SF25A Payment Bond.pdf

PDF 596 KB Posted Aug 9, 2023

Attached to: Install Two Standby Generators and Liquid Propane Tanks Federal contract opportunity
Solicitation number: 246-23-Q-0163
Issued by: Department of Health and Human Services Indian Health Service

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Written by GovTribe AI · Dec 21, 2023

This document is a Standard Form 25A Payment Bond template. It outlines the requirements and terms for a payment bond to be provided by a contractor awarded a contract by the Department of Health and Human Services Indian Health Service. The payment bond is required for contract number 246-23-Q-0163 to install two standby generators and liquid propane tanks. The document details the principal, surety, penal sum, conditions and signatures required for the payment bond. It includes spaces for the contractor and surety information, contract details, bond execution date, and signatures from the principal and multiple surety corporations.

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Corporate Seal

LIABILITY LIMITNAME &

ADDRESS

NAME(S) &

TITLE(S)

(Typed)

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)

INDIVIDUAL

CORPORATION

PARTNERSHIP

JOINT VENTURE

STATE OF INCORPORATION

MILLION(S)

CONTRACT DATE CONTRACT NO.

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)

Public reporting burden for this collection of information is estimate to average 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 the FAR Secretariat (MVR), Federal Acquisition Policy Division, GSA, Washington, DC 20405.

OMB Number: 9000-0045 Expiration Date: 6/30/2016

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME(S)

(Typed)

SIGNATURE(S)

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is usable

(Seal)

STATE OF INC.

Corporate Seal

STANDARD FORM 25A (REV. 10/1998)

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

Corporate Seal

LIABILITY LIMIT

STANDARD FORM 25A (REV. 10/1998) BACK

CORPORATE SURETY(IES) (Continued)

Y F

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

STATE OF INC. LIABILITY LIMIT

LIABILITY LIMIT

STATE OF INC.

LIABILITY LIMIT

STATE OF INC.

LIABILITY LIMIT

STATE OF INC.

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 U.S.C. 270a-270e). 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 their 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.

INSTRUCTIONS

Corporate Seal

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)

INDIVIDUAL

CORPORATION

PARTNERSHIP

JOINT VENTURE

STATE OF INCORPORATION

MILLION(S)

CONTRACT DATE

CONTRACT NO.

THOUSAND(S)

HUNDRED(S)

CENTS

PENAL SUM OF BOND

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

OBLIGATION:

CONDITIONS:

WITNESS:

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

PRINCIPAL

INDIVIDUAL SURETY(IES)

CORPORATE SURETY(IES)

OMB Number: 9000-0045 Expiration Date: 6/30/2016

SIGNATURE(S)

NAME(S) &

TITLE(S)

(Typed)

SIGNATURE(S)

NAME(S)

(Typed)

SIGNATURE(S)

AUTHORIZED FOR LOCAL REPRODUCTION

Previous edition is usable 1.

(Seal) (Seal) 2.

(Seal) (Seal) 3.

(Seal) 1.

STATE OF INC.

Corporate Seal

STANDARD FORM 25A (REV. 10/1998)

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. 10/1998) 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

STATE OF INC.

LIABILITY LIMIT

STATE OF INC.

LIABILITY LIMIT

STATE OF INC.

LIABILITY LIMIT

STATE OF INC.

In the space designated "SURETY(IES)" on the face of the form, insert only the letter identification of the sureties.

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.

INSTRUCTIONS

8.2.0.3062.1.452232.445150

PRINCIPAL (Legal name and business address):

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

TYPE OF ORGANIZATION ("X" one). INDIVIDUAL: 0

TYPE OF ORGANIZATION ("X" one). JOINT VENTURE: 0

TYPE OF ORGANIZATION ("X" one). PARTNERSHIP: 0

TYPE OF ORGANIZATION ("X" one). CORPORATION: 0

STATE OF INCORPORATION:

CONTRACT NUMBER:

CONTRACT DATE. Enter 2 digit month, 2 digit day and 4 digit year.:

DATE BOND EXECUTED (Must be same or later than date of contract). Enter 2 digit month, 2 digit day and 4 digit year.:

PENAL SUM OF BOND. MILLION(S):

PENAL SUM OF BOND. THOUSAND(S):

PENAL SUM OF BOND. HUNDRED(S):

PENAL SUM OF BOND. CENTS:

PRINCIPAL. SIGNATURE(S). 1. This is a protected field.:

CORPORATE SURETY(IES). SURETY B. SIGNATURE(S). 1. DIGITAL SIGNATURE:

PRINCIPAL. SIGNATURE(S). 2. This is a protected field.:

PRINCIPAL. SIGNATURE(S). 3. This is a protected field.:

INDIVIDUAL SURETY(IES). SIGNATURE(S). 1. This is a protected field.:

INDIVIDUAL SURETY(IES). SIGNATURE(S). 2. This is a protected field.:

CORPORATE SURETY(IES). SURETY A. SIGNATURE(S). 1. This is a protected field.:

CORPORATE SURETY(IES). SURETY A. SIGNATURE(S). 2. This is a protected field.:

PRINCIPAL. NAME(S) & TITLE(S) (Typed). 1.:

INDIVIDUAL SURETY(IES). NAME(S)

(Typed). 1.:

