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State of California Department of Insurance
Bond of Insurance Adjuster
Form 31A-14 (Rev 4/2017)
California Code of Regulations Title 11 section 50.22
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Producer Licensing Bureau
P.O. Box 1139
Sacramento, CA 95812-1138
Information (916) 492-3085
www.insurance.ca.gov

State of California
Department of Insurance
BOND OF INSURANCE ADJUSTER
(California Insurance Code sections 14050-14054)

BOND No._____________
PREMIUM ___________

KNOW ALL BY THESE PRESENTS:

THAT WE, , as Principal, an applicant for or holder
of a California adjuster’s license, whose address upon which process may be served is,
__________________________________________________________________________ and
_______________________________________________, an admitted surety insurer as Surety
hereon, whose address upon which process may be served is _____________________________
__________________________________________________________________bind ourselves
in the penal sum of TWO THOUSAND DOLLARS ($2,000) to the People of the State of
California, which sum shall be the limit of total aggregate liability hereunder for which payment
we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and
severally, firmly by these presents.

This obligation shall be conditioned on the obligations set forth in California Insurance Code
sections 14050 and 14051, i.e., the faithful and honest conduct of business by the Principal, and
every person injured by the willful, malicious, or wrongful act of the Principal may bring an
action on this bond in her or his own name to recover damages suffered by reason of such
willful, malicious, or wrongful conduct.

When the Surety makes payment on any claim against a bond required by Insurance Code
sections 14050 and 14051, the Surety shall, within thirty (30) days of payment, notify the
California Insurance Commissioner of the date of payment, amount of payment, payee and bond
number.

This bond shall take effect on ___________________________, but not prior to the date of its
execution. If no date is hereinabove written, it shall take effect on the later of the two dates
of execution set forth below.
—————————————————–

This bond shall remain in force and effect until the Surety is released from further liability by the
Commissioner or until the bond is canceled by the Surety. The Surety may cancel the bond and
be released of further liability hereunder by delivering 30 days’ notice to the Commissioner.
Such cancellation shall not affect any liability incurred or accrued prior to the termination of the
30-day period.

This bond is executed by the Surety to comply and the bond shall be subject to the provisions of
Chapter 1 (commencing with section 14000) of Division 5 of the California Insurance Code and
Chapter 2 (commencing with section 995.010) of Title 14 of Part 2 of the California Code of
Civil Procedure and shall be subject to all of the terms and provisions thereof.

By executing this bond, Principal and Surety agree any action on this bond shall be instituted and
prosecuted in the counties of the State of California, with service by U.S. mail as prescribed in
the California Code of Civil Procedure sections 417.10 and 417.20 and this bond shall be
governed by the laws of the State of California.

In witness whereof the Principal has subscribed his/her/its true name on the date and at the place
entered opposite his/her/its signature, and the Surety has subscribed its full and correct name and
affixed its corporate seal on the date shown opposite its signature.

________________________________________ ___________________________
Principal Preview
Date
By_______________________________________ ___________________________
Name Place Where Executed

__________________________________________ ___________________________
Surety Date

By_______________________________________ ___________________________
Name Place Where Executed

By______________________________________ ___________________________
Name Place Where Executed

Seal

Note: For instructions as to execution by principal and surety and for form of entity
acknowledgement and for form of acknowledgement by individual adjuster, see California Code
of Regulations, title 11, section 50.20.
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ACKNOWLEDGMENT

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A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.

State of California
County of _____________________________)

On _________________________ before me, _________________________________________
(insert name and title of the officer)

personally appeared ______________________________________________________________,
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.

WITNESS my hand and official seal.

