KNOW ALL MEN BY THESE PRESENTS:
That we, _______________________________________________
Doing Business at _________________________________________________________________________________
As Principal and __________________________________________________________________________________
(Surety Company)
duly authorized to do business within the Commonwealth of Virginia, as Surety, are held and firmly bound unto the people
of the Commonwealth of Virginia to indemnify any person who may be aggrieved by fraud, fraudulent representation, or
loss or damage resulting from a breach of contract or violation by said Principal or his representative acting for such
Principal or within the scope of the employment of such representative of any of the provisions of Chapter 21, Title 46.2 of
the Code of Virginia in the amount of fifty thousand dollars ($50,000) lawful money of the United States of America, for
which payment, well and truly to be made we bind ourselves, jointly and severally, our joint and several heirs, executors,
administrators, successors and assigns, firmly by these presents; provided, that the aggregate liability under this bond, to
any and all persons, regardless of the number of claims made against the bond or the number of years the bond remains
in force, shall in no event exceed fifty thousand dollars ($50,000).
WHEREAS, the above bounden Principal desires that a certificate of fitness be issued and thereafter reissued from time
to time by the Commissioner of the Department of Motor Vehicles, Commonwealth of Virginia to Principal pursuant to
Chapter 21 of Title 46.2; and
WHEREAS, this bond executed by the said Principal and Surety is filed with the Commissioner in compliance with the
provisions of Section 46.2-2122 of the Code of Virginia to enable said Principal to obtain a certificate from the Department
of Motor Vehicles under the provisions of Chapter 21 of Title 46.2 of the Code of Virginia.
NOW THEREFORE, the conditions of this obligation are such that if the Principal shall well and truly observe and strictly
and faithfully comply with the aforesaid requirements of law, and shall save and keep harmless any person from any fraud
practiced on him or fraudulent representation made to him by such Principal or any of such Principal’s representatives
acting for the Principal or within the scope of employment of such representatives or from any loss or damage resulting
from a breach of any contract entered into on or after July 1, 2002, or from any loss or damage suffered by reason of the
violation by such Principal or any of such representatives of the provisions of Chapter 21, Title 46.2 of the Code of
Virginia, then this obligation shall be null and void; otherwise it shall remain in full force and effect.
This bond shall not automatically expire with the certificate for which it is initially issued, but shall continue from certificate
term to certificate term for a period of five consecutive years from the effective date above. Surety may cancel this bond at
any time upon sixty days prior written notice to the Commissioner; provided, however, such cancellation shall not operate
to relieve, release or discharge the Surety from any liability already accrued or which shall accrue before the expiration of
the sixty day period.
Signed and sealed this ________________ day of _______________________, _________
(Year)
__________________________________________(Seal) By:_______________________________________(Seal)
Principal
(Signature of Owner, Partner or Officer of Corporation)
Witness: _________________________________________ ____________________________________________
(Signature above must be witnessed)
(Printed Name of Witness)
Name of Surety Company____________________________________________________________________(Seal)
By:______________________________________(Seal) __________________________________________
(Attorney or Attorney in Fact of Surety Company) (Printed Name of Signing Person)
COUNTERSIGNED
By:________________________________________ ___________________________________________
Address ________________________________________________________________________________
HOUSEHOLD GOODS CARRIER
BOND
OA 436 (07/01/2011)
BOND NUMBER
BOND EFFECTIVE DATE (mmddyyyy)
(Printed Name of Registered Virginia Agent
(Registered Virginia Agent)
(Physical Address of Carrier)
Business Name of Carrier
