UNITED STATES DISTRICT COURT 

DISTRICT OF OREGON 

PORTLAND DIVISION 

UNITED STATES OF AMERICA 

vs 

JAMIE FAYE COBAT, dba artificial entity 

Affiant/Defendant. 

by; jamie faye; of family Cobat - A Living Soul, as Sui Juris 

Date: 27, June 2017 

To: Michael S. Mosman 

To: Mary L. Moran 

the above case is; 

CASE NO 3:16-CR-187-MO 

ACCEPTED FOR HONOR ON BEHALF OF 

THE UNITED STATES 

ACCEPTED FOR VALUE AND CONSIDERATION, EXEMPT FROM LEVY, 

WITH HONOR. PLEASE DEPOSIT TO ACCOUNT of UNITED STATES, 

50 USC 4305 B (2) "Any payment, conveyance, transfer, assignment, or delivery of 

property or interest therein, made to or for the account of the United States, or as 

otherwise directed, pursuant to this subdivision or any rule, regulation, instruction, or 

direction issued hereunder shall to the extent thereof be a full acquittance and 

discharge for all purposes of the obligation of the person making the same; and no 

person shall be held liable in any court for or in respect to anything done or omitted in 

good faith in connection with the administration of, or in pursuance of and in reliance 

on, this subdivision, or any rule, regulation, instruction, or direction issued hereunder." 

(formerly 12 USC 95 (A) (2) 

Case 3:16-cr-00187-MO Document 101-1 Filed 08/07/17 Page 1 of 22
Pay to the order of the UNITED STATES TREASURY 

Without Recourse 

Instructions and Orders: 

Accepted for value, Exempt from Levy 

H.J. Res. 192, ?3rd Cong., 1st Sess. Approved June 5, 1933, 4:30 p.m. 

Executive Order 61 02 

Notice of Mandate Authority by Claim of Right 

Signatur~, ~ <6_'i:YJ,f-; DATE: 06/27 /2017 27th day, of June, 2017 

Exempti ID#JAOE COBAT I 543-78-0979 SS# 

Deposit to the U.S. Treasury OBA The Internal Revenue Service 

Charge the same to JAMIE FAYE COBAT 543780979 CUSIP branch with the 

remittance. 

803119906 

Case# 3:16-CR-187-MO 

I have accepted this on behalf of the United States. Here is the clear concise and 

unequivocal Mandate/transfer order, you may collect at 

Department of The Treasury 

1500 Pennsylvania Avenue, N.W. Washington, D.C. 20220, 

my obligation to the court is done as per 50 USC 4305 b(2) "formerly 12 USC 95(a)" 

As we the people are the highest authority in the land, we have the authority to create a 

mandate. 

Warning: If notice is not answered or mandate is not performed, silence confirms claim, 

otherwise liability has been imposed in the public without remedy. 

Respond or perform mandate within (15) Fifteen, Days of receiving this notice. 

Respectfully Submitted, Without prejudice, Without recourse 

jamie faye: Cobat 

"Title 28 U.S. Code Chapter 176 - The Federal Debt Collection Procedure places all courts 

under equity and commerce and under the International Monetary Fund." 

* 

The IRS is not a U.S. Government Agency. It is an Agency of the IMF. 

(Diversified Metal Products v. IRS et al. CV-93-405E-EJE U.S.D.C.D.I. , Public Law 94-564, 

Senate Report 94-1148 pg. 5967, Reorganization Plan No. 26, Public Law 102-391 .) 2. 

Case 3:16-cr-00187-MO Document 101-1 Filed 08/07/17 Page 2 of 22
The IMF is an Agency of the UN. (Blacks Law Dictionary 6th Ed. Pg. 816) 3. 

The U.S. Has not had a Treasury since 1921. 

* 

The U.S. Treasury is now the IMF. (Presidential Documents Volume 29-No.4 pg. 113, 22 U.S.C. 

285-288) 

* 

"Federal Rules of Civil Procedure (FRCP) 4j states that the Court jurisdiction and immunity fall 

under a foreign state." 

* 

"Title 28 U.S. Code 3002 Section 15A states United States is a Federal Corporation and not a 

government, including the Judicial Procedural Section." 

* 

"Title 8 U.S. Code 1481 states once an oath of office is taken, citizenship is relinquished, thus 

one becomes a foreign entity, agency, or state. That means every public office is a foreign state, 

including all political subdivisions. (i.e. every single court is considered a separate foreign 

entity)." 

UCC 1-308, UCC 1-207, UCC 3-419, UCC 10-104, UCC1-104, PUBLIC POLICY 73-10, 

TITLE 18 SECTION 8, USC 3123, USC 5103, HOUSE JOINT RESOLUTION 192 OF 

JUNE 5 1933, ARTICLE 6 CLAUSE 3 CONSTITUTION, UNDER 1 OTH & 14TH 

AMENDMENT, USC TITLE 18 PART I CHAPTER 13 U.S CIVIL CODE 241 & 242, 

"Marbury v. Madison 5 U.S. 137 1803, 

CONTRACT LAW, ADMIRALTY LAW, TRUST LAW, COMMON LAW JURISDICTION, § . 

