Form BMC-84 Broker's or Freight Forwarder's Surety Bond Under 49 U.S

FORM BMC-84

OMB No.: 2126-0017

Revised 06/09/2015

USDOT Number:

Expiration: 02/28/2017

Date Received:

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.

United States Department of Transportation
Federal Motor Carrier Safety Administration

Broker’s or Freight Forwarder’s Surety Bond under 49 U.S.C. 13906

FORM BMC-84
KNOW ALL MEN BY THESE PRESENTS, that we,
of

,

(Name of Broker or Freight Forwarder)

(Street)

(City)

as PRINCIPAL (hereinafter called Principal), and

American
Alberta
Alaska
Alabama
British
Arkansas
Arizona
District
Delaware
Connecticut
Colorado
California
Marshall
Manitoba
Maine
Louisiana
Kentucky
Kansas
Iowa
Indiana
Illinois
Idaho
Hawaii
Guam
Georgia
Florida
Nevada
Nebraska
Montana
Missouri
Mississippi
Minnesota
Micronesia
Michigan
Massachusetts
Maryland
New
Newfoundland
North
Northern
Northwest
Nova
Prince
Pennsylvania
Palau
Oregon
Ontario
Oklahoma
Ohio
Nunavut
Puerto
Rhode
Quebec
Saskatchewan
South
Virgin
Vermont
Utah
Texas
Tennessee
West
Washington
Virginia
Yukon
Wyoming
Wisconsin
Brunswick
Hampshire
Jersey
Mexico
Virginia
Scotia
Carolina
Dakota
Carolina
Dakota
Edward
Island
Islands
Columbia
Rico
ofIslands
Marianas
Samoa
Columbia
Territories
Island
and Labrador
(State)York
(Zip)

(Name of Surety)

a corporation, or a Risk Retention Group established under the Liability Risk Retention Act of 1986, Pub. L. 99-563, created and existing
under the laws of the State of

(hereinafter called Surety), are held and firmly bound unto the United States of

American
Alberta
Alaska
Alabama
British
Arkansas
Arizona
District
Delaware
Connecticut
Colorado
California
Marshall
Manitoba
Maine
Louisiana
Kentucky
Kansas
Iowa
Indiana
Illinois
Idaho
Hawaii
Guam
Georgia
Florida
Nevada
Nebraska
Montana
Missouri
Mississippi
Minnesota
Micronesia
Michigan
Massachusetts
Maryland
New
Newfoundland
North
Northern
Northwest
Nova
Prince
Pennsylvania
Palau
Oregon
Ontario
Oklahoma
Ohio
Nunavut
Puerto
Rhode
Quebec
Saskatchewan
South
Virgin
Vermont
Utah
Texas
Tennessee
West
Washington
Virginia
Yukon
Wyoming
Wisconsin
Brunswick
Hampshire
Jersey
Mexico
Virginia
Scotia
Carolina
Dakota
Carolina
Dakota
Edward
Island
Islands
Columbia
Rico
ofIslands
Marianas
Samoa
Columbia
Territories
Island
and Labrador
(State)York

America in the sum of $75,000 for a broker or freight forwarder, for which payment, well and truly to be made, we bind ourselves and our
heirs, executors, administrators, successors, and assigns, jointly and severally, firmly by these presents.
WHEREAS, the Principal is or intends to become a Broker or Freight Forwarder pursuant to the provisions of Title 49 U.S.C. 13904, and
the rules and regulations of the Federal Motor Carrier Safety Administration relating to insurance or other security for the protection
of motor carriers and shippers, and has elected to file with the Federal Motor Carrier Safety Administration such a bond as will ensure
financial responsibility and the supplying of transportation subject to the ICC Termination Act of 1995 in accordance with contracts,
agreements, or arrangements therefore, and
WHEREAS, this bond is written to assure compliance by the Principal as either a licensed Broker or a licensed Freight Forwarder
of Transportation by motor vehicle with 49 U.S.C. 13906(b), and the rules and regulations of the Federal Motor Carrier Safety
Administration, relating to insurance or other security for the protection of motor carriers and shippers, and shall inure to the benefit of
any and all motor carriers or shippers to whom the Principal may be legally liable for any of the damages herein described.
NOW, THEREFORE, the condition of this obligation is such that if the Principal shall pay or cause to be paid to motor carriers or shippers
by motor vehicle any sum or sums for which the Principal may be held legally liable by reason of the Principal’s failure faithfully to
perform, fulfill, and carry out all contracts, agreements, and arrangements made by the Principal while this bond is in effect for the
supplying of transportation subject to the ICC Termination Act of 1995 under license issued to the Principal by the Federal Motor Carrier
Safety Administration, then this obligation shall be void, otherwise to remain in full force and effect.
The liability of the Surety shall not be discharged by any payment or succession of payments hereunder, unless and until such payment
or payments shall amount in the aggregate to the penalty of the bond, but in no event shall the Surety’s obligation hereunder exceed
the amount of said penalty. The Surety agrees to furnish written notice to the Federal Motor Carrier Safety Administration forthwith of all
suits filed, judgements rendered, and payments made by said Surety under this bond.
This bond is effective the
day of
,
, 12:01 a.m., standard time at the address of the
December
November
October
September
August
July
June
May
April
March
February
January
2023
2022
2021
2020
2019
2018
2017
2016
31stshall continue in
30th
29th
28th
27th
26th
25th
24th
23rd
22nd
21st
20th
19th
18th
17th
16th
15th
14th
13th
12th
11th
10th
9th
8th
7th
6th
5th
4th
3rd
2nd
1st
Principal as stated herein and
force until terminated as2015
hereinafter provided. The Principal or the Surety may at any time
cancel this bond by written notice to the Federal Motor Carrier Safety Administration at its office in Washington, DC, such cancellation to
become effective thirty (30) days after actual receipt of said notice by the FMCSA on the prescribed Form BMC-36, Notice of Cancellation
Motor Carrier and Broker Surety Bond. The Surety shall not be liable hereunder for the payment of any damages herein before described
which arise as the result of any contracts, agreements, undertakings, or arrangements made by the Principal for the supplying of
transportation after the termination of this bond as herein provided, but such termination shall not affect the liability of the Surety
hereunder for the payment of any such damages arising as the result of contracts, agreements, or arrangements made by the Principal
for the supplying of transportation prior to the date such termination becomes effective.
The receipt of this filing by the FMCSA certifies that a Broker Surety Bond has been issued by the company identified above, and that
such company is qualified to make this filing under Section 387.315 of Title 49 of the Code of Federal Regulations.
Falsification of this document can result in criminal penalties prescribed under 18 U.S.C. 1001.
FORM BMC-84 Page 1 of 2

