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PERFORMANCE AND INDEMNITY BOND <br />43 <br />NORTH CAROLINA DEPARTMENT OF TRANSPORTATION -HIGHWAY ENCROACHMENT INSTALLATION <br />PRINCIPAL (Contractor for second party to encroachment agreement) <br />SUKGIY <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 parry to Encroachment A reement <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, }ointly 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~Encraachment 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 governin body. <br />(Seal of Principal) <br />ATTEST: <br />Clerk or Secretary <br />President or Vice President <br />(Delete Inappropriate Title) <br />(Name of SURETY) <br />(Seal of Surety) <br />BY: <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 />PRINCIPAL (Type Name of Principal) <br />R/w (16A) :Party of the Second Part certifies that this agreement is true and accurate copy of the form <br />R/VV (16A) incorporating all revisions to date. <br />