1-103. c:::c,, 

STATE OF OREGON, } 

L SS. 

County of __ Q_\(e_ __________________________________ _ 

On ___ J _une ___ ~~CL.1-011 _________________ , before me personally appeared _JQm!:t:,__f_O..¥e __ Co_k_t _____ _ DATE 

FORM No. 23 - ACKNOWLEDGMENT, INDIVIDUAL EA © 1992-2001 STEVENS-NESS LAW PUBLISHING CO., PORTLAND, OR www.stevensness.oom 

J 

Case 3:16-cr-00187-MO Document 101-1 Filed 08/07/17 Page 3 of 22
CEASE AND DESIST 

Nemo me im une lacessit. 

PRIVATE 

Tms IS NOT A PUBLIC COMMUNICATION 

Notice to agent is Notice to principle 

Notice to principle is Notice to Agent 

Applications to all successors and assigns 

To; U.S. DISTRICT COURT 

MARK 0. HATFIELD U.S. Courthouse 

From; jamie faye; Cobat Familey 

Always retaining all rights. 

Care of postal service address: 

2189 Mayfly St. 

Lebanon, Oregon union state 

USA without USDC 

Zip exempt, but near 97355 

Attn: Federal Courthouse, U.S. Marshall's and to all it may concern. 

1000 SW 3rd Ave. NW 

Washington DC 20224 

Attachments: 

1) Birth certificate. 

It is a fact that: I am a natural born, American State National of Oregon State, in its constitutional capacity, as one of the several states of the Union. And I am an inhabitant thereof. 

It is a fact that: My birth certificate is proof that I am a State Citizens. See attached birth certificate. 

It js a fact that: I am not a United States citizen, resident, person, individual or any other legal 

fiction, nor have I ever been. 

It is a fact that: I explicitly reserve all of my rights always and forevermore. 

It is a fact that: That the United States, with intent and great deception, uses the term "United 

States citizen'', to deprive the people of their rights, their birth rights, their property and freedom. 

And further, to relegate the status of the people, to that of livestock or chattel. 

I owe you nothing nor do you have any jurisdiction over me. Your constant unceasing letters 

from you and your satellite departments that harass, threatens, attempts at coercion, scare tactics, 

stalking and all other actions are depriving me of our right to tranquility guaranteed by the preamble of, and the rest of the constitution for the United States of America. You are violating the 

RICO laws, stocking laws, mail fraud laws, depriving rights under color of law as well as the 

common law and the constitution. Your actions are also acts of treason and tyranny. 

Case 3:16-cr-00187-MO Document 101-1 Filed 08/07/17 Page 4 of 22
CEASE AND DESIST 

Nemo me impune lacessit. 

I ORDER YOU TO CEASE AND DESIST ALL ACTIVITIES AGAINST ME! 

Jamie Faye; Cobat House and Family thereof 

Seventeenth day of July in the year of our Lord 2017 

Without Prejudice - Without Recourse 

ucc 1-308 

Notice to Principal is Notice to Agent, Notice to Agent is Notice to Principal 

Case 3:16-cr-00187-MO Document 101-1 Filed 08/07/17 Page 5 of 22
ABID 

0 0 60 0 (Unct r $10 ) 

Apphc.abon: This bond g arantees that 1f b1d of pn 01pal ts low. they will enter into a contract and 

ftle a ear!PllJlilnxt ijggd. 

B D 60 D (Ov S 001'<) 

APObeahon This ond g r~ t that 1f 1<! of pr c;.p I 1 I . th 'I will nt r into a eontr;JICt ana 

fl a Performance BondPAY E 80 D (Und S100K) 

A p-;>ymcQI bond 1:s given by tJ concr 

.wh1 o 

be oonta1ned the pe(f · ooe bond. 1n v. 

(payment bond rS not 15-sued. 

r gu nt s 

P R 0 °"' •U.nd .r StOOK} 

Appbcation: The Contract Performance Bond 1-s given by a cootrac or to an owner guarantees. 

at they I fa h lly perform the terms and coodi ions of a written contract. 

~··~·················••1••···········,········~················ .....••.••.••..•.... 

