Public Adjuster'S Bond Form - Illinois Department Of Insurance

ADVERTISEMENT

Illinois Department of Insurance
320 West Washington Street
Springfield, IL 62767-0001
Public Adjuster's Bond
Co. Code # ________________
Bond # ___________________
Tax # _____________________
KNOW ALL MEN BY THESE PRESENTS, THAT I ______________________________________________
of ___________________________________________________________, a Public Adjuster doing business as
____________________________________________________________________________, as principal and
__________________________________________________________ a company duly authorized to transact
surety business in the State of Illinois, as Surety, are held and firmly bound unto the People of the State of Illinois and
payable to any party injured under the terms and conditions of this bond, in the full and penal sum of Five Thousand
($5,000) 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, administrators, successors and assigns, jointly and severally, firmly by
these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH that the above bonded Principal is now or is about to
become licensed to engage or continue in the business of a Public Adjuster, as provided by the Illinois Insurance
Code, as amended.
NOW, THEREFORE, if the said Principal shall, while this bond is in force and effect make a full accounting and
due payment to the person or company entitled thereto of funds coming into his possession as an incident to
transactions under his license, and shall comply with all the provisions of the "Public Adjuster's Regulatory Act," then
this obligation shall be null and void; otherwise to remain in full force and effect.
PROVIDED, HOWEVER, that this bond shall be continuous in form and may be terminated by the Surety, upon
its giving thirty (30) days notice of its intention of termination, such notice to be filed with the Director, Department of
Insurance, Springfield, Illinois.
IN WITNESS WHEREOF, the said principal has hereunto set his hand and seal, and the said surety has
caused these presents to be signed by its duly authorized officers and its corporate seal to be hereto affixed this
_________ day of _____________________, 20______.
(Principal)
(Bonding Company)
(Social Security Number)
(Officer)
(Attorney-in-Fact)
Important Notice: Under the Illinois Revised Statutes' insurance laws, disclosure of this information is voluntary; however, failure to comply
may result in this form not being processed. This form has been approved by the Forms Management Center.
PAB Rev. 5/09
Public Adjuster's Bond

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Legal
Go