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In the bustling landscape of Indiana's infrastructure development, the Indiana State 415 23 form stands as a critical document, guiding the interactions between contractors and the Department of Transportation. Recognized formally as a Permit Bond, its approval by the State Board of Accounts in 2000 underscores its significance. This document specifically ensures that any entity looking to undertake construction or excavation activities within the state’s purview, involving driveways, pole lines, bridge attachments, or other miscellaneous structures, adheres to a predefined set of standards and regulations. The form binds the contractor (referred to as the Principal) and their surety to a commitment towards the State of Indiana, encapsulating a promise to fulfill all duties and obligations as outlined in the permit to the satisfaction of the Indiana Department of Transportation. Not only does it cover the execution of agreed tasks but also extends to the financial aspects, including ensuring payment for labor, materials, and services related to the project. Moreover, in instances of non-compliance, it clearly delineates the repercussions, including the surety’s liability beyond the penal sum for court costs and attorney fees. The completion and execution of this form, symbolized by the signatures of the involved parties, including a notary public acknowledgment, mark the beginning of a project's journey, emphasizing due diligence and legal adherence. Showing detailed elements such as bond numbers, and specifics about termination of liability, the form intricately links the administrative process with the practicalities of civil engineering and construction work across Indiana.

Sample - Indiana State 415 23 Form

PERMIT BOND

State Form 415 23 (R4 / 3-00)

Approved by State Board of Accounts, 2000

STATE OF INDIANA

DEPARTMENT OF TRANSPORTATION

Driveway

Excavation

Pole Line

Bridge Attachment

Misc.____________________

Know all men by these presents that we, the Undersigned _________________________________________

(address) ___________________________________________________________________as Principal and

_________________________________________________________________________________________

(address) ___________________________________________________________________as Surety, are

hereby held and firmly bound unto the State of Indiana in the penal sum of ____________________ , for the

payment of which well and truly to be made, we hereby jointly and severally bind ourselves, our heirs, executors, administrators successors and assigns:

DATED THIS ____________________________________ .

The conditions of the above obligation are such that, whereas, the above named _______________________

_________________________________________________________________________________________

did on ____________________________________ make application for a permit with the State of Indiana for:

__________________________________________________________________________________________

__________________________________________________________________________________________

which permit is made a part of this bond the same as though set forth herein.

Now, if said ________________________________________ (Principal - Applicant) shall well and faithfully do

and perform the things agreed by the _________________________________________ (Principal - Applicant)

to be done and performed according to the terms of said permit and to the satisfaction of the Indiana Department of Transportation, and shall pay all lawful claims of the contractor, vendors and laborers for labor performed and materials furnished, or other services rendered in the carrying forward, performing and completing of said permit, (on file with the Department of Transportation), then this obligation shall be void, otherwise the same shall remain in full force and effect, it being expressly understood and agreed that the liability of the Surety for any and all claims hereunder except as provided below shall in no event exceed the penal sum of this obligation as herein stated. In event of noncompliance the surety shall be liable for the court costs and attorney fees spent in the collection of this bond over and above the penal sum of this obligation.

IN WITNESS WHEREOF, we hereunto set our hands and seals this _________________________ day of

___________________, 20 ____

 

__________________________________________

_____________________________________________

__________________________________________

_____________________________________________

Surety

Principal

(Attach Power of Attorney)

 

State of __________________________________ ,

County of _________________________________ ss:

Personally appeared before me, ____________________________________________________________

______________________________as Principal and______________________________________________

___________________________________as Surety and each acknowledged the execution of the above bond

this___________________day of _______________________ , 20______

Witness my hand and _________________________________seal the said last named date.

My Commission Expires______________________, 20_____

_____________________________________

 

 

Notary Public (Written Signature)

I reside in _____________________________County, ______

_____________________________________

 

(State)

Notary Public (Printed or Typed Name)

Bond number

NOTICE OF TERMINATION OF LIABILITY

COMPLIED CANCELLED ___________________________________, 20 _____

DATE

Submit all 5 copies By: ___________________________________________________________________

PERMIT MANAGER

Application number

Road number

County number Received date

Issue date

Permit number

Form Overview

Fact Detail
Form Type PERMIT BOND
Form Number State Form 415 23 (R4 / 3-00)
Approval Approved by State Board of Accounts, 2000
Governing Department STATE OF INDIANA DEPARTMENT OF TRANSPORTATION
Purpose To ensure compliance with terms of a permit for Driveway Excavation, Pole Line, Bridge Attachment, etc., issued by the State of Indiana.
Principal and Surety Obligation Held to the State of Indiana for a designated penal sum, for faithful performance according to the permit conditions and payment of all lawful claims.
Governing Law Conditions detailed within the bond form, obligations under Indiana state laws, and the satisfaction requirements of the Indiana Department of Transportation.