Admiralty Bond 

Case 3:16-cr-00187-MO Document 101-1 Filed 08/07/17 Page 6 of 22
110 (Insurance) 

120 (Contract: Marine) 

130 Miller Act 

Case 3:16-cr-00187-MO Document 101-1 Filed 08/07/17 Page 7 of 22
Surety Bonds 

31 C.F.R. § 224.6 - Sample Power of Attorney 

A surety appointing an individual as its process agent, pursuant to 31 U.S.C. § 9306 and 31 C.F.R Part 224, 

may use the following language to meet applicable power of attorney requirements. While use of this sample 

language is not required, any power of attorney.filed should use substantially the same terms: 

Know all men by these presents, that the -------------------- a corporation existing under and by virtue of the 

laws of the State of -- -----------------and having its principal office at------:--------------, desiring to comply 

with section 9306 of Title 31, United States Code, hereby constitutes and appoints----------, of------------------

--,its true and lawful attorney and agent in and for the------------------- judicial district of------------------, 

upon whom all lawful process in any action or proceeding against the company in said district may be served 

in like manner and with the same effect as if the company existed therein, and who is authorized to enter an 

appearance in its behalf. 

In witness whereof the said company, pursuant to proper authority of its board of directors or other governing 

body, has caused these presents to be subscribed by its ------------president and its corporate seal to be affixed 

hereto this------ day of------------, a.cl 20--

[Corporate Seal] 

-------------------------- President, 

State of --------------------

County of--------------------, ss: 

On this---------- day of------------, a.d. 20--, before me appeared----------~---------, president of the-----------

--------- Company, who being duly sworn, says that he is -------------------- president of the --------------------

Company; that he knows the corporate seal of the company; that the seal affixed to the foregoing instrument is 

such corporate seal; that it was affixed by order of the board of directors or other governing body of said 

company, and that he signed said instrument as -------------- president of said company by like authority. 

[Notary Seal] 

Case 3:16-cr-00187-MO Document 101-1 Filed 08/07/17 Page 8 of 22
REINSURANCE AGREEMENT FOR A BOND STATUTE PERFORMANCE BOND 

(See instructions on reverse) 

OMB Control Number: 9000-0045 

I Expiration Date: 7/31/2019 

Paperworl< Reduction Act Statement - This information collection meets the requirements of 44 USC§ 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You do 

not need to answer these questions unless we di~1ay a valid Office of Management and Budget {OMB) control number. The OMB control number for this co leclion :is 9000-0045. We 

estimate that it will take 60 minutes to read the instructions, gather the facts. and answer the questions. Send only comments relating to our time estimate. including suggestions for 

reducing this burden, or any other aspects oHhis cdllection of 1informalion to: General Ser.iices Administration, Regulatory Secretariat Division (M1V1CB), 1800 F Street, NW, 

Washington, DC 20405. 

1. DIRECT WRITING COMPANY° 1A. DATE DIRECT WRITING COMPANY EXIEClJJTIES THIS 

AGREEMENT 

18. STATE OF INCORPO:RATION 

2. REINSURING COMPANY' 2A. AMOlf<T OF THIS REINSURANCE($) 

2B. D ' E REINSURlNG COMPANY EXECUTES THIS AGREEMENT 

2C. STATE OF INCORPORATION 

3. DESCRIPTION OF CONTRACT 4_ DESCRIPTION OF BONO 

3A. AMOUNT OF CONTRACT 4A. PENAL SUM OF BOND 

3B. CONTRACT DATE 3C. CONTRACT NUMBER 4B DA BOND 4C. BOND NUMBER 

30. DESCRIPTION OF CONTRACT 

3E. CONTRACTING AGENCY 4E. ST A TE OF INCORPORATION (If Corporate Principal) 

AGREEMENT: 

(a) The Direct Writing Company named . bou111d as surety to the United States ·Of America on the performance bond described above, wherein the 

above described is the principal, for the protecr e United States on the cootract described above. The contract is for the construction, alteration, or repair 

of a public building or public work of the United State • the performance bo111d was furnished to the United States under 40 U.S.C. chapter 31 , subchapter Ill, 

Bonds, known as the Bonds Statute. The Direct Writing ompany has appfied to the Reinsuring Company named above to be reinsured and oounter-sectlfed in 

the amount shown opposite the name of the Reinsuring Company (referred to as the •Amount of this Reinsurance"). or for whatever amount less than the 

"Amount of this Reinsurance" the Direct Wriliflg Company is liable to pay under ·OT by virtue of the perfoanance bond. 

(b) For a sum mutually agreed upon, paid by the Direct Writing Company to the Reinsuring Company which acknowledges its receipt. the parties to this 

Agreement covenant and agree to the terms conditions of the agreement 

TERMS AND CONDITIONS: 

(a) The purpose and intent o this ag ement is to guarantee and indemnify the United States against loss under the performance and to the extent of the "Amount of this Reinsurance," or . y sum less than the "Amooot·of tllis Reirnsurance" that is owing and umpaid by the Direct Writing Company to the United 

States under the performance bo 

(b) 

Reinsu 

Writing 

agrees 

th Direct Writing Company fails to pay any default under the performance bond ·equal to or in e~cess of the 'Amount of this Reinsurance,' the 

ng Campa!!!'. covenants and a11rees to pay to the United States, the obligee on the performance bond, the 'Amount of this Reinsurance.· If the Direct 

om s to to the United States any default for a sum less than the "Amount of this Reinsurance" the Reinsuring Company ·covenants and 

the United tes the full amount of the default, or so much thereof that is not paid to the United States by the Direct Writing Company. 

