Bond For Performance Of The Work Alabama Dot Page 3
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1
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3Form BM-174
Page 3 of 3
Revised March 2016
The decision of the Director of the Alabama Department of Transportation upon any
question connected with the execution of the permit Contract, or any failure or delay in the
prosecution of the permit contract work, attached hereto and incorporated
herein,
by said
Principal or Surety, shall be final and conclusive.
WITNESS our hands and seals, this ______ day of __________________, 20_____.
ATTEST:
_____________________________________ ____________________________________
(Name and Title)
(Signature of Applicant Official)
____________________________________
(Title of Officer Signing)
(Affix Seal)___________________________
Name of Surety
________________________________________
Legal Name of Applicant (Company) as Principal
________________________________________
Address
________________________________________
Contact Number
By: _________________________________
Attorney in Fact – for Surety
NOTICE TO INSURANCE PRODUCER
Countersigned by Alabama Licensed
Please print or write legibly your name,
Insurance Producer for Surety, if applicable:
complete address, and license number below:
__________________________________
______________________________________
Name (signature)
Name (print)
______________________________________________________________________________
Address
___________________________________
License Number
(A copy of the Power of Attorney properly executed by the Company authorizing the Agent
signing above to bind the Company as Surety on this Bond must be attached hereto. Said Power
of Attorney must be dated so as to correspond with the execution date of the bond.)
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