Compilation of Rules and Regulations of the State of Georgia
Department 120 - OFFICE OF COMMISSIONER OF INSURANCE, SAFETY FIRE COMMISSIONER AND INDUSTRIAL LOAN COMMISSIONER
Chapter 120-2 - RULES OF COMMISSIONER OF INSURANCE
Subject 120-2-2 - PRACTICE AND PROCEDURE
Rule 120-2-2-.61 - Letters of Certification

(1) Upon request, the Commissioner issues letters of certification, indicating the license history or status of anyone who has held or currently holds an insurance license in this State. This information is furnished on form GID-111, attached hereto as "Exhibit K", and incorporated herein. There is no charge for this service.

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INSURANCE BROKER'S BOND

(Georgia)

KNOW ALL MEN BY THESE PRESENTS, that _______________________

____________________, whose residence is in ________________

(City)

____________________, and place of business is in __________

(State) (City)

____________________, and ______________________, as surety,

(State)

are held and firmly bound unto James L. Bentley, Comptroller General, Ex-officio Insurance Commissioner of Georgia, and his successors in office in the penal sum of Twenty-five Hundred ($2,500) Dollars, lawful money of the United States of America, for the payment of which well and truly to be made, we bind ourselves and our and each of our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents.

THE CONDITIONS OF THIS OBLIGATION ARE SUCH THAT if the above bounden _______________________________________ shall faithfully account to all persons requesting the said

________________________________________ to obtain insurance for them for all monies or premiums collected in connection therewith as provided in Section 56-837b of the Georgia Insurance Code of 1960, then this obligation shall be void, otherwise to remain in full force and effect.

IN WITNESS WHEREOF, the said principal has caused these presents to be executed by affixing hereto his or her signature, and the said surety has caused these presents to be executed by the signature of its ________________________

(Agent or Attorney-in-fact

_______________________ and its corporate seal to be affixed of Surety Company)

hereto, attested by its __________________________, this the

_____________ day of _______________, 19__.

(SEAL)

______________________(Seal)

(Principal)

______________________(Seal)

(Surety)

(Note Attach to this Bond a By: ________________________

properly certified copy of (Title)

power of attorney or representative of surety __________________(Seal)

company who signs Bond.) (Attorney-in-Fact)

____________________________

(Licensed Resident Agent)

PUBLIC ADJUSTER'S S BOND

(Georgia)

KNOW ALL MEN BY THESE PRESENTS, that _______________________

_____________________, whose residence is in ______________,

Georgia, and place of business is in ______________________,

Georgia, as principal, and ______________________________ as surety, are held and firmly bound unto James L. Bentley, Comptroller General, Ex-officio Insurance Commissioner of Georgia, and his successors in office, in the penal sum of Twenty-five Hundred ($2,500) Dollars, lawful money of the United States of America, for the payment of which well and truly to be made, we bind ourselves, and our and each of our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents:

THE CONDITIONS OF THIS OBLIGATION ARE SUCH THAT

if the above bounden _________________________________ shall faithfully account to any insured whose claim he is handling for all monies or any settlement received in connection therewith as provided in Section 56-845b of the Georgia Insurance Code of 1960, then this obligation shall be void, otherwise to remain in full force and effect.

IN WITNESS WHEREOF, the said principal has caused these presents to be executed by affixing hereto his or her signature, and the said surety has caused these presents to be executed by the signature of its

_______________________________________________ and its

(Agent or Attorney-in-Fact of Surety Company)

corporate seal to be affixed hereto, attested by its

_____________________ this the _______________ day of

___________________________, 19__.

____________________(Seal)

(SEAL) (Principal)

____________________(Seal)

(Surety)

(Note: Attach to this Bond a By: ________________________

properly certified copy of Title:

power of attorney of __________________(Seal)

representative of surety Attorney-in-Fact company who signs Bond.) ________________________

Licensed Resident Agent.

SURPLUS LINES BROKER'S BOND

STATE OF GEORGIA

COUNTY OF ____________________

KNOW ALL MEN BY THESE PRESENTS:

That _________________________________________________,

whose residence or place of business is in the City of ___________________________,

State of Georgia, as Principal, and ___________________________________________ as Surety, a corporation duly authorized to write surety bonds in this State, are held and firmly bound unto JAMES L. BENTLEY, Comptroller General, Ex-officio Insurance Commissioner of the State of Georgia, and his successors in office in the penal sum of Twenty Thousand Dollars ($20,000.00) lawful money of the United States of America, for the payment of which well and truly to be made, we bind ourselves, and our and each of our heirs, executors, administrators, successors and assigns jointly and severally, firmly by these presents:

The Conditions of the above obligation are such that:

WHEREAS, the above bounden Principal pursuant to the provisions of the Georgia Insurance Code of 1960 (Sections 56-613 through 56-628), as amended, is about to apply or has applied to the Insurance Commissioner of the State of Georgia for a license to place surplus lines of insurance in companies or with insurers not admitted to do business in this State;

NOW, THEREFORE, if the said above bounden Principal shall fully and faithfully comply with the requirements of the said Georgia Insurance Code of 1960, as amended, and shall file with the Insurance Commissioner of Georgia on or before April 15th of each year and quarterly thereafter, a sworn statement of the gross premiums charged for insurance placed, and the gross premiums returned on such insurance cancelled under such license during the preceding quarter, and at the time of filing such statement shall pay to the insurance Commissioner of the State of Georgia a sum equal to four percentum of such gross premiums, less return premiums, so reported; and shall faithfully account to all persons requesting him to obtain insurance for them for monies or premiums collected is connection therewith; and will in all other respects fully comply with the provision of the said Georgia Insurance Code of 1960, as amended; then this obligation is to be void; otherwise to remain in full force and effect.

IN WITNESS WHEREOF, the said principal has caused these presents to be executed by affixing hereto his or her signature, and the said surety has caused these presents to be executed by the signature of its _______________________________________________ and its (Agent or Attorney-in-Fact of Surety Company) corporate seal to be affixed hereto, attested by its

________________, this the ______ day of ____________, 19__.

(SEAL)

____________________________(Seal)

(Principal)

____________________________(Seal)

(Surety)

(NOTE: Attach a certified By: ______________________________ copy of Power of Attorney As _____________________ of Surety of Representative of (Title) Surety Company who signs Attest:___________________________ bonds). (If required by power of attorney)

As _____________________ of Surety

(Title)

__________________________________

(Licensed Resident Agent)

(2) Letters of certification may be obtained by submitting a request to the Georgia Insurance Department, Agents Licensing Division, Room 132, State Capitol Building, Atlanta, Georgia.