(c) If there is a default on th performance bond for the "Amount of this Reinsurance," or mor·e. the Reinsuring Company .and the Direct Writing Company 

hereby covenant and agree Iha the United States may bring suit against the Reinsuring Company for the 'Amount of this Reinsurance" or, in case the amount of 

the default is for less than the • ount of this Reinsurance,• for the full amount of the default. 

WITNESS: 

' y and the Reirnsurirlg Company, respectively, have ·caused this Agreement to be signed .and impressed with their respective 

possessing power to sign this instrument, and to be duly attested by officers ·empowered thereto, on the day and date above written 

names. 

•items 1, 2, 40 - Furnish legal name, business eddress and ZIP Code. (Ove1' 

AUTHORIZED FOR LOCAL REPRODUCTION 

Previous edition is usable 

STANDARD FORM 273 {REV.4/2013) 

Prnscriibed lby GSA - FAR {48 CFR) 53.228(h) 

Case 3:16-cr-00187-MO Document 101-1 Filed 08/07/17 Page 9 of 22
5. DIRECT WRITING COMPANY 

5A(1) SIGNATURE (2) ATTEST: SIGNATURE 

Corporate 

58(1 ) NAME AND TITLE (Typed) (2) NAME AND TITLE (Type<f) Seal 

6. REINSURING COMPANY 

6A(1) SIGNATURE (2) ATTEST: SIGNATURE 

Corporate 

68(1) NAME AND TITLE (Typed) (2) NAME AND TITL£ (Type<f) Seal 

INSTRUCTIONS 

This form is to be used in cases where it is des·red to cover the excess of a Direct Writing Company's 

underwriting limitation by reinsurance instead of co..,insurance on Bonds Statute performance bonds 

running to the United States. See FAR (48 CFR) 28.202-1 and 53.228(h).. 

Execute and file this form as foHows: 

Original and copies (as specified by the bond-approving officer), signed and sealed, shall accompany th e 

bond or be filed within the time period shown in the bid or proposal. 

One copy, signed and sealed, shall accompany the Direct Writing Company's quarterly Schedule of Excess 

Risks filed with the Department of the Treasury. 

Other copies may be prepared for the use of the Direct Writing Company and Reinsuring Company. Eaoh 

Reinsuring Company should use a separate form. 

STANDARD FORM 273 (REV. 412013) BACK 

Case 3:16-cr-00187-MO Document 101-1 Filed 08/07/17 Page 10 of 22
REINSURANCE AGREEMENT FOR A BONDS STATUTE PAYMENT BOND 

(See instructions on reverse) 

OMB Control Number: 9000-0045 

Expiration Date: 7/31/2019 

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 USC§ 3507, as amended by section 2 of the Paperwork Reduction Act of 1995. You 

do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 9000-0045. 

We estimate that it will take 60 minutes to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate, including suggestions 

for reducing this burden, or any other aspects of this collection of information to: General Services Administration, Regulatory Secretariat Division (M 1V1 CB), 1800 F Street, NW, 

Washington, DC 20405. 

1. DIRECT WRITING COMPANY* 

2. REINSURING COMPANY* 

3. DESCRIPTION OF CONTRACT 

3A. AMOUNT OF CONTRACT 

3B. CONTRACT DA TE 

3D. DESCRIPTION OF CONTRACT 

3E. CONTRACTING AGENCY 

AGREEMENT: 

3C . CONTRACT NUMBER 

I 

,,-

/ 

1A. DATE DIRECT WRITING COMPANY EXECUTES THIS 

AGREEMENT 

1B. STATE OF INCORPORATION 

OUNT OF THIS REINSURANCE 

B. DATE REINSURING COMPANY EXECUTES THIS 

AGREEMENT 

2C. STATE OF INCORPORATION 

4. DESCRIPTION OF BOND 

4C. BOND NUMBER 

4E. STATE OF INCORPORATION (If Corporate Principal) 

(a) The Direct Writing Company na ve is bo'rund as a surety on the payment bond described above, wherein the above described is the 

principal, for the protection of all pers s suppl)'.! labo1 and material on the contract described above, which is for the construction, alteration, or repair of 

a public building or public work of the nited State : The payment bond is for the use of persons supplying labor or material, and is furnished to the United 

States under 40 U.S.C. chapter 31 , s bchapter Ill, onds, known as the Bonds Statute. The Direct Writing Company has applied to the Reinsuring 

Company named above to be reinsur and count -secured in the amount above opposite the name of the Reinsuring Company (referred to as "Amount 

of this Reinsurance"), or for whatever amount lesJ ! an the "Amount of this Reinsurance" the Direct Writing Company is liable to pay under or by virtue of 

the payme bond. · 

or a sum mutually agreed upon, paid by the Direct Writing Company to the Reinsuring Company which acknowledges its receipt, the parties to 

ement covenant an terms and conditions of this agreement. 

