53.301-1413 Standard Form 1413, Statement and Acknowledgment. STATEMENT AND ACKNOWLEDGMENT FORM APPROVED OMB NO. 9000-0014 Public reporting burden for this collection of information is estimated 10 average .15 hours 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, Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the FAR Secretariat (VAS), Office of Federal Acquisition and Regulatory Policy, GSA, Washington, DC. 20405; and to the Office of Management and Budget, Paperwork Reduction Project (9000-0014), Washington, D.C. 20503 PART STATEMENT OF PRIME CONTRACTOR 12. DATE SUBCONTRACT AWARDED 1. PRIME CONTRACT NO. 3. SUBCONTRACT NUMBER 4. PRIME CONTRACTOR (Name, address and ZIP code) S. SUBCONTRACTOR (Name, address and ZIP code) 6. The prime contractor states that under the contract shown in item 1, a subcontract was awarded on date shown in Hem 2 by (Name of Awarding Firm) 12. The subcontractor acknowledges that the following clauses of the contract shown in Item 1 are included in this subcontract: 53.301-1414 SF 1414 (Rev. 10/93) Consent of Surety. CONSENT OF SURETY 1. CONTRACT NURABER MODIFICATION NUMBLA 3. GATED The Surety (Co-Suresies) consents (consent) to the foregoing contract modification and agrees (agree) that its (their) bond er bende shall apply and extend to the centrest as modified or amended. The Principal or authorized representative shall execute this Consent of Surety with the medification to which it pertains. If the representative & PERSON EXECUTING CONSENT (ingrotury 53.301-1415 SF 1415 (Rev. 7/93) Consent of Surety and Increase of Penalty. 1. CONTRACT NUR 2. MODIFICATION NUMBER CONSENT OF SURETY AND The surety (cro-suraties) censents (consent) to the foregoing contrast mediñestion and agrees (agres) that i › (their) ben dollars (S the par ) and the parisity of the payment band of the partnership, er joint ventura, er en afficer of the The Principal or authorized represe reve shall anesute this Consent of Surety and increase of Pensity with th 10. CORPORATE/INDIVIDUAL SURETY (CO-SURETIES) 4. CORPORATE/INDVIDUAL SURETY'S NAME AND ADDRESS to which i DATE THIS CONSENT EXECUTEO STANDARD FORM 1415 REV. 7-93 Publie reporting burden for this collection of Information is estimated to average 25 minutes per response, including the time for reviewing instructions. searning existing date sources, gathering and maintaining the data needed, and completing and reviewing the collection of information, Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the FAR Secretariat (VRS), Office of Federal Acquisition Polley, GSA, Washington, D.C. 20405; and to the Office of Management and Budget. Paperwork Reduction Project (9000-0045), Washington, D.C. 20503. We, the Principal and Surety(ies) are firmly bound to the United States of America (hereinafter called the Government) in the above penal sum. For payment of the penal sum, we bind ourselves, our heirs, executors, administrators, and successors, jointly and severally. However, where the Sureties are corporations acting as co-sureties, we, the sureties, bind ourselves in such sum "jointly and severally as well as "severally only for the purpose of allowing a joint action or actions against any or all of us. For all other purposes, each Surety binds itself, jointly and severally with the Principal, for the payment of the sum shown opposite the name of the surety. If no Imit of liability is indicated, the limit of liability is the full amount of the penal sum. CONDITIONS: The principal has entered into the contract identified above. THEREFORE: (a) The above obligation is void if the Principal promptly makes payment to all persons (claimants) having a contract relationship with the Principal or a subcontractor of the Principal for furnishing labor, material or both in the prosecution of the work provided for in the contract identified above and any duly authorized modifications thereof. Notice of those modifications to the Surety(ies) are waived. (b) The above obligation shall remain in full force if the Principal does not promptly make payments to all persons (claimants) having a contract relationship with the Principal or a subcontractor of the Principal for furnishing labor, material or both in the prosecution of the contract identified above. In these cases, persons not paid in full before the expiration of ninety (90) days after the date of which the last labor was performed or material furnishing, have a direct right of action against the Principal and Surety(ies) on this bond for the sum or sums justly due. The claimant, however, may not bring a suit or any action (1) Unless claimant, other than one having a direct contract with the Principal, had given written notice to the Principal within ninety (90) days after the claimant did or performed the last of the work or labor, or furnished or supplied the last of the materials for which the claim is made. The notice is to state with substantial accuracy the amount claimed and the name of the party to whom the materials were furnished or supplied, or for whom the work or labor was done or performed. Such notice shall be served by mailing the same by registered or certified mail, postage prepaid, in an envelope addressed to the Principal at any place where an office is regularly maintained for the transaction of business, or served in any manner in which legal process is served in the state in which the contract is being performed, save that such service need not be made by a public officer. (2) After the expiration of one (1) year following the date on which claimant did or performed the last of the work or labor, or furnished or supplied the last of the materials for which the suit is brought. (3) Other than in the United States District Court for the district in which the contract, or any part thereof, was performed and executed, and not elsewhere. WITNESS: The Principal and Surety(ies) executed this payment bond and affixed their seals on the above date. 1. This form is authorized for use when payment bonds are required under FAR (48 CFR) 28.103-3, ie, payment bonds for other than construction contracts. Any deviation from this form will require the written approval of the Administrator of General Services. 2. Insert the full legal name and business address of the Principal in the space designated "Principal on the face of the form. An authorized person shall sign the bond. Any person signing in a representative capacity (e.g., an attorney-in-fact) must furnish evidence of authority if that representative is not a member of the firm, partnership, or joint venture, or an officer of the corporation involved. 3. (a) Corporations executing the bond as sureties must appear on the Department of the Treasury's list of approved sureties and must act within the limitation listed therein. Where more than one corporate surety is involved, their names and addresses shall appear in the spaces (Surety A, Surety B, etc.) headed "CORPORATE SURETY(ES)." in the space designated "SURETY(ES) on the face of the form, insert only the letter identification of the sureties. (b) Where individual Sureties are involved, a completed Affidavit of Individual Surety (Standard Form 28), for each individual surety, shall accompany the bond. The Government may require the surety to furnish additional substantiating information concerning its financial capability. 4. Corporations executing the bond shall affix their corporate seals. Individuals shall execute the bond opposite the word "Corporate Seal"; and shall affix an adhesive seal if executed in Maine, New Hampshire, or any other jurisdiction requiring adhesive seals. 5. Type the name and title of each person signing this bond in the space provided. [55 FR 25567, June 21, 1990] STANDARD FORM 1416 REV. 1-800 BACK (Seal) |