ALCOHOLIC LIQUOR TAX BOND NEBRASKA LIQUOR CONTROL COMMISSION 301 CENTENNIAL MALL SOUTH PO BOX 95046 LINCOLN, NE 68509-5046 PHONE: (402) 471-2571 FAX: (402) 471-2814 Website: www.lcc.nebraska.gov KNOW ALL MEN BY THESE PRESENTS: That we, __________________________________________of the County of_____________________, State of Nebraska as Principal of _______________________________, and duly licensed to transact the business of surety insurance in the State of Nebraska, as Surety, are held and firmly bound unto the State of Nebraska, and the City (Village) of ________________________in ____________________County, Nebraska, and the Nebraska Liquor Control Commission and each of them jointly or severally, in the penal sum of ________________________DOLLARS ($___________) for the payment of which, we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly, severally and firmly by these presents. The condition of this obligation is such that, WHEREAS, the said __________________________________________________ has made application under the Nebraska Liquor Control Commission Act for the following license(s) check each that apply: ____ Class L-Craft Brewery ____ Class Y-Farm Winery ____ Class W-Wholesale Beer ____ Class V-Manufacturer (beer, wine, spirits) ____ Class X-Wholesale Liquor ____ Class Z-Micro Distillery NOW, THEREFORE, upon application for such license and continuing after the issuance of the same to the said principal above named, if the said principal hereinabove named shall faithfully perform all the terms and conditions of said license(s), and shall promptly account for and pay to the proper authorities all lawful taxes, fees, assessments that have accrued during the term of said license or licenses, and all fines, penalties and costs which shall become due from or shall be levied, charges or adjudged against said principal on account of defaults occurring during the entire effective period of this bond, under the provisions of said Act by said Commission, or any court or other lawful authority; and shall truly and faithfully comply as such licensee with all of the provisions of said Act of the Legislature and all future Nebraska Liquor Control laws which may be enacted during the term of such license or licenses, and shall truly and faithfully comply with all lawful rules and regulations of said Commission, and said City (Village) during the term of said license or licenses, then this obligation shall be null and void. OTHERWISE, to be and remain in full force and effect; This Bond shall run concurrently with the term of said license or licenses granted to the principal, and shall remain in full force and effect for any renewal thereof, provided, however, that the penalty of the Bond may not be cumulative from year to year, and the total aggregate liability of the surety shall not exceed $_________________, regardless of the number of claims made under this Bond and the number of years this Bond remain in effect. The surety may cancel this Bond by providing 60 days prior written notice of such cancellation to the Nebraska Liquor Control Commission, but the surety providing such notice shall not be discharged from any liability already accrued under this Bond or which shall accrue under this Bond before expiration of said 60 day period. Upon cancellation of this Bond, the surety shall be relieved of liability accruing after the effective date of cancellation, and the rights of the principal under such license, as is supported by said Bond, shall be cancelled and terminated on the date specified, unless the principal provides a sufficient replacement Bond. Page 1 of 2 REV 6/23/16 FORM 115 American LegalNet, Inc. www.FormsWorkFlow.com This Bond shall be effective during all proceedings involving the application for license under the Nebraska Liquor Control Act for Alcoholic Liquor and/or Beer license and upon issuance of said license this Bond shall continue until cancelled as set forth hereinabove. This Bond has been given Bond number ______________________________________________________. PRINCIPAL IN TESTIMONY, WHEREOF, said PRINCIPAL has hereunto subscribed his or their names or has caused this instrument to be signed by its duly authorized officer this date: ________________________A.D. 20_________ SURETY COMPANY IN TESTIMONY, WHEREOF, said SURETY has caused this instrument to be signed by its duly authorized office and its corporate seal to be hereunto affixed this date: ______________________________A.D. 20 ______ ____________________________________________ SIGNATURE ____________________________________________________________ PRINT NAME HERE ___________________________________________________________ WITNESS SIGNATURE ___________________________________________________________ PRINT NAME HERE _________________________________________ SIGNATURE for Attorney-in-Fact FOR Surety Company __________________________________________________________ PRINT NAME HERE __________________________________________________________ SURETY COMPANY NAME __________________________________________________________ SURETY COMPANY MAILING ADDRESS ___________________________________________________________ SURETY COMPANY AREA CODE AND PHONE NUMBER ____________________________________________________________ INSURANCE PRODUCER'S AREA CODE AND PHONE NUMBER NOTICE Bond will not be accepted unless properly signed by applicant, whose signature shall be witnessed. It is also necessary that all Bonds be signed by an official or agent of the Bonding Company who holds and unexpired power-of-attorney from the Bonding Company and unexpired Nebraska liquor license as insurance producer for said company. An additional requirement is attachment of the seal of the Bonding Company and, if applicant is a corporation, their seal should also be attached. Page 2 of 2 REV 6/23/16 FORM 115 American LegalNet, Inc. www.FormsWorkFlow.com