TERM 

The purp Cl intent of this agreement is ( ) to guarantee and indemnify the persons who have furnished or supplied labor or material in the 

prosecution of the work provided for in the c ntract referred to above (hereinafter referred to as "laborers and materialmen," the term "materialmen" 

including persons having a direct contractu relation with a subcontractor but no contractual relationship expressed or implied with the contractor who has 

furnished the said payment bond) against ss under the payment bond to the extent of the "Amount of this Reinsurance," or for any sum less than the 

"Amount of this Reinsurance," that is o · g and unpaid by the Direct Writing Company to the "laborers and materialmen" on the payment bond; and (b) to 

make the "laborers and materialmenpaligees under this Reinsurance Agreement to the same extent as if their respective names were written herein. 

THEREFORE: 

1. The Reinsuring Company covenants and agrees -

(a) To pay the "Amount of this Reinsurance" to the "laborers and materialmen" in the event of the Direct Writing Company's failure to pay to the 

"laborers and materialmen" any default under the payment bond equal to or in excess of the "Amount of this Reinsurance;" and 

(b) To pay (1) the full amount to the "laborers and materialmen," or (2) the amount not paid to them by the Direct Writing Company; in case the 

Direct Writing Company fails to pay the "laborers and materialmen" any default under the payment bond less than the "Amount of this Reinsurance." 

*Items 1, 2 ,40 - furnished legal name, business address and ZIP Code. 

AUTHORIZED FOR LOCAL REPRODUCTION 

Previous edition is usable 

(Over) 

STANDARD FORM 274 (REV. 4/2013) 

Prescribed by GSA - FAR (48 CFR) 53.228(i) 

Case 3:16-cr-00187-MO Document 101-1 Filed 08/07/17 Page 11 of 22
2. The Reinsuring Company and the Direct Writing Company covenant and agree that, in the case of default on the payment bond for the "Amount of this 

Reinsurance," or more, the persons given a "right of action" or a "right to sue" on the payment bond by 40 U.S.C. 3133 may bring suit against the Reinsuring 

Company in the United States District Court for the district in which the contract described above is to be performed and executed for the "Amount of this 

Reinsurance" or, if the amount of the default is for less than the "Amount of this Reinsurance," for whatever the full amount of the default may be. The 

Reinsuring Company further covenants and agrees to comply with all requirements necessary to give such court jurisdiction, and to consent to determination 

of matters arising under this Reinsurance Agreement in accordance with the law and practice of the court. It is expressly understood by the parties that the 

rights, powers, and privileges given in this paragraph to persons are in addition to or supplemental to or in accordance with other rights, powers, and privileges 

which they might have under the statutes of the United States, any States, or the other laws of either, and should not be construed as limitations. 

3. The Reinsuring Company and the Direct Writing Company further covenant and agree that the Reinsuring Company designates the process agent, 

appointed by the Direct Writing Company in the district in which the contract is to be performed and executed, as an agent to accept service of process in any 

suit instituted on this Reinsurance Agreement, and that the process agent shall send, by registered mail, to the Reinsuring Company at its principal place of 

business shown above, a copy of the process. 

4. The Reinsuring Company and the Direct Writing Company further covenant and agree that this Reinsurance Agreement is an integral part of the 

payment bond. 

WITNESS: 

The Direct Writing Company and the Reinsuring Company, respectively, have caused this Agreement to be signed and impressed with their respective 

corporate seals by officers possessing the power to sign this instrument, and to be duly attested to by officers empowered thereto, on the day and date in Item 

1A written opposite their respective names. 

5. DIRECT WRITING COMPANY 

SA. (1) SIGNATURE (2) ATTEST: SIGNATURE 

Corporate 

58. (1) NAME AND TITLE (Typed) (2) NAME AND TITLE (Typed) Seal 

6. REINSURING COMPANY 

SA. (1) SIGNATURE (2) ATTEST: SIGNATURE 

Corporate 

68. (1) NAME AND TITLE (Typed) (2) NAME AND TITLE (Typed) Seal 

INSTRUCTIONS 

This form is to be used in cases where it is desired to cover the excess of a Direct Writing Company's 

underwriting limitation by reinsurance instead of co-insurance on Bonds Statute payment bonds running 

to the United States. See FAR (48 CFR) 28.202-1 and 53.228(i). 

