Common use of Surety Information Clause in Contracts

Surety Information. Surety Posted by: Owner Agent County Resolution Waived Bonding Company Name Xxxx # Irrevocable Letter of Credit - Bank Name Surety paid by Check - Check Number Irrevocable Letter of Credit # Amount of Surety $ Obligation Amount $ Request permission to perform the following activity(s): as per attached plans. Location: County Town City of Route No. Street Name Between Route No. Street Name and Route No. Street Name Latitude Longitude Tax Map Number Applicant Job No. Applicant shall provide proof of registration as an operator with the appropriate notification center in accordance as defined in §2.2-1151.1 of the Code of Virginia & must provide a notarized affidavit, stating that the utility owner has notified the commercial and residential developer, owner of commercial or multifamily real estate, or local government entities with a property interest in any parcel of land located adjacent to the property over which the land use is being requested, that application for the permit has been made. IF APPLICABLE, I AGREE TO PAY THE FULL SALARY AND EXPENSES OF A STATE ASSIGNED INSPECTOR IN CONJUNCTION WITH ACTIVITIES AUTHORIZED UNDER THE AUSPICES OF A VDOT LAND USE PERMIT. By signing below, I acknowledge that I am fully cognizant of all the LUP-SPG requirements associated with the issuance of a VDOT Land Use Permit. The permittee or their agent must contact the VDOT Customer Service Center at 0-000-000-0000 a minimum of 48 hours prior to initiating any planned excavation within 1,000 feet of a signalized intersection and/or near VDOT ITS infrastructure. Signature of Applicant: Title Date Signature of Agent: Title Prepayment required with remittance payable to Treasurer of Virginia. All applicable items on this form must be completed to avoid delay in processing the issuance of a VDOT Land Use Permit. VDOT USE ONLY Date Receipt is hereby acknowledged for: CHECK No.: MONEY ORDER No.: In the Amount of $ for PERMIT FEE $ CASH SURETY $ Authorized VDOT Signature: Date:

Surety Information. Surety Posted by: Owner Agent Surety County Resolution Waived Bond Surety - Bonding Company Name Xxxx # Irrevocable Letter of Credit - Bank Name Surety paid by Check - Check Number Irrevocable Letter of Credit # Amount of Surety $ Obligation Amount $ Request permission to perform the following activity(s): as per attached plans. Location: County Town City of _ Route No. Street Name Between Route No. Street Name and Route No. Street Name Latitude Longitude Tax Map Number Applicant Job No. Applicant shall provide proof of registration as an operator with the appropriate notification center in accordance as defined in §2.2-1151.1 of the Code of Virginia & must provide a notarized affidavit, stating that the utility owner has notified the commercial and residential developer, owner of commercial or multifamily real estate, or local government entities with a property interest in any parcel of land located adjacent to the property over which the land use is being requested, that application for the permit has been made. IF APPLICABLE, I AGREE TO PAY THE FULL SALARY AND EXPENSES OF A STATE ASSIGNED INSPECTOR IN CONJUNCTION WITH ACTIVITIES AUTHORIZED UNDER THE AUSPICES OF A VDOT LAND USE PERMIT. By signing below, I the undersigned hereby acknowledge that I am fully cognizant of all of the LUP-SPG requirements associated with the issuance of a VDOT Land Use Permit. The permittee or their agent must contact the VDOT Customer Service Center at 0-000-000-0000 a minimum of 48 hours prior to initiating any planned excavation within 1,000 feet of a signalized intersection and/or near VDOT ITS infrastructure. Signature of Applicant: Title Date Signature of Agent: Title Prepayment required with remittance payable to Treasurer of Virginia. Date Date All applicable items on this form must be completed to avoid delay in processing the issuance of a VDOT Land Use Permit. Prepayment required with remittance payable to Virginia Department of Transportation. VDOT USE ONLY Date Receipt is hereby acknowledged for: CHECK No.: MONEY ORDER No.: In the Amount of $ for PERMIT FEE $ CASH SURETY $ Authorized VDOT Signature: Date:: *Agent mean: Applicant contractor’s or a person or business authorized to act on another's behalf. LAND USE PERMIT LUP-LC Bank Irrevocable Letter of Credit [Bank Letterhead] LETTER OF CREDIT BANK AGREEMENT Date: APPLICANT NAME: _ Issuing Bank: _ Tax ID number or Driver’s license Number: _ Address: _ Telephone Number: City: State Zip Code_ _ Address: _ Amount: _ City: _ State Zip Code Expiration Date: VIRGINIA DEPARTMENT OF TRANSPORTATION Address: City: _ State _ Zip Code _ We hereby issue Irrevocable Letter of Credit number _ in favor of the Virginia Department of Transportation (the Department) for the account of _ in an amount not to exceed U.S. Dollars ($ ) available by sight draft on the above stated issuing bank accompanied by the documents specified below: A certified statement signed by the Department’s Permit Manager or their representative stating that _ has not satisfactorily completed work pursuant to the permit issued to the permittee or his agent to perform the work as described on the face of the land use permit in the County of , Virginia. A certified statement signed by the Department’s Permit Manager or their representative stating that: “This draw is for the explicit purpose of providing for completion or restoration of the right of way to the terms of the Land Use Permit Regulations and pursuant to the agreement of the permittee or their Agent to perform the work covered by permit to the satisfaction of the Department.” All drafts must bear the clause “Drawn under _ Irrevocable Letter of Credit No. dated _ , 20 .” We hereby engage with drawers, endorsers and bona fide holders that all drafts drawn in compliance with the terms of this credit shall be duly honored upon presentation and delivery of this document. This Irrevocable Letter of Credit shall remain in full force and effect for a period of two (2) years from the date hereof and shall automatically renew itself from year to year for three (3) years, one (1) year periods thereafter unless and until the above issuing bank shall give ninety (90) days prior written notice to the department by CERTIFIED MAIL, RETURN RECEIPT REQUESTED, of its intent to terminate same at the expiration of said ninety-day period. During said ninety

