Form Mv-126-Ds-P - Surety Bond Form Sample, Integrity Surety Bond Application

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Bond No
MV-126-DS-P
.__________________________
Rev. 4-2008
SURETY BOND
KNOW ALL MEN BY THESE PRESENTS:
That _________________________________________________________________________
of
(Name of Dealership as it appears on Dealer License)
the City of _______________________, County of __________________, West Virginia, as PRINCIPAL,
and the _______________________________________________________________________________,
(Name of Insurance/Bonding Company)
a corporation, authorized to do business in the State of West Virginia, as SURETY, are held and firmly
bound, effective the _________ day of _________________________, _________, unto the West Virginia
Division of Motor Vehicles (DMV) in the penal sum of Twenty Five Thousand Dollars ($25,000) for
payment to the West Virginia DMV, we bind ourselves, our successors and assigns, jointly and severally
firmly by these presents.
THE CONDITION OF THIS BOND IS SUCH THAT, if the Principal practices any fraud or
makes any fraudulent representation which causes a financial loss to a purchaser, seller, financial institution
or agency, or the State of West Virginia, then the Surety is obligated to pay the penalty sum of Twenty Five
Thousand Dollars ($25,000) to the West Virginia DMV.
The Surety shall notify the West Virginia DMV by certified mail, within thirty days of
cancellation of the bond by the Surety or the Principal. If the Surety fails to notify the West Virginia DMV
within the thirty days, then the bond will be deemed to be in full force and effect until such cancellation
notice is received by the West Virginia DMV. This bond is required of all dealers licensed pursuant to
Article 6, Chapter 17A of the West Virginia Code. All pertinent sections of that statute and all pertinent
rules and regulations of the West Virginia DMV are hereby expressly made a part of this bond.
IN WITNESS WHEREOF the said Principal has hereunder set his or its hand, and the said Surety
has caused its corporate name to be signed hereto by its duly authorized official or agent and executed this
instrument the ___________ day of ________________________________, ______________.
This bond covers acts and omissions by the Principal that occur during the license year July 1,
______________, to June 30, _________, as of the effective date the Principal is issued or renewed license
by the West Virginia DMV.
___________________________________________
Name of Dealership
___________________________________________
Signature of Individual, Partner, or Corporate Officer
___________________________________________
Name Surety/Bonding Company
___________________________________________
Address of Surety/Bonding Company
___________________________________________
Authorized Company Representative
___________________________________________
Signature of Authorized Company Representative
Bond forms change; this is for educational purposes only.

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