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HOUSEHOLD MOVING SERVICES
PERFORMANCE BOND
1-800-HELP-FLA (435-7352) • 850-410-3800
Calling Outside Florida
www.800helpfla.com • 850-410-3804
Fax
Surety Bond Number: Date of Surety Bond:
/ /
KNOWN ALL BY THIS PRESENT INSTRUMENT that we,
Principal (Applicant/Registrant)
Name
(Legal name as registered with the Florida Department of State (if applicable) followed by fictitious/dba name):
Physical Street Address:
City: State: Zip Code:
-
Mailing Address
(if different from above):
City: State: Zip Code:
-
Telephone Number: Fax Number:
( )
-
( ) -
Email Address:
AND
Surety
Name
(Full legal name of Surety):
Street Address:
City: State: Zip Code:
-
Mailing Address
(if different from above):
City: State: Zip Code:
-
Telephone Number: Fax Number:
( )
-
( ) -
Return completed form to:
FDACS
Terry Lee Rhodes Building
2005 Apalachee Parkway
Tallahassee, FL 32399-6700
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Bond # _______________________
which Surety is authorized to do business and issue surety bonds in the State of Florida, are held firmly bound unto the State of
Florida, Department of Agriculture and Consumer Services, (“Obligee”), the sum of $25,000 for the use and benefit of any
consumer who is injured as a result of the Principal’s fraud, misrepresentation, breach of contract, misfeasance, malfeasance,
financial failure, or any violation of Chapter 507, Florida Statutes, Household Moving Services. Liability for these injuries may be
determined in an administrative proceeding of the department or through a civil action in a court of competent jurisdiction,
However, claims against this bond shall only be paid, in amounts not to exceed the determined liability for these injuries, by
order of the department in an administrative proceeding. NOW, THEREFORE, the condition of this obligation is such that if the
Principal shall perform or cause to be performed all duties and responsibilities for which the Principal may be held liable by
reason of the Principal’s failure to perform, fulfill, or carry out any duty or responsibilities governed by Chapter 507, F.S., then
this obligation shall be void. Otherwise this obligation shall remain in force and effect in law subject, however, to the following
limitations:
1. That the Obligee (State of Florida) shall notify the Surety of any default of the Principal hereunder, at the earliest possible
time following the discovery of such default.
2. That the Surety shall promptly notify the Obligee in writing of any changes in either the Principal or amount of bond set
forth above. However, failure of the Surety to provide such notice shall not affect the validity of this bond.
3. That if the Surety shall so elect, this bond may be canceled by giving 30 days written notice to the Obligee. Said notice
shall contain the full name, city, and state where the Principal is located, and the intrastate mover or intrastate moving
broker registration number assigned to the Principal by the Obligee. The Surety, however, will remain liable for any
default occurring during the period up to the expiration of said 30 days notice and such 30 day period shall begin only
upon receipt of said notice by the Obligee.
4. This bond is subject to successive claims but in no event shall the Surety be liable for a greater amount than that shown
above.
This bond is effective this day of , 20 , 12:01 A.M., standard time and shall
continue in force until canceled.
In witness hereof, the Principal and Surety have executed this instrument through their respective undersigned representatives,
who are fully authorized to execute this instrument, on the day of , 20 .
Principal
Witness
Signature (Seal)
Witness
Title
Full Legal Name of Principal
Surety
Witness
Signature (Seal)
Witness
Title
Local Agent
Name of Local Agent
Address
Contact Person
Contact Telephone Number