Attach_5_SF-25A_Payment_Bond_Form.pdf

Corporate Seal

LIABILITY LIMITNAME &

ADDRESS

NAME(S) &

TITLE(S)

(Typed)

SU

R

ET

Y

A

PAYMENT BOND

(See instructions on reverse)

DATE BOND EXECUTED (Must be same or later than date of contract)

PRINCIPAL (Legal name and business address) TYPE OF ORGANIZATION ("X" one)

STATE OF INCORPORATION

MILLION(S)

CONTRACT DATE CONTRACT NUMBER

THOUSAND(S) HUNDRED(S) CENTS

PENAL SUM OF BONDSURETY(IES) (Name(s) and business address(es))

OBLIGATION:

CONDITIONS:

WITNESS:

We, the Principal and Surety(ies), are firmly bound to the United States of America (hereinafter called the Government) in the above penal sum. For payment of the penal sum, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally. However, where the Sureties are corporations acting as co-sureties, we, the Sureties, bind ourselves in such sum "jointly and severally" as well as "severally" only for the purpose of allowing a joint action or actions against any or all of us. For all other purposes, each Surety binds itself, jointly and severally with the Principal, for the payment of the sum shown opposite the name of the Surety. If no limit is indicated, the limit of liability is the full amount of the penal sum.

The above obligation is void if the Principal promptly makes payment to all persons having a direct relationship with the Principal or a subcontractor of the Principal for furnishing labor, material or both in the prosecution of the work provided for in the contract identified above, and any authorized modifications of the contract that subsequently are made. Notice of those modifications to the Surety(ies) are waived.

The Principal and Surety(ies) executed this payment bond and affixed their seals on the above date.

PRINCIPAL

INDIVIDUAL SURETY(IES)

CORPORATE SURETY(IES)

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 USC § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 9000-0045. We estimate that it will take 60 minutes to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate, including suggestions for reducing this burden, or any other aspects of this collection of information to: General Services Administration, Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, Washington, DC 20405.

OMB Control Number: 9000-0045 Expiration Date: 7/31/2019

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME(S)

(Typed)

SIGNATURE(S)

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is NOT usable

1.

(Seal)

(Seal)

2.

(Seal)

(Seal)

3.

2.

2.

2.

2.

2.

3.

(Seal)

1.

1.

1.

1.

1.

STATE OF INCORPORATION

Corporate Seal

STANDARD FORM 25A (REV. 8/2016)

Prescribed by GSA-FAR (48 CFR) 53.2228(c)

JOINT VENTURE

OTHER (Specify)

PARTNERSHIPINDIVIDUAL

CORPORATION

Corporate Seal

Corporate Seal

Corporate Seal

Corporate Seal

Corporate Seal

LIABILITY LIMIT

STANDARD FORM 25A (REV. 8/2016) BACK

CORPORATE SURETY(IES) (Continued)

SU

R

ET

B

SU

R

ET

C

ET

D

ET

Y

E

SU

R

ET

Y F

SU

R

ET

Y

G

NAME(S) &

TITLE(S)

(Typed)

NAME &

ADDRESS

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

NAME &

ADDRESS

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

NAME &

ADDRESS

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

NAME &

ADDRESS

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

NAME &

ADDRESS

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME &

ADDRESS

2.

1.

1.

1.

1.

1.

1.

1.

1.

1.

1.

1.

1.

STATE OF INCORPORATION LIABILITY LIMIT

2.

2.

LIABILITY LIMIT

2.

LIABILITY LIMIT

2.

2.

STATE OF INCORPORATION

LIABILITY LIMIT

STATE OF INCORPORATION

2.

2.

2.

STATE OF INCORPORATION

LIABILITY LIMIT

STATE OF INCORPORATION

2.

2.

2.

STATE OF INCORPORATION

INSTRUCTIONS

1. This form, for the protection of persons supplying labor and material, is used when a payment bond is required under 40 USC Chapter 31, Subchapter III, Bonds. Any deviation from this form will require the written approval of the Administrator of General Services.

2. Insert the full legal name and business address of the Principal in the space designated "Principal" on the face of the form. An authorized person shall sign the bond. Any person signing in a representative capacity (e.g., an attorney-in-fact) must furnish evidence of authority if that representative is not a member of the firm, partnership, or joint venture, or an officer of the corporation involved.

3. (a) Corporations executing the bond as sureties must appear on the Department of the Treasury's list of approved sureties and must act within the limitations listed therein. The value put into the LIABILITY LIMIT block is the penal sum (i.e., the face value) of the bond, unless a co-surety arrangement is proposed.

(b) When multiple corporate sureties are involved, their names and addresses shall appear in the spaces (Surety A, Surety B, etc.) headed "CORPORATE SURETY(IES)." In the space designated "SURETY(IES)" on the face of the form, insert only the letter identifier corresponding to each of the sureties. Moreover, when co-surety arrangements exist, the parties may allocate their respective limitations of liability under the bonds, provided that the sum total of their liability equals 100% of the bond penal sum.

(c) When individual sureties are involved, a completed Affidavit of Individual Surety (Standard Form 28) for each individual surety shall accompany the bond.

The Government may require the surety to furnish additional substantiating information concerning its financial capability.

4. Corporations executing the bond shall affix their corporate seals. Individuals shall execute the bond opposite the words "Corporate Seal", and shall affix an adhesive seal if executed in Maine, New Hampshire, or any other jurisdiction requiring adhesive seals.

