Form Ca-643-002 - Collection Agency Or Out-Of-State Collection Agency Surety Bond
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1COLLECTION AGENCY SECTION
COLLECTION AGENCY OR OUT-OF-STATE
BUSINESS AND PROFESSIONS DIVISION
PO BOX 9045
COLLECTION AGENCY SURETY BOND
OLYMPIA, WA 98507-9045
Sole Proprietor
Partnership
Corporation
KNOW ALL PERSONS BY THESE PRESENTS: That _____________________________________________________
APPLICANT/OWNER
________________________________________________________________________________________________
doing business as __________________________________________________________________________________
BUSINESS NAME
as Principal, at the following address _____________________________________________________________ and/or
BUSINESS ADDRESS
________________________________________________________________________________________________
a corporation organized and existing under the laws of the State of ___________________________________________
and authorized to transact surety business in the State of Washington, as Surety, are held and firmly bound unto the STATE
OF WASHINGTON in the sum of $5000 Dollars lawful money of the United States of America to be paid to the said State of
Washington, for which payment well and truly to be made, we bind ourselves, our heirs, executors, administrators, successors
and assigns, jointly and severally firmly by these presents.
THE CONDITION OF THE ABOVE OBLIGATION IS SUCH THAT: Whereas, the said principal has made application for a
Collection Agency or Out-of-State Collection Agency license by the Business and Professions Division of the State of
Washington for carrying on the business of a Collection Agency or Out-of-State Collection Agency within the State of
Washington; and is required by Chapter 19.16 RCW to furnish a bond in the penal sum of $5000 Dollars with good and
sufficient surety, conditioned as required by said law.
NOW, THEREFORE, If the said principal will comply with all the provisions of Chapter 19.16 RCW of the State of Washington
and with all rules and regulations adopted by the Director of the Department of Licensing, of said state pursuant to the
provisions of Chapter 19.16 RCW and will pay all amounts that may be adjudged against principal by reason of violation of
Chapter 19.16 RCW or any rules or regulations adopted pursuant thereto in the conduct of principal's business as a Collection
Agency or Out-of-State Collection Agency then the above obligation shall be null and void; otherwise to remain in full force
and effect.
PROVIDED: That any person having a claim against the principal for damage as a result of any violation by principal or his/
her agent of Chapter 19.16 RCW or any rules or regulations adopted pursuant thereto may bring a suit on this bond in the
Superior Court of the County in which the principal's business is located, or of any county in which jurisdiction of the principal
may be had.
PROVIDED FURTHER: That the aggregate liability of the Surety hereunder for any and all claims presented shall not exceed
the penal sum of this bond. PROVIDED FURTHER: That the Business and Professions Divisions shall be notified prior to
the cancellation of this bond, along with the reason for cancellation or termination. No bond filed shall be approved unless
it expressly provides that it will be effective for one year following the effective date of its cancellation or termination, whether
because of expiration, suspension, or revocation of the license, or otherwise, as to any covered act or acts and omission or
omissions of the licensee occurring on, or prior to, the effective date of cancellation or termination.
IN WITNESS WHEREOF, the said principal and the said Surety have affixed their hands and seal this _______________
day of _____________________________ , _____.
Effective date of bond _________________________
Bond Number ________________________________
SIGNATURE OF PRINCIPAL
SURETY
__________________________________________________
Name _____________________________________
SIGNATURE OF APPLICANT/OWNER OR INDIVIDUAL AUTHORIZED
TO SIGN FOR PARTNERSHIP OR CORPORATION
Attorney-in-Fact _____________________________
(SURETY SEAL)
Agency Name _______________________________
Resident Agent ______________________________
Address ____________________________________
The Department of Licensing has a policy of providing equal access to its services. If
you need special accommodation, please call (360)664-1389 or TTY (360)586-2788.
CA-643-002 COLL. AGENCY BOND (R/2/00)M/W
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