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FORM OF PAYMENT BOND B°nd#B 10723/1 <br />Date Of Contract: September 17, 209 <br />Date of Execution: <br />Name of Principal <br />(Contractor) <br />Name of Surety: <br />Name of Contracting <br />Body <br />Amount of Bond <br />Project <br />September 17, 2~C8 <br />McQueen Construction, Inc. <br />Selective Insurance Company of America <br />Orange County, NG <br />Nine Hundred Eighty-5x Thousand and OCYIOODollars ($9~GOOQO~ <br />Orange County, Fairview Community Park <br />KNOW ALL MEN BY THESE PRESENTS, that we, the principal and surety above <br />named, are held and firmly bound unto the above named contracting body, hereinafter <br />called the contracting body, in the penal sum ofi the amount stated above for the payment <br />of which sum well and truly to be made, we bind ourselves, our heirs, executors, <br />administrators, and successors, jointly and severally, firmly by these presents. <br />THE CONDITION OF THIS OBLIGATION 1S SUCH, that whereas the principal <br />entered into a certain contract with the contracting body identified as shown above and <br />hereto attached: <br />NOW, THEREFORE, if the principal shall promptly make payment to all persons <br />supplying labor/material in the prosecution of fihe work provided for in said contract, and <br />any and all duly authorized modifications of said contract that may hereafter be made, <br />notice of which modifications to the surety being hereby waived, then this obligation to be <br />void; otherwise to remain in full force and virtue. <br />IN WITNESS WHEREOF, the above-bounden parties have executed this instrument <br />under their several seals on the date indicated above, the name and corporate seal of each <br />corporate party being hereto affixed and these presents duly signed by its undersigned <br />representative, pursuant to authority of its governing body. <br />Executed in four counterparts . <br />