Guide to Filling Out Indiana State 415 23

Completing the Indiana State 415 23 form is a structured process that necessitates detailed attention to ensure all elements are accurately provided. This form serves as a bond between the applicant, the surety, and the State of Indiana, ensuring that all responsibilities and obligations related to a specific permit - such as driveway excavation, pole line, bridge attachment, or other specified tasks - are fulfilled according to state laws and regulations. By following these guided steps, applicants can successfully fill out the form to comply with the necessary requirements.

  1. Begin by stating the type of work the permit is for by ticking the appropriate box: Driveway Excavation, Pole Line, Bridge Attachment, or fill in the blank for other specific work under "Misc."
  2. Fill in the full legal name and address of the Principal (the entity or individual applying for the permit) in the designated space.
  3. Enter the full legal name and address of the Surety (the guarantor for the bond) in the provided space.
  4. State the penal sum of the bond - that is, the maximum amount the surety will be liable for - in words and then in numerical form.
  5. Include the date the form is being filled out and signed where indicated.
  6. Specify the full legal name of the Principal again, followed by a description of the application for the permit, including what the permit is for and any additional details relevant to the permit application.
  7. Reiterate the name of the Principal in the next section where it asks for the name of the party (Principal - Applicant) who will be executing the duties outlined in the permit agreement.
  8. Both the Principal and the Surety need to sign their names and affix their seals (if applicable) on the lines provided at the end of the document, thereby agreeing to the conditions of the bond.
  9. Attach a Power of Attorney if it is required or applicable for the Surety’s authorization to act on behalf of another.
  10. In the acknowledgment section, fill in the state and county where the notarization is taking place.
  11. The Principal and Surety must then appear before a Notary Public to swear the information provided is accurate and to acknowledge the execution of the bond.
  12. The Notary Public completes their section, inserting the date, and providing their signature, printed name, commission expiration date, and noting the county and state of residence.
  13. If the liability of the bond is to be terminated, indicate whether it is because it has been COMPLIED with or CANCELLED, and specify the date of termination.
  14. Finally, complete the lower section with details regarding the Permit Manager, application number, road number, county number, received date, issue date, and the permit number.

Once completed, ensure all signatures are in place and that the document has been notarized before submitting it to the appropriate department. This form is a key part of ensuring that all legal and financial responsibilities are clearly understood and agreed upon by all parties involved in the permit process.

Frequently Asked Questions

What is the State Form 415 23 used for in Indiana?

The State Form 415 23, also known as the PERMIT BOND form, is used in Indiana to provide a financial guarantee to the State of Indiana Department of Transportation (INDOT) when applying for various types of permits. These permits include, but are not limited to, Driveway, Excavation, Pole Line, and Bridge Attachment permits. The form ensures that the principal (applicant) will fulfill their obligations under the permit's terms, complete the agreed-upon work to INDOT's satisfaction, and pay all lawful claims from contractors, vendors, and laborers.

Who needs to complete the State Form 415 23?

Any individual or entity (referred to as the "Principal") applying for a permit that requires a bond with the Indiana Department of Transportation must complete the State Form 415 23. This includes applications for driveway access to state roads, excavation near state roadways, installing pole lines along state roads, or attaching structures to state-owned bridges, among others.

What are the roles of the Principal and the Surety in this form?

The "Principal" is the individual or entity applying for the permit and seeking to perform work that necessitates the bond. The "Surety" is the financial guarantor that backs the bond, ensuring the state that the Principal will fulfill their obligations. If the Principal fails to meet their responsibilities, the Surety is obligated to cover costs up to the bond amount specified in the form.

What happens if the obligations under the permit are not met?

If the Principal fails to meet the obligations specified in the permit and outlined in the bond agreement, the bond remains in full force, meaning the Surety is responsible for covering the penal sum of the bond. This includes paying for lawful claims of labor and materials, as well as potentially covering court costs and attorney fees if legal action is necessary to collect on the bond.

How is the penal sum of the obligation determined?

