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KNOWN ALL BY THIS PRESENT INSTRUMENT that we, (Florida Department of Agriculture and Consumer Services)

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BROWSE FLORIDA DEPARTMENT OF AGRICULTURE AND CONSUMER SERVICES (FL) FORMS

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Page 1 of 2
GAME PROMOTION
SURETY 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 32399-6500
Page 2 of 2
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 $______________________ for the
purpose of paying the prizes offered in the game promotion named . This
bond shall be amenable to and enforceable only upon certification to the Department of Agriculture and Consumer Services of
the name of the winner or winners, the amount of the prize or prizes, and the value thereof, or upon direction to the surety from
the Department for payment. NOW, THEREFORE, the condition of this obligation is such that if the Principal shall perform or
cause to be performed all duties and requirements for which the Principal may be held liable by reason of the Principal’s failure
to perform, fulfill, or carry out any duty or responsibility governed by provisions of ss.849.094, 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 game promotion filing 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. That 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
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KNOWN ALL BY THIS PRESENT INSTRUMENT that we, (Florida Department of Agriculture and Consumer Services)

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Completed 20 July 2020

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