Fillable Form 5-5243 - Performance Bond (Bureau of Indian Affairs)

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Form 5-5243 - Performance Bond (Bureau of Indian Affairs)

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Form 5-5423
OMB. No. 1076-0157
UNITED STATES
Expires: 3/31/2023
DEPARTMENT OF THE INTERIOR
BUREAU OF INDIAN AFFAIRS
PERFORMANCE BOND
Date Bond Executed:
Principal
Surety
Lease/Permit
Number
Date of
Lease/Permit
Purpose of Bond
Total Bond Amount
OBLIGATION
We, the PRINCIPAL and SURETY above named, are firmly bound unto the United States of America (hereinafter
called the Government) in the penal sum of the amount stated above. For the payment of the penal sum, we bind
ourselves, our heirs, executors, administrators, and successors, jointly and severally.
CONDITIONS
The Principal has entered into the Lease/Permit(s) listed and dated above; and
The principal and surety agree that the neglect or forbearance of the Government or landowner in enforcing against
the lessee or permittee the payment of rentals or the performance of any other covenant or condition of the
agreement, shall not in any way release the principal and surety, or either of them, from any liability under this bond;
and
The principal and surety agree that in the event of any default under such lease/permit, the Government or landowner
may prosecute any claim, suit, action, or other proceeding against either the principal or surety without the necessity
of joining the other.
THEREFORE
If the principal shall well and truly perform and fulfill all the undertakings, covenants, terms, and conditions of said
agreement during the original term of said agreement and any duly authorized extensions thereof, with or without
notice to the surety, and during the life of any guaranty required under the agreement, and shall also well and truly
perform and fulfill all the undertakings, covenants, terms, and conditions of any and all duly authorized modifications
to said agreement that may hereafter be made, notice of which modifications to the surety being hereby waived, then,
this obligation is void; it otherwise remains in full force and virtue.
IT IS FURTHER UNDERSTOOD AND AGREED between all parties hereto, that, if the Surety shall so elect, this bond
may be cancelled by giving at least forty-five (45) days advance notice in writing to both the Principal and the
Superintendent or other officer in charge of the Indian Agency or field office concerned, and this bond shall be
deemed cancelled as of the date specified on such notice, the said Surety remaining liable for all acts covered by this
bond which may have been committed by the Principal up to said date under the terms, conditions, and provisions of
this bond.
Form 5-5423, Performance Bond, Page 1 of 2
Permittee Initial ______
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
_____________________________________________
WITNESS
The Principal and Surety(ies) have executed this performance bond on the above date, the name and corporate seal
of each corporate party being hereto affixed, and these presents duly signed by its undersigned representative,
pursuant to authority of its governing body.
IN PRESENCE OF:
WITNESS
1. ________________________________________ as to
2. ________________________________________ as to
3. ________________________________________ as to
WITNESS
1. ________________________________________ as to
2. ________________________________________ as to
INDIVIDUAL PRINCIPAL
INDIVIDUAL SURETY
Attest:
Corporate Principal____________________________
____________________________________________
____________________________________________
____________________________________________
Attest:
____________________________________________
Business Address
___________________________________________
By
____________________________________________
___________________________________________
Title
AFFIX CORPORATE SEAL
____________________________________________
Corporate Surety
____________________________________________
Business Address
___________________________________________
By
___________________________________________
Title
AFFIX CORPORATE SEAL
Paperwork Reduction Act Statement: This form is covered by the Paperwork Reduction Act. It is used to establish
the respective rights and responsibilities of the respondent and the Federal government. The information is provided
by respondents to obtain or retain a benefit. In compliance with the Paperwork Reduction Act of 1995, as amended,
the collection has been reviewed by the Office of Management and Budget and assigned a number and an expiration
date. The number and expiration date are at the top right corner of the form. An agency may not sponsor or conduct,
and a person is not required to respond to, a request for information collection unless it displays a currently valid
OMB Control Number. The public reporting burden is estimated to average 20 minutes per respondent. This
includes the time needed to understand the requirements, gather the information, complete the form, and submit it to
the Department. Comments regarding the burden or other aspects of the form may be directed to the Indian Affairs
Information Collection Clearance Officer, Office of Regulatory Affairs – Indian Affairs, 1849 C Street, NW, MS-4141,
Washington, DC 20240.
Form 5-5423, Performance Bond, Page 2 of 2
Permittee Initial ______
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Form 5-5243 - Performance Bond (Bureau of Indian Affairs)

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Completed 26 September 2021

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