United States Department of the Interior
OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT
SURETY BOND FOR SOLE PROPRIETORSHIP
KNOW ALL PERSONS BY THESE PRESENTS, THAT THE UNDERSIGNED
d/b/a
,
(Name of Individual)
(Name of Company – Permittee)
,
(Street Address)
(City)
(State)
(ZIP)
a sole proprietorship, as Principal, and __________________________________________
(Name and Address of Surety Company)
________________________________________________ organized and existing under the laws of
the State of
and licensed to do business in the State of
, as
Surety, are held and firmly bound unto the United States Department of the Interior, Office of
Surface Mining Reclamation and Enforcement (OSM) in the sum of ____________________
($
),
for the payment of which sum we hereby jointly and severally bind ourselves, our successors, and
assigns.
THE CONDITION OF THE ABOVE OBLIGATION is such, that:
Whereas, the above named Principal has submitted Permit Application No.
,
including a mining and reclamation plan, to conduct and reclaim a surface coal mining operation, as
defined pursuant to the Surface Mining Control and Reclamation Act of 1977, 30 U.S.C. §1201 et
seq., (the Act) and its attendant regulations; and
Whereas, the Principal has chosen to file this performance bond as a guarantee that the
reclamation of the land disturbed during this surface mining operation will be completed as required
by the Act and 30 CFR Chapter VII, and as specified in the Permit as issued;
Whereas, the Surety, and their successors and assigns agree to guarantee the obligation and to
indemnify, defend, and hold harmless OSM from any and all losses and expenses which OSM may
sustain as a result of the Principal’s failure to comply with the condition of the obligation;
Whereas obligations guaranteed by this performance bond shall be in effect for the following
described lands approved as the permit area or increment upon which initial or succeeding operations
will be conducted: _________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________;
(If more space is needed use an attachment signed by the Surety)
Now, if the Principal faithfully completes all reclamation and abatement requirements set forth in the
Act, in 30 CFR Chapter VII, and in its Permit, including the mining and reclamation plans, then this
Permit No.
Page 1 of 4
Bond No. ______________________
United States Department of the Interior
OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT
SURETY BOND FOR SOLE PROPRIETORSHIP
KNOW ALL PERSONS BY THESE PRESENTS, THAT THE UNDERSIGNED
d/b/a
,
(Name of Individual)
(Name of Company – Permittee)
,
(Street Address)
(City)
(State)
(ZIP)
a sole proprietorship, as Principal, and __________________________________________
(Name and Address of Surety Company)
________________________________________________ organized and existing under the laws of
the State of
and licensed to do business in the State of
, as
Surety, are held and firmly bound unto the United States Department of the Interior, Office of
Surface Mining Reclamation and Enforcement (OSM) in the sum of ____________________
($
),
for the payment of which sum we hereby jointly and severally bind ourselves, our successors, and
assigns.
THE CONDITION OF THE ABOVE OBLIGATION is such, that:
Whereas, the above named Principal has submitted Permit Application No.
,
including a mining and reclamation plan, to conduct and reclaim a surface coal mining operation, as
defined pursuant to the Surface Mining Control and Reclamation Act of 1977, 30 U.S.C. §1201 et
seq., (the Act) and its attendant regulations; and
Whereas, the Principal has chosen to file this performance bond as a guarantee that the
reclamation of the land disturbed during this surface mining operation will be completed as required
by the Act and 30 CFR Chapter VII, and as specified in the Permit as issued;
Whereas, the Surety, and their successors and assigns agree to guarantee the obligation and to
indemnify, defend, and hold harmless OSM from any and all losses and expenses which OSM may
sustain as a result of the Principal’s failure to comply with the condition of the obligation;
Whereas obligations guaranteed by this performance bond shall be in effect for the following
described lands approved as the permit area or increment upon which initial or succeeding operations
will be conducted: _________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________;
(If more space is needed use an attachment signed by the Surety)
Now, if the Principal faithfully completes all reclamation and abatement requirements set forth in the
Act, in 30 CFR Chapter VII, and in its Permit, including the mining and reclamation plans, then this
Permit No.
Page 1 of 4
Bond No. ______________________
obligation shall be void; otherwise, it shall remain in full force and effect:
(a) beginning on the date of the approval and issuance of Permit No.__________ and
extending until all reclamation, restoration, and abatement work pursuant to the Act, 30
CFR Chapter VII, and the permit has been completed to the satisfaction of OSM; and
(b) until the bond is released pursuant to 30 CFR §800.40, replaced in accordance with 30
CFR §800.30, or until the permit has been sold, reassigned or otherwise transferred in
accordance with 30 CFR §774.17; and
(c) for a minimum period of
years, notwithstanding the requirements of sub-
paragraphs (a) and (b) above, it being further understood that if the Principal performs
any augmented seeding, fertilization or other supplemental reclamation work on the site
prior to bond release, the period of liability under this bond shall begin again subject to
the exception found in 30 CFR § 816.116(c)(4) or 30 CFR §817.116(c)(4).