The penal sum, or the maximum financial guarantee provided by the bond, is determined based on the specific requirements of the permit being applied for. It reflects the estimated cost to ensure the completion of the work and the payment of all related claims. The exact amount is set by the Indiana Department of Transportation at the time the permit application is processed.

Is the liability of the Surety unlimited?

No, the liability of the Surety is not unlimited. It is explicitly capped at the penal sum specified in the bond. This means the Surety's maximum financial responsibility does not exceed the bond amount, except for court costs and attorney fees incurred in the collection of the bond amount if there is noncompliance by the Principal.

What is the NOTICE OF TERMINATION OF LIABILITY section?

The NOTICE OF TERMINATION OF LIABILITY section on the form is used to officially release the Surety from its obligations under the bond. This can occur when the terms of the permit have been fully complied with or if the permit is cancelled. The Permit Manager will indicate the appropriate status and provide the date of compliance or cancellation, effectively terminating the bond's liability.

Can the State Form 415 23 be used for permits not listed on the form?

While the form specifically mentions Driveway, Excavation, Pole Line, and Bridge Attachment permits, it's designed to cover any permit that requires a bond as part of the application with the Indiana Department of Transportation. Applicants should consult with INDOT to confirm if their specific permit needs a bond and if State Form 415 23 is appropriate for their application.

Common mistakes

Filing out the Indiana State Form 415 23, or the Permit Bond form, is crucial for obtaining certain permits from the Indiana Department of Transportation. However, people often make mistakes that can complicate or delay the process. Understanding these common pitfalls can help ensure the form is completed accurately and efficiently.

  1. Not providing complete information for the principals and sureties. Every field that requires the name, address, and other details of the principals and sureties must be filled out thoroughly. Incomplete information may lead to the rejection of the application.
  2. Incorrect penal sum. The penal sum must reflect the actual amount as prescribed by the Department of Transportation. Mistakes here could invalidate the bond or result in undercoverage, exposing the applicant to potential liabilities.
  3. Failure to attach the Power of Attorney. If a Power of Attorney is involved, the document must be attached. Missing attachments can lead to delays or questions about the authority of individuals signing the bond.
  4. Neglecting the specifics of the permit application in the bond conditions. The form requires details about the permit being applied for. Generalizations or vague descriptions may not suffice. Specificity is key to ensuring the bond is applicable to the intended permit activity.

  5. Omitting the date or incorrect dating. All dates must be accurately recorded, including the day the bond is signed and the day the notary public acknowledges the principals and sureties. Incorrect dates can cause procedural delays.

  6. Notary public mistakes. The section for the notary public must be completed correctly, including the notary's printed or typed name, signature, and commission expiration date. Oversight here can invalidate the acknowledgment of the bond.
  7. Ignoring the NOTICE OF TERMINATION OF LIABILITY section. While it might be tempting to skip over this section during the initial filing, understanding its importance and preparing for eventual completion is crucial. This section outlines the process for officially terminating liability under the bond, crucial for closing out obligations once the permitted work is completed.

Commonly overlooked yet important:

  • Ensure all signatures are present. Both the principal and the surety need to sign the document. Missing signatures will result in automatic rejection.
  • Pay attention to the county and state of the notary’s commission. This might seem trivial, but the correct jurisdiction is vital for the validity of notarizations.
  • Double-check the bond number and related details. These must match any corresponding paperwork and be accurate to ensure traceability and verification of the bond.

By avoiding these common mistakes, applicants can streamline their Permit Bond application process, ensuring a smoother execution of their projects that require permits from the Indiana Department of Transportation. Always read the form thoroughly before starting to fill it out and consult the instructions or a professional if any doubts arise.

Documents used along the form

When dealing with the Indiana State 415 23 form, a Permit Bond, several other documents are commonly required to support or complement this process. These documents play critical roles in ensuring compliance, establishing legal protections, or providing necessary details related to the permit application. It's essential to understand these documents' purposes to effectively navigate the permit application process.

