WA-80 Warehouse Operator's Bond

This form is available electronically. Form Approved – OMB No. 0560-0120

WA-80 U.S. DEPARTMENT OF AGRICULTURE (10-31-11) Farm Service Agency United States Warehouse Act WAREHOUSE OPERATOR’S BOND (See Page 2 for the Privacy Act and Paperwork Reduction Act Statements)

1. FOR FSA USE ONLY

A. License Number      

B. Initials      

C. Bond Number      

See Instructions before completion of Items 2(a) through 2(l) of this form.

2. I or WE (a)

     

(Principal, Name of Legal Entity, Warehouse Operator) Proprietor Partnership Limited Partnership LLC Corporation

     

(Principal: Name of Legal Entity, Warehouse Operator)

(b)

     

, at (c)

     

,

(State of Incorporation or Where Organized)

(Principal Place of Business (City))

(d)

     

, operating the following warehouse(s) for the storage of:

(Principal Place of Business (State))

(e)

     

(Agricultural Product(s))

(f) License No.

(g) Name of Warehouse

(h) City

(i) County

(j) State

     

     

    

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

     

For in excess of 5 warehouses, please attach an 8 1/2 x 11 inch sheet listing the warehouses in the manner of the above followed by a

statement "This listing is an integral part of the bond number

     

executed effective

     

.”

This statement must be signed by both the Principal and Surety. as principal, and the other subscriber, are held and firmly bound unto the United States of America in the amount of

(k) $

     

(l)

     

Dollars

for the payment of which we bind ourselves and our successors and assigns, jointly and severally, firmly by these presents.

3. The conditions of this obligation are such that,

(a) The above-bound principal has applied to the Secretary of Agriculture of the United States of America for license(s) or a continuation of license(s) for the conduct of a warehouse under the United States Warehouse Act (Pub. L. 106 - 472) (7 U.S.C. 241 - 256) (the Act), the regulations promulgated thereunder, and the licensing agreements applicable to the above-named agricultural product(s); and (b) The principal has agreed, and does hereby agree as a condition to the granting of the license(s), to comply with and abide by the terms and conditions of the Act, and the regulations and the licensing agreements, so far as they may relate to the principal; and (c) The Act provides that each warehouse operator applying for a license to conduct a warehouse for the storage of the above-specified agricultural product(s) in accordance with the Act must, as a condition to the granting of the license, execute and file with the Secretary of Agriculture a good and sufficient bond to the United States. This bond will secure the faithful performance of the obligations of a warehouse operator under the terms of the Act, and regulations, and licensing agreements. Additionally, it will secure additional obligations of a warehouse operator that may be assumed by the warehouse operator under contracts with the respective depositors of the above-specified agricultural product(s) in such licensed warehouse(s): (d) Therefore, if the principal does perform and fulfill all of its obligations under the Act, then the obligations of the principal and surety on this bond shall become void; otherwise, these obligations shall remain in full force and effect.

4.

For purposes of this bond, the obligations under the Act, regulations, licensing agreements, and contracts include obligations under any and all modifications of the Act, regulations, licensing agreements, and the contracts that may hereafter be made, notice of these modifications to the surety being hereby waived. This bond will remain in force and effect for a minimum term of one year beginning with the effective date of this bond and subsequently will be considered as a continuous bond, subject to termination as provided.

WA-80 (10-31-11) Page 2 of 3

5.	This bond may be terminated at the end of the initial one year term by providing at least 120 calendar days advance written notice of cancellation by certified mail to the Deputy Administrator for Commodity Operations, Farm Service Agency, or designee.
6.	This bond may be canceled at any time after the initial one year term beginning with the bond effective date by providing 120 calendar days advance written notice of cancellation by certified mail to the Deputy Administrator for Commodity Operations, Farm Service Agency, or designee. If notice is given by the surety, a copy of the notice must be mailed by certified mail on the same day to the principal. Cancellation of this bond will not affect any liability that may have accrued under this bond prior to the effective date of cancellation.
7.	This bond shall be effective on and after effective date			     				.
				(MM-DD-YYYY)
8.	The above-bound parties have executed this instrument
	This (a)	     	day of (b)		     
		(Day)			(Month and Year)