Signature ______________________________ (Seal)

State of California Department of Insurance
Bond of Public Insurance Adjuster
Form 94A (Rev. 3/2020)
California Code of Regulations Title 11 section 50.21
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Producer Licensing Bureau
320 Capitol Mall
SACRAMENTO, CA 95814-4309
Information (800) 967-9331
www.insurance.ca.gov

State of California
Department of Insurance
Bond of Public Insurance Adjuster

(California Insurance Code sections 15011(g), 15033-15037)

BOND No. ___________________

PREMIUM _________________

KNOW ALL BY THESE PRESENTS:

That we__________________________________________ an applicant for or holder of
a California Public Insurance Adjusters license, whose address upon which process may be
served is _____________________________________________________________________
____________________________________________________________, as PRINCIPAL, and
___________________________________________, a corporation authorized to transact a
surety business in the State of California, as SURETY, whose address upon which process may
be served is ___________________________________________________________________,
are held and firmly bound to the People of the State of California in the penal sum of TWENTY
THOUSAND DOLLARS ($20,000), for which payment we bind ourselves, our heirs, executors,
administrators, successors and assigns jointly and severally, firmly by these presents.

WHEREAS, the provisions of Insurance Code section 15011(g) require that the
PRINCIPAL file a bond in connection with said Public Insurance Adjuster license and this bond
is executed and tendered in accordance therewith,

THE CONDITION OF THIS OBLIGATION IS SUCH,

That if the PRINCIPAL shall conduct business, including adjusting claims for fire and
allied coverages, burglary, flood and all property claims both real and personal, and loss of
income in a faithful and honest manner, then this obligation shall be null and void; otherwise it
shall remain in full force and effect.
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This bond shall be deemed continuous in form and shall remain in full force and effect
and shall run concurrently with the license period for which the license is granted and each and
every succeeding renewal period or periods, or until the bond is canceled by the Surety. The
Surety may cancel the bond and be released of further liability hereunder by delivering 30 days’
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notice to the Commissioner. Such cancellation shall not affect any liability incurred or accrued
prior to the termination of the 30-day period, after which liability hereunder shall cease except as
to any liability or indebtedness therefor incurred or accrued hereunder.

The aggregate liability of the Surety hereunder on all claims whatsoever shall not
exceed the penal sum of this bond.

This bond is executed by the Surety to comply with and the bond shall be subject to the
provisions of Chapter 2 (commencing with section 15000), of Division 5 of the California
Insurance Code and to the provisions of Chapter 2 (commencing with section 995.010) of Title
14 of Part 2 of the California Code of Civil Procedure.

By executing this bond, Principal and Surety agree any action on this bond shall be
instituted and prosecuted in the counties of the State of California, with service by U.S. mail as
prescribed in the California Code of Civil Procedure sections 417.10 and 417.20 and this bond
shall be governed by the laws of the State of California.

Dated: _________________ __________________________________________
Name of Public Adjuster

By_______________________________________

__________________________________________
Name and Title of Signator

Dated: _________________ __________________________________________
Name of Surety

By_______________________________________

__________________________________________
Name and Title of Signator

By_______________________________________

__________________________________________
Name and Title of Signator

SEAL
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I certify (or declare) under penalty of perjury under the laws of the State of California that I have
executed the foregoing bond under an unrevoked Power of Attorney.

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Executed in ____________________________________________ on ____________________,
(city and state) (date)

_________________________________________
(Signature of Surety or Surety’s Attorney-in-Fact)

Note: For instructions as to execution by principal and surety and for form of entity
acknowledgement and for form of acknowledgement by individual adjuster, see California Code
of Regulations, title 11, section 50.20.
—————————————————–

ACKNOWLEDGMENT

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A notary public or other officer completing this
certificate verifies only the identity of the individual
who signed the document to which this certificate is
attached, and not the truthfulness, accuracy, or
validity of that document.
State of ______________________________)
County of _____________________________)

On _________________________ before me, _________________________________________
(insert name and title of the officer)

personally appeared ______________________________________________________________,
who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are
subscribed to the within instrument and acknowledged to me that he/she/they executed the same in
his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the
person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing
paragraph is true and correct.

WITNESS my hand and official seal.

Signature ______________________________ (Seal)