Permit No. _______________ Page 1 of 3 Collateral Bond/Indemnity – Sole Proprietor

United States Department of the Interior

OFFICE OF SURFACE MINING RECLAMATION AND ENFORCEMENT

COLLATERAL BOND AND INDEMNITY AGREEMENT

(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, organized and existing under the laws of the State of , as

Obligor, is hereby held and firmly bound unto the United States Department of the Interior, 

Office of Surface Mining Reclamation and Enforcement (OSM) in the sum of 

__________________________________________________ ($ ). 

Contemporaneously with the execution and delivery of this Bond, the Obligor gives OSM 

a _______________ numbered: , as collateral, pursuant to 30 CFR §800.5(b), 

(kind of instrument) (instrument ID number)

in the amount specified above, and attached as Exhibit 1. 

THE CONDITION OF THIS OBLIGATION is such, that:

Whereas, the above named Obligor has submitted an application for surface coal mining 

operations, Permit Application No. , including a mining and reclamation plan, to 

conduct and reclaim the 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, pursuant to 30 CFR §800.5(b) the Obligor has chosen to post a collateral bond 

and indemnity agreement (Bond) as a guarantee that the reclamation of the land disturbed during 

this surface coal mining operation will be completed as required by the Act and 30 CFR Chapter 

VII, and as specified in the Permit as issued; and

Whereas, the Obligor, and his/her 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 Obligor’s failure to comply with the 

condition of the obligation; 
Permit No. _______________ Page 2 of 3 Collateral Bond/Indemnity – Sole Proprietor

Whereas obligations guaranteed by this 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, attached a signed legal description exhibit to this collateral bond agreement)

Now therefore, if the Obligor 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 plan, then this 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) extending for a minimum period of years, notwithstanding the 

requirements of sub-paragraphs (a) and (b) above, it being further understood that 

if the Obligor 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 Obligor to fulfill the obligations specified by the Act, 30 CFR Chapter 

VII, and its permit, shall result in forfeiture of performance bond collateral posted with this 

indemnity agreement according to the procedures described in 30 CFR §800.50.

IN WITNESS WHEREOF, the Obligor has hereunto set their signature this

 day of _______________________, .

Date:_________________________

______________________________

(Company/Permittee)

 By: __________________________

(Individual – Sole Proprietor)
Permit No. _______________ Page 3 of 3 Collateral Bond/Indemnity – Sole Proprietor

ACKNOWLEDGEMENT OF INDIVIDUAL - OBLIGOR

On this _______ day of ___________________, , 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 foregoing instrument and who, being by me fully sworn, did say that he/she 

executed the same for the purposes herein 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

NOTE: Where negotiable securities are used as collateral, a complete POWER OF ATTORNEY 

AND AGREEMENT must be attached.

Paperwork Reduction Act Notice

We use the information required by this form to ensure that the requirements for a collateral bond under 30 CFR 

800.21 have been met. You must provide the requested information to obtain a benefit (a collateral 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 collateral 

bond will vary depending on individual circumstances. We estimate that the average time will be 10.5 hours per 

response. This number includes 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, 1849 C Street, NW, Room 4559, 

Washington, DC 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 10/31/2021