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 2 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 subparagraphs (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 3 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 4 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