Wisconsin Department of Transportation
MV2623 1/2019
Surety Bond Number
Beginning Date (mm/dd/yyyy)
Surety Bond Face Amount U.S. Dollars
Participating Agent Legal Business Name
(No DBA Information)
Participating Agent Legal Business Street Address
Zip Code
Surety Location (City, State)
The above named Participating Agent as Principal and the above-named corporation duly licensed and authorized to transact business
in the State of Wisconsin as surety, are firmly bound to the Division of Motor Vehicles, Department of Transportation, State of
Wisconsin for the bond amount.
The condition of this obligation is that the Principal and the Division of Motor Vehicles entered into a contract for the operation of a
Delegated Office representing the Division of Motor Vehicles
for the purpose of processing electronic title and/or registration
transactions under the terms and conditions set forth in the contract.
The face amount of this bond shall apply separately to each 12-month period (commencing with the beginning date of the bond) during
which this bond is effective so that the full face amount shall be entirely available for the benefit of any claimant during each 12-month
period this bond is effective; thus, a liability of the surety incurred under this bond for an act or omission of the agent occurring in one
12-month period shall not reduce the sum available to less than the above face amount for any other 12-month period during which the
bond is effective.
The Principal and/or the Surety shall indemnify the Division of Motor Vehicles against any and all claims, losses, damages, judgments,
liabilities or similar costs and expense which arise in whole or in part out of the acts or omissions of the Principal during the period of
the bond with respect to the express terms of the contract.
This bond and all obligations under it shall remain continuously in effect through the date shown above. If this bond is indicated above
as ‘continuous,’ then this bond shall not automatically expire, but shall continue from year to year as a new and separate obligation for
each 12-month period.
This bond may be terminated by surety giving 60 days written notice to the Wisconsin Department of Transportation, Division of Motor
Vehicles. Notice of termination shall also be sent to the participating agent. Drafts drawn under and in compliance with the terms of this
bond shall be duly and immediately honored and may be presented after the ending date of this bond provided the claim was filed
within two years of the last day of that one year period covered by this bond.
In Witness, principal and surety have signed this bond.
tach Power of Attorney and file this surety bond to:
Wisconsin Department of Transportation, Dealers Section, P.O. Box 7909, Madison, WI 53707-7909
(Please place Surety Bond Company
Seal here)
Date Signed (mm/dd/yyyy)
__________________________________________________ __________________________________________________
(Print Legal Business Name No DBA Information)
(Signature - Owner)
(Print Surety Company Name)
(Witness to Principal Signature)
(Witness to Surety Signature)
(Signature of Surety Officer, Attorney-in-Fact)