Execute and file this form as follows: 

Original and copies (as specified by the bond-approving officer), signed and sealed, shall accompany 

the bond or be filed within the time period shown in bid or proposal. 

One copy, signed and sealed, shall accompany the Direct Writing Company's quarterly Schedule of 

Excess Risks filled with the Department of Treasury. 

Other copies may be prepared for the use of the Direct Writing Company and Reinsuring Company. 

Each Reinsuring Company should use a separate form. 

STANDARD FORM 274 (REV. 4/2013) BACK 

Case 3:16-cr-00187-MO Document 101-1 Filed 08/07/17 Page 12 of 22
REINSURANCE AGREEMENT IN FAVOR OF THE UNITED STATES 

(See instructions on reverse) 

OMB Control Number: 9000-0045 

Expiration Date: 7/31/2019 

aperwork Reduction Act tatement - his information collection meets the requirements of 44 § 3507, as amended by section 2 of the aperwork eduction Act of 1995. ou 

do not need to answer these questions unless we display a valid Office of Management and Budget (OMB) control number. The OMB control number for this collection is 9000-0045. 

We estimate that it will take 25 minutes to read the instructions, gather the facts, and answer the questions. Send only comments relating to our time estimate, including suggestions 

for reducing this burden, or any other aspects of this collection of information to: General Services Administration, Regulatory Secretariat Division (M1V1CB}, 1800 F Street, NW, 

Washin ton DC 20405. 

1. DIRECT WRITING COMPANY* 1A. DATE DIRECT WRITING COMPANY EXECUTES THIS 

2. REINSURING COMPANY* 

3A. DESCRIPTION OF BOND (Type, purpose etc.) (If associated with contract 

number, date. amount, etc., include name of Government agency involved.) 

AGREEMENT: 

D 

AGREEMENT 

1B. STATE OF INCORPORATION 

2A. AMOUNT OF THIS REINSURANCE ($) 

2B. ATE REINSURING COMPANY EXECUTES THIS AGREEMENT 

I 

2C. STATE OF INCORPORATION 

3B. PENAL SUM OF BOND 

. DATE OF BOND 3D. BOND NUMBER 

. STATE OF INCORPORATION (If Corporate Principal) 

(a) The Direct Writing Company named above is bound r,s surety to the United States of America, on the bond described above, wherein 

the above-named is the principal. The bond is given for the,protection of the United States and the Direct Writing Company has applied to the 

above Reinsuring Company to be reinsured an ounter-secured in the amount shown opposite the name of the Reinsuring Company 

(referred to as the "Amount of this Reinsuran "}, JQ!:_vyjiatever amount less than the "Amount of this Reinsurance" the Direct Writing 

Company is liable to pay under or by virtue of e bo d. 

(b) For a sum mut agreed upon, paid b tJ.e D ect Writing Company to the Reinsuring Company which acknowledges its receipt, the 

parties to this Agree nt covenant and ag_rg_e to the terms and conditions of this agreement. 

The purpose and i tent of tnfs agreement is to guarantee and indemnify the United States against loss under the bond to the extent of the 

"Amount of this Reinsur nee," or for any less sum than the "Amount of this Reinsurance," that is owing and unpaid by the Direct Writing 

Company to the United States. 

THEREFORE: 

1. If the Direct Writing Company fails to~y any default under the bond equal to or in excess of the "Amount of this Reinsurance," the 

Reinsuring Company covenants and agrees o pay to the United States, the obligee on the bond, the "Amount of this Reinsurance." If the 

Direct Writing Company fails to pay to the nited States any default for a sum less than the "Amount of this Reinsurance," the Reinsuring 

Company covenants and agrees to pay t9 the United States the full amount of the default, or so much thereof that is not paid to the United 

States by the Direct Writing Company. 1 

2. The Reinsuring Company further covenants and agrees that in case of default on the bond for the "Amount of this Reinsurance," or 

more, the United States may sue the Reinsuring Company for the "Amount of this Reinsurance" or for the full amount of the default when the 

default is less than the "Amount of this Reinsurance." 

WITNESS 

The Direct Writing Company and the Reinsuring Company, respectively, have caused this Agreement to be signed and impressed with 

their respective corporate seals by officers possessing power to sign this instrument, and to be duly attested to by officers empowered thereto, 

on the day and date above -- written opposite their respective names. 

•items 1, 2, 3E - Furnish legal name, business address and ZIP Code. 

