Compilation of Rules and Regulations of the State of Georgia › Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER › Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE › Subject 120-2-2 - PRACTICE AND PROCEDURE › Rule 120-2-2-.61 - Letters of Certification

Current through Rules and Regulations filed through June 27, 2024
(1) Upon request, the Commissioner issues
				letters of certification, indicating the license history or status of anyone
				who has held or currently holds an insurance license in this State. This
				information is furnished on form GID-111, attached hereto as "Exhibit K", and
				incorporated herein. There is no charge for this service.
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INSURANCE BROKER'S BOND
(Georgia)
KNOW ALL MEN BY THESE PRESENTS, that
				  _______________________
____________________, whose residence is in
				  ________________
(City)
____________________, and place of business is in
				  __________
(State) (City)
____________________, and ______________________, as
				  surety,
(State)
are held and firmly bound unto James L. Bentley, Comptroller
				  General, Ex-officio Insurance Commissioner of Georgia, and his successors in
				  office in the penal sum of Twenty-five Hundred ($2,500) Dollars, lawful money
				  of the United States of America, for the payment of which well and truly to be
				  made, we bind ourselves and our and each of our heirs, executors,
				  administrators, successors and assigns, jointly and severally, firmly by these
				  presents.
THE CONDITIONS OF THIS OBLIGATION ARE SUCH THAT if the above
				  bounden _______________________________________ shall faithfully account to all
				  persons requesting the said
________________________________________ to obtain insurance
				  for them for all monies or premiums collected in connection therewith as
				  provided in Section 56-837b of the Georgia Insurance Code of 1960, then this
				  obligation shall be void, otherwise to remain in full force and effect.
IN WITNESS WHEREOF, the said principal has caused these
				  presents to be executed by affixing hereto his or her signature, and the said
				  surety has caused these presents to be executed by the signature of its
				  ________________________
(Agent or Attorney-in-fact
_______________________ and its corporate seal to be affixed
				  of Surety Company)
hereto, attested by its __________________________, this
				  the
_____________ day of _______________, 19__.
(SEAL)
______________________(Seal)
(Principal)
______________________(Seal)
(Surety)
(Note Attach to this Bond a By:
				  ________________________
properly certified copy of (Title)
power of attorney or representative of surety
				  __________________(Seal)
company who signs Bond.) (Attorney-in-Fact)
____________________________
(Licensed Resident Agent)
PUBLIC ADJUSTER'S S BOND
(Georgia)
KNOW ALL MEN BY THESE PRESENTS, that
				  _______________________
_____________________, whose residence is in
				  ______________,
Georgia, and place of business is in
				  ______________________,
Georgia, as principal, and ______________________________ as
				  surety, are held and firmly bound unto James L. Bentley, Comptroller General,
				  Ex-officio Insurance Commissioner of Georgia, and his successors in office, in
				  the penal sum of Twenty-five Hundred ($2,500) Dollars, lawful money of the
				  United States of America, for the payment of which well and truly to be made,
				  we bind ourselves, and our and each of our heirs, executors, administrators,
				  successors and assigns, jointly and severally, firmly by these presents:
THE CONDITIONS OF THIS OBLIGATION ARE SUCH THAT
if the above bounden _________________________________ shall
				  faithfully account to any insured whose claim he is handling for all monies or
				  any settlement received in connection therewith as provided in Section 56-845b
				  of the Georgia Insurance Code of 1960, then this obligation shall be void,
				  otherwise to remain in full force and effect.
IN WITNESS WHEREOF, the said principal has caused these
				  presents to be executed by affixing hereto his or her signature, and the said
				  surety has caused these presents to be executed by the signature of its
_______________________________________________ and
				  its
(Agent or Attorney-in-Fact of Surety Company)
corporate seal to be affixed hereto, attested by its
_____________________ this the _______________ day of
___________________________, 19__.
____________________(Seal)
(SEAL) (Principal)
____________________(Seal)
(Surety)
(Note: Attach to this Bond a By:
				  ________________________
properly certified copy of Title:
power of attorney of __________________(Seal)
representative of surety Attorney-in-Fact company who signs
				  Bond.) ________________________
Licensed Resident Agent.
SURPLUS LINES BROKER'S BOND
STATE OF GEORGIA
COUNTY OF ____________________
KNOW ALL MEN BY THESE PRESENTS:
That
				  _________________________________________________,
whose residence or place of business is in the City of
				  ___________________________,
State of Georgia, as Principal, and
				  ___________________________________________ as Surety, a corporation duly
				  authorized to write surety bonds in this State, are held and firmly bound unto
				  JAMES L. BENTLEY, Comptroller General, Ex-officio Insurance Commissioner of the
				  State of Georgia, and his successors in office in the penal sum of Twenty
				  Thousand Dollars ($20,000.00) lawful money of the United States of America, for
				  the payment of which well and truly to be made, we bind ourselves, and our and
				  each of our heirs, executors, administrators, successors and assigns jointly
				  and severally, firmly by these presents:
The Conditions of the above obligation are such that:
WHEREAS, the above bounden Principal pursuant to the
				  provisions of the Georgia Insurance Code of 1960 (Sections 56-613 through
				  56-628), as amended, is about to apply or has applied to the Insurance
				  Commissioner of the State of Georgia for a license to place surplus lines of
				  insurance in companies or with insurers not admitted to do business in this
				  State;
NOW, THEREFORE, if the said above bounden Principal shall
				  fully and faithfully comply with the requirements of the said Georgia Insurance
				  Code of 1960, as amended, and shall file with the Insurance Commissioner of
				  Georgia on or before April 15th of each year and quarterly thereafter, a sworn
				  statement of the gross premiums charged for insurance placed, and the gross
				  premiums returned on such insurance cancelled under such license during the
				  preceding quarter, and at the time of filing such statement shall pay to the
				  insurance Commissioner of the State of Georgia a sum equal to four percentum of
				  such gross premiums, less return premiums, so reported; and shall faithfully
				  account to all persons requesting him to obtain insurance for them for monies
				  or premiums collected is connection therewith; and will in all other respects
				  fully comply with the provision of the said Georgia Insurance Code of 1960, as
				  amended; then this obligation is to be void; otherwise to remain in full force
				  and effect.
IN WITNESS WHEREOF, the said principal has caused these
				  presents to be executed by affixing hereto his or her signature, and the said
				  surety has caused these presents to be executed by the signature of its
				  _______________________________________________ and its (Agent or
				  Attorney-in-Fact of Surety Company) corporate seal to be affixed hereto,
				  attested by its
________________, this the ______ day of ____________,
				  19__.
(SEAL)
____________________________(Seal)
(Principal)
____________________________(Seal)
(Surety)
(NOTE: Attach a certified By: ______________________________
				  copy of Power of Attorney As _____________________ of Surety of Representative
				  of (Title) Surety Company who signs Attest:___________________________ bonds).
				  (If required by power of attorney)
As _____________________ of Surety
(Title)
__________________________________
(Licensed Resident Agent)
(2) Letters of certification may be obtained
				by submitting a request to the Georgia Insurance Department, Agents Licensing
				Division, Room 132, State Capitol Building, Atlanta, Georgia.
O.C.G.A. §
											33-2-9
et
				  seq.