FL-42 (Rev 12.22) - Payment Bond.pdf

PAYMENT BOND

(See instructions on reverse)

DATE BOND EXECUTED (Must be same or later than date of subcontract) OMB Control Number: 9000-0045

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 1 hour 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.

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

INDIVIDUAL PARTNERSHIP JOINT VENTURE

CORPORATION OTHER (Specify)

STATE OF INCORPORATION

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

MILLION(S) THOUSAND(S) HUNDRED(S) CENTS

SUBCONTRACT DATE SUBCONTRACT NUMBER

OBLIGATION:

We, the Principal and Surety(ies), are firmly bound to the United States of America and Fermi Research Alliance, LLC, 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.

CONDITIONS:

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 subcontract identified above, and any authorized modifications of the subcontract that subsequently are made. Notice of those modifications to the Surety(ies) are waived.

WITNESS:

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

PRINCIPAL

SIGNATURE(S)

1. 2. 3.

Corporate Seal

(Seal) (Seal) (Seal)

NAME(S) &

TITLE(S)

(Typed)

1. 2. 3.

INDIVIDUAL SURETY(IES)

SIGNATURE(S)

1.

(Seal)

2.

(Seal)

NAME(S)

(Typed)

1. 2.

CORPORATE SURETY(IES)

S U

R E

T Y

A

NAME &

ADDRESS

STATE OF INCORPORATION LIABILITY LIMIT

Corporate Seal

SIGNATURE(S)

1. 2.

NAME(S) &

TITLE(S)

(Typed)

1. 2.

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is NOT usable

STANDARD FORM 25A (REV. 8/2016)

FRA FORM FL-42 (REV. 12/12/2022)

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

CORPORATE SURETY(IES) (Continued)

S U

R E

T Y

B

NAME &

ADDRESS

SIGNATURE(S)

1. 2.

NAME(S) &

TITLE(S)

(Typed)

1. 2.

S U

R E

T Y

C

NAME &

ADDRESS

SIGNATURE(S)

1. 2.

NAME(S) &

TITLE(S)

(Typed)

1. 2.

S U

R E

T Y

D

NAME &

ADDRESS

SIGNATURE(S)

1. 2.

NAME(S) &

TITLE(S)

(Typed)

1. 2.

S U

R E

T Y

E

NAME &

ADDRESS

SIGNATURE(S)

1. 2.

NAME(S) &

TITLE(S)

(Typed)

1. 2.

S U

R E

T Y

F

NAME &

ADDRESS

SIGNATURE(S)

1. 2.

NAME(S) &

TITLE(S)

(Typed)

1. 2.

S U

R E

T Y

G

NAME &

ADDRESS

SIGNATURE(S)

1. 2.

NAME(S) &

TITLE(S)

(Typed)

1. 2.

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. There shall be no deviation from this form.

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.

Fermi Research Alliance, LLC 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.

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

FRA FORM FL-42 (REV. 12/12/2022)