This form is to be used in cases where it is desired to cover the excess of a Direct Writing Company's
underwriting limitation by reinsurance instead of co-insurance on Miller Act payment bonds running to the
United States. See FAR (48 CFR) 28.202-1 and 53.228(i).
Execute and file this form as follows:
Original and copies (as specified by the bond-approving officer), signed and sealed, shall accompany the bond
or be filed within the time period shown in the bid or proposal.
One carbon copy, signed and sealed, shall accompany the Direct Writing Company's quarterly Schedule of
Excess Risks filed with the Department of Treasury.
Other copies may be prepared for the use of the Direct Writing Company and Reinsuring Company. Each
Reinsuring Company should use a separate form.