Page images
PDF
EPUB

§ 1-16.901-275 Standard Form 275, Reinsurance Agreement in Favor of the United States. (a) Page 1 of Standard Form 275.

[graphic][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][merged small][subsumed][subsumed][merged small]

WHEREAS the above named Direct Writing Company has become bound as surety unto the United States of America, on the above described bond, wherein the above named is principal; and WHEREAS the said bond was given for the protection of the United States; and WHEREAS the Direct Writing Company has applied to the above Reinsuring Company to be reinsured and countersecured in the amount set forth opposite the name of the Reinsuring Company (herein referred to as the "Amount of this Reinsurance"), or for whatever amount less than the "Amount of this Reinsurance" the Direct Writing Company may become liable to pay under or by virtue of the said bond:

NOW, THEREFORE, in consideration of a sum mutually agreed upon, paid by the Direct Writing Company to the Reinsuring Company, the receipt whereof is hereby acknowledged, the parties to this Agreement hereby covenant and agree to the terms and conditions set forth herein TERMS AND CONDITIONS AGREED TO:

IT IS THE PURPOSE AND INTENT HEREOF to guarantee and indemnify the United States against loss under the aforesaid bond to the extent of the Amount of this Reinsurance," or for any less sum than the "Amount of this Reinsurance," that may be owing and unpaid by the Direct Writing Company to the United States.

THEREFORE:

[ocr errors]

1 In the event of the Direct Writing Company's failure to pay any default under said bond equal to or in excess of the Amount of this Reinsurance," the Reinsuring Company hereby covenants and agrees to pay to the United States, the obligee on said bond, the "Amount of this Reinsurance." In case of the failure of the Direct Writing Company to pay to the United States any default for a sum less than the "Amount of this Reinsurance," the Reinsuring Company hereby covenants and agrees to pay to the United States the full amount of such default, or so much thereof as shall not be paid to the United States by the Direct Writing Company

2. The Reinsuring Company further covenants and agrees that in case of default on said bond for the "Amount of this Reinsurance," or more, the Reinsuring Company may be sued by the United States for the "Amount of this Reinsurance" or for whatever the amount of the default may be less than the "Amount of this Reinsurance."

IN WITNESS WHEREOF, the Direct Writing Company and the Reinsuring Company, respectively, have caused this Agreement to be signed and impressed with their respective corporate seals by officers possessing power to sign such instruments, and to be duly attested to by officers empowered thereto. on the day and date above written opposite their respective names.

Items 1. 8, 86-Furnish Legal Name, Business Address and Zip Code 275-101

STANDARD FORM 275 (8-77) Prescribed by GSA, FPR (41 CFR) 1-16.801

[merged small][graphic][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed]

INSTRUCTIONS: This Standard Form 275 is to be used in cases where it is desired to cover the excess of a Direct Writing Company's underwriting limitation by reinsurance instead of coinsurance on bonds running to the United States except Miller Act Performance and Payment Bonds. See 41 CFR 1-10.202 and 1-16.801. If this form is used to reinsure a bid bond, the "Penal Sum of Bond" and "Amount of this Reinsurance" may be expressed as a percentage of the bid provided the actual amounts will not exceed the companies respective underwriting limitations.

This form should be executed and filed as follows:

Original and copies as specified by the bond-approving officer, signed and sealed, shall be filed with the bond or within the time period set forth in the bid or proposal.

One carbon copy, signed and sealed, shall accompany the Direct Writing Company's quarterly Schedule of Excess Risks filed with the Department of the Treasury.

Other copies may be prepared for the use of the Direct Writing Company and the Reinsuring Company. A separate form should be used for each Reinsuring Company.

[42 FR 56119, Oct. 21, 1977]

US. GOVERNMENT PRINTING OFFICE 1977-O-240-463 104

STANDARD FORM 275 BACK (8-77)

[blocks in formation]

ITEM PURCHASED FOR EXCLUSIVE USE OF THE US. GOVERNMENT (Describe)

[blocks in formation]

§ 1-16.901-1094 Standard Form 1094, U.S. Tax Exemption Certificate.

[blocks in formation]

I certify that the information on this form is true and correct to the best of knowledge and belief.

[blocks in formation]
[blocks in formation]

SPECIMEN

DATE

[blocks in formation]
[blocks in formation]

STANDARD FORM 1094 (REV. 4-80)
Prescribed by GSA, FPR (41 CFR) 1-16.807

INSTRUCTIONS

1. This form will be used to establish the Government's ex-
emption or immunity from State or Local taxes whenever
no other evidence is available.

2. This form shall NOT be used for:

(a) Purchases of quarters or subsistence made by employ. ees in travel status.

(b) Expenses incident to use of a privately owned motor vehicle for which a mileage allowance has been authorized, or (c) Merchandise purchased which is subject only to Federal Tax.

3. If the spaces provided on the face of this form are inadequate, attach a separate statement containing the required information.

4. If both State and Local taxes are involved, use a separate form for each tax. The certificate will be provided to the vendor when the prices exclude State or Local tax.

5. The serial number of each certificate prepared will be shown on the payment voucher.

THE FRAUDULENT USE OF THIS CERTIFICATE FOR THE PURPOSE OF OBTAINING EXEMPTION FROM OR ADJUST-
MENT OF TAXES IS PROHIBITED.

[46 FR 17562, Mar. 19, 1981]

STANDARD FORM 1094 BACK (REV. 4-80)

Record.

§ 1-16.901-1094-A Standard Form 1094, U.S. Tax Exemption Certificates Accountability

[blocks in formation]

To be used for convenience of the issuing agency for maintaining a control record of tax exemption certifi. cates issued.

ISSUED TO

THROUGH

TITLE AND OFFICE DESIGNATION

[blocks in formation]

SPECIMEN

OFFICE DESIGNATION

SIGNATURE

THROUGH

DATE ISSUED

ISSUING
OFFICER

TITLE AND OFFICE DESIGNATION

DATE ISSUED

[blocks in formation]
[blocks in formation]

SPECIMEN

VENDOR NAME AND ADDRESS

VENDOR NAME AND ADDRES

[blocks in formation]

ITEM PURCHASED

ITEM PURCHASED

TRANSACTION
REFERENCE

[blocks in formation]

STANDARD FORM 1094-A BACK (REV. 4-80)

§1-16.902 Optional forms.

Optional forms are illustrated in this section in the same manner and for the same purpose as is stated in § 1-16.901 for standard forms.

[merged small][merged small][merged small][merged small][merged small][graphic][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][ocr errors][subsumed][subsumed][subsumed][subsumed][subsumed][subsumed][merged small][subsumed]
« PreviousContinue »