Form BMC-83 Household Goods Motor Carrier Cargo Liability Surety Bon

U.S. DEPARTMENT OF TRANSPORTATION

A Federal Agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current valid OMB Control Number. The OMB Control Number for this information collection is 2126-0017. Public reporting for this collection of information is estimated to be approximately 10 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and reviewing the collection of information. All responses to this collection of information are mandatory. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal Motor Carrier Safety Administration, MC-RRA, Washington, D.C. 20590.

Form BMC-83 To be sent to: FMCSA Office of Enforcement and Compliance Commercial Enforcement Division (MC-ECC W63-105) 1200 New Jersey Ave., S.E. Washington, D.C. 20590

HOUSEHOLD GOODS MOTOR CARRIER CARGO LIABILITY SURETY BOND UNDER 49 U.S.C. 13906 filed with FEDERAL MOTOR CARRIER SAFETY ADMINISTRATION OFFICE OF ENFORCEMENT AND COMPLIANCE Commercial Enforcement Division Washington, D.C. 20590

Approved by OMB 2126-0017 Expires: FMCSA Docket No. MC

Received: Filer Account No.

Date:

KNOW ALL MEN BY THESE PRESENTS, That

a corporation created and existing under the laws of the State of

with principal office at

(hereinafter called Surety), as Surety for

^{(Name of motor carrier principal)}

of

^{(Address) (City) (State) (Zip Code)}

(hereinafter called Principal), is held and firmly bound unto the United States of America in the sum or sums hereinafter provided for which payment, well and truly to be made, said Surety hereby binds itself, its successors and assigns, firmly by these presents.

THE CONDITION OF THIS OBLIGATION IS SUCH THAT:

WHEREAS, the Principal is or intends to become a common carrier by motor vehicle subject to the provisions of Title 49 of the United States Code, and the rules and regulations of the Federal Motor Carrier Safety Administration relating to insurance or other security for the protection of the shippers and consignees, and has elected to file with the FMCSA a surety bond conditioned as hereinafter set forth; and

WHEREAS, this bond is written to assure compliance by the Principal as a common carrier by motor vehicle with 49 U.S.C. 13906 and the rules and regulations of the FMCSA relating to insurance or other security for the protection of shippers and consignees, and shall insure to the benefit of any and all shippers or consignees to whom the Principal may be held liable for any of the damages herein described.

NOW, THEREFORE, if the Principal shall make compensation to shippers and consignees for all losses of or damages to property belonging to them which shall, while this bond is in effect, come into the possession of the Principal in connection with its transportation service under certificate issued to the Principal, by the FMCSA or otherwise in transportation in interstate or foreign commerce subject to Title 49 U.S.C., and the pertinent rules and regulations of the FMCSA, regardless of whether such losses or damages occur while said property is in a motor vehicle, terminal, warehouse or other place, for which losses or damages the Principal may be held legally liable.

The liability of the Surety for the limits provided shall be a continuing one notwithstanding any recovery hereunder, and extends to such losses or damages regardless of whether the motor vehicles, terminals, warehouses, and other facilities used in connection with the transportation service of the Principal are specifically described herein, and whether occurring on the route or in the territory authorized to be served by the Principal or elsewhere. The bond is effective from 12:01 a.m., standard time, as the address of the Principal as stated herein, and shall continue in force until canceled.

The Principal or the Surety may at any time cancel this bond by written notice to the FMCSA at its office in Washington, DC, such termination to become effective thirty (30) days after actual receipt of said notice by the FMCSA on the prescribed Form BMC-36, Notice of Cancellation of Motor Carrier and Broker Surety Bonds. The Surety shall not be liable hereunder for the payment of any of the losses or damages hereinbefore described which arise on property coming into possession of the Principal in connection with its transportation service after the cancellation of this bond as herein provided, but such cancellation shall not affect the liability of the Surety hereunder for the payment of any such losses or damages occurring to property coming into the possession of the Principal in connection with its transportation service during the time the bond is in effect.

The receipt of this cargo liability surety bond by the FMCSA certifies that the company is qualified to make this filing under 49 CFR 387.315 or 387.411.

Falsification of this document can result in criminal penalties prescribed under 18 USC 1001.

IN WITNESS WHEREOF, the said Surety has executed this instrument on the day of , .

[AFFIX CORPORATE SEAL]

^(Surety)

By

^{(City) (State) (Zip code) (Signature and Title)}

ACKNOWLEDGMENT OF SURETY:  STATE OF COUNTY OF

On this day of , , before me personally came who,

being by me duly sworn, did depose and say that he/she resides in ; that he/she is the of the

, the corporation described in and which executed the foregoing instrument; that he/she knows the seal of said corporation; that the seal affixed to said instrument is such corporate seal; that it was so affixed by order of the board of directors of said corporation; that he/she signed his/her name thereto by like order, and he/she duly acknowledged to me that he/she executed the same for and on behalf of said corporation.

(OFFICIAL SEAL)

^{(Title of official administering oath)}

Surety Company File No.

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