The failure of the Principal to fulfill the obligations specified by the Act, 30 CFR Chapter
VII, and its permit, shall result in a forfeiture of this performance bond according to the procedures
described in 30 CFR §800.50.
The Surety shall not cancel this bond at any time for any reason, including non-payment of
premium or bankruptcy of the Principal during the period of liability. The amount of the Surety’s
liability may be adjusted by OSM pursuant to 30 CFR §800.15 for lands covered by this bond which
have not been disturbed by the Principal, upon application by the Principal pursuant to 30 CFR
§774.13 for revision of the Permit to delete such acreage, and approval by OSM of such revision.
The Surety will give prompt notice to the Principal and to OSM of any notice received or
action filed alleging the insolvency or bankruptcy of the Surety, or alleging any violations of
regulatory requirements which could result in suspension or revocation of the Surety’s license to do
business.
In the event the Surety becomes unable to fulfill its obligation under the bond for any reason,
notice shall be given immediately to the Principal and to OSM.
Upon the incapacity of the Surety by reason of bankruptcy, liquidation, insolvency, or
suspension or revocation of its license, the Principal shall be deemed to be without bond coverage in
violation of 30 CFR §800.11 and shall be subject to the requirements described in 30 CFR
§800.16(e)(2).
IN WITNESS WHEREOF, the Principal and Surety have hereunto set their signatures and seals as of
the dates set forth below. This bond shall be effective this _____ day of ______________, 20____.
PRINCIPAL
Date
__________________________________
(Company/Permittee)
By: ________________________________
(Individual/Sole Proprietor)
Permit No.
Page 2 of 4
Bond No. ______________________
ACKNOWLEDGEMENT OF INDIVIDUAL - PERMITTEE
On this
Day of __________________, 20
, before me, a Notary Public in and for the
County of
, in the State of
, appeared ______________________
personally known to me to be the person whose name is subscribed to the forgoing instrument and
who, being by me duly sworn, did say that he/she executed the same for the purposes therein
contained.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal on the day, month,
and year aforesaid.
My Commission Expires:
______________________________________
(Notary Public in aforesaid County and State)
SURETY
Date: _______________________
________________________________________
(Corporate Surety)
(Affix Seal)
By: _________________________
Title: ________________________
(Attorney-in-fact*)
NOTE: Where one signs by virtue of Power of Attorney or Corporate Resolution for a Surety, or corporate Principal, a certified
copy of that Power of Attorney or Corporate Resolution must be filed with this bond.
*If applicable, the name, address, and phone number of the Agency representing the Surety Company:
ACKNOWLEDGEMENT OF CORPORATE SURETY
On this
Day of
,
, before me, a Notary Public in and for the County
of
, in the State of
, appeared ____________________ to me personally
known, who being by me duly sworn, did say that he/she is _________________ of, the corporate
surety named in and which executed the within instrument, and that the seal affixed to said
instrument is the corporate seal of said corporation, and that said instrument was signed, sealed and
delivered in behalf of said corporation by authority of its Board of Directors, and he/she, as such
officer, acknowledged said instrument to be the free act and deed of said corporation for the uses and
purposes of said instrument as therein set forth.
IN WITNESS WHEREOF, I have hereunto set my hand and official seal on the day, month,
and year aforesaid.
My Commission Expires:
______________________________________
(Notary Public in aforesaid County and State)
Paperwork Reduction Act Notice
We use the information required by this form to ensure that the requirements for a surety bond under 30 CFR 800.20 have been
met. You must provide the requested information to obtain a benefit (a surety bond). Under 30 CFR 842.16, the information
collected is a matter of public record.
The time needed to complete this form and related forms and submit the requested information to obtain a surety bond will vary
depending on individual circumstances. We estimate that the average time will be 10 hours per response. This number includes
Permit No.
Page 3 of 4
Bond No. ______________________
the time spent reviewing instructions, learning about the regulations, gathering and maintaining information, and completing and
reviewing the forms. If you have comments concerning the accuracy of this estimate or suggestions for simplifying the forms or
instructions, you may write to the Information Collection Clearance Officer, Office of Surface Mining Reclamation and
Enforcement, Room 202 SIB, 1951 Constitution Ave, NW, Washington, D.C. 20240.
Under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501 et seq.), you are not required to respond to, nor will you be subject
to a penalty for a failure to comply with, a collection of information unless it displays a currently valid OMB control number.
OMB Control No. 1029-0043, expires 11/30/2018
Permit No.
Page 4 of 4
Bond No. ______________________
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