DFI/LFS/210 (R 4/2002) Page 1 of 2
Section 218.02, Wis. Stats. Bond No._____________________
STATE OF WISCONSIN
ADJUSTMENT SERVICE COMPANY BOND
COMPLETION OF THIS FORM IS MANDATORY
KNOW ALL, that __________________________________________________________________________________, at all locations
(Name of Adjustment Service Company)
licensed under Section 218.02, Wisconsin Statutes, and all locations where records pertaining to such license are maintained, as principal,
and ____________________________________________________________________________________ as surety, are held and
firmly bound unto the
STATE OF WISCONSIN
through the Department of Financial Institutions for Wisconsin, or any person or
persons injured or damaged by any act or omission of the principal covered by this bond, in the sum of
______________________________________________________DOLLARS ($_______________________) for the payment of which,
well and truly to be made, we jointly and severally, bind ourselves, ours heirs, executors, administrators, assigns and successors firmly by
these presents this __________________ day of ________________________, _________.
EFFECTIVE DATE OF THIS BOND ___________________________
THIS BOND IS CONTINUOUS UNTIL CANCELLED, AS PROVIDED BELOW.
WHEREAS
, the above bounden principal has applied for a license under Section 218.02, Wisconsin Statutes.
THE CONDITION OF THIS BOND IS SUCH THAT, if the above named principal shall receive a license or licenses and shall
comply with the provisions of Section 218.02, Wis. Stats., or any subsequent amendment or amendments thereof and all lawful orders,
rules and regulations in effect or which may be issued thereunder, and shall pay and turn over to or for the person, partnership, association
or corporation, who may have a cause of action against the principal for failure to pay any and all monies that may become due and owing
to such person, partnership, association or corporation under and by virtue of the provisions of said Section 218.02, Wis. Stats., and shall
pay any and all costs incurred by the Department of Financial Institutions for Wisconsin under the provisions of Section 218.02, Wis.
Stats., which costs shall be considered a preferred claim, then this obligation shall be void, otherwise this bond shall remain in force and
effect.
PROVIDED, HOWEVER, AND THIS BOND IS EXECUTED UPON THE FOLLOWING EXPRESS CONDITIONS:
1. It is intended that this bond be one of guaranty of payment and not of collection and if any person shall be aggrieved by the
misconduct of any licensee, he or his agent may bring suit directly upon the bond of the licensee in any court having jurisdiction
of the amount claimed.
2. That a separate license is required for each office of a company to be operated under Section 218.02, Wisconsin Statutes and the
Department of Financial Institutions may require any licensee to file a bond, not to exceed the sum of $5,000 per licensed office,
and that this bond is intended to be one of guaranty of payment of each separately licensed office.
3. That this bond is
continuous.
The surety may be released from liability for any future act or omission of said principal after a
written notice stating when the cancellation shall take effect is served on or sent by certified mail return receipt requested to the
Department of Financial Institutions, P.O. Box 7876, Madison, Wisconsin 53707-7876, at least sixty (60) days prior to the
effective date of cancellation. The surety shall remain liable for any or all acts of commission or omission covered by this bond,
which may have occurred up to and including said cancellation date.
4. That the amount of this bond may be decreased only if the surety sends written notice of such decrease by certified mail (return
receipt requested) to the Department of Financial Institutions, P.O. Box 7876, Madison, Wisconsin 53707-7876, at least 30 days
prior to the effective date of the decrease.
