Fl Bond Issuance Form (Page 2 of 2) in pdf

4. Every credit grantor damaged as a result of unlawful or fraudulent commercial collection

activities of the failure of principal, or any salesperson, agency or representative thereof, to comply with

the provisions of Chapter 559, Part V, and the duly promulgated rules that may be issued now or hereafter

of the State of Florida, Office of Financial Regulation, or it successors, and other lawful orders of the

State of Florida, Office of Financial Regulation, or its successors, and any amendments to them, may

bring an action in a proper court on this bond for the amounts of damages sustained as a result of unlawful

or fraudulent commercial collection practices or for the failure of principal, or any employee, agent or

representative thereof, to comply with the provisions of Chapter 559, Part V, and duly promulgated rules

that may be issued now or hereafter of the State of Florida, Office of Financial Regulation, or its

successors, and other lawful orders of the State of Florida, Office of Financial Regulation, or its

successors, and any amendments to them.

5. The aggregate liability of surety under this bond shall not exceed in any and all cases the sum

of $50,000.

6. In the event principal and surety, or either of them is served with notice of any action brought

against principal or surety under this bond, written notice of the filing of such action shall be immediately

given by principal or surety, as each is served with notice to the action, to the State of Florida, Office of

Financial Regulation, 200 E. Gaines Street, Tallahassee, FL 32399-0376 or its successors, by United

States certified mail.

7. THE BOND IS EFFECTIVE THIS _________________ DAY OF ______________, _____.

IN WITNESS WHEREOF the said principal has caused these presents to be executed by affixing

hereto the signature of its duly authorized representative and its corporate seal to be affixed hereto

attested by its duly authorized representative, and the said surety has caused these presents to be executed

by the signature of its duly authorized representative and its corporate seal to be affixed hereto attested by

its duly authorized representative this _______ day of ___________________, ______ and shall be

deemed to be continuous; subject to cancellations as hereinabove provided.

________________________________________

_____________________________________

NAME OF WITNESS AS TO PRINCIPAL

NAME OF PRINCIPAL

(SEAL)

_____________________________________

NAME OF DULY AUTHORIZED

REPRESENTATIVE OF PRINCIPAL

_____________________________________

SIGNATURE OF DULY AUTHORIZED

REPRESENTATIVE OF PRINCIPAL

________________________________________

SIGNATURE OF WITNESS AS TO PRINCIPAL

_____________________________________

(SEAL)

NAME OF SURETY

_____________________________________

NAME OF DULY AUTHORIZED

REPRESENTATIVE OF SURETY

_____________________________________

SIGNATURE OF DULY AUTHORIZED

REPRESENTATIVE OF SURETY

NOTE: SIGNATURE OF PRINCIPAL MUST BE WITNESSED.

OFR-CCA-101 Revised 5-01-2004

Fl Bond Issuance Form Page 2

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