Leased Nursing Home Surety Bond Form - Agency For Health Care Administration (Page 2 of 2) in pdf

The liability of the surety on this bond shall cease sixty (60) days after receipt of the termination notice by the Agency,

and principal, or on the filing and acceptance of a new bond whichever first occurs; and the bond shall terminate and be of

no further force and effect, except as to any liability, debt, or other obligation incurred or accrued prior to the effective

date of such termination. The principal insured under the bond shall, within thirty (30) days of the filing of the notice of

termination, provide the Agency with a replacement bond.

5. In the event principal and surety, or either of them, cancels this bond or is served with notice of any action brought

against principal or surety under this bond, written notice of the cancellation or filing of such action shall be immediately

given by both principal and surety, as each is served with or generates notice of the action to:

The State of Florida, Agency for Health Care Administration, General Counsel’s Office, MS 3,

2727 Mahan Drive, Tallahassee, FL 32308.

6. In the event any action or proceedings are initiated with respect to this bond, the parties agree that the venue shall be in

Leon County, State of Florida.

7. Should any proceedings be necessary to enforce this bond, obligee shall be allowed to recover attorney fees, in addition

to other sums found due.

8. It is agreed that this bond shall be governed by and construed in accordance with the laws of the state of Florida.

9. Neither this bond nor the obligation of this bond, nor any interest in the bond, may be assigned without the prior,

express and written consent of surety.

10. No right of action shall accrue on or on account of this bond for the use or benefit of any individual, partnership,

corporation, or other entity, other than named obligee.

The premium for this bond is _____________________________________________________dollars

($________________________).

NURSING FACILITY LICENSEE

SURETY COMPANY

____________________________

_____________________________

Principal Representative

Surety Representative

SIGNED and SEALED in the presence of:

__________________________________

______________________________

Witness

_________________________________

______________________________

Witness

Executed at ______________________, Florida, this

___________ day of ________________, _______

Date

Month

Year

Note: Attach to this Bond a properly certified copy of the Agent’s Power of Attorney

AHCA Form 3110-6009 A – July, 2001

Leased Nursing Home Surety Bond Form - Agency For Health Care Administration Page 2