Form Self-bond agreemen Self-bond agreemen Self-bond agreement

United States Department of the Interior
OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT

SELF-BOND AGREEMENT
Permit No.____________

Self-Bond No._____________

Know all persons by these presents, that the undersigned, _______________________
_________________________________________________ duly authorized to do business in
(State name and form of business organization)

the State of ______________________, AS PRINCIPAL, is held firmly bound unto the United
States in the sum of ___________________________________________________________
($
), lawful money of the United States, to be paid to the United States
Department of the Interior, Office of Surface Mining Reclamation and Enforcement (OSM) upon
order of forfeiture by an authorized representative of OSM pursuant to 30 CFR §800.50. The
undersigned hereby jointly and severally bind ourselves, our heirs, executors, administrators,
successors, and assigns for payment of said sum.
Whereas, OSM issued Permit Number(s)
and Renewals and Revisions(s) numbered and dated
application of the Principal.

and dated

,
pursuant to the

Whereas, (check one of the following):
(a)
(b)

(c)

This is an original agreement.
This is an agreement in addition to previous bond agreement(s) for the above
referenced permit(s) to mine and which agreement(s) remain(s) in full force and
effect.
This is a replacement agreement for:
1.

Bond Number_________________________
Principal_____________________________
Surety_______________________________
Dated _______________________________

2.

Bond Number_________________________
Principal_____________________________
Surety_______________________________
Dated _______________________________

3.

Bond Number_________________________
Principal_____________________________
Surety_______________________________
Dated _______________________________

Whereas, the Principal has completed an application for self-bonding and an Indemnity
Permit No.______________

Page 1 of 4

Self-Bond No.____________

Agreement, which are incorporated herein and made a part of this Self-Bond Agreement,
Whereas, said self-bonding agreements shall be governed by, and construed in accordance with,
the laws of the United States,
Whereas, said self-bonding agreement(s) shall cover any and all land affected or to be affected
by the mining operation under the above mentioned permit, revision(s) and renewal(s) since the
date of issuance of the permit, upon the following described land, as given within said permit
and revision(s), and renewals:

(if more space is needed, attach a signed legal description exhibit to this self-bond)

NOW, THEREFORE, the conditions of the obligation are such that this agreement shall remain
in full force and effect until either released, or the sum specified above forfeited pursuant to the
provision(s) of the Surface Mining Control and Reclamation Act, 30 U.S.C. 1201, et seq.
(SMCRA), and the rules and regulations adopted pursuant to that Act, or pursuant to applicable
federal laws and regulations.
Said principal herein agrees that this obligation shall be noncancellable and that the liability
hereunder is for the duration of the above specified surface coal mining and reclamation
operations and continues thereafter for a period coincident with the principal's responsibility for
the establishment of revegetation on the affected areas pursuant to the requirements of SMCRA,
EXCEPT THAT the obligation herein may be reduced beforehand when such reduction is
approved by the Authorized Representative of the Secretary of the Interior (hereinafter referred
to as the Secretary) changes in the permittee’s method of operation or other circumstances which
reduce the estimated cost of reclamation in accordance with SMCRA OR where bond acceptable
to OSM has been submitted to replace this obligation.
The principal herein further agrees and understands that the procedures for the adjustment of the
amount under this bond are specified in 30 CFR §800.15; that procedures governing the release
of all or part of this bond are specified in 30 CFR §800.40; and that the procedures for the
forfeiture of this bond are specified in 30 CFR §800.50.
The Principal herein further agrees that the conditions of this obligation are such that if the said
principal herein shall comply with the terms and conditions of said permit, revisions, and
renewals thereto, the provisions of and obligations imposed by SMCRA and any amendments
thereto, then the release of this obligation shall proceed as specified in 30 CFR §800.40.
The principal herein further agrees that this self-bond is posted to insure the permittee’s
performance upon all acres specified in the above permit. Upon bond forfeiture pursuant to 30
CFR §800.50, all bond or bonds which continue to be held by OSM for the above permit may be
forfeited and the forfeited bond or bond increments may be used by OSM to complete the
reclamation plan or a modified plan for any or all acres in the above permit and to cover
associated administrative expenses.
Permit No.______________

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Self-Bond No.____________

The principal herein further understands and agrees that this self-bond may continue to remain in
full force and effect as long as all information required by 30 CFR § 800.23(f) is submitted
within ninety (90) days after the close of each fiscal year, following the issuance of the selfbond, to OSM, and demonstrates that the principal and/or guarantor remains qualified. The
failure by the principal to file this information in a timely manner shall in no manner impinge
upon or prejudice the rights held by the United States under this Agreement. Further, this
agreement remains in full force and effect until released or substituted in accordance with the
requirements of SMCRA and the regulations promulgated thereunder.
The principal herein further understands and agrees that this self-bond may continue while the
principal or its Guarantor qualify under the regulations. The principal must notify OSM
immediately at any time it, or its Guarantor no longer meets the limitation of the federal
regulations at 30 CFR §800.23(d), or the criteria specified at 30 CFR §800.23(b), or 30 CFR
§800(c)(1), or 30 CFR §800(c)(2).
The principal herein further agrees and understands that the authorized representative of OSM
may require a substitution of this self-bond by a corporate surety licensed to do business in the
State of
, or other form of bond allowed by 30 CFR §800.12(a), (b), or (d).
In witness whereof, we, the said parties, have set our hand and seals.
PRINCIPAL
Signed and executed this

day of

, ______

BY:

BY: ________________________

TITLE: _________________________________TITLE:_________________________
State of
County of

)
)SS.
)

(Corporate Seal)

ALL APPLICABLE CORPORATE ACKNOWLEDGEMENTS ARE ATTACHED HERETO
AS PART OF THIS AGREEMENT.

Permit No.______________

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Self-Bond No.____________

This foregoing instrument was acknowledged by me ___________________________________,
(Name of Principal Signatory- please type or print)

this

day of

,

.

Witness my hand and official seal. ______________________________________
(Notary Public or other authorized officer)

______________________________________
(Title)

My Commission Expires:________________
----------------------------------------------------------------- -----------------------------------RESIDENT AGENT FOR SERVICE
Resident Agent:

Date:
(Signature)

Address: __________________________________
(Printed Name)

-------------------------------------------------------------------------------------------------------Approved as to form and execution:
BY:

Date: ___________________

APPROVED: __________________________________Date:___________________
OSM Authorized Representative

Paperwork Reduction Act Notice
We use the information required by this form to ensure that the requirements for a self-bond under 30 CFR 800.23 are met. You
must provide the requested information to obtain a benefit (a self-bond). Under 30 CFR 842.16, the information collected is a
matter of public record.
The time needed to complete this form and submit the requested information will vary depending on individual circumstances.
We estimate that the average time will be 3 hours per response. This number includes the time spent reviewing instructions,
learning about the regulations, gathering and maintaining information, and completing and reviewing the form. If you have
comments concerning the accuracy of this estimate or suggestions for simplifying the form or instructions, you may write to the
Information Collection Clearance Officer, Office of Surface Mining Reclamation and Enforcement, Room 202 SIB, 1951
Constitution Ave, NW, Washington, D.C. 20240.
Under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.), you are not required to respond to, nor will you be subject
to a penalty for a failure to comply with, a collection of information unless it displays a currently valid OMB control number.
OMB Control No. 1029-0043; expires 1/31/2009

Permit No.______________

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Self-Bond No.____________