AUTHORIZED FOR LOCAL REPRODUCTION 

Previous edition usable 

(Over) 

STANDARD FORM 275 (REV. 10-98) 

Prescribed by GSA-FAR (48 CFR) 53.228(j) 

Case 3:16-cr-00187-MO Document 101-1 Filed 08/07/17 Page 13 of 22
4A.(1). SIGNATURE 

48.(1). NAME AND TITLE (Typed) 

5A.(1). SIGNATURE 

58.(1). NAME AND TITLE (Typed) 

4. DIRECT WRITING COMPANY 

(2). ATTEST: SIGNATURE 

48.(2). NAME AND TITLE (Typed) 

5. REINSURING COMPANY 

(2). ATTEST: SIGNATURE 

58.(2). NAME AND TITLE (Typed) 

INSTRUCTIONS 

Corporate 

Seal 

Corporate 

Seal 

This form is to be used in cases where it is desired to cover the excess of a Direct Writing Company's underwriting 

limitation by reinsurance instead of co-insurance on bonds running to the United States except Miller Act Performance 

and Payment Bonds. See FAR (48 CFR) 28.202-1 and 53.228(j) and 31 CFR 223.11 (b)(1 ). If this form is used to reinsure 

a bid bond, the "Penal Sum of Bond" and "Amount of this Reinsurance" may be expressed as percentage of the bid 

provided the actual amounts will not exceed the companies' respective underwriting limitations. 

Execute and file this form as follows: 

Original and copies (as specified by the bond-approving officer), signed and sealed, shall accompany the bond or be 

filed within the time period shown in the bid or proposal. 

One carbon copy, signed and sealed, shall accompany the Direct Writing Company's quarterly Schedule of Excess 

Risks filed with the Department of Treasury. 

Other copies may be prepared for the use of the Direct Writing Company and Reinsuring Company. Each Reinsuring 

Company should use a separate form. 

STANDARD FORM 275 (REV. 10-98) BACK 

Case 3:16-cr-00187-MO Document 101-1 Filed 08/07/17 Page 14 of 22
f Fidelity Or 

 Insured (If 

 Lines) 

Amounts of Risks 

Penal Sum (If Bond) Maximum Llability (If 

Or Face Amount (If Less Than Penal Sum 

Policy) Or Face Amount) 

$5,000,000 (None 

larger) All reinsured in same manner 

$5,000,000 (None 

Iaeger) All reinsured 

in same manner 

$10,000,000 $10,000,000 

$10,000,000 $1,000,000 

per location 

SAMPLE II 

SCHEDULE OF EXCESS RISKS 

Coinsurance Or Reinsurance 

Date Of Amount of T rcasUl'y 

Coinsurance Authorized Coinsurance 

Or Name Of Coinsuring Or Reinsuring (Denote With*) Or 

Net Retention Reinsurance Comoanv Authorized Reinsurance 

$50,000 A.B.C. Reinsurance Co. $1,000,000 

A.A.A. Reinsurance C.0. $1,000,000 

B.B.B. Reinsurance Co. $1,000,000 

C.C.C. Reinsurance Co. 

--

D . .D.D. Reinsurance Co. 1...25l!.!l2!! 

J.2!l.!l!l!! 

$50,000 First Surplus 1 I $4,000,000 

-- Combination Pool 2/ 

J.2!l.!l!l!! W!!!l.!l:QQ 

$250,000 I / I / XX Reinsurance Company & Mutual $9,750,000 

through Reinsurance Co. - 50% - 50"/1 Excess of 3/ 31 / XX $250,000 

respectively 

$95,000 I/ I / XX Mutual Underwritecs Asociation $9,905,000 

through 

3/ 31 / XX 

$100,000 I/ I / XX X.Y.Z. Reinsurance Company 

per location through 

3/ 31/ XX 

Amount of Marker Value Of 

Unauthorized Admissible Assets 

Coinsurance Pledged (Attach Cop) 

(Denote With') Or Of Trust, Joint 

Unauthorized Concrol Or 

Reinsurance lndemnitv A0'ecmen 

$1,000,000 

---

Wl!lllJ!!l!l 

12.lllJlil!l 

$900,000 

per location 

I / Lis 

per 

2/ List 

and 

IP.,.., 

Retention For 

Treasury 

Purnl">'les 

l.LJW.ll!l!l 

W,J!!Xl 

Wl!!!l.!l!l!! 

OMB No. 1510-0004 

Exp. Date: 0513112008 

Remarks 

int suplus partic 

'pants and 

entag< 

combination po< participants 

percentage 

ricipants may be 'stcd under 

inm: tn nnoa r n n lll'tl\rhoati 

Case 3:16-cr-00187-MO Document 101-1 Filed 08/07/17 Page 15 of 22
xxxx xxxx 

xxxx 

xxx.x 

1,100,000 

SAMPLE II 

SCH EDULE OF EXCESS RISKS 

Contact Person Contact Person Tide Contact Person Telephone No. Cont1Ct Person E-Mail 

xxx.x 

xxxx 

xxxx xxx.x 

OM8 No. 1510.00<J.4 

Exp. Date: 05131/2008 

n established by che Treasury. (This applies to casualty and other lines of business as well as surety risks whether o r not the United States is obligee.) In protecting excess risks, the undciwriting limitation in force on the date of the execution of the 

