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Indiana State 415 23 Sample

PERMIT BOND

State Form 415 23 (R4 / 3-00)

Approved by State Board of Accounts, 2000

STATE OF INDIANA

DEPARTMENT OF TRANSPORTATION

Driveway

Excavation

Pole Line

Bridge Attachment

Misc.____________________

Know all men by these presents that we, the Undersigned _________________________________________

(address) ___________________________________________________________________as Principal and

_________________________________________________________________________________________

(address) ___________________________________________________________________as Surety, are

hereby held and firmly bound unto the State of Indiana in the penal sum of ____________________ , for the

payment of which well and truly to be made, we hereby jointly and severally bind ourselves, our heirs, executors, administrators successors and assigns:

DATED THIS ____________________________________ .

The conditions of the above obligation are such that, whereas, the above named _______________________

_________________________________________________________________________________________

did on ____________________________________ make application for a permit with the State of Indiana for:

__________________________________________________________________________________________

__________________________________________________________________________________________

which permit is made a part of this bond the same as though set forth herein.

Now, if said ________________________________________ (Principal - Applicant) shall well and faithfully do

and perform the things agreed by the _________________________________________ (Principal - Applicant)

to be done and performed according to the terms of said permit and to the satisfaction of the Indiana Department of Transportation, and shall pay all lawful claims of the contractor, vendors and laborers for labor performed and materials furnished, or other services rendered in the carrying forward, performing and completing of said permit, (on file with the Department of Transportation), then this obligation shall be void, otherwise the same shall remain in full force and effect, it being expressly understood and agreed that the liability of the Surety for any and all claims hereunder except as provided below shall in no event exceed the penal sum of this obligation as herein stated. In event of noncompliance the surety shall be liable for the court costs and attorney fees spent in the collection of this bond over and above the penal sum of this obligation.

IN WITNESS WHEREOF, we hereunto set our hands and seals this _________________________ day of

___________________, 20 ____

 

__________________________________________

_____________________________________________

__________________________________________

_____________________________________________

Surety

Principal

(Attach Power of Attorney)

 

State of __________________________________ ,

County of _________________________________ ss:

Personally appeared before me, ____________________________________________________________

______________________________as Principal and______________________________________________

___________________________________as Surety and each acknowledged the execution of the above bond

this___________________day of _______________________ , 20______

Witness my hand and _________________________________seal the said last named date.

My Commission Expires______________________, 20_____

_____________________________________

 

 

Notary Public (Written Signature)

I reside in _____________________________County, ______

_____________________________________

 

(State)

Notary Public (Printed or Typed Name)

Bond number

NOTICE OF TERMINATION OF LIABILITY

□COMPLIED □ CANCELLED ___________________________________, 20 _____

DATE

Submit all 5 copies By: ___________________________________________________________________

PERMIT MANAGER

Application number

Road number

County number Received date

Issue date

Permit number

File Characteristics

Fact Name Description
Purpose of the Form The Indiana State Form 415 23 is a permit bond used to ensure compliance with state regulations when applying for permits related to driveway excavation, pole line installation, bridge attachment, and other miscellaneous activities.
Governing Law This form is governed by Indiana state laws, particularly those administered by the Indiana Department of Transportation, which oversees the issuance of permits and the enforcement of related obligations.
Parties Involved The form requires the signatures of two key parties: the Principal, who is the applicant for the permit, and the Surety, who guarantees the obligations of the Principal under the bond.
Liability Conditions The Surety is liable for claims related to the permit, ensuring that all lawful claims from contractors, vendors, and laborers are paid. However, the Surety's liability is limited to the penal sum stated in the bond.

Essential Points on This Form

What is the Indiana State 415 23 form?

The Indiana State 415 23 form, also known as the Permit Bond, is a legal document used by individuals or entities applying for permits related to construction or excavation activities in Indiana. It serves as a guarantee that the applicant will fulfill the obligations outlined in the permit, including payment for labor and materials.

Who needs to fill out the 415 23 form?

Any individual or organization that seeks to obtain a permit from the Indiana Department of Transportation for activities such as driveway excavation, pole line installation, or bridge attachment must complete this form. It is essential for ensuring compliance with state regulations.

What information is required on the form?

The form requires several key pieces of information, including:

  • The name and address of the principal (the applicant).
  • The name and address of the surety (the bonding company).
  • The penal sum of the bond, which is the maximum amount the surety will pay if the principal fails to meet their obligations.
  • A description of the work for which the permit is requested.
  • The date of the application and the execution of the bond.

What are the obligations of the principal?

The principal must perform all tasks as agreed in the permit and to the satisfaction of the Indiana Department of Transportation. This includes completing the work according to the terms of the permit and paying all lawful claims related to the project, such as those from contractors and laborers.

What happens if the principal does not comply with the permit terms?

If the principal fails to comply with the terms of the permit, the surety is liable for claims up to the penal sum of the bond. Additionally, the surety may also be responsible for court costs and attorney fees incurred during the collection of the bond, beyond the penal sum.

How is the bond executed?

The bond must be signed by both the principal and the surety. Additionally, a notary public must witness the signatures to ensure the document's validity. The notary will also provide their seal and signature, along with their commission expiration date.

Is it necessary to attach a Power of Attorney?

Yes, if the surety is a corporate entity, a Power of Attorney must be attached to the bond. This document grants the individual signing the bond the authority to do so on behalf of the surety company.

How many copies of the form need to be submitted?

The completed form requires five copies to be submitted to the appropriate authorities. This ensures that all parties involved have access to the necessary documentation for their records.

Where can I obtain the Indiana State 415 23 form?

The Indiana State 415 23 form can be obtained from the Indiana Department of Transportation's website or through their local offices. It is important to ensure that you are using the most current version of the form.

Misconceptions

  • Misconception 1: The Indiana State 415 23 form is only for large construction projects.

    • This form is applicable for various types of permits, including smaller projects like driveway excavations and pole line installations. It’s not limited to large-scale endeavors.

  • Misconception 2: Once the bond is submitted, the applicant has no further responsibilities.

    • Submitting the bond does not absolve the applicant of their duties. They must still adhere to the terms of the permit and ensure all work is completed satisfactorily.

  • Misconception 3: The surety bond guarantees that the project will be completed without issues.

    • The bond serves as a financial guarantee that the applicant will fulfill their obligations. It does not ensure that the project will be free from problems or delays.

  • Misconception 4: The bond amount is fixed and cannot be adjusted.

    • The bond amount is determined based on the specifics of the project and can vary. It’s important for applicants to assess their needs and discuss this with their surety provider.

  • Misconception 5: Notary public involvement is optional for the bond to be valid.

    • The signature of a notary public is essential for the bond’s validity. This step ensures that all parties have acknowledged their commitment legally.

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