,
,

FORM BMC-84

OMB No.: 2126-0017

Revised 06/09/2015

IN WITNESS WHEREOF, the said Principal and Surety have executed this instrument on the

day of

31st
30th
29th
28th
27th
26th
25th
24th
23rd
22nd
21st
20th
19th
18th
17th
16th
15th
14th
13th
12th
11th
10th
9th
8th
7th
6th
5th
4th
3rd
2nd
1st

PRINCIPAL

SURETY

COMPANY NAME

COMPANY NAME

Expiration: 02/28/2017

,

December
November
October
September
August
July
June
May
April
March
February
January

2023
2022
2021
2020
2019
2018
2017
2016
2015

.

STREET ADDRESS

CITY

STREET ADDRESS

CITY

American
Alberta
Alaska
Alabama
British
Arkansas
Arizona
District
Delaware
Connecticut
Colorado
California
Marshall
Manitoba
Maine
Louisiana
Kentucky
Kansas
Iowa
Indiana
Illinois
Idaho
Hawaii
Guam
Georgia
Florida
Nevada
Nebraska
Montana
Missouri
Mississippi
Minnesota
Micronesia
Michigan
Massachusetts
Maryland
New
Newfoundland
North
Northern
Northwest
Nova
Prince
Pennsylvania
Palau
Oregon
Ontario
Oklahoma
Ohio
Nunavut
Puerto
Rhode
Quebec
Saskatchewan
South
Virgin
Vermont
Utah
Texas
Tennessee
West
Washington
Virginia
Yukon
Wyoming
Wisconsin
Brunswick
Hampshire
Jersey
Mexico
Virginia
Scotia
Carolina
Dakota
Carolina
Dakota
Edward
Island
Islands
Columbia
Rico
ofIslands
Marianas
Samoa
Columbia
Territories
Island
and Labrador
STATEYork
ZIP CODE

TELEPHONE NUMBER

American
Alberta
Alaska
Alabama
British
Arkansas
Arizona
District
Delaware
Connecticut
Colorado
California
Marshall
Manitoba
Maine
Louisiana
Kentucky
Kansas
Iowa
Indiana
Illinois
Idaho
Hawaii
Guam
Georgia
Florida
Nevada
Nebraska
Montana
Missouri
Mississippi
Minnesota
Micronesia
Michigan
Massachusetts
Maryland
New
Newfoundland
North
Northern
Northwest
Nova
Prince
Pennsylvania
Palau
Oregon
Ontario
Oklahoma
Ohio
Nunavut
Puerto
Rhode
Quebec
Saskatchewan
South
Virgin
Vermont
Utah
Texas
Tennessee
West
Washington
Virginia
Yukon
Wyoming
Wisconsin
Brunswick
Hampshire
Jersey
Mexico
Virginia
Scotia
Carolina
Dakota
Carolina
Dakota
Edward
Island
Islands
Columbia
Rico
ofIslands
Marianas
Samoa
Columbia
Territories
Island
and Labrador
STATEYork
ZIP CODE

TELEPHONE NUMBER

(type or print Principal officer’s name and title)

(type or print Principal officer’s name and title)

(Principal officer’s signature)

(Principal officer’s signature)

(type or print witness’s name)

(type or print witness’s name)

(witness’s signature)

(witness’s signature)

(affix Surety seal)

Filings must be transmitted online via the Internet at http://www.fmcsa.dot.gov/urs.

FORM BMC-84 Page 2 of 2