Attachment H, Payment Bond, SF 1416.pdf

PAYMENT BOND FOR OTHER THAN

CONSTRUCTION CONTRACTS

(See instructions on reverse)

DATE BOND EXECUTED (Must not be later than bid opening date) OMB Control Number: 9000-0045

Expiration Date: 7/31/2019

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 25 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.

PRINCIPAL (Legal name and business address)

SURETY(IES) (Name(s) and business address(es)) (Include ZIP code)

CONDITIONS:

The Principal has entered into the contract identified above.

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

(a) The above obligation is void if the Principal promptly makes payment to all persons (claimants) having a contract 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 duly authorized modifications thereof. Notice of those modifications to the Surety(ies) are waived.

(b) The above obligation shall remain in full force if the Principal does not promptly make payments to all persons (claimants) having a contract relationship with the principal or a subcontractor of the Principal for furnishing labor, material or both in the prosecution of the contract identified above. In these cases, persons not paid in full before the expiration of ninety (90) days after the date of which the last labor was performed or material furnishing, have a direct right of action against the principal and Surety(ies) on this bond for the sum or sums justly due.

The claimant, however, may not bring a suit or any action -

(1) Unless claimant, other than one having a direct contract with the Principal, had given written notice to the Principal within ninety (90) days after the claimant did or performed the last of the work or labor, or furnished or supplied the last of the materials for which the claim is made. The notice is to state with substantial accuracy the amount claimed and the name of the party to whom the materials were furnished or supplied, or for whom the work or labor was done or performed. Such notice shall be served by mailing the same registered or certified mail, postage prepaid, in an envelope addressed to the Principal at any place where an office is regularly maintained for the transaction of business, or served in any manner in which legal process is served in the state in which the contract is being performed, save that such service need not be made by a public officer.

(2) After the expiration one (1) year following the date on which claimant did or performed the last of the work or labor, or furnished or supplied the last of the materials for which the suit is brought.

(3) Other than in the United States District court for the district in which the contract, or any part thereof, was performed and executed, and not elsewhere.

THEREFORE:

WITNESS:

TYPE OF ORGANIZATION ("X" one)

STATE OF INCORPORATION

INDIVIDUAL

CORPORATION

PARTNERSHIP

JOINT VENTURE

PENAL SUM OF BOND

MILLION(S)

CONTRACT DATE CONTRACT NUMBER

THOUSAND(S) HUNDRED(S) CENTS

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 of liability is indicated, the limit of liability is the full amount of the penal sum.

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition not usable

STANDARD FORM 1416 (REV. 10-98)

Prescribed by GSA-FAR (48 CFR) 53.228(m)

Corporate Seal

LIABILITY LIMITSTATE OF INCORPORATION

2.

2.1.

1.

NAME(S) &

TITLE(S)

(Typed)

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME &

ADDRESS

SU

R

ET

Y

B

INSTRUCTIONS

1. This form is authorized for use when payment bonds are required under FAR (48 CFR) 28.103-3, i.e., payment bonds for other than construction contracts. 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 limitation listed therein. Where more than one corporate surety is 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 identification of the sureties.

(b) Where 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 word "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 1416 (REV. 10-98) BACK

PRINCIPAL

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

1.

1.

2.

3.

(Seal)

3.

INDIVIDUAL SURETY(IES)

CORPORATE SURETY(IES)

SIGNATURE(S)

NAME(S) &

TITLE(S) (Typed)

NAME &

ADDRESS

SIGNATURE(S) Corporate Seal

(Seal)(Seal) 1.

1.

1.

2.

2.

1.

2.

2.

2.

(Seal) (Seal) Corporate

Seal

SU

R

ET

Y

A

STATE OF INCORPORATION LIABILITY LIMIT

PAYMENT BOND FOR OTHER THAN

CONSTRUCTION CONTRACTS

(See instructions on reverse) DATE BOND EXECUTED (Must not be later than bidopening date) OMB Control Number: 9000-0045 Expiration Date: 7/31/2019 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 25 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.

PRINCIPAL (Legal name and business address) SURETY(IES) (Name(s) and business address(es)) (Include ZIP code)

CONDITIONS:

The Principal has entered into the contract identified above.

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

(a) The above obligation is void if the Principal promptly makes payment to all persons (claimants) having a contract 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 duly authorized modifications thereof. Notice of those modifications to the Surety(ies) are waived.

(b) The above obligation shall remain in full force if the Principal does not promptly make payments to all persons (claimants) having a contract relationship with the principal or a subcontractor of the Principal for furnishing labor, material or both in the prosecution of the contract identified above. In these cases, persons not paid in full before the expiration of ninety (90) days after the date of which the last labor was performed or material furnishing, have a direct right of action against the principal and Surety(ies) on this bond for the sum or sums justly due. The claimant, however, may not bring a suit or any action -

(1) Unless claimant, other than one having a direct contract with the Principal, had given written notice to the Principal within ninety (90) days after the claimant did or performed the last of the work or labor, or furnished or supplied the last of the materials for which the claim is made. The notice is to state with substantial accuracy the amount claimed and the name of the party to whom the materials were furnished or supplied, or for whom the work or labor was done or performed. Such notice shall be served by mailing the same registered or certified mail, postage prepaid, in an envelope addressed to the Principal at any place where an office is regularly maintained for the transaction of business, or served in any manner in which legal process is served in the state in which the contract is being performed, save that such service need not be made by a public officer.

(2) After the expiration one (1) year following the date on which claimant did or performed the last of the work or labor, or furnished or supplied the last of the materials for which the suit is brought.

(3) Other than in the United States District court for the district in which the contract, or any part thereof, was performed and executed, and not elsewhere.

THEREFORE:

WITNESS:

TYPE OF ORGANIZATION ("X" one)

STATE OF INCORPORATION

INDIVIDUAL

CORPORATION

PARTNERSHIP

JOINT VENTURE

PENAL SUM OF BOND

MILLION(S)

CONTRACT DATE

CONTRACT NUMBER

THOUSAND(S)

HUNDRED(S)

CENTS

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 of liability is indicated, the limit of liability is the full amount of the penal sum.

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition not usable STANDARD FORM 1416 (REV. 10-98) Prescribed by GSA-FAR (48 CFR) 53.228(m) Corporate Seal

LIABILITY LIMIT

STATE OF INCORPORATION

2.

2.

1.

1.

NAME(S) &

TITLE(S)

(Typed)

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME &

ADDRESS

SURETY B

INSTRUCTIONS

1. This form is authorized for use when payment bonds are required under FAR (48 CFR) 28.103-3, i.e., payment bonds for other than construction contracts. 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 limitation listed therein. Where more than one corporate surety is 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 identification of the sureties.

(b) Where 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 word "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 1416 (REV. 10-98) BACK

PRINCIPAL

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed) 1.

1.

2.

3.

(Seal) 3.

INDIVIDUAL SURETY(IES)

CORPORATE SURETY(IES)

SIGNATURE(S)

NAME(S) &

TITLE(S) (Typed)

NAME &

ADDRESS

SIGNATURE(S)

Corporate Seal (Seal) (Seal) 1.

1.

1.

2.

2.

1.

2.

2.

2.

(Seal) (Seal) Corporate Seal

SURETY A

STATE OF INCORPORATION

LIABILITY LIMIT

8.2.1.4029.1.523496.503679