Form 440-2014 - Surety Bond printable pdf download

Oregon Department of Consumer & Business Services

Division of Finance & Corporate Securities — Securities Section

350 Winter St. NE, Room 410, Salem, Oregon 97301-3881

Mailing address: P.O. Box 14480, Salem, OR 97309-0405

(503) 378-4140 • Fax: (503) 947-7862 • TTY: (503) 378-4100

Bond No.: ______________

SURETY BOND

(ORS 59.175(4))

Principal: _________________________________________________________________________________

has applied to the Securities Section of the Oregon Department of Consumer & Business Services, Division of Finance and Corporate

Securities, for a license as an Oregon-based state investment adviser under ORS Chapter 59 and is required by ORS 59.175 to furnish

a bond in the sum of $10,000, U.S. legal tender.

Surety: ___________________________________________________________________________________

is a corporation authorized by the insurance commissioner to transact insurance in the State of Oregon and is obligated to pay the sum

of $10,000 to the State of Oregon for the use of said state and any person who has a cause of action against the principal.

If the principal and its agents and employees comply with the provisions of Oregon Securities Law, this obligation shall be void. If the

principal or its agents or employees violate any provisions of Oregon Securities Law and fail to pay all damages suffered by any person

due to violation of Oregon Securities Law, the surety is obligated to pay those damages suffered as a result of the violations up to $10,000.

This bond becomes effective on __________________ and shall remain in force until the Securities Section of the Department of

Consumer & Business Services, Division of Finance and Corporate Securities, releases the surety from liability, or until the surety cancels

this bond. The surety may cancel this bond and be relieved of further liability hereunder by giving 30 days' written notice to the principal

and to the Securities Section of the Department of Consumer & Business Services, Division of Finance and Corporate Securities.

This bond shall be a continuing obligation, and the liability of the surety for the aggregate of any and all claims that may arise shall not

exceed $10,000.

This surety and its heirs, personal representatives, successors, and assigns, and the principal and its heirs, personal representatives,

successors, and assigns bind themselves, jointly and severally, to the State of Oregon by this agreement.

Principal: __________________________________________________________________________

Address: ___________________________________________________________________________

City: __________________________________ State: ____________________ ZIP:______________

By (Typed name): ____________________________________________________________________

Signature: __________________________________________________________________________

Date: ______________________

Surety: ____________________________________________________________________________

Address: ___________________________________________________________________________

City: __________________________________ State: ____________________ ZIP:______________

By (Attorney in fact/registered agent — typed name): ________________________________________

Signature: __________________________________________________________________________

Date: ______________________

440-2014 (7/03COM)

Form 440-2014 - Surety Bond