Mississippi Administrative Code › Title 19 - Department of Insurance › Part 1 - General › Chapter 36 - (2007-4) Licensure and Regulation of Public Adjusters › Rule 19-1-36.13 - Exhibit A- Surety Bond for Public Adjuster Filed with the Mississippi Insurance Department

Current through June 25, 2024
SURETY BOND FOR PUBLIC ADJUSTER FILED WITH THE MISSISSIPPI
				  INSURANCE DEPARTMENT
STATE OF ____________________
COUNTY OF ____________________
This form shall
				  not be altered in any way
.
Part 1: Bond, Surety and Principal.
Bond #:
Original Bond Date of Issuance:
If a Continuation Bond, Effective Date:
Name of the Surety Company:
NAIC # of Surety Company:
MID License Number of Surety Company:
Name of Principal (Public Adjuster)
MID License Number of Public Adjuster:
Amount of Bond: $50,000.00
Part 2: Type and Bond Amount.
The type and amount of the bond for one year commencing on
				  the original date of issuance or continuation stated hereinabove at Part 1 is
				  as follows:
Public Adjuster, Bond Equal to Fifty Thousand current
				  U.S. Dollars ($50,000.00)
Part 3: KNOW ALL MEN BY THESE PRESENTS THAT, the Principal
				  and Surety, who, after being duly sworn, deposed and said:
THAT
they are firmly bound unto the
				  Commissioner of Insurance , State of Mississippi, or his successor in office,
				  under the surety bond, delivered in lieu of errors and omissions liability
				  insurance coverage, conditioned only for and dedicated exclusively to the
				  prompt payment of all claims arising and accruing to any persons who sustained
				  damages as a result of the Principals erroneous acts, failure to act,
				  conviction of fraud, or conviction of unfair practices in his capacity as a
				  public adjuster for which the Principal and Surety bind themselves, their
				  heirs, administrators, executors, successors and as signs, jointly and
				  severally, by this agreement;
THAT
the Commissioner of Insurance shall be
				  authorized to recover on behalf of any person in the State of Mississippi who
				  sustained damages described herein;
THAT
the condition of this obligation is such
				  that if the above named Principal shall well and faithfully discharge and
				  perform the duties incumbent on him under the provisions of all applicable
				  laws, including but not limited to Title 83 of the Mississippi Code and
				  Mississippi Insurance Department Regulation 2007-4, then in such case the above
				  obligation is to become null and void, else to remain in full force, effect and
				  virtue;
THAT
the provisions of all applicable laws,
				  including but not limited to Title 83 of the Mississippi Code and Mississippi
				  Insurance Department Regulation 2007-4, for principals and sureties are
				  applicable;
THAT
this surety bond shall not be terminated
				  unless at least thirty days' prior written notice will have been filed with the
				  Commissioner of Insurance, State of Mississippi, and given to the
				  principal;
THAT
this obligation may be continued for any
				  subsequent year by a continuation certificate duly signed and sealed by the
				  Principal and Surety, subject to the terms and conditions of the original bond,
				  and filed with the Commissioner of Insurance, State of Mississippi;
IN WITNESS THEREOF,
Principal and Surety have
				  executed this bond on the dates stated hereinbelow.
Part 4. Signatures and Notary. Complete all information
				  BY:
___________________________________________________
				  __________________________
Principal Date Surety's Authorized Representative
				  Date
___________________ ______________________________
				  _________________
Print Name Print Name/Title of Surety's Authorized
				  Representative
_________________________________ ____________
				  ________________
Physical Address of Principal Physical Address of
				  Surety
Subscribed and sworn to before me this the _______ day of
				  _______, 20__
{Seal of Notary Public}
_________________________________
Notary Public
If a power of attorney used, a copy of the power of attorney
				  or the authorized agent of the surety company must accompany the
				  bond.
Miss. Code Ann.
				  §§
										83-5-1;
				  83-17-505 (Rev. 2011)