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ASSIGNMENT TO FLOOD CONTROL DISTRICT OF MARICOPA COUNTY

STATE OF ARIZONA

SECURITY IN LIEU OF PERFORMANCE BOND

NAME____________________________________________________________________________________

STREET ADDRESS_________________________________________________________________________

COUNTY________________STATE___________________TELEPHONE NUMBER____________________

hereinafter referred to as ASSIGNOR, does hereby assign and transfer to the Flood Control District of Maricopa

County, hereinafter referred to as DISTRICT, all right, title and interest of any kind whatsoever owned or held by

ASSIGNOR in the principal, but not in the interest hereinafter accruing in the insured account of ASSIGNOR so

long as such funds remain on deposit in the _______________________________________________________

FINANCIAL INSTITUTION

whose address is_____________________________________________________________________________

STREET ADDRESS

CITY

COUNTY

Arizona, as evidenced by an account in the amount of ________________________________________dollars

($_____________________), identified by account number____________________________________which

account is insured by the Federal Deposit Insurance Corporation or the Federal Savings and Loan Insurance

Corporation. This assignment is given as security for completion of the work as identified in the Permit granted

to ASSIGNOR by the DISTRICT.

DATED this _________ day of _______________________________, 20___, at Phoenix, Arizona

______________________________________

_________________________________________________

IMPORTANT - SIGNATURE OF ASSIGNOR

NAME OF ASSIGNOR EXACTLY AS SHOWN ABOVE

This Assignment shall be signed

BY:_____________________________________________

by the individual:

SIGNATURE OF ASSIGNOR

FIRST ENDORSEMENT - RECEIPT FOR NOTICE OF ASSIGNMENT

Receipt is hereby acknowledged to the Flood Control District of Maricopa County, State of Arizona, hereinafter

referred to as the DISTRICT, of written notice of the assignment to said DISTRICT of the above-identified

account. Our records have been noted to show the interest of the DISTRICT in said account as shown in and by

the assignment above. We have retained a copy of this document, and hereby certify that we have not received

any notice of lien, encumbrance, hold, claim or other obligation against the above-identified account prior to its

assignment to the DISTRICT. We further hereby waive any current and future right of set-off against such account.

We agree to make payment as requested in writing by the Chief Engineer and General Manager of the DISTRICT,

or his designee.

DATED this __________ day of _____________________________, 20___, at Phoenix, Arizona

___________________________________________________________________________________________

NAME OF FINANCIAL INSTITUTION

By:________________________________________________________________________________________

SIGNATURE OF OFFICER OF FINANCIAL INSTITUTION

TITLE

Subscribed and sworn to before me this __________ day of _________________________________, 20___.

My Commission Expires:

__________________________________

____________________________________

NOTARY PUBLIC

Security In Lieu Of Performance Bond Form - Assignment To Flood Control District Of Maricopa County State Of Arizona

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