Form 5-5423 Performance Bond (Surety)

Form 5-5423 UNITED STATES OMB No. 1076-0157

DEPARTMENT OF THE INTERIOR Expires: __________

BUREAU OF INDIAN AFFAIRS

PERFORMANCE BOND

Date Bond Executed

Principal	Surety
Amount of Bond (express in words and figures) Total _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ $________________	Lease or Permit No.	Date of Lease or Permit

The PRINCIPAL and SURETY above named, are held and firmly bound unto the United States of America, hereinafter called the Government, and _____________________________ (lessor or permittee). in the penal sum of the amount stated above, for the payment of which sum well and truly to be made, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally, firmly by these presents, provided, however, that the liability of the Surety to either one or both of the obliges shall not exceed in the aggregate the penal sum of the bond.

THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas the principal entered into a certain agreement, numbered and dated as shown above and hereto attached; and whereas the principal and surety agree that the neglect or forbearance of the lessor or permittee 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 whereas the principal and surety agree that in the event of any

default under such lease, the lessor or permittee may prosecute any claim, suit, action, or other proceeding against either the principal or surety without the necessity of joining the other.

NOW 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 said agreement that may hereafter be made, notice of which modifications to the surety being hereby waived, then, this obligation to be void; otherwise to remain 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.

Page 2 of form 5-5423

IN WITNESS WHEREOF, the above‑bounden parties have executed this instrument under their several seals on the date indicated above, 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 INDIVIDUAL PRINCIPAL

1. ________________________________________________ as to ______________________________________________________

2. ________________________________________________ as to ______________________________________________________

3. ________________________________________________ as to ______________________________________________________

4. ________________________________________________ as to ______________________________________________________

WITNESS INDIVIDUAL SURETY

1. ________________________________________________ as to ______________________________________________________

2. ________________________________________________ as to ______________________________________________________

Attest: _____________________________________________________ _____________________________________________________ Attest: _____________________________________________________ _____________________________________________________

Corporate Principal ________________________________________________________ ________________________________________________________ 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.