21a-190k-6

Regulations of Connecticut State Agencies

Sec. 21a-190k-6. Fund-raising counsel or paid solicitor bond

Fund-raising counsel required to file a bond with the department pursuant to section 21a-190e(b) of the Connecticut General Statutes and every paid solicitor shall use the following bond form:

FUND RAISING COUNSEL OR PAID SOLICITOR BOND

PLEASE READ INSTRUCTIONS BEFORE COMPLETING THIS FORM

BOND NUMBER: ______________________________

State the name and address of the insurance agency through which this bond was purchased:

Agency Name

_______________________________________________

Address

_______________________________________________

City, State & Zip Code

_______________________________________________

KNOW ALL MEN BY THESE PRESENTS:

That _______________________________________________________________ of

Name of Fund Raising Counsel or Paid Solicitor

______________________________________________________________________

Address of Fund Raising Counsel or Paid Solicitor

as Principal, and _________________________________________________________

Name of Surety Company

a corporation organized and existing under the laws of the State of _________________

Name of State

and duly authorized by law to become surety on bonds in the State of Connecticut, as Surety, are held and firmly bound jointly and severally, unto the State of Connecticut and to any person who may have a cause of action against the Principal for any liabilities arising out of the conduct of business by the Principal as Fund Raising Counsel or Paid Solicitor, in the sum of TWENTY THOUSAND DOLLARS ($20,000.00), lawful money of the United States of America, to be paid to the Commissioner of Consumer Protection, State of Connecticut, for the use of the State of Connecticut, and to any person who may have a cause of action against the Principal for any such liabilities, as their interests may appear, not exceeding in the aggregate the said sum of TWENTY THOUSAND DOLLARS ($20,000.00) for which payment well and truly to be made we, the Principal and Surety, bind ourselves, our heirs, executors, administrators, successors and assigns, by these presents.

WHEREAS, the above bounden Principal intends to register with the Department of Consumer Protection of the State of Connecticut as Fund Raising Counsel or Paid Solicitor for the purpose of acting as Fund Raising Counsel or Paid Solicitor for a charitable organization required to register with the Department of Consumer Protection of the State of Connecticut pursuant to the Connecticut General Statutes.

NOW, the condition of the obligation is such that if the above bounden Principal shall register as such Fund Raising Counsel or Paid Solicitor with the Department of Consumer Protection of the State of Connecticut, and said Principal shall faithfully and honestly act as such Fund Raising Counsel or Paid Solicitor in accordance with law, and fully complies with all applicable provisions of the Connecticut General Statutes, and if the Principal shall fully indemnify and save harmless from loss the State of Connecticut and any person who may have a cause of action against the Principal for any liabilities arising out of the conduct of business as such Fund Raising Counsel or Paid Solicitor, then this obligation shall be void, otherwise to be and remain in full force and effect.

This bond shall not become void upon the first recovery thereon but may be sued upon from time to time until the full amount thereof shall have been exhausted. This bond is to cover all claims arising on account of the registration of the Principal as Fund Raising Counsel or Paid Solicitor, and his acting as such.

This bond shall be effective for the full annual term herof beginning

__________________, and expiring on __________________ .

Effective Date

Expiration Date

Signed this _______ day of _______________________, _______________,

__________________________________________________

Principal (Fund Raising Counsel of Paid Solicitor)

By:

__________________________________________________

Signature and title of authorized representative of Principal

__________________________________________________

Surety

By:

__________________________________________________

Attorney-in-Fact (Attach copy of Power of Attorney)

ACKNOWLEDGMENT OF INDIVIDUAL

STATE OF _________________________ COUNTY OF ___________________________

On this _________ day of _________________, _____________________ , before me personally appeared _______________________________________________ , known to me to be the individual whose name is subscribed in the foregoing instrument and acknowledged to me that such person executed the same for the purposes therin contained.

______________________________________

Notary

(seal)

ACKNOWLEDGMENT OF PARTNERSHIP OR LIMITED LIABILITY COMPANY

STATE OF _________________________ COUNTY OF ___________________________

On this _________ day of _________________, _____________________ , before me personally appeared _______________________________________________ , known to me to be the individual whose name is subscribed in the foregoing instrument and acknowledged to me that such person executed the same on behalf of said firm and for the purposes therin contained.

______________________________________

Notary

(seal)

ACKNOWLEDGMENT OF CORPORATION

STATE OF _________________________ COUNTY OF ___________________________

On this _________ day of _________________, _____________________ , before me personally appeared _________________________________________________ , who acknowledged to me that such person is the ________________________________ of ________________________ , a corporation, and that as such corporate officer, being authorized so to do, executed the foregoing instrument for the purposes therein contained, by signing on behalf of said corporation.

______________________________________

Notary

(seal)

(Adopted effective June 6, 2001)