Surety Information. Surety Posted by: Owner Agent County Resolution Surety Waived Bonding Company Name Xxxx # Irrevocable Letter of Credit - Bank Name Surety paid by Check - Check Number Irrevocable Letter of Credit # Amount of Surety $ Obligation Amount $ Request permission to perform the following activity(s): as per attached plans. Location: County Town City of _ Route No. Street Name Between Route No. Street Name and Route No. Street Name Latitude Longitude Tax Map Number Applicant Job No. Applicant shall provide proof of registration as an operator with the appropriate notification center in accordance as defined in §2.2-1151.1 of the Code of Virginia & must provide a notarized affidavit, stating that the utility owner has notified the commercial and residential developer, owner of commercial or multifamily real estate, or local government entities with a property interest in any parcel of land located adjacent to the property over which the land use is being requested, that application for the permit has been made. IF APPLICABLE, I AGREE TO PAY THE FULL SALARY AND EXPENSES OF A STATE ASSIGNED INSPECTOR IN CONJUNCTION WITH ACTIVITIES AUTHORIZED UNDER THE AUSPICES OF A VDOT LAND USE PERMIT. By signing below, I the undersigned hereby acknowledge that I am fully cognizant of all of the LUP-SPG following attached requirements associated with the issuance of a VDOT Land Use Permit. The permittee or their agent must contact the VDOT Customer Service Center at 0-000-000-0000 a minimum of 48 hours prior to initiating any planned excavation within 1,000 feet of a signalized intersection and/or near VDOT ITS infrastructure. : Signature of Applicant: Title Date Signature of Agent: Title Prepayment required with remittance payable to Treasurer of Virginia. Date Date All applicable items on this form must be completed to avoid delay in processing the issuance of a VDOT Land Use Permit. Prepayment required with remittance payable to Virginia Department of Transportation. VDOT USE ONLY Date Receipt is hereby acknowledged for: CHECK No.: MONEY ORDER No.: In the Amount of $ for PERMIT FEE $ CASH SURETY $ Authorized VDOT Signature: Date:: *Agent mean: Applicant contractor’s or a person or business authorized to act on another's behalf.