  • Certificate of Insurance: Demonstrates proof of insurance coverage. This document is important because it assures the State of Indiana that the applicant has sufficient insurance coverage for liability and other potential risks associated with the project.
  • Power of Attorney: Grants authority to a representative to act on behalf of the individual or entity applying for the permit. It is attached to the permit bond form to authorize the surety's actions related to the bond.
  • Notice of Commencement: Officially signals the start of a project. Filed before work begins, it officially notifies the state and other interested parties that the project covered by the permit is commencing.
  • Construction Plan: Provides detailed information about the proposed work, including drawings and specifications. This document is critical for the Indiana Department of Transportation to assess if the project aligns with state regulations and infrastructure plans.
  • Right-of-Way Permit Application: Required for any work that occurs within the state's right-of-way. This application is necessary in addition to the Permit Bond when the project impacts state-controlled lands or roadways.
  • Landowner Consent Form: Provides proof that the landowner approves of the project. This is particularly important for projects that might affect adjacent private properties or when accessing private land is necessary for the state project.
  • Environmental Impact Assessment: Evaluates the potential environmental effects of the proposed project. This assessment might be required to ensure that the project does not negatively impact the environment, adhering to state and federal environmental regulations.
  • Workers’ Compensation Insurance Proof: Demonstrates that the contractor has workers' compensation insurance. This is necessary to protect the workers and comply with state laws regarding worker safety and compensation.

Each document serves as a piece of the larger puzzle in the permit application process, ensuring that all legal, environmental, and safety requirements are met. Navigating these requirements can be complex, but understanding each document's role makes it easier to manage the overall process. Proper preparation and submission of these documents, alongside the Indiana State 415 23 form, contribute to a smooth permitting process and successful project initiation.

Similar forms

The Indiana State 415 23 form is similar to Performance Bonds in many respects. Performance Bonds are essential documents that ensure the completion of a project or a contract to the satisfaction of the involved parties, typically required in construction projects or large-scale goods and services agreements. Both the Indiana State 415 23 form and Performance Bonds serve as a financial guarantee. This guarantee ensures that the obligations laid out in the contract or permit are met, and both involve a principal who seeks to fulfill an obligation, a surety who assures the principal's financial capacity, and an obligee who benefits from the guarantee. The principal difference lies in their specific applications—while the Indiana form is used for permits related to transportation infrastructure, Performance Bonds have a broader application across various industries.

Similarly, the Indiana State 415 23 form has notable similarities with Payment Bonds. Payment Bonds are designed to assure payment to subcontractors, laborers, and materials suppliers involved in a project. The core similarity between the Indiana form and Payment Bonds revolves around the promise of payment to third parties for labor and materials provided. Both types of bonds protect against the non-payment risks that might occur during the execution of a project or service, ensuring that all parties receive their due compensation. Where they diverge is in the focus of their application; the Indiana State form is more narrowly focused on permits for specific activities like driveway excavation or bridge attachments, whereas Payment Bonds are generally associated with ensuring payments within broader construction or procurement projects.

Another document that the Indiana State 415 23 form aligns with is the Bid Bond. Bid Bonds are submitted with a project bid and are designed to provide a guarantee to the project owner that the bidder, if awarded the contract, will undertake the contract under the terms at which they bid. This bond's similarity with the Indiana State 415 23 form comes into play with its underlying purpose to safeguard the interests of the engaging party (in this case, the State of Indiana or the project owner) by ensuring the serious commitment of the applicant or bidder. However, while Bid Bonds are specifically for the bidding process of a project, ensuring that contractors can and will secure performance and payment bonds if selected, the Indiana State 415 23 form serves as a guarantee for permits related to infrastructural projects, ensuring compliance with state regulations and fulfillment of the agreed upon work.

Dos and Don'ts

Completing the Indiana State Form 415 23, also known as a Permit Bond, requires attention to detail and an understanding of the legal obligations it embodies. This document is crucial for individuals or entities applying for permits related to construction or modification activities within the jurisdiction of the Indiana Department of Transportation. To aid in this endeavor, here is a carefully compiled list of recommendations:

Do:
  • Review the entire form before filling it out. This ensures understanding of all requirements and sections, which facilitates accurate and complete disclosure of information.
  • Ensure accuracy of the information provided, including the full legal names of the principal and surety, correct addresses, and the precise penal sum committed to by the bond.
  • Specify the type of permit being applied for (e.g., Driveway Excavation, Pole Line, Bridge Attachment) clearly, to avoid any ambiguity regarding the scope of the project and the associated responsibilities.
  • Sign and date the form as indicated, with all parties involved (Principal and Surety) providing their signatures to validate the bond. Attach the Power of Attorney if required.
  • Have the bond notarized, as this legal form requires acknowledgment before a Notary Public to confirm the identities of the signatories and the veracity of their signatures.
  • Submit all 5 copies of the completed form to the designated Permit Manager to ensure proper processing and acknowledgment of your application and bond.
Don't:
  • Leave any sections blank. Incomplete forms may lead to delays in processing or outright rejection of the application.
  • Misrepresent any information, especially concerning the identities of the parties and the nature of the work to be done. Such actions can lead to legal repercussions, including the nullification of the permit.
  • Forget to include the total penal sum or mistakenly undervalue it, as this figure is critical to the enforcement and compliance elements of the bond agreement.
  • Overlook the need for a Power of Attorney attachment when the signing authority on behalf of the Principal or Surety is being exercised by an agent.
  • Fail to check the specific requirements for Notarization in Indiana, as these may differ from other jurisdictions and are vital for the document's legality.
  • Ignore filing deadlines and procedural timelines set forth by the Indiana Department of Transportation for permit applications and bond submissions.

Adherence to these guidelines will facilitate a smoother process in fulfilling statutory obligations and moving forward with projects that necessitate a Permit Bond in Indiana.

Misconceptions

Understanding the Indiana State 415 23 form can sometimes be confusing. Here are 9 common misconceptions clarified to help you better comprehend its use and implications:

  1. It's only for major construction companies. This form is applicable not just to large construction companies but also to small businesses and individuals needing a permit for projects like driveway excavation or bridge attachments.

  2. It covers all types of permits. The form specifically relates to permits for driveway excavation, pole line, bridge attachment, and similar projects. It does not cover every possible permit you might need from the Indiana Department of Transportation.

  3. The bond amount is the same for everyone. The penal sum of the bond, which is the maximum amount that might be paid out, varies based on the project's scope and other factors determined by the State of Indiana.

  4. Once submitted, the form guarantees a permit. Submission of the form and the associated bond does not guarantee permit approval. The application must be reviewed and approved based on its own merits and compliance with state regulations.

  5. No need to comply with the permit terms once it's issued. Compliance with the terms of the issued permit is vital. Failure to do so can result in the bond being forfeited and the permit revoked.

  6. The Surety's liability is unlimited. The surety (the guarantor of the bond) is liable up to the penal sum of the obligation. Liability does not extend beyond the stated amount, except for court costs and attorney fees in the event of non-compliance.

  7. The form is the only document needed for the permit. While the State Form 415 23 is crucial, it often needs to be accompanied by additional documentation such as plans or proof of insurance, depending on the specific project and requirements.

  8. Filling out the form is a one-time event. The requirements around these permits may necessitate updates or additional forms if project details change or if further permits are needed.

  9. The bond is automatically cancelled when the project is completed. Completion of the project does not automatically cancel the bond. A Notice of Termination of Liability must be submitted and approved for the bond to be formally cancelled.

Understanding these misconceptions can help ensure that your application process is smoother and more transparent, allowing you to focus on the success of your project.

Key takeaways

When dealing with the State Form 415 23, commonly referred to as the Permit Bond in Indiana, there are several key points to consider. This form plays a crucial role for individuals or entities planning to perform work that requires permission from the Indiana Department of Transportation (INDOT).

  • The purpose of the Indiana State Form 415 23 is to ensure that the principal (the applicant seeking the permit) will fulfill their obligations both in terms of conducting the agreed-upon work to INDOT's satisfaction and covering all lawful claims from contractors, vendors, and laborers related to labor, materials, or other services.

  • This form requires detailed information about the principal and the surety (the entity guaranteeing the principal's obligations), including addresses and the penal sum (the maximum amount for which the surety is liable).

  • The penal sum indicated on the form represents the maximum financial liability of the surety, ensuring that funds are available to cover costs arising from the principal’s failure to meet the obligations stated in the permit, including court costs and attorney fees over the penal sum if necessary.

  • Filling out the form accurately is paramount. It must include the specific type of work being permitted (e.g., Driveway Excavation, Pole Line, Bridge Attachment, etc.), the date, and signatures from both the principal and the surety. Additionally, the surety must attach a Power of Attorney, verifying their authority to enter into the agreement.

  • Termination of Liability is an important section of the form — it must be marked as either complied or canceled to inform INDOT about the status of the bond. This is crucial for record-keeping and ensuring that the bond is released or enforced according to the work's completion and compliance with the permit terms.

In conclusion, the Indiana State Form 415 23 is essential for ensuring compliance and financial security for projects requiring a permit from INDOT. Both principals and sureties must carefully review and complete the form to ensure that all legal and financial obligations are clearly understood and agreed upon, thereby facilitating a smooth process for obtaining the necessary work permits.

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