. Notice to the Surety, the Owner or the Contractor shall be mailed or delivered to the address shown in the Construction Contract. Actual receipt of notice by Surety, the Owner or the

Contractor, however accomplished, shall be sufficient compliance as of the date received at the address shown on the Construction Contract.

13. When this Bond has been furnished to comply with a statutory or other legal requirement in the location where the construction was to be performed, any provision in this Bond conflicting with said statutory or legal requirement shall be deemed deleted herefrom and provisions conforming to such statutory or other legal requirement shall be deemed incorporated herein.

The intent is that this Bond shall be construed as a statutory bond and not as a common law bond.

14. Upon request by any person or entity appearing to be a potential beneficiary of this Bond, the

Contractor shall promptly furnish a copy of this Bond or shall permit a copy to be made.

15. Definitions

15.1 Claimant: An individual or entity having a direct contract with the Contractor or with a subcontractor of the Contractor to furnish labor, materials or equipment for use in the

West Branch Regional Authority 00600-19 January 2026 performance of the Contract. The intent of this Bond shall be to include without limitation in the terms “labor, materials or equipment” that part of water, gas, power, light, heat, oil, gasoline, telephone service or rental equipment used in the

Construction Contract, architectural and engineering services required for performance of the work of the Contractor and the Contractor's subcontractors, and all other items for which a mechanic's lien may be asserted in the jurisdiction where the labor, materials or equipment were furnished.

15.2 Construction Contract: The agreement between the Owner and the Contractor identified on the first recitation page, including all Contract Documents and changes thereto.

15.3 Owner Default: Failure of the Owner, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contractor or to perform and complete or comply with the other terms thereof.

(Individual Principal)

West Branch Regional Authority 00600-20 January 2026

(Partnership Principal)

(Partner)

By: (SEAL)

(Partner)

By: (SEAL)

(Partner)

(Corporation of Limited Liability Company Principal)

West Branch Regional Authority 00600-21 January 2026

(Corporate Surety)

**By:

**Attach an appropriate power of attorney, dated as of the same date as the Bond, evidencing the Authority of the Attorney-in-Fact to act on behalf of the corporation.

(FOR INFORMATION ONLY - Name, Address and Telephone)

AGENT OR BROKER: OWNER'S REPRESENTATIVE:

Levine Engineering, LLC 2703 Washington Avenue Altoona, PA 16601 Phone: (814) 935-1928 Fax: (814) 941-2630 Email: tmlevine81@gmail.com

West Branch Regional Authority 00600-22 January 2026

CONSENT OF SURETY COMPANY TO FINAL PAYMENT

In accordance with the provisions of the Agreement dated , 20 , between WEST BRANCH REGIONAL AUTHORITY (the “Owner”) and

(the “Contractor”), the

, (the “Surety”) on the Bond of Contract No. WB-1 the (“Construction Contract”), after a careful examination of the books and records of said Contractor or after receipt of an affidavit from Contractor, which examination or affidavit satisfied this Surety, that all claims for labor and materials have been satisfactorily settled, hereby approved of the final payment of the said Contractor, and by these presents witnesseth that payment to the Contractor of the final estimates shall not relieve the Surety of its obligations to the Owner as set forth in the said Surety's Bond.

IN WITNESS WHEREOF, the said Surety has hereunto set its hand and seal this day of

, 20 .

NOTE: This statement, if executed by any person other than the President or Vice-President of the Surety, must be accompanied by a certificate of even date showing Authority conferred upon the person so signing to execute such instruments on behalf of the Surety represented.

West Branch Regional Authority 00600-23 January 2026

CONTRACTOR'S AFFIDAVIT OF PAYMENT OF DEBTS AND CLAIMS

State of _______________________________)

) SS:

County of _____________________________)

Before me, the undersigned, a in and for said

County and State, personally appeared hereby certifies that, except as listed below, payment has been made in full and all obligations have otherwise been satisfied for all materials and equipment furnished, for all work, labor and services performed, and for all known indebtedness and claims against Contractor for damages arising in any manner in connection with the performance of the Contract referenced herein for which Owner or Owner's property might in any way be held responsible or encumbered.

EXCEPTIONS:

SUPPORTING DOCUMENTS ATTACHED HERETO:

1. Consent of Surety to Final Payment. Whenever Surety is involved, Consent of Surety is required.

2. Contractor's Release or Waiver of Liens, conditional upon receipt of final payment.

3. Separate Releases or Waivers of Liens from Subcontractors and material and equipment suppliers, to the extent required by Owner, accompanied by a list thereof.

(Individual, Partner, or Authorized Representative of Corporation)

Sworn to and subscribed before me this day of , 20 .

Notary Public

My Commission Expires: