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The Indiana State 415 23 form, known as the Permit Bond, plays a pivotal role in the regulatory framework of the State of Indiana, particularly within the ambit of the Department of Transportation. This document outlines an airtight agreement involving a principal party and a surety, binding them together in a financial guarantee to the state. The bond covers various activities like driveway excavation, pole line, and bridge attachment among others, underscoring its importance in managing civil and construction projects that interact with state-managed lands or infrastructure. With a clearly stated penal sum, the form sets forth conditions under which the principal is obligated to perform tasks or services to the state's satisfaction. These tasks are related to the application connected to the permit for which the bond is posted. Its clauses ensure that laborers, contractors, and vendors are compensated for their contributions, thereby safeguarding their interests and ensuring the smooth execution of projects. Moreover, it implicates both the principal and the surety in a legal and financial framework, making them accountable for the completion of the permitted activities as agreed. The form also outlines the consequences of noncompliance, including the coverage of court costs and attorney fees by the surety, highlighting the document's role in enforcing compliance with state regulations. With spaces provided for detailed information such as engaging parties, addresses, and specific terms of the agreement, the form serves as a comprehensive record of the bond's conditions and stipulations.

Example - Indiana State 415 23 Form

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 Information

Fact Name Description
Form Title PERMIT BOND State Form 415 23 (R4 / 3-00)
Approval Authority Approved by State Board of Accounts, 2000
Relevant State State of Indiana
Administering Department Indiana Department of Transportation
Purpose of Form To bind the applicant (Principal) and the surety to a penal sum, ensuring compliance with terms of a permit issued by the Indiana Department of Transportation for projects like driveway excavation, pole line, bridge attachment, etc.
Governing Law(s) This form is governed by the regulations and statutes of the State of Indiana pertinent to the issuance of permits for construction-related activities and their assurances.
Requirements for Execution The bond requires signatures from the Principal and Surety, acknowledgment by a Notary Public, and the association of a Power of Attorney if applicable.

How to Fill Out Indiana State 415 23

Filling out the Indiana State Form 415 23 is a straightforward task requiring attention to detail. This process ensures that individuals or entities entering into agreements with the Indiana Department of Transportation for activities like driveway excavation or pole line installation, amongst others, are bonded. Providing this bond is critical; it serves as a financial guarantee to the State of Indiana that the applicant will comply with the terms of the permit. Once completed, the form outlines the obligations and conditions tied to the issuance of a potential permit. Here’s how you tackle the form, step by step:

  1. Start by identifying the purpose of the bond from the listed options: Driveway Excavation, Pole Line, Bridge Attachment, or Misc. (specify), and mark the appropriate box.
  2. Fill in the name and address of the Principal (the individual or entity applying for the permit) in the space provided after "Know all men by these presents that we, the Undersigned."
  3. Enter the name and address of the Surety (the guarantor for the bond) next to the Principal's information.
  4. Specify the penal sum of the bond -- the maximum amount guaranteed -- where indicated.
  5. Input the date of the bond agreement where it says "DATED THIS."
  6. Further down, you'll need to recount the permit application details: type of permit and the date of application.
  7. Describe the permit's agreed-upon works and obligations in the space following the brief explanation of the bond's conditions.
  8. Ensure the Principal - Applicant's name is accurately reflected in the section beginning "Now, if said" to reinforce their commitment to fulfilling the permit's terms.
  9. On the dates and signatures section at the bottom, record the day's date and have both the Principal and Surety sign their names and seal the document to symbolize their joint agreement and understanding.
  10. The Statement of Execution by the Notary Public must be filled in by a notary, who will validate the Principal and Surety's acknowledgment of the bond. This includes documenting the date of acknowledgment, the notary’s signature, seal, and commission expiry date, as well as the notary’s printed or typed name and residential county.
  11. If the liability of the bond is terminated, indicate whether it is due to compliance or cancellation in the "NOTICE OF TERMINATION OF LIABILITY" section. Provide the termination date and have it signed by the Permit Manager.

After completing all the necessary parts of the form, it’s critical to submit all five copies to the relevant department within the Indiana Department of Transportation. Making sure every detail is accurate and accounted for reduces the chances of delays or rejections of the permit application. Ensuring that everything is in order, from the bond’s scope to the signatures, streamlines the process for both the applicant and the state, setting a clear path for moving forward.

Things to Know About Indiana State 415 23

What is the Indiana State 415 23 form?

The Indiana State 415 23 form, commonly known as the Permit Bond form, is an official document used by the Indiana Department of Transportation. Its purpose is to bind an applicant (referred to as the Principal) and a surety (an entity that provides financial assurance) in an agreement to ensure the Principal follows the terms of a specific permit issued by the state. This could involve various types of work such as driveway excavation, pole line installation, bridge attachments, among others. The bond guarantees that the Principal will complete the agreed work to the satisfaction of the Indiana Department of Transportation and will pay all lawful claims from contractors, vendors, and laborers for labor and materials supplied.

Who needs to submit the Indiana State 415 23 form?

Any individual or entity that applies for a permit to perform specific types of work within the jurisdiction of the Indiana Department of Transportation needs to submit this form. This includes, but is not limited to, contractors planning to excavate for driveway installations, set up pole lines, or attach structures to bridges. It ensures that those performing the work have a financial guarantee backing the proper completion of the project and the settlement of related claims.

What information is required when filling out the form?

When completing the form, the applicant (Principal) and the surety company providing the financial assurance must provide their full names and addresses. The form also requires the penal sum of the bond, which is the maximum amount the surety will pay in the event of a claim. Additionally, details of the permit application, including the type of work to be done, must be clearly outlined. Finally, both the Principal and the Surety must sign and seal the form, which must also be witnessed and sealed by a Notary Public.

What is the penal sum mentioned in the form?

The penal sum is the maximum financial amount the Surety agrees to pay in case the Principal fails to fulfill their obligations under the terms of the permit. It acts as a financial cap on the surety bond, designed to cover any claims made by contractors, vendors, or laborers for unpaid labor and materials, as well as any other costs arising from the Principal's failure to comply with the permit's conditions.

What happens if the Principal fails to comply with the terms of the permit?

If the Principal fails to comply with the permit's terms, the bond remains in full force, meaning the Surety can be called upon to pay up to the penal sum to settle claims for labor performed, materials furnished, or other services provided. This can also include covering court costs and attorney fees if necessary to collect on the bond. Essentially, the Surety guarantees that the financial obligations of the Principal will be met up to the bonded amount.

Where can I obtain the Indiana State 415 23 form?

The Indiana State 415 23 form is available through the Indiana Department of Transportation (INDOT). It may be accessed online through INDOT's official website or obtained in person at an INDOT office. It's advisable to check the most current information on the INDOT website to ensure obtaining the latest version of the form.

How does one terminate the liability under this bond?

Liability under the bond can be terminated either by complying fully with the terms of the permit, thereby fulfilling all obligations, or through cancellation. The form includes a section for Notice of Termination of Liability, which must be completed and submitted to the issuing authority, indicating whether compliance or cancellation has occurred, along with the required date and signatures.

Is there a specific period within which the work under the permit should be completed?

While the Indiana State 415 23 form itself does not specify a completion period, the permit issued by the Indiana Department of Transportation will outline the timeline for the work. It is crucial to refer to the specific permit details for the deadlines and any other requirements. Failure to complete the work within the specified timeframe, unless properly extended, can result in claiming against the bond to ensure compliance and completion of the permitted work.

Common mistakes

Filling out the Indiana State 415 23 form, commonly known as the Permit Bond form, requires attention to detail and a clear understanding of its requirements. Though it may seem straightforward, there are common mistakes that applicants frequently make. It is crucial to avoid these errors to ensure the form is processed swiftly and effectively.

One of the first and most frequent errors is not providing complete information for both the Principal and the Surety. The form requires addresses and signatures for both parties, and lacking any details can lead to processing delays. Additionally, failing to specify the exact nature of the permit needed (Driveway, Excavation, Pole Line, Bridge Attachment, or Misc.) can cause confusion and further hold-ups. Applicants often overlook the need to clearly link the bond to the specific permit by failing to detail the permitted activities sufficiently.

  1. Incomplete addresses and signatures for the Principal and the Surety: Not providing full details can delay the process.
  2. Not specifying the type of permit: This omission can cause confusion about the bond's purpose.
  3. Lack of detail about the permitted activities: It's important to describe what the permit covers explicitly.
  4. Forgetting to attach the Power of Attorney (if applicable): When a Surety is involved, this document is crucial and often overlooked.
  5. Incorrect penal sum: The amount should match what's required for the type of permit being applied for. Misstating this figure can invalidate the bond.
  6. Failing to properly execute the bond: All parties involved must sign and date the bond correctly. Any mistakes here can lead to unnecessary complications.
  7. Omitting the Notary Public's section: This section is essential for validating the bond's execution.
  8. Not specifying the bond number: This is a critical identifier for the Department of Transportation.
  9. Ignoring the notice of termination of liability section: This needs to be filled out accurately to inform when the bond's obligations have been fulfilled or cancelled.

To ensure a smooth process, attention to detail is paramount when completing the Indiana State 415 23 form. Understanding and avoiding the mistakes listed can help in the efficient approval and implementation of the necessary permit. It is always recommended to review the form thoroughly before submission, possibly even seeking professional guidance to avoid common pitfalls. Compliance with all listed requirements not only facilitates professional conduct but also supports the successful execution of projects within the state's regulatory framework.

Documents used along the form

When interacting with the State of Indiana Department of Transportation, particularly concerning the State Form 415 23, it is common for individuals and entities to deal with a variety of other forms and documents essential for compliance and procedural completion. Each document plays a critical role in ensuring that the obligations under the permit are fulfilled and that all parties adhere to the state's regulations.

  1. Application for Permit: This is often the initial document required to kickstart the permit process. It outlines the applicant's request and the specifics of the project, including location and nature of work.
  2. Notice of Award: After reviewing the application, the Department may issue a Notice of Award, indicating acceptance of the proposal and moving the process forward towards fulfillment of the permit requirements.
  3. Contractor's Agreement: This legal document sketches out the agreement between the applicant (now a contractor) and a third party, defining the work scope, terms of labor, materials supply, and other conditions related to the permit awarded.
  4. Proof of Insurance: Required by the State, this confirms that the applicant has adequate insurance coverage, protecting against potential liabilities arising from the work performed under the permit.
  5. Performance Bond: Beyond the Permit Bond, a Performance Bond acts as a financial guarantee ensuring the completion of the project under the terms agreed upon. It safeguards the state's interests, ensuring that the project will not impose undue financial burden due to non-completion or malpractice.
  6. Environmental Impact Assessment (EIA): For certain projects, an EIA may be required to evaluate the potential environmental impacts. This document helps in ensuring that the project follows environmental protection standards.
  7. Right-of-Way (ROW) Permit: If the project involves state-owned land or needs access across such ground, a ROW permit may be indispensable. It grants legal access to or use of the property for the duration of the project.

Together, these documents contribute to a robust framework that governs the initiation, execution, and completion of projects under the Indiana Department of Transportation. Ensuring meticulous completion and submission of these documents not only facilitates a smoother operational flow but also enhances compliance with the state's regulatory demands, ultimately driving toward the successful achievement of the project's goals.

Similar forms

The Indiana State 415 23 form, primarily utilized for ensuring compliance with state regulations regarding construction and excavation related to transportation infrastructure, shares similarities with other documents designed to provide a security guarantee to state entities. One such document with resemblances to the Indiana State 415 23 form is the Performance Bond. Like the permit bond outlined in the form 415 23, a Performance Bond serves as a financial guarantee that a contractor will fulfill their obligations as per the terms of the contract. This similarity lies in their shared purpose of protecting the interests of the public and governmental bodies by ensuring that the contracted work is completed satisfactorily and within the agreed parameters, including time frames and specifications. Both forms function to provide a safety net against potential default by contractors, thereby minimizing financial risk.

Another document similar to the Indiana State 415 23 form is the Payment Bond. While the Permit Bond focuses on the permit holder's adherence to the conditions of the permit, a Payment Bond assures that all subcontractors, laborers, and material suppliers will be paid, protecting the state or municipality from claims that could arise from unpaid parties. The core similarity between these documents is their function as financial guarantees; however, the Payment Bond specifically addresses the risk of non-payment to third parties involved in the work, which complements the broader safety and compliance assurances provided by the Permit Bond in the 415 23 form.

One more comparable document is the Licensing Bond, often required for businesses that apply for professional licenses within their state. Similar to the Indiana State 415 23 form, Licensing Bonds protect the state and its citizens by ensuring that licensed professionals comply with applicable laws and regulations. Both these bonds ensure accountability and protect public welfare by requiring adherence to specific standards of practice. Though the Permit Bond primarily secures permit-related obligations and the Licensing Bond secures compliance with regulatory requirements, their underlying purpose is to safeguard the public interest by enforcing professional and operational accountability..

Dos and Don'ts

When filling out the Indiana State Form 415 23, it is important to follow certain dos and don'ts to ensure the process goes smoothly. Paying attention to these guidelines can help avoid common mistakes that might delay or affect the approval of your permit bond.

Do:
  • Check all the details twice: Ensure that all the information provided is accurate and complete, including names, addresses, and the penal sum.
  • Sign and date the form correctly: Make sure that the form is signed by the required parties on the designated lines, and that dates are consistent and accurate.
  • Include the power of attorney if necessary: If the Surety’s signing authority comes from a power of attorney, attach a copy of the document as indicated on the form.
  • Print legibly or type: To avoid any confusion or misinterpretation of the information provided, ensure all entries are legible or typed.
  • Submit all required documents: Make sure all supplemental documentation, including the Notice of Termination of Liability, if applicable, is completed and submitted with your bond form.
Don't:
  • Leave sections blank: Do not skip any sections that are applicable to your situation. Incomplete forms can lead to delays or rejection of the permit bond.
  • Forget to specify the type of permit: Clearly indicate whether the bond is for Driveway Excavation, Pole Line, Bridge Attachment, or another type of project.
  • Misstate the bond amount: Ensure the penal sum mentioned is correct and matches the required amount for your specific project.
  • Overlook the witness section: The Notary Public must witness the signing of the form. The notarization is invalid without the Notary’s signature and seal.
  • Submit outdated information: Double-check that all personal and project-related information is current. Submitting outdated information can invalidate the bond.

Misconceptions

  • One common misconception is that the State Form 415 23 is only for new construction projects. However, the form clearly includes various types of work such as driveway excavation, pole line, and bridge attachment, indicating its applicability beyond just new construction.

  • Many people mistakenly believe that once the State Form 415 23 is submitted, no further action is required on their part. In truth, the form states that the principal applicant must not only complete the work agreed upon but also ensure it satisfies the Indiana Department of Transportation. This involves ongoing communication and possibly additional paperwork.

  • There's a misconception that this form guarantees immediate approval of the proposed work. The form is actually a permit bond, meaning it's a financial guarantee for the state that the applicant will adhere to the terms of the permit. Approval is contingent on meeting all conditions set forth by the department.

  • Some believe that the penal sum specified on the State Form 415 23 is the total cost of the project. The penal sum is actually the maximum amount for which the surety can be held liable, not the project's total cost. This sum ensures compliance and protection against non-performance or financial liabilities.

  • A common misunderstanding is that the responsibility of the surety ends once the bond is submitted. However, the form specifies that the surety's liability includes court costs and attorney fees in case of non-compliance, indicating an ongoing financial commitment until the project is completed according to the permit's terms.

  • Lastly, it's often thought that the State Form 415 23 only serves as a bureaucratic requirement without practical purpose. In reality, this permit bond plays a crucial role in protecting the public and the state from improper use or damage to public infrastructure by ensuring that applicants are financially and legally accountable for their projects.

Key takeaways

When you’re involved with the Indiana State form 415 23, commonly known as the Permit Bond form, it is crucial to understand its purpose and the necessary steps to fill it out properly. This document is integral for individuals or entities looking to obtain a permit for activities such as driveway excavation or bridge attachments that potentially affect state-managed infrastructure. Here are key takeaways to guide you through the process:

  • Understand the Bond Requirements: The Permit Bond is a financial guarantee to the State of Indiana that the applicant will adhere to the terms of the permit, including completing the project satisfactorily and paying all related claims such as labor and materials.
  • Identify the Principal and Surety: The form requires the identification of two parties: the Principal (the applicant seeking to perform the work) and the Surety (the entity guaranteeing the completion of the work and commitments). Both parties’ information must be accurately filled out.
  • Know the Penal Sum: This term refers to the maximum amount the surety is liable for in the event of a default by the principal. It’s crucial to ensure this sum is correctly stated and agreed upon by all parties.
  • Proper Execution: The form must be signed and sealed by both the Surety and the Principal. Additionally, a Power of Attorney document should be attached if applicable.
  • Notarization Is Required: A notary public must witness the signing of the form. The notary will verify the identities of the signatories and seal the document, making it legally binding.
  • Notice of Termination of Liability: The form includes a section for the termination of liability, indicating whether the Surety’s obligations under the bond are complied with or cancelled. This is important for the conclusion of the bond’s effectiveness.
  • Submission Guidelines: After completing and signing the form, adhere to the submission instructions which typically involve sending all required copies to the relevant department or permit manager, ensuring the process moves forward without delays.

Filling out the Indiana State form 415 23 with attentiveness to detail is paramount. It underscores the commitment of the principal to comply with state regulations and standards, ensuring public and infrastructural safety. Conversely, understanding the form’s complexities and requirements will facilitate a smoother process for obtaining the necessary permits for infrastructure-related projects.

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