Fillable EXISTING SELF-INSURED GENERAL PURPOSE RIDER (State of New Hampshire)

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EXISTING SELF-INSURED GENERAL PURPOSE RIDER (State of New Hampshire)

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U.S.A. forms for State of New Hampshire

BROWSE STATE OF NEW HAMPSHIRE (NH) FORMS

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EXISTING SELF-INSURED
GENERAL PURPOSE RIDER
To be attached to and form part of Bond Number_____________________________________
effective____________________________issued by the ______________________________
_____________________________________in the amount of__________________________
_________________________________________Dollars, on behalf of __________________
________________________________________________as Principal, and in favor of State of
New Hampshire as obligee:
Now, Therefore, it is agreed that:
The Surety agrees that the obligation of this bond shall cover and extend all past, present, existing
and potential liability of said principal, incurred as a self-insured, in the State of New Hampshire, to the
extent of the peal sum of the bond without regard to specific injuries, happenings or events.
It is further understood and agreed that all other terms and conditions of this bond shall
remain unchanged.
This rider is to be effective the _____________________day of ___________________20_________.
Signed, sealed and dated this_______________________day of ___________________20_________.
_____________________________________________________
For Principal
_____________________________________________________
Title
_____________________________________________________
For Surety
_____________________________________________________
Title
____________________________________________________
WCSI-2A(8/30/94) Counter Signature
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EXISTING SELF-INSURED GENERAL PURPOSE RIDER (State of New Hampshire)

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Completed 21 July 2020

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