CORPORATE SURETY(IES). SURETY A. STATE OF INCOME.:

CORPORATE SURETY(IES). SURETY A. NAME AND ADDRESS.:

INDIVIDUAL SURETY(IES). NAME(S)

(Typed). 2.:

PRINCIPAL. NAME(S) & TITLE(S) (Typed). 2. :

PRINCIPAL. NAME(S) & TITLE(S) (Typed). 3. :

CORPORATE SURETY(IES). SURETY A. NAME(S) & TITLE(S) (Typed). 1.:

CORPORATE SURETY(IES). SURETY A. NAME(S) & TITLE(S) (Typed). 2. :

CORPORATE SURETY(IES). SURETY A. LIABILITY LIMIT $.:

CORPORATE SURETY(IES) (Continued). SURETY C. NAME AND ADDRESS.:

CORPORATE SURETY(IES) (Continued). SURETY C. STATE OF INCOME.:

CORPORATE SURETY(IES) (Continued). SURETY C. LIABILITY LIMIT $.:

CORPORATE SURETY(IES). SURETY C. SIGNATURE(S). 2. This is a protected field.:

CORPORATE SURETY(IES). SURETY C. SIGNATURE(S). 1. This is a protected field.:

CORPORATE SURETY(IES) (Continued). SURETY C. NAME(S) & TITLE(S) (Typed). 1. :

CORPORATE SURETY(IES) (Continued). SURETY D. NAME AND ADDRESS.:

CORPORATE SURETY(IES). SURETY D. SIGNATURE(S). 1. This is a protected field.:

CORPORATE SURETY(IES) (Continued). SURETY E. NAME AND ADDRESS.:

CORPORATE SURETY(IES) (Continued). SURETY E. STATE OF INCOME.:

CORPORATE SURETY(IES) (Continued). SURETY E. LIABILITY LIMIT $.:

CORPORATE SURETY(IES). SURETY E. SIGNATURE(S). 2. This is a protected field.:

CORPORATE SURETY(IES) (Continued). SURETY E. NAME(S) & TITLE(S) (Typed). 2. :

CORPORATE SURETY(IES) (Continued). SURETY E. NAME(S) & TITLE(S) (Typed). 1. :

CORPORATE SURETY(IES). SURETY E. SIGNATURE(S). 1. This is a protected field.:

CORPORATE SURETY(IES) (Continued). SURETY F. NAME AND ADDRESS.:

CORPORATE SURETY(IES) (Continued). SURETY F. STATE OF INCOME.:

CORPORATE SURETY(IES) (Continued). SURETY F. LIABILITY LIMIT $.:

CORPORATE SURETY(IES). SURETY F. SIGNATURE(S). 2. This is a protected field.:

CORPORATE SURETY(IES) (Continued). SURETY F. NAME(S) & TITLE(S) (Typed). 2. :

CORPORATE SURETY(IES) (Continued). SURETY G. NAME AND ADDRESS.:

CORPORATE SURETY(IES). SURETY G. SIGNATURE(S). 1. This is a protected field.:

CORPORATE SURETY(IES) (Continued). SURETY G. STATE OF INCOME.:

CORPORATE SURETY(IES) (Continued). SURETY G. LIABILITY LIMIT $.:

CORPORATE SURETY(IES). SURETY G. SIGNATURE(S). 2. This is a protected field.:

CORPORATE SURETY(IES) (Continued). SURETY G. NAME(S) & TITLE(S) (Typed). 1. :

CORPORATE SURETY(IES) (Continued). SURETY G. NAME(S) & TITLE(S) (Typed). 2. :

CORPORATE SURETY(IES) (Continued). SURETY F. NAME(S) & TITLE(S) (Typed). 1. :

CORPORATE SURETY(IES). SURETY F. SIGNATURE(S). 1. This is a protected field.:

CORPORATE SURETY(IES). SURETY D. SIGNATURE(S). 2. This is a protected field.:

CORPORATE SURETY(IES) (Continued). SURETY D. LIABILITY LIMIT $.:

CORPORATE SURETY(IES) (Continued). SURETY D. STATE OF INCOME.:

CORPORATE SURETY(IES) (Continued). SURETY D. NAME(S) & TITLE(S) (Typed). 2. :

CORPORATE SURETY(IES) (Continued). SURETY D. NAME(S) & TITLE(S) (Typed). 1. :

CORPORATE SURETY(IES) (Continued). SURETY C. NAME(S) & TITLE(S) (Typed). 2. :

CORPORATE SURETY(IES) (Continued). SURETY B. NAME(S) & TITLE(S) (Typed). 2. :

CORPORATE SURETY(IES) (Continued). SURETY B. NAME(S) & TITLE(S) (Typed). 1.:

CORPORATE SURETY(IES). SURETY B. SIGNATURE(S). 2. This is a protected field.:

CORPORATE SURETY(IES). SURETY B. SIGNATURE(S). 1. This is a protected field.:

CORPORATE SURETY(IES) (Continued). SURETY B. LIABILITY LIMIT $.:

CORPORATE SURETY(IES) (Continued). SURETY B. STATE OF INCOME.:

CORPORATE SURETY(IES) (Continued). SURETY B. NAME AND ADDRESS.:

File details come from the government source that posted it. Updated Aug 9, 2023.