Application Form For Parties Wishing To Offer, Render, Furnish, Or Supply Electricity Or Electric Generation Services To The Public In The Commonwealth Of Pennsylvania Page 23
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31Appendix D (Continued)
Page 2 of 2
Example Bond
Bond Number:____________________
KNOW ALL MEN BY THESE PRESENTS that APPLICANT NAME as Principal, and XYZ
Insurance Company of CITY, STATE, as Surety, are firmly bound unto Pennsylvania Public Utility
Commission, as obligee, in the penal sum of ___________________dollars ($_________), lawful money of
the United States of America for the payment of which, well and truly to be made, we bind ourselves, our
heirs, executors and administrators, successors and assigns, jointly, severally, and firmly by these presents.
SIGNED, SEALED AND DATED THIS day of Month, Year
THE CONDITION OF THIS OBLIGATION IS SUCH, that Whereas the Principal has made
application for a license to the Obligee to offer, render, furnish or supply electricity or electric generation
services to the public.
NOW THEREFORE, the condition of this obligation is such that the Principal must act in accordance
with Section 2809(c)(1)(i) of the Public Utility Code, 66 Pa. C.S. 2809(c)(1)(i), to assure compliance with
applicable provisions of the Public Utility Code, 66 Pa. C.S. 101, et seq. and the rules and regulation of the
Pennsylvania Public Utility Commission by the Principal as a licensed electric generation supplier; to ensure
the payment of Gross Receipts Tax as required by Section 2810 of the Public Utility Code, 66 Pa. C.S.
2810; and to ensure the supply of electricity at retail in accordance with contracts, agreements or
arrangement. Payment of claims shall have the following priority: (I) The Commonwealth of Pennsylvania;
(II) Electric Distribution Companies for the reimbursement of Gross Receipts Tax; and (III) Private
Individuals. Proceeds of the bond may not be used to pay any penalties or fines levied against the Principal
for violations of the law, or for the payment of any other tax obligations owed to the Commonwealth of
Pennsylvania.
NOW THEREFORE, if the Principal shall, during the period commencing on the aforesaid date,
faithfully observe and honestly comply with such rules, regulations and statutes that are applicable to an
electric generation supplier licensed in Pennsylvania and fulfills its obligation to pay the Gross Receipts Tax
to the Commonwealth, and to deliver electricity at retail in accordance with contracts, agreements and
arrangements, require the execution of this bond, then this obligation shall become void and of no effect.
PROVIDED, the Surety may terminate its future liability under this Bond sixty (60) days after
furnishing written notice of such intention to terminate. This termination shall not affect the liability of the
Surety and the Principal for any liability incurred by the Principal prior to the effective date of such
termination. Any claim under this bond must be instituted within three (3) months of the effective date of
termination.
THIS BOND WILL EXPIRE Month Day, Year, but may be continued by continuation certificate
signed by Principal and XYZ. XYZ may at any time terminate its liability by giving sixty (60) days written
notice of the Obligee, and XYZ shall not be liable for any default after such sixty-day notice period, except
for defaults occurring prior thereto.
Signed, sealed and dated Month Day, Year.
_______________________________________
Principal
_______________________________________
COUNTERSIGNED BY
Surety
______________________________
By_______________________________________
Surety Agent
Attorney-in-Fact
20
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