Surety Information. Surety Posted by: Owner Agent County Resolution Surety Waived Bonding Company Name Xxxx # Irrevocable Letter of Credit - Bank Name Surety paid by Check - Check Number Irrevocable Letter of Credit # Amount of Surety $ Obligation Amount $ Request permission to perform the following activity(s): as per attached plans. Location: County Town City of _ Route No. Street Name Between Route No. Street Name and Route No. Street Name Latitude Longitude Tax Map Number Applicant Job No. Applicant shall provide proof of registration as an operator with the appropriate notification center in accordance as defined in §2.2-1151.1 of the Code of Virginia & must provide a notarized affidavit, stating that the utility owner has notified the commercial and residential developer, owner of commercial or multifamily real estate, or local government entities with a property interest in any parcel of land located adjacent to the property over which the land use is being requested, that application for the permit has been made. IF APPLICABLE, I AGREE TO PAY THE FULL SALARY AND EXPENSES OF A STATE ASSIGNED INSPECTOR IN CONJUNCTION WITH ACTIVITIES AUTHORIZED UNDER THE AUSPICES OF A VDOT LAND USE PERMIT. By signing below, I the undersigned hereby acknowledge that I am fully cognizant of all of the LUP-SPG following attached requirements associated with the issuance of a VDOT Land Use Permit. The permittee or their agent must contact the VDOT Customer Service Center at 0-000-000-0000 a minimum of 48 hours prior to initiating any planned excavation within 1,000 feet of a signalized intersection and/or near VDOT ITS infrastructure. : Signature of Applicant: Title Date Signature of Agent: Title Prepayment required with remittance payable to Treasurer of Virginia. Date Date All applicable items on this form must be completed to avoid delay in processing the issuance of a VDOT Land Use Permit. Prepayment required with remittance payable to Virginia Department of Transportation. VDOT USE ONLY Date Receipt is hereby acknowledged for: CHECK No.: MONEY ORDER No.: In the Amount of $ for PERMIT FEE $ CASH SURETY $ Authorized VDOT Signature: Date:: *Agent mean: Applicant contractor’s or a person or business authorized to act on another's behalf. [Bank Letterhead] LETTER OF CREDIT BANK AGREEMENT LAND USE PERMIT LUP-LC Bank Irrevocable Letter of Credit Date: APPLICANT NAME: Issuing Bank: _ Tax ID number or Driver’s license Number: _ Address: City: _ State Zip Code Amount: Expiration Date: _ VIRGINIA DEPARTMENT OF TRANSPORTATION

Surety Information. Surety Posted by: Owner Agent County Resolution Waived Bonding Company Name Xxxx # Irrevocable Letter of Credit - Bank Name Surety paid by Check - Check Number Irrevocable Letter of Credit # Amount of Surety $ Obligation Amount $ Request permission to perform the following activity(s): as per attached plans. Location: County Town City of _ Route No. Street Name Between Route No. Street Name and Route No. Street Name Latitude Longitude Tax Map Number Applicant Job No. Applicant shall provide proof of registration as an operator with the appropriate notification center in accordance as defined in §2.2-1151.1 of the Code of Virginia & must provide a notarized affidavit, stating that the utility owner has notified the commercial and residential developer, owner of commercial or multifamily real estate, or local government entities with a property interest in any parcel of land located adjacent to the property over which the land use is being requested, that application for the permit has been made. IF APPLICABLE, I AGREE TO PAY THE FULL SALARY AND EXPENSES OF A STATE ASSIGNED INSPECTOR IN CONJUNCTION WITH ACTIVITIES AUTHORIZED UNDER THE AUSPICES OF A VDOT LAND USE PERMIT. By signing below, I acknowledge that I am fully cognizant of all the LUP-SPG requirements associated with the issuance of a VDOT Land Use Permit. The permittee or their agent must contact the VDOT Customer Service Center at 0-000-000-0000 a minimum of 48 hours prior to initiating any planned excavation within 1,000 feet of a signalized intersection and/or near VDOT ITS infrastructure. Signature of Applicant: Title Date Signature of Agent: Title Prepayment required with remittance payable to Treasurer of Virginia. Date Date All applicable items on this form must be completed to avoid delay in processing the issuance of a VDOT Land Use Permit. Prepayment required with remittance payable to Virginia Department of Transportation. VDOT USE ONLY Date Receipt is hereby acknowledged for: CHECK No.: MONEY ORDER No.: In the Amount of $ for PERMIT FEE $ CASH SURETY $ Authorized VDOT Signature: Date:: *Agent mean: Applicant contractor’s or a person or business authorized to act on another's behalf. Form W-9 Commonwealth of Virginia Substitute W-9 Form Revised July 2014 Request for Taxpayer Identification Number and Certification