Car Insurance Bond

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PRIVATE AUTO INSURANCE SURETY BOND

NEGOTIABLE $5,000,000 NEGOTIABLE


Five million United States Dollars
Payable to bearer
Discharge Bond # abc-123456-PB

Your name
C/O rr 122 Some street
Town, State Republic

_____________SPACE ABOVE THIS LINE FOR RECORDER’S USE___________

Written Undertaking/Surety Bond — Financial Responsibility


Form #abc-123456-PB (Private Number was assigned)

I, your name, hereinafter “the Undersigned” do hereby promise to pay “pledge” myself as surety as follows:

Whereas: There exists a requirement by The US Federal Government pursuant to 49 CFR 387 that drivers of motor carriers have
evidence of financial responsibility and;

Whereas: The Undersigned may operate a motor carrier, and;

Whereas: The Undersigned has not been able to locate any lawful money of account in circulation (Gold or Silver coin or bullion) in
this State or any State, and;
Whereas: Public Policy as established with Chap. 48, 48 Stat. 112 of June 5, 1933 states in part:
That (a) Every provision contained in or made with respect to any obligation which purports to give the obligee a right
to require payment in gold or a particular kind of coin or currency, or in an amount of money of the United States measured
thereby, is declared to be against public policy; and no such provision shall be contained in or made with respect to any obligation
hereafter incurred. Every obligation, heretofore or hereafter incurred, whether or not any such provision is contained therein or
made with respect thereto, shall be discharged upon payment, dollar for dollar, in any coin or currency which at the time of
payment is legal tender for public and private debts. Any such provisions contained in any law authorizing obligations to be issued
by or under authority of the United States, is hereby repealed:

Now therefore and in consideration thereof, the Undersigned does hereby promise to pay i.e. undertakes, “bonds” UPPER CASE

NAME'S commercial activity for the following amount: Five Million Dollars.

In the event that any person is damaged and can demonstrate a bona fide claim of injury or loss, the Undersigned shall discharge

all obligations dollar for dollar by and through tender of payment pursuant to public policy, Chap. 48, 48 Stat. 112.

Dated the __th day of the ____th month, Two Thousand Twenty Three

_______________________________

C/O RR 123 Some street


Town, State Republic
Non domestic zip exempt

ALL CAPS NAME Your name


ATTN: CEO or CFO c/o rr 123 Some street
123 Some street Town, State near [12345]
Town ST, 12345 Non-Domestic without the US

____________________ _________________
Date of Issue Authorized Signature

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