Bond Number: Effective Bond Date:
(Principal) (Mailing address)
, and
(City and State) (Surety)
are held and firmly bound unto the State of Iowa, Division of Labor as the holder in the penal sum of
twenty-five thousand dollars ($25,000.00) lawful money of the United States, to the payment of which
sum, the Principal and Surety firmly bind themselves, their heirs, executors, successors, assigns and
administrators, jointly and severally.
This obligation arises because the Principal is an out-of-state contractor desiring to perform
construction work in the State of Iowa. Iowa Code Chapter 91C requires the Principal file this bond.
The Principal shall pay all taxes and penalties, including but not limited to contributions due under the
unemployment compensation insurance system, penalties, interest and related fees which may accrue to
the State of Iowa, due to the Principal’s work in Iowa.
This bond shall be continuous in nature until cancelled by the Surety with not less than thirty (30) days’
written notice to the Principal and to the Iowa Division of Labor.
The obligation of this bond shall be operative until released in the manner provided in Iowa Code
Chapter 91C.
Executed this day of , 20 .
Principal (signature)
Surety (signature)
Registration number:
Date received:
Iowa Division of Labor
Contractor Registration
Mailing address: 1000 East Grand Avenue, Des Moines, IA 50319-0209
Physical address: 150 Des Moines Street, Des Moines, IA 50309 (UPS/FedEx)
Phone: 515-242-5871
Fax: 515-725-2427