Form 780 2054 PDF Details

The Missouri Department of Natural Resources has instituted the Personal Bond – Secured by Surety Bond, commonly known as Form 780, as a critical mechanism to ensure compliance and financial responsibility among contractors permitted for activities such as the drilling of water, heat pump or monitoring wells, and the installation of pumps. This contractual document binds the contractor (obligator) and the surety (a party that guarantees the obligator's performance) to the State, representing a pledge of a penalty sum in lawful U.S. money for the faithful completion of drilling or installation work according to the state's regulatory standards. The bond's key feature is that it is payable to the Groundwater Protection Fund, and its execution guarantees that contractors adhere to stringent conditions set forth by the Missouri Well Installation Board. These conditions mandate compliance with state laws, rules, and regulations concerning well construction and plugging, with failure to comply resulting in the forfeiture of the bond. Such measures ensure that operations do not detrimentally affect Missouri's groundwater resources. Furthermore, the bond outlines conditions under which it may be canceled and specifies the protocol for executing the bond, including requirements for corporate principals and agents acting under power of attorney. The thoroughness of Form 780 safeguards public and environmental health, reflecting Missouri's commitment to maintaining the integrity of its natural resources.

QuestionAnswer
Form NameForm 780 2054
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesexecutors, Groundwater, MISSOURI, how to fill up personal bond form

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MISSOURI DEPARTMENT OF NATURAL RESOURCES

GEOLOGICAL SURVEY PROGRAM

PERSONAL BOND – SECURED BY SURETY BOND

NAME OF SURETY

ADDRESS

CITY

STATE

ZIP CODE

As Surety, authorized to do business in Missouri, are held firmly bound unto the State in the penal sum as indicated, lawful money of the United States, for which payment, well and truly be made, we bind ourselves, and each of us, and each of our heirs, executors, administrator or successors, and assigns jointly and severally, firmly by these presents.

CERTIFICATE NO.

ISSUING BANK (IF MORE ROOM IS NEEDED, PLEASE LIST ON BACK OF FORM)

AMOUNT

Each Surety Bond described above is payable to the Groundwater Protection Fund, and shall be kept in the custody of the State of Missouri until successful completion of the conditions of this obligation, and shall be forfeitable by the State of Missouri, acting through the Well Installation Board, if the conditions of this obligation are not met.

The condition of this obligation is such, that whereas the above-named obligator will be a permitted contractor for the drilling of water, heat pump or monitoring wells or for the installation of pumps and that the obligator will undertake operations and complete plugging in accordance with the statutes, the rules, regulations and orders of the Well Installation Board, and that this bond is subject to forfeiture pursuant to the statutes and regulations for failure to so comply.

Now, therefore, if the obligator shall comply with all of the provisions of the laws of this State, the rules, regulations and orders of the Missouri Well Construction Rules, including the proper construction, proper plugging and filing with the Department all required forms, this obligation is void; otherwise, the same shall be and remain in full force and effect. This obligation may be canceled by said Surety by giving thirty (30) days notice in writing of its intention to do so to said Obligee; and provided further, that nothing herein shall affect any rights or liabilities which shall have accrued under this bond prior to the date of termination; and the said Surety shall be relieved of any further liability under this bond thirty (30) days after receipt of said notice by the said Obligee.

Witness our hands and seals,

day of

, 20 .

 

 

 

 

 

____________________________

Principal

____________________________

Surety

State of _____________________ )

) SS.

County of ___________________ )

 

 

 

 

 

 

Appeared before me on this

day of

, 20 ,

 

 

 

 

 

 

 

____________________________, to me personally known, who executed the above as his or her free act and deed.

 

 

 

________________________________

 

 

Notary Public

 

 

 

My Commission Expires_

 

_______

Note: If the principal is a corporation, the bond should be executed by its duly authorized officers, with the seal of the corporation affixed. When principal or surety executes this bond by agent, power of attorney or other, evidence of authority must accompany the bond.

APPROVAL BY DIVISION

SIGNATURE

DATE

780-2054 (09-10)

REMIT TWO (2) COPIES TO:

MISSOURI DEPARTMENT OF NATURAL RESOURCES, WELLHEAD PROTECTION SECTION

 

PO BOX

250, ROLLA, MO 65402 573-368-2450 – ONE COPY WILL BE RETURNED

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