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PERFORMANCE AND INDEMNITY BOND <br />NORTH CAROLINA DEPARTMENT OF TRANSPORTATION - HIGHWAY ENCROACHMENT INSTALLATION <br />PRINCIPAL (Contractor for second party -to encroachment agreement) <br />SURETY <br />AMOUNT OF BOND <br />DATE OF BOND <br />DESCRIPTION OF ENCROACHMENT AGREEMENT: <br />Route or Highway No. <br />County <br />Date of Encroachment Agreement <br />Specific Location of Encroachment: <br />Between & <br />Type of Encroachment <br />(Water, sewer, gas, etc.) <br />Second party to Encroachment Agreement <br />43 <br />KNOW ALL MEN BY THESE PRESENTS, That we the PRINCIPAL and SURETY above named, are held and firmly <br />-bound unto the Department-of Transportation; an agency_of_the_ _State._of North Carolina, hereinafter call the <br />DEPARTMENT, in the amount stated above -for the payment for which sum we bind ourselves, our heirs, executors,_ <br />administrators, and _successors, jointly and severally, firmly by these presents. <br />THE CONDITION -OF THIS OBLIGATION IS SUCH, that whereas the above indicated second -party to an <br />-Encroachment Agreement named above entered into an Encroachment Agreement with the DEPARTMENT, and <br />the PRINCIPAL (contractor) entered into a contract with the said second party to an Encroachment Agreement <br />named above to perform certain work, including'the installation or relocation of certain encroachments described in <br />a-certain Encroachment Agreement with the DEPARTMENT hereinabove described and incorporated herein by <br />reference; <br />NOW, THEREFORE, if the PRINCIPAL shall well and truly install the said encroaching facilities on and along the <br />highway in accordance with the "Policies and Procedures for Accommodating Utilities on Highway Rights of Way" <br />and any supplements thereto and in accordance with the other provisions.of the said Encroachment Agreement, and <br />shall indemnify the DEPARTMENT for the failure to install the encroachments in accordance with the foregoing <br />manual and provisions of the said Encroachment Agreement, then, this obligation to be void; otherwise to remain in <br />full force and effect. <br />IN WITNESS WHEREOF, the above - bounden parties have executed this instrument under their several seals on <br />the date indicated above, the name and corporate seal of each corporate party being hereto affixed and these <br />presents duly signed by its undersigned representative, pursuant to authority of its governing body. <br />(Seal of Principal) <br />ATTEST: PRINCIPAL (Type Name of Principal) <br />Clerk or Secretary <br />(Seal of Surety)- <br />MM <br />President or Vice President <br />(Delete Inappropriate Title) <br />(Name of SURETY) <br />BY: <br />Attorney -in -Fact <br />NOTE: Attach -Power of Attorney and Certificate of Authority of Attorney -in -Fact. <br />FORM R/W 16A (This form to be used only by Contractor for second party to encroachment agreement.) <br />RNV (16A) : Party of the Second Part certifies that this agreement is true and accurate copy of the form <br />R/W (16A) incorporating all revisions to date. <br />