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

FORM BMC-83

OMB No.: 2126-0017

Revised 06/05/2015

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

Household Goods Motor Carrier Cargo Liability Surety Bond under 49 U.S.C. 13906

FORM BMC-83

,

KNOW ALL MEN BY THESE PRESENTS, that
a corporation created and existing under the laws of the State of
(Street)

(hereinafter called Surety), as Surety for
(Street)

(City)

, with principal office at
(State)

, of

(Name of Motor Carrier Principal)
(City)

,

(Zip)

(State)

(Zip)

(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 at 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.

FORM BMC-83 Page 1 of 2

FORM BMC-83

OMB No.: 2126-0017

Revised 06/05/2015

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

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

day of

,

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

2023
2022
2021
2020
2019
2018
2017
2016
2015

Expiration: 02/28/2017

.

SURETY

(affix Corporate seal)

STREET

CITY

STATE

ZIP CODE

By
(Name and Title)
(Signature)

ACKNOWLEDGMENT OF SURETY: STATE OF:

COUNTY OF:

On this

day of
,
, before me personally came
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
December
November
October
September
August
July
June
May
April
March
February
January
2023
2022
2021
2020
2019
2018
2017
2016
2015
who, being by me duly sworn, did depose and say that he/she resides in
is the

of the

; that he/she
, 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.

(Title of official administering oath)

(affix official seal)

(Signature)

Surety Company File Number:

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

FORM BMC-83 Page 2 of 2