COURT COUNTY .OF. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ......... .. : STATE OF CALIFORNIA DEPARTMENT OF INDUSTRIAL RELATIONS SELF-INSURANCE PLANS 2265 Watt Avenue, Suite 1 Sacramento, CA 95825 Phone No. (916) 483-3392 -againstFAX (916) 483-1535 Index No. Calendar No. : Plaintiff(s) : : : JUDICIAL SUBPOENA INFORMATIONAL BULLETIN: SURETY BOND : To meet the deposit requirements of California Labor Code Section 3701, a self Defendant(s) : ..... .... .... ...... ..... . .................. ... insurer. may. post .a. Surety. Bond .or. Increase/Decrease .Rider to meet ongoing deposit changes. If THE PEOPLE OF THE STATE OF NEW YORK as security deposit, they must notify a self insurer chooses to post a surety bond Self Insurance Plans, who will partially complete the bond or rider by inserting the TO Master Certificateholder's number, the surety bond number, the complete legal name of principal (i.e. Master Certificateholder) and any co-principals (i.e. Subsidiaries), its address, and its/their respective states of incorporation and the penal sum of the bond. The surety bond and all riders must be executed in GREETINGS: triplicate. WE COMMAND YOU, that all business and excuses being laid aside, you and each of you attend before , the Honorable at the Court The surety company or Attorney-In-Fact is to fill in the surety's name and address. located at is the date of execution by the Attorney-InCounty of The effective date of the bond or rider in room , on the day of 20 , at o'clock in the noon, and Fact. All the executed originals of the surety, bond or rider are to be returned to this at any recessed or adjourned date, to testify and give evidence as a witness in this action on the part of the office. All of the rider forms shall be signed by the carrier or Attorney-In-Fact for the Your failure to comply with this subpoena is punishable as a contempt of court and will surety company, in accordance with the instructions set forth on the form. Attach make you liable to the party on whose behalf this subpoena was issued for signing haspenaltyauthorized by the the Power of Attorney form showing the person a maximum been of $50 and all damages sustained as a result of your failure to comply. surety company to execute bonds in the amount. Effective December 2001, California Code of Regulations, Title 8, Section 15212 Court in County, day of , 20 (a)(h) which was newly adopted reads in part: "The surety company or its parent shall have and maintain an acceptable credit rating as set forth below: (1) Standard and Poor's Insurer Financial Strength Rating of "A" or better ratings, or (Attorney must sign above and type name below) (2) A.M. Best Company, Financial Strength Ratings of B+ or better rating. Attorney(s) for Witness, Honorable , one of the Justices of the Office and P.O. Address Telephone No.: Facsimile No.: E-Mail Address: Mobile Tel. No.: American LegalNet, Inc. www.USCourtForms.com