Employment Agency Bond Form. This is a Arizona form and can be use in Workers Comp.
Tags: Employment Agency Bond, Arizona Workers Comp,
THE INDUSTRIAL COMMISSION OF ARIZONA State Labor Department P. O. BOX 19070, PHOENIX, ARIZONA 85005 EMPLOYMENT AGENCY BOND No. Effective Date KNOW ALL MEN BY THESE PRESENTS: That I (we) (Principal) (Corporate Name) (Trade Name) as Principal, and a corporation organized under the laws of the State of , as Surety are indebted to the People of the State of Arizona, in the penal sum of Five Thousand ($5,000.00.) Dollars, for which payment we bind ourselves and our legal representatives and successors, jointly and severally. The condition of the obligation is that the Principal has made application for a license to operate a private employment agency and is required by the terms of Arizona Revised Statutes 23-521, et seq., to furnish a bond on the terms and conditions as set forth in such statutes. If Principal and Principal’s agents and employees faithfully conform to and abide by the provisions of Arizona Revised Statutes 23-521 et seq., and Arizona Administrative Rules R20-5-301, et seq., together with all amendments or supplementary acts now or hereafter promulgated, and if Principal honestly and faithful performs all obligations and undertakings made pursuant to the provisions of such statutes in the conduct of the operation of a private employment agency by Principal and Principal’s agents and employees, then this obligation shall be null and void: otherwise, it shall be in full force and effect. The total aggregate liability of Surety heron shall be limited to the sum of Five Thousand (5,000.00) Dollars. This Bond shall be deemed continuous in form and shall remain in full force and effect unless terminated or canceled by the Surety as to subsequent liability by giving thirty (30) days written notice to the Industrial Commission of Arizona and the named Principal; provided that such cancellation shall not effect any liability incurred or accrued hereunder prior to the termination of the notice period. The State of Arizona, acting through the Industrial Commission, reserves the right to terminate this bond at any time by the giving of thirty (30) days prior written notice thereof to the Surety and named Principal at the last known address of each. In the event Principal or Surety, or either of them, is served with notice or summons of any action brought against Principal or Surety under this Bond, written notice of the receipt of such action or summons shall immediately be given to The Industrial Commission of Arizona, Labor Department. SIGNED, sealed and dated this ______________ day of ______________________________, 20________ Principal__________________________________________ (Agency Name) By ______________________________________________ (Responsible Agent) SUBSCRIBED AND SWORN to before me this ________ day of _________________________ 20________ Notary Public Seal/stamp: Surety ____________________________________________ By _______________________________________________ (Attorney-in-fact) SUBSCRIBED AND SWORN to before me this ________ day of _________________________ 20________ __________________________________________________ Notary Public Seal/stamp: American LegalNet, Inc. www.FormsWorkflow.com