Payment Bond.pdf

OMB Control No. 2120-0595

2. 3. TYPE OF ORGANIZATION (“X” ONE)

Individual Part

Corp nership

Joint Venture oration

4. STATE OF INCORPORATION

5. SURETY(IES) (NAME AND BUSINESS ADDRESS)

a. Penal Sum of Bond b. Bid Identification Percent of Amount not to exceed Bid Date Invitation No.

of Bid Million(s) Thousand(s) Hundred(s) Cents Price For (Construction , Supplies or Services)

OBLIGATION: 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.

CONDITIONS: The above obligation is void if the Principal promptly makes payment to al 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.

WITNESS: The Principal and surety(ies) executed this bid bond and affixes their seals on the above date.

INSTRUCTIONS

1. This form, for the protection of persons supplying labor and material is used when a payment bond is required under the Act of August

24, 1935, 49 Stat. 793 (40 USC 270a-270e).

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 space (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.

PAPERWORK REDUCTION ACT STATEMENT. A federal agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a currently valid OMB Control Number. The OMB Control Number for this information collection is 2120-0595. Public reporting for this collection of information is estimated to be approximately 25 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.

Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Aviation Administration, 10101 Hillwood Parkway, Fort Worth, TX 76177-1524

1 DATE BOND EXECUTED (MUST NOT BE LATER THAN DATE OF CONTRACT.)

PRINCIPAL (LEGAL NAME AND BUSINESS ADDRESS)

PAYMENT BOND

Page 1 of 2FAA 4400-61 (01/23)

S u

a. Name & Address

b. State of Inc. a. Liability Limit r e

d. Signatures (1) (2) t y

e. Name(s) & Title(s)

(1) (2) Seal

B (Typed)

S u

a. Name & Address

b. State of Inc. a. Liability Limit r e

d. Signatures (1) (2) Corporate t y

e. Name(s) & Title(s)

(1) (2) Seal

C (Typed)

S u

a. Name & Address

b. State of Inc. a. Liability Limit r e d. Signatures

(1) (2) Corporate t y

e. Name(s) & Title(s)

(1) (2) Seal

D (Typed)

S u

a. Name & Address

b. State of Inc. a. Liability Limit r e

d. Signatures (1) (2) Corporate t y

e. Name(s) & Title(s)

(1) (2)

State of Inc. a. Liability Limitb.

Seal E (Typed)

S u

a. Name & Address r e

d. Signatures (1) (2) Corporate t y

e. Name(s) & Title(s)

(1) (2) Seal

F (Typed)

S u

a. Name & Address

b. State of Inc. a. Liability Limit r e

d. Signatures (1) (2) Corporate t y

e. Name(s) & Title(s)

(1) (2) Seal

G (Typed)

6. PRINCIPAL

a. Signature(s) (1) (2) (3)

(seal) (seal)

(1) (2) (3) b. Name(s) &

Titles (Typed)

7. INDIVIDUAL SURETY(IES)

a. Signature(s) (1) (2)

(Seal)

b. Name(s) (1) (2)

(Typed)

8. CORPORATE SURETY(IES)

S u

a. Name & Address

b. State of Inc. a. Liability Limit r e

d. Signatures (1) (2) t y

e. Name(s) & (1) (2)

A (Typed) Title(s)

OMB Control No. 2120-0595

(seal) Corporate Seal

(Seal)

Corporate

Seal

Corporate

FAA 4400-61 (01/23)