FORM AL-SLB-13
STATE OF ALABAMA – DEPARTMENT OF INSURANCE SURPLUS LINE BROKER BOND
KNOW ALL MEN BY THESE PRESENTS, THAT ___________________________________________
(Name of Surplus Line Broker)
whose residence is in ____________________________________, State of __________, as Principal, and
(City) (State)
______________________________________________________________________________________
(Name of Authorized Corporate Surety)
as Surety, are held and firmly bound unto the ALABAMA COMMISSIONER OF INSURANCE, and his or her successors in office, in the penal sum of Fifty Thousand Dollars ($ 50,000.00) for payment of which well and truly to be made, we bind ourselves and each of our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents: THE CONDITION OF THIS OBLIGATION IS SUCH, that whereas the Principal has applied to the Commissioner of Insurance of the State of Alabama for a license to procure insurance on risks in this State, in foreign and alien insurance companies not authorized to transact business in this State, in accordance with the provision of the Alabama Surplus Line Insurance Law, Article 2, Chapter 10, Title 27 (Section 2710-20 through 27-10-38) Code of Alabama 1975, and provided that the Commissioner of Insurance, in accordance with the powers vested in him or her, issue such license, the Principal shall faithfully comply with all requirements of the Alabama Surplus Line Insurance Law, and the rules and regulations prescribed by said law the tax mentioned in Section 27-10-31, Code of Alabama 1975. NOW THEREFORE, if the Principal shall well and truly perform and fulfill all the terms and conditions of such law said license is in full force and effect, then this obligation shall be void; otherwise, to remain in force and effect for and until the license herein mentioned shall be revoked by the Commissioner of Insurance. IT IS MUTUALLY AGREED AND UNDERSTOOD BETWEEN ALL PARTIES HERETO, that if the Surety shall so elect, this bond may be cancelled and discontinued by giving thirty (30) days notice in writing to the Principal and the Commissioner of Insurance by Registered or Certified Mail, and this bond shall be deemed cancelled at the expiration of the said thirty (30) days from the service of said notice, the surety remaining liable for all or any part of such tax and other obligations covered by this bond which may have accrued by default of the Principal prior to the effective date of cancellation. It is further so agreed and understood that the Surety hereunder shall not be liable hereunder to pay a greater sum in aggregate in respect of the principal sum and interest thereon than the penal sum indicated above. WITNESS OUR HANDS AND OFFICIAL SEALS, this ____ day of __________________, 20_______. Witness as to signature: of principal: ______________________________ Witness as to signature of surety representative: ______________________________ By: __________________________________________________ Signature of Principal (Surplus Line Broker) __________________________________________________ Typed Name of Corporate Surety By: ___________________________________________ Signature of Authorized Representative of Corporate Surety ___________________________________________ Typed Name of Authorized Representative of Corporate Surety (Attach Power of Attorney)