5. Type the name and title of each person signing this bond in the space provided.

LIABILITY LIMIT

NAME &

ADDRESS

NAME(S) &

TITLE(S)

(Typed)

SURETY A

PAYMENT BOND

(See instructions on reverse) DATE BOND EXECUTED (Must be same or later than date of contract) PRINCIPAL (Legal name and business address) TYPE OF ORGANIZATION ("X" one)

STATE OF INCORPORATION

MILLION(S)

CONTRACT DATE

CONTRACT NUMBER

THOUSAND(S)

HUNDRED(S)

CENTS

PENAL SUM OF BOND

SURETY(IES) (Name(s) and business address(es))

OBLIGATION:

CONDITIONS:

WITNESS:

We, the Principal and Surety(ies), are firmly bound to the United States of America (hereinafter called the Government) in the above penal sum. For payment of the penal sum, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally. However, where the Sureties are corporations acting as co-sureties, we, the Sureties, bind ourselves in such sum "jointly and severally" as well as "severally" only for the purpose of allowing a joint action or actions against any or all of us. For all other purposes, each Surety binds itself, jointly and severally with the Principal, for the payment of the sum shown opposite the name of the Surety. If no limit is indicated, the limit of liability is the full amount of the penal sum.

The above obligation is void if the Principal promptly makes payment to all persons having a direct relationship with the Principal or a subcontractor of the Principal for furnishing labor, material or both in the prosecution of the work provided for in the contract identified above, and any authorized modifications of the contract that subsequently are made. Notice of those modifications to the Surety(ies) are waived.

The Principal and Surety(ies) executed this payment bond and affixed their seals on the above date.

PRINCIPAL

INDIVIDUAL SURETY(IES)

CORPORATE SURETY(IES)

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 USC § 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 9000-0045. We estimate that it will take 60 minutes to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate, including suggestions for reducing this burden, or any other aspects of this collection of information to: General Services Administration, Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, Washington, DC 20405.

OMB Control Number: 9000-0045 Expiration Date: 7/31/2019

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME(S)

(Typed)

SIGNATURE(S)

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is NOT usable 1.

(Seal) (Seal) 2.

(Seal) (Seal) 3.

2.

2.

2.

2.

2.

3.

(Seal) 1.

1.

1.

1.

1.

STATE OF INCORPORATION

Corporate Seal

STANDARD FORM 25A (REV. 8/2016)

Prescribed by GSA-FAR (48 CFR) 53.2228(c) Corporate Seal Corporate Seal Corporate Seal Corporate Seal Corporate Seal Corporate Seal

LIABILITY LIMIT

STANDARD FORM 25A (REV. 8/2016) BACK

CORPORATE SURETY(IES) (Continued)

SURETY B

SURETY C

SURETY D

SURETY E

SURETY F

SURETY G

NAME(S) &

TITLE(S)

(Typed)

NAME &

ADDRESS

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

NAME &

ADDRESS

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

NAME &

ADDRESS

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

NAME &

ADDRESS

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

NAME &

ADDRESS

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME &

ADDRESS

2.

1.

1.

1.

1.

1.

1.

1.

1.

1.

1.

1.

1.

STATE OF INCORPORATION

LIABILITY LIMIT

2.

2.

LIABILITY LIMIT

2.

LIABILITY LIMIT

2.

2.

STATE OF INCORPORATION

LIABILITY LIMIT

STATE OF INCORPORATION

2.

2.

2.

STATE OF INCORPORATION

LIABILITY LIMIT

STATE OF INCORPORATION

2.

2.

2.

STATE OF INCORPORATION

INSTRUCTIONS

1. This form, for the protection of persons supplying labor and material, is used when a payment bond is required under 40 USC Chapter 31, Subchapter III, Bonds. Any deviation from this form will require the written approval of the Administrator of General Services.

2. Insert the full legal name and business address of the Principal in the space designated "Principal" on the face of the form. An authorized person shall sign the bond. Any person signing in a representative capacity (e.g., an attorney-in-fact) must furnish evidence of authority if that representative is not a member of the firm, partnership, or joint venture, or an officer of the corporation involved.

3. (a) Corporations executing the bond as sureties must appear on the Department of the Treasury's list of approved sureties and must act within the limitations listed therein. The value put into the LIABILITY LIMIT block is the penal sum (i.e., the face value) of the bond, unless a co-surety arrangement is proposed.

(b) When multiple corporate sureties are involved, their names and addresses shall appear in the spaces (Surety A, Surety B, etc.) headed "CORPORATE SURETY(IES)." In the space designated "SURETY(IES)" on the face of the form, insert only the letter identifier corresponding to each of the sureties. Moreover, when co-surety arrangements exist, the parties may allocate their respective limitations of liability under the bonds, provided that the sum total of their liability equals 100% of the bond penal sum.

(c) When individual sureties are involved, a completed Affidavit of Individual Surety (Standard Form 28) for each individual surety shall accompany the bond.

The Government may require the surety to furnish additional substantiating information concerning its financial capability.

4. Corporations executing the bond shall affix their corporate seals. Individuals shall execute the bond opposite the words "Corporate Seal", and shall affix an adhesive seal if executed in Maine, New Hampshire, or any other jurisdiction requiring adhesive seals.

5. Type the name and title of each person signing this bond in the space provided.

8.2.0.3062.1.452232.445150

(Typed). 1.:

(Typed). 2.: