19 Miss. Code. R. 1-36.13
SURETY BOND FOR PUBLIC ADJUSTER FILED WITH THE MISSISSIPPI INSURANCE DEPARTMENT
STATE OF ____________________
COUNTY OF ____________________ This form shall not be altered in any way.
Part 1: Bond, Surety and Principal.
| Bond #: | Original Bond Date of Issuance: | If a Continuation Bond, Effective Date: |
| Name of the Surety Company: | NAIC # of Surety Company: | MID License Number of Surety Company: |
| Name of Principal (Public Adjuster) | MID License Number of Public Adjuster: | Amount of Bond: $50,000.00 |
Part 2: Type and Bond Amount.
The type and amount of the bond for one year commencing on the original date of issuance or continuation stated hereinabove at Part 1 is as follows:
Public Adjuster, Bond Equal to Fifty Thousand current U.S. Dollars ($50,000.00)
Part 3: KNOW ALL MEN BY THESE PRESENTS THAT, the Principal and Surety, who, after being duly sworn, deposed and said:
THAT they are firmly bound unto the Commissioner of Insurance , State of Mississippi, or his successor in office, under the surety bond, delivered in lieu of errors and omissions liability insurance coverage, conditioned only for and dedicated exclusively to the prompt payment of all claims arising and accruing to any persons who sustained damages as a result of the Principals erroneous acts, failure to act, conviction of fraud, or conviction of unfair practices in his capacity as a public adjuster for which the Principal and Surety bind themselves, their heirs, administrators, executors, successors and as signs, jointly and severally, by this agreement;
THAT the Commissioner of Insurance shall be authorized to recover on behalf of any person in the State of Mississippi who sustained damages described herein;
THAT the condition of this obligation is such that if the above named Principal shall well and faithfully discharge and perform the duties incumbent on him under the provisions of all applicable laws, including but not limited to Title 83 of the Mississippi Code and Mississippi Insurance Department Regulation 2007-4, then in such case the above obligation is to become null and void, else to remain in full force, effect and virtue;
THAT the provisions of all applicable laws, including but not limited to Title 83 of the Mississippi Code and Mississippi Insurance Department Regulation 2007-4, for principals and sureties are applicable;
THAT this surety bond shall not be terminated unless at least thirty days' prior written notice will have been filed with the Commissioner of Insurance, State of Mississippi, and given to the principal;
THAT this obligation may be continued for any subsequent year by a continuation certificate duly signed and sealed by the Principal and Surety, subject to the terms and conditions of the original bond, and filed with the Commissioner of Insurance, State of Mississippi;
IN WITNESS THEREOF, Principal and Surety have executed this bond on the dates stated hereinbelow.
Part 4. Signatures and Notary. Complete all information BY:
___________________________________________________ __________________________
Principal Date Surety's Authorized Representative Date
___________________ ______________________________ _________________
Print Name Print Name/Title of Surety's Authorized Representative
_________________________________ ____________ ________________
Physical Address of Principal Physical Address of Surety
Subscribed and sworn to before me this the _______ day of _______, 20__
{Seal of Notary Public}
_________________________________
Notary Public
If a power of attorney used, a copy of the power of attorney or the authorized agent of the surety company must accompany the bond.
19 Miss. Code. R. 1-36.13