Description

This 1-3 year $10,000 Insurance Broker Surety Bond is required for all property, casualty, and personal lines broker-agents operating in the state of California. This bond protects the public from any financial damages the California Insurance Broker may cause. A surety bond is not insurance. As an insurance agent, additional insurance coverage is advised.

More information regarding Insurance Brokers may be found at www.insurance.ca.gov

Additional information

State of California Department of Insurance
Bond of Insurance Broker
Form 50.12 (Rev. 4/2017)
California Code of Regulations Title 11 section 50.12

Producer Licensing Bureau
P.O. Box 1139
Sacramento, CA 95814-1139
Information 800-967-9331
www.insurance.ca.gov

State of California
Department of Insurance
Bond of Insurance Broker
(California Insurance Code sections 1662-1665)

Bond No. _____________
Premium $____________

WE, _______________________________________ as Principal, an applicant for or holder of a
California broker’s license, whose address for service is ________________________________
Street Address
________________________________________________________, and _________________
City State Zip Code
___________________________________, an admitted surety insurer, as Surety, whose address
for service is___________________________________________________________________
Street Address City
________________________________, bind ourselves jointly and severally, in the penal sum of
State Zip Code
TEN THOUSAND DOLLARS ($10,000) to the People of the State of California, for payment of
which, we bind ourselves, our heirs, executors, successors and assigns, jointly and severally,
firmly by these presents. The aggregate liability of the Surety hereunder on all claims
whatsoever shall not exceed the penal sum of this bond in any event.

The condition of this obligation is that if the Principal is granted, or during the term hereof holds,
an insurance broker’s license issued by the Insurance Commissioner of the State of California,
the Principal shall account to any person requesting to obtain insurance, for moneys or premiums
collected by the Principal, the Principal’s solicitors or employees, for insurance other than life; if
the Principal shall so account as required by law, then this obligation shall be null and void;
otherwise to remain in full force and effect.

This bond shall take effect on_____________________, 20___, but not prior to the date of its
execution. If no date is hereinabove written, it shall take effect on the later of the two dates of
execution set forth below. This bond shall remain in force and effect until the Surety is released
from further liability by the Commissioner or until the bond is canceled by the Surety. The
Surety may cancel the bond and be released of further liability hereunder by delivering 30 days’
notice to the Commissioner. Such cancellation shall not affect any liability incurred or accrued
prior to the termination of the 30-day period.
—————————————————–

This bond is executed by the Surety to comply with and the bond shall be subject to the
provisions of Article 5 (commencing with section 1662) of Chapter 5 of Part 2 of Division 1 of
the California Insurance Code, and to the provisions of Chapter 2 (commencing with section
995.010) of Title 14 of Part 2 of the California Code of Civil Procedure.

By executing this bond, Principal and Surety agree any action on this bond shall be instituted and
prosecuted in the counties of the State of California, with service by U.S. mail as prescribed in
the California Code of Civil Procedure sections 417.10 and 417.20 and this bond shall be
governed by the laws of the State of California.

In witness whereof the Principal has subscribed his (its) true name on the date and at the place
entered opposite his (its) signature, and the Surety has subscribed its full and correct name and
affixed its corporate seal on the date and at the place shown opposite its signature.

________________________________ ____________________________, 20____
Principal (type or print) Date

By_____________________________ ___________________________________
Place Where Executed

______________________________________
Surety (Seal)

By ____________________________________ ____________________, 20____
Name Date
__________________________________ _____________________________
Position or Title Place Where Executed

By ____________________________________ ____________________, 20____
Name Date

__________________________________ _____________________________
Position or Title Place Where Executed

IT IS NECESSARY THAT A STATUTORY REPLACEMENT BOND FEE BE
SUBMITTED, UNLESS BOND IS FILED WITH AN ORIGINAL APPLICATION.
See Insurance Code section 1751(j) and the Insurance Commissioner’s current fee
bulletin for the fee amount.

Note: For instructions as to execution by principal and surety and for form of entity
acknowledgement and for form of acknowledgement by individual broker, see California Code
of Regulations, title 11, section 50.20.