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Blank Indiana State 415 23 PDF Template

The Indiana State 415 23 form is a permit bond utilized by individuals or entities applying for specific permits from the State of Indiana, particularly in relation to transportation projects. This form establishes a financial guarantee, ensuring that the principal will fulfill the obligations outlined in the permit application to the satisfaction of the Indiana Department of Transportation. Compliance with the terms of the bond protects the interests of contractors, vendors, and laborers involved in the project.

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Outline

The Indiana State 415 23 form, commonly referred to as the Permit Bond, serves a crucial role in the regulatory framework of construction and excavation activities within the state. This form is primarily utilized by individuals or entities applying for permits related to various projects, such as driveway excavations, pole line installations, and bridge attachments. The document establishes a financial guarantee, binding the applicant, known as the Principal, and their Surety to the State of Indiana. It ensures that the Principal will adhere to the terms of the permit and fulfill all obligations, including the payment of claims from contractors, vendors, and laborers involved in the project. Should the Principal fail to comply with the permit conditions, the Surety becomes liable for the financial repercussions, including court costs and attorney fees, up to the penal sum specified in the bond. The form requires signatures from both the Principal and Surety, along with notarization, to validate the agreement. Additionally, it includes sections for the application number, road number, and other essential details, ensuring that all parties are clearly identified and that the bond is appropriately recorded. This document not only protects the interests of the state but also provides a layer of security for those involved in construction projects, fostering accountability and compliance within the industry.

Form 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

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Form Specifics

Fact Name	Description
Form Title	The Indiana State Form 415 23 is known as the Permit Bond.
Approval	This form was approved by the State Board of Accounts in the year 2000.
Governing Law	The form is governed by Indiana state law, specifically related to permits issued by the Department of Transportation.
Purpose	This bond ensures that the principal will fulfill obligations related to driveway excavation, pole line, bridge attachment, or other miscellaneous permits.
Liability	The surety is liable for claims up to the penal sum stated in the bond, covering payment for labor and materials.
Noncompliance Consequences	If the principal does not comply, the surety may be responsible for court costs and attorney fees beyond the penal sum.
Execution	The bond must be signed by both the principal and the surety, and it requires a notary public for validation.
Submission Requirements	Five copies of the completed form must be submitted to the Permit Manager along with the application number and other details.

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