22. TOTAL AMOUNT OF CONTRACT $ CONTRACTING OFFICER WILL COMPLETE BLOCK 22 OR 26 AS APPLICABLE CONTRACTOR'S NEGOTIATED AGREEMENT (Contractor is required to sign this document and return. copies to issuing office.) Contractor agrees to furnish and deliver all items or perform all the services set forth or otherwise identified above and on any continuation sheets for the consideration stated herein. The rights and obligations of the parties to this contract shall be subject to and gov. erned by the following documents: (a) this award/contract, (b) the solicitation, if any, and (c) such provisions, representations, certifications, and specifications, as are attached or incorporated by reference herein. (Attachments are listed herein.) 23. NAME OF CONTRACTOR 26. AWARD (Contractor is not required to sign this document.) Your offer on Solicitation Number including the additions or changes made by you which additions or changes are set forth in full above, is hereby accepted as to the items listed above and on any continuation sheets. This award consummates the contract which consists of the following documents: (a) the Government's solicitation and your offer, and (b) this award/contract. No further contractual document is necessary. 27, UNITED STATES OF AMERICA 26-103 [31 FR 14741, Nov. 19, 1966] » U.S, GOVERNMENT PRINTING OFFICE 1964 OF-238-148-186) § 1-16.901-28 Standard Form 28: Affidavit of Individual Surety. (a) Page 1 of Standard Form 28. I, the undersigned, being duly sworn, depose and say that I am one of the sureties to the attached bond; that I am a citizen of the United States (or a permanent resident of the place where the contract and bond are executed as provided in paragraph 3 of the Instructions on reverse), and of full age and legally competent; that I am not a partner in any business of the principal on the bond or bonds on which I appear as surety; that the information herein below furnished is true and complete to the best of my knowledge. This affidavit is made to induce the United States of America to accept me as surety on the attached bond. 7. THE FOLLOWING IS A TRUE REPRESENTATION OF MY PRESENT ASSETS, LIABILITIES, AND NET WORTH AND DOES NOT INCLUDE ANY FINANCIAL INTEREST I HAVE IN THE ASSETS OF THE PRINCIPAL ON THE ATTACHED BOND: a. Fair value of solely owned real estate* b. All mortgages or other encumbrances on the real estate included in Line a c. Real estate equity (subtract Line b from Line o) d.. Fair value of all solely owned property other than e. Total of the amounts on Lines c and SPECIMEN f. All other liabilities owing or insured not g. Net worth (subtract Lipo Do not include property exempt from execution and sale for any reason. Surety's interest in community property may be included if not so exempt. 8. LOCATION AND DESCRIPTION OF REAL ESTATE OF WHICH I AM SOLE OWNER, THE VALUE OF WHICH IS INCLUDED IN LINE (0), ITEM 7 ABOVE Amount of assessed valuation of above real estate for taxation purposes:_ 9. DESCRIPTION OF PROPERTY INCLUDED IN LINE (d), ITEM 7 ABOVE (List the value of each category of property separately) 10. ALL OTHER BONDS ON WHICH I AM SURETY (State character and amount of each bond; if none, so state) (b) Page 2 of Standard Form 28. CERTIFICATE OF SUFFICIENCY I Hereby Certify. That the surety named herein is personally known to me; that, in my judgment, said surety is responsible, and qualified to act as such; and that, to the best of my knowledge, the facts stated by said surety in the foregoing affidavit are true. nent resident of the place of execution of the contract and bond. 4. The individual surety shall show net worth in a sum not less than the penalty of the bond by supplying the information required on the face hereof, under oath befor united States commissioner, a clerk of United States Court, or notary public, or some other officer having authority to administer oaths gener If the ancer has an official seal, it shall febrerwise the proper certificate as to his icialcharacter shall be furnished. EC are arriv ing at the net worth figure in Item 7 on the face of this affidavit an individual surety will not include any financial interest he may have in the assets of the principal on the bond which this affidavit supports. 3. An individual surety shall be a citizen of the United States, except that if the contract and bond are executed in any foreign country, the Commonwealth of Puerto Rico, the Virgin Islands, the Canal Zone, Guam, or any other territory or possession of the United States, such surety need only be a perma. 5. The certificate of sufficiency shall be signed by an officer of a bank or trust company, a judge or clerk of a court of record, a United States district attorney or commissioner, a postmaster, a collector or deputy collector of internal revenue, or any other of ficer of the United States acceptable to the department or establishment concerned. Further certificates showing additional assets, or a new surety, may be required to assure protection of the Government's interest. Such certificates must be based on the personal investigation of the certifying officer at the time of the making thereof, and not upon prior certifications. (Back of SF 28 June 66) [31 FR 15093, Dec. 1, 1966] |