'sk. as shown in Treasurv Circular 570. will 20vcm absolutcl' -· 

Amounu of Risks Coinsurance Or Reinsurance 

Amount of Muket Value Of 

Unauthorized Admissible Assets 

Date Of Amount of Treasury Cotnsurance Plectg.d (Attach Cop) 

f Fidcliry Or Penal Sum (l f Bond) Maximum Liability (If Coinsurance Authorized Coinsurance (Denote With•) Or Of Trust, j oint Retention For 

 Insured (l f Or Face Amount (If Less Than Penal Sum Or Name Of Coi.nsuring Or Reinsuring (Denote With•) Or Unauthorized Control Or Treasury 

 I....inc&) Policy) O r Face Amount) Net Retention Reinsurance Comoanv Authorized Reinsurance Reinsunince lndcmnitv AJUCemen Pun')()!ICB Remarks 

TREATY URANCE 

$1,000,000 (None $50,000 A B. C. Reinsurance Co. 

larger) All re.insured $356,250 

in same manner 

$356,250 

15%-Exceu 50M Retention $142,500 

C.C.C. Reinsurance Co. 

-- 10-/ .. Excess SOM Retention 

l25.ll!l!I 

IS855.000 S95.000 1145.000 

nd___ Sccretuy of the COMPANY NAME of Toom, Stare being duly swom, depose and say, and each for himself says, that they arc the 

 schedule (with the accompanying exhibits) contains a full, true, and correct statement of all cccognizanccs, stipulations, bonds, undertakings, or other risks, whereon the liabilities arc in excess of its Treasury underwriting limitation, executed by the 

sociation, or corporation, during the quarter ended XXX 20-XX....; and. further, that the statements and declarations contained herein arc correct and true in every particular. 

day of. 

xxx 

lLXX 

xxx 

xxx 20_xx._ 

Notary Public 

.fwi'Bll'v!T 

Secretary 

NOTE TO PRESlDENI' AND SECRETARY: If any amount in the ''Retention for Treasury Purposes" column exceeds the "Treaury 

Underwriting Limitation", it is probable that applicable Treasury regulations have been violated (see Treasury Circular '297, sections 

223.10, .11 and .13). If so, immediate remedial measures are required to comply with the regulations. 

Case 3:16-cr-00187-MO Document 101-1 Filed 08/07/17 Page 16 of 22
SAMPLE 

AS OF DATE ______ _ POLICYHOLDERS' SURPLUS AS OF 12/31/ __ 

MMARY OF REINSURANCE TREATIES ON ALL LINES OF BUSINESS 

(6) 

AUTHORIZED REINSURERS I 

(3) (4) (S) 

PE OF TREATY AMT. OF COVERAGE RETENTION 

($) ($) CO.NAME AMOUNT 

 SHARE $70,000 $30,000 I ABC CO. IS30,000 

$30.000 

es recognized by the Treasury Department either as Certified companies or Admitted Reinsurers. 

t have Treasury recognition. To verify, refer to the latest list of both in your application package, or 

74-6850 and soeak with a financial analvst. 

1 

(7) 

UNAlffHORIZED REINSURERS I 

CO.NAME AMOUNT 

fXYZCO. ISI 0,000 

$10.000 

LIST OF DATA ITEM #15 

(8) 

(ADD COLS. S & 7) NET 

RETENTION 

($) 

1540,000 

540.000 

Case 3:16-cr-00187-MO Document 101-1 Filed 08/07/17 Page 17 of 22
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Case 3:16-cr-00187-MO Document 101-1 Filed 08/07/17 Page 18 of 22
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Case 3:16-cr-00187-MO Document 101-1 Filed 08/07/17 Page 19 of 22
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Case 3:16-cr-00187-MO Document 101-1 Filed 08/07/17 Page 20 of 22
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Case 3:16-cr-00187-MO Document 101-1 Filed 08/07/17 Page 21 of 22
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< Judgement Fund Frequently Asked Questions 

fiscal.treasury.gov 

1dgment Fund 

~quently Asked Questions 

What is the Judgment Fund? 

What is the statutory authority for Judgment Fund? 

The law creating the Judgment Fund has been codified at 31 U.S.C. § 1304. 

Does the Judgment Fund pay all awards for judgmer 

and settlements against the United States? 

How much money does the Judgment Fund pay out 

typical year? 

Are federal agencies required to reimburse the Judg 

Fund for payments made on their behalf? 

What criteria must be met for the Judgment Fund to 

judgment or settlement? 

Who administers the Judgment Fund? 

Who can request payment from the Judgment Fund'i 

Which agencies submit the most claims? 

How do agencies request payments? 

Case 3:16-cr-00187-MO Document 101-1 Filed 08/07/17 Page 22 of 22