9. Principal
	Principal: (a)		     
	(Legal Entity Name)
	(Legal Entity Name)
	By: (b)	     
		(Individual Partners, General Partner, Corporate Officer)
		     
		(Individual Partners, General Partner, Corporate Officer)
Witness to Signatures of Principal(s):
Witness: (c)				Witness: (e)
City and State: (d)				City and State: (f)

10. Certificate as to Corporate Principal
	I, (a)		     
			(Individual’s Name – Corporate Office Holder)
	certify that I am the (b)			     		of the
				(Office Held – Usually the Secretary)
	(c)	     
		(Corporation)
	     
	(Corporation)
named as Principal in the within bond, that the person(s) who signed the said bond on behalf of principal was or were then incumbent(s) in the position(s) shown above of said corporation, that I know his or her signature(s), and his or her signature(s) thereto is or are genuine, and that said bond was duly signed, sealed and attested for and in behalf of said corporation by authority of its governing body.
10D. Signature of Secretary of Other Officer as above					10E. Date (MM-DD-YYYY)      

WA-80 (10-31-11) Page 3 of 3

11. Surety
	Surety: (a)		     
	By: (b)	     
	Bond Number: (c)			     
		Attach a Power of Attorney for this Signature
Witness to Signatures of Surety(s):
Witness: (d)					Witness: (f)
City and State: (e)					City and State: (g)

NOTE:

The following statement is made in accordance with the Privacy Act of 1974 (5 U.S.C. 552a - as amended).  The authority for requesting the information identified on this form is 7 CFR Part 735, 7 CFR Part 1423, 7 CFR Part 1427, the United States Warehouse Act (Pub. L. 106-472), and the Commodity Credit Corporation Charter Act (15 U.S.C. 714 et seq.).  The information will be used to complete the terms of a license and/or licensing agreement between the warehouse operator and the Deputy Administrator for Commodity Operations under the United States Warehouse Act.  The information collected on this form may be disclosed to other Federal, State, Local government agencies, Tribal agencies, and nongovernmental entities that have been authorized access to the information by statute or regulation and/or as described in applicable Routine Uses identified in the System of Records Notice for USDA/FSA-2, Farm Records File (Automated) and USDA/FSA-3, Consultants File.  Providing the requested information is voluntary.  However, failure to furnish the requested information will result in a determination of ineligibility to obtain new licensing or retain existing licensing under the United States Warehouse Act. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0560-0120. The time required to complete this information collection is estimated to average 15 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. The provisions of appropriate criminal and civil fraud, privacy, and other statutes may be applicable to the information provided.  RETURN THIS COMPLETED FORM TO THE KANSAS CITY COMMODITY OFFICE, WAREHOUSE LICENSE AND EXAMINATION DIVISION, STOP 9148, P.O. BOX 419205, KANSAS CITY, MO 64141-6205.

The U.S. Department of Agriculture (USDA) prohibits discrimination in all of its programs and activities on the basis of race, color, national origin, age, disability, and where applicable, sex, marital status, familial status, parental status, religion, sexual orientation, political beliefs, genetic information, reprisal, or because all or part of an individual’s income is derived from any public assistance program.  (Not all prohibited bases apply to all programs.)  Persons with disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at (202) 720-2600 (voice and TDD).  To file a complaint of discrimination, write to USDA, Assistant Secretary for Civil Rights, Office of the Assistant Secretary for Civil Rights, 1400 Independence Avenue, S.W., Stop 9410, Washington, DC  20250-9410, or call toll-free at (866) 632-9992 (English) or (800) 877-8339 (TDD) or (866) 377-8642 (English Federal-relay) or (800) 845-6136 (Spanish Federal-relay).  USDA is an equal opportunity provider and employer.