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BOND REQUIREMENTS COMPLETION INSTRUCTIONS A. Pursuant to A.R.S. (Arizona)

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DEPARTMENT OF HOUSING
1110 WEST WASHINGTON, SUITE 280
PHOENIX, ARIZONA
85007
( (602) 771-1000 WWW.AZHOUSING.GOV FAX: (602) 771-1002
BOND REQUIREMENTS COMPLETION INSTRUCTIONS
A. Pursuant to A.R.S. § 41-4029, before granting an original license, the Director shall require a surety bond or
cash deposit on the form provided, which shall be continuous in form. The amount of the bond is
determined by the type and scope of the applied for license.
B. A separate bond or cash deposit is required for each branch location. Space is provided for such branch
location address in the upper right corner of the License Bond Form ADOH 107.
1. Installer Branch Location means a separate business location from the licensee's principal place of
business where transactions are conducted.
2. Manufacturer Branch Location means a separate business location from the licensee's principal
place of business where units are manufactured.
C. Surety (bonding) company to complete License Bond Form ADOH 107 as follows:
1. Side one of form:
a. Upper right corner indicate bond number. If applicable, show licensee's branch address
on lines provided. See Paragraph B. above.
b. 1st Line: Name of business exactly as shown on the Application.
c. 2nd Line: Licensee's principal physical business address as shown on Application.
d. 3rd Line: Indicate license classification, i.e., D-8, I-10C, M-9A, etc., as shown on
Application.
e. 4th Line: Name of Surety (bonding) Company and Claims Address for Surety Company.
f. 5th Line: Amount of bond in words and numerals.
2. Side two of form:
a. Date bonding company signed and sealed the bond.
b. Effective date of bond.
c. Signatures, left side:
Full business name of applicant, typewritten or printed.
Signature and title of applicant.
Type or print the name, mailing address and telephone number for the purpose of
filing claims in this section.
d. Signatures, right side:
Name of surety typed or printed.
Signature of person acknowledging for the surety; and,
Type or print name and title on line below.
Surety signature must be notarized.
D. TO AVOID DELAY or inconvenience, be sure the bond is completed as delineated above. If necessary,
the bond will be returned for correction or a rider will be requested to properly complete the bond before
issuance of the license.
ADOH 139 (8-17)
STATE OF ARIZONA
DEPARTMENT OF HOUSING
1110 WEST WASHINGTON, SUITE 280
PHOENIX, AZ
85007-2935
(602) 771
-1000
Bond
Number
Branch
(of principal) if applicable
Name
Address
LICENSE BOND
KNOW ALL MEN BY THESE PRESENTS:
That
we
as
Principal, whose physical business address
is
conducting
business under the classification
of
and
a
corporation duly authorized and licensed to transact surety business in the State of Arizona, for the purpose of making, guaranteeing or becoming
sole surety upon bonds or undertakings required or authorized by the laws of the State of Arizona as surety, are held and firmly bound unto the State
of Arizona for the benefit of:
1. Any purchaser of a manufactured home, mobile home, factory-built building or subassembly thereof who is damaged by the failure of
the
Principal to perform a sales or installation agreement or fails to perform repairs under a warranty, as provided by A.R.S.
§ 41-4029 (D);
2. The Director of the Department of Housing, if the Principal owes said Department under the provision of Articles 3 and 4,
Chapter 37
,
Title 41, Arizona Revised Statutes, and the Rules adopted pursuant thereto;
) In the sum of: ($
lawful money of the United States of America for payment under the terms expressed herein, we bind ourselves, our heirs, executors,
successors
and
assignees, jointly and severally, firmly by these presents.
THE CONDITION OF THE FOREGOING OBLIGATION IS SUCH THAT:
Whereas, the above bounden Principal has made application with the Department of Housing of the State of Arizona for a license to conduct
business under the classification and at the address set forth above and tenders this bond to comply
with the
provisions of Articles 3 and 4,
Chapter 37, Title 41, Arizona Revised Statutes, and the Rules adopted pursuant thereto by the Department of Housing.
The persons claiming against this bond may maintain action at law against the Principal and the Surety and this bond may be sued upon in
successive actions until the full amount thereof is exhausted. No suit may be commenced on this bond after the expiration of two years following
the commission of the act on which the suit is based except that the time for purposes of the claim for fraud shall be measured as provided in A.R.S.
§12-543.
It is further provided that upon any demand or claim against the bond the Surety shall give notice to the Director by registered mail of
any such
demand or claim and of any judgment, recovery or settlement made prior to the payment thereof. This bond shall be continuous in form and shall be
conditioned that the total aggregate liability of the Surety for all claims shall be limited to the face amount of the bond irrespective of the number of
years this bond is in force. If the Surety desires to make payment without awaiting court actions, the amount of this bond shall be reduced to the
extent of any payment or payments made by the Surety, in good faith thereunder. Any such payments shall be based on priority of written claims
received by the Surety prior to court action.
(OVER)
ADOH (8/17)
The liability of the Surety may be terminated and this bond cancelled as to future liability by the giving of written notice by the Surety
to the Director, of the Surety’s desire to terminate liability and by stating in such notice the effective date of such termination, which
shall not be less than thirty (30) days from the receipt of such notice by the Director.
Previous locations are automatically covered by the existing bond when a rider or endorsement is received by the Department
indicating a new location.
Nothing in this bond shall be construed to be in conflict with the provisions of Articles 3 and 4, Chapter 37, Title 41, of the Arizona
Revised Statutes.
Signed and sealed this day of , 20 .
This bond becomes effective on the day of , 20 .
Type or Print Licensed Business Name
(Name of Principal) (Name of Surety)
By:
By:
(Signature & Title of Principal) Signature of Person Signing for
Surety
By:
Agent
(Type or Print Name) (Type Name & Title of Person Signing for Surety)
This instrument was acknowledged
Representing (Name of Company) before me this day of , 20 _____
(Area Code) (Telephone Number) (Notary Public)
(Mailing
Address)
My
commission
expires:
(City)
(State)
(Zip)
STATE
OF
NOTE:
Provide
address
and
phone
number
where
claims
against
COUNTY
OF
this bond are to be sent in the spaces appropriated above for insurance
agent if bond is not being countersigned by insurance/surety Agent.
SIGNATURE OF SURETY MUST BE NOTARIZED
---------------------------------------------------------------------
NOTE ------------------------------------------------------------------------------------------
In cases where a minor discrepancy exists between the information contained on the license application and that contained on the bond, the
clarification notice below will be filled in to reflect the proper information. A copy of the bond form with the completed clarification notice will then be
sent to the surety. If written notice from the surety is not received by the Office of Administration contradicting the information contained in the
clarification notice, it will be assumed that such information is correct. This procedure will eliminate the delays caused by bond rider requests when
minor differences exist.
DO NOT WRITE BELOW
LICENSEE’S BOND CLARIFICATION
NOTICE
The Department of Housing’s records indicate that the correct business name, license classification and/or form of business for the Licensee
covered by this surety bond is as stated below.
Business
Name
Classification
Form
of Business: Individual Partnership Corporation Limited Liability Co.
Other
I certify that on a copy of this notice was mailed postage prepaid to:
Date
By
Surety’s Name Signature of Licensing Clerk
ADOH 107 (8/17)
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BOND REQUIREMENTS COMPLETION INSTRUCTIONS A. Pursuant to A.R.S. (Arizona)

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Completed 12 August 2020

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