Additional information

Bond Term	4-year
Errors and Omissions (E&O)	Bond Only, $10,000, $15,000, $20,000, $25,000, $100,000
Surety Company	Travelers Surety, Western Surety Company

Bond No. ________________
State of Wisconsin
Department of Financial Institutions Notary Public Bond
Notary Records
All persons applying or reapplying for a four-year notary public commission must purchase a $500 bond from an
insurance company. Contact the insurance company of your choice to purchase a bond. This bond form, or a bond form
supplied by an insurance company, must be completed and submitted to the Wisconsin Department of Financial
Institutions as proof that you have purchased a bond. Any bond form supplied by an insurance company must be in a
format previously approved by DFI. The insurance company you choose to supply your bond must be qualified to write
surety bonds in Wisconsin.

Notary Applicant: Complete sections 1-6. Section 1 must be an original signature.

Insurance Agent: Complete sections 7-13. Sections 9, 10, and 11 must indicate the surety company’s information rather
than the local insurance agency’s name and address. For section 13, if a seal or stamp is affixed, the name of the surety
company on the seal or stamp must match the name listed in section 9. If a power of attorney form is used, the agent’s
name as signed in section 7 must appear on the power of attorney.

Notary Applicant & Surety Bond Agent Agreement

KNOW ALL TO WHOM THESE PRESENTS SHALL COME, that we (notary applicant and surety), jointly and severally,
undertake and agree that the notary applicant, upon appointment to the office of Notary Public, will faithfully discharge the
duties of said office according to law, and that the surety will pay to the parties entitled to receive the same, such
damages, not exceeding the aggregate FIVE HUNDRED DOLLARS ($500) as may be suffered by them in consequence
of the failure of the notary applicant herein to discharge his or her duties as a Notary Public.

Notary Applicant Complete 1 6 Insurance Agent Complete 7 13

1. Signature of notary applicant 7. Signature of surety company agent

8.
Print name of person who signed #7
2. Print name of notary applicant Preview
3. In care of: (Business name, if applicable) 9. Print name of surety company

4. Mailing address of notary applicant 10. Mailing address of surety company

5. City State Zip 11. City State Zip

6. Daytime telephone of notary applicant 12. Date

13.Surety company seal, stamp or power of attorney
After this form has been completed, email or mail it in the must be affixed.
same envelope along with your completed application,
Notary exam certificate, Oath of Office, and $20 filing fee
(if not already paid online) to:

Email: DFINotary@dfi.wisconsin.gov
OR
Mail:
Notary Records Section
WI Dept of Financial Institutions
PO Box 7847
Madison WI 53707-7847
Questions

Email: DFINotary@dfi.wisconsin.gov
Call: 608-266-8915
Fax: 608-264-7965
DFI/NOT/100 (R01/21) Page 4 of 4
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Travelers Casualty and Surety Company of America

One Tower Square, Hartford, Connecticut 06183
.
NOTARY PUBLIC ERRORS AND OMISSIONS POLICY
Policy No ____________
Term Premium: ____________
Preview
Policy Effective Date ____________

TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA (the “Company”) will pay on behalf of
______________________________________________ of ________________________________________________________
(the “Insured”), all sums which the Insured shall become obligated to pay by reason of liability for breach of duty while acting as a duly
commissioned and sworn Notary Public, claim for which is made against the Insured by reason of any negligent act, error or omission, committed or
alleged to have been committed by the Insured, arising out of the performance of notarial service for others in the Insured’s capacity as a duly
commissioned and sworn Notary Public.

POLICY PERIOD: This policy applies only to negligent acts, errors or omissions which occur during the Policy Period and then only if
claim, suit or other action arising therefrom is commenced within the applicable Statute of Limitations pertaining to the Insured. The Policy Period
commences on the Effective Date hereof and terminates upon the expiration of the Insured’s commission as a Notary Public unless cancelled earlier
as provided in this policy. This policy is not valid for more than one commission term.

LIMIT OF LIABILITY: The liability of the Company shall not exceed in the aggregate for all claims under this insurance the amount of:
_________________________________________________________________________________________ DOLLARS (________________).
In addition to the limit of liability and in accordance with the other provisions of this policy, the Company will pay costs and expenses paid and
incurred in investigating, contesting or settling liability in an amount not to exceed, in the aggregate, one-half of the limit of this policy.

INSURED’S DUTIES IN THE EVENT OF OCCURRENCE, CLAIM OR SUIT:
(a) Upon knowledge of any occurrence which may reasonably be expected to result in a claim or suit, written notice containing
particulars sufficient to identify the Insured and also reasonably obtainable information with respect to the time, place and circumstances thereof, and
the names and addresses of the potential claimant and of available witnesses, shall be given by or for the Insured to the Company or any of its
authorized agents as soon as practicable, but in no event longer than forty-five (45) days after discovery.
(b) If claim is made or suit is brought against the Insured, the Insured shall immediately forward to the Company every demand,
notice, summons or other process received by him or his representative.
(c) The Insured shall cooperate with the Company and, upon the Company’s request, assist in making settlements, in the conduct of
suits and the Insured shall attend hearings and trials and assist in securing and giving evidence and obtaining the attendance of witnesses. The
Insured shall not, except at his own cost, voluntarily make any payment, assume any obligation or incur any expense except with the prior written
consent of the Company.

EXCLUSIONS: Coverage under this policy does not apply to any dishonest, fraudulent, criminal or malicious act or omission of the
Insured.

OTHER INSURANCE: If the Insured has other insurance against a loss covered by this policy, the Company shall not be liable under this
policy for a greater proportion of such loss, cost and expenses than the limit of liability stated in this policy bears to the total limit of liability of all
valid and collectible insurance against such loss.

CANCELLATION: The insured may cancel this policy at any time by mailing or delivering to us advance written notice of cancellation.
The company may cancel this policy by mailing or delivering to the insured written notice of cancellation at least 10 days before the effective date of
cancellation if we cancel for nonpayment of premium or 30 days before the effective date of cancellation if we cancel for any other reason. If we
cancel, the premium refund will be pro rata and if the insured cancels, the refund may be less than pro rata. The cancellation will be effective even if
we have not made or offered a refund.

IN WITNESS WHEREOF, the Company has caused this Policy to be signed by its authorized Company officers at Hartford, CT.

____________________________________________ ___________________________________________
President Corporate Secretary

EO1001 (03-04)
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ISSUED BY: POLICY NO:
ISSUED TO:

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CANCELLATION/NONRENEWAL – WISCONSIN
FULL CANCELLATION – INSURER
Preview

It is agreed that:

1. The policy provisions regarding cancellation by the Company are deleted and replaced with the following:

A. CANCELLATION OF POLICIES IN EFFECT FOR LESS THAN 60 DAYS
(a) If this Policy has been in effect for less than 60 days and is not a renewal of a policy we issued, we may cancel this
Policy for any reason by mailing or delivering to the entity named in Item 1 of the Declarations written notice of
cancellation at least 10 days before the effective date of cancellation. Notice is by first class mail.

B. CANCELLATION OF POLICIES IN EFFECT FOR 60 DAYS OR MORE
If this Policy has been in effect for 60 days or more, or is a renewal of a Policy we issued, we may cancel only for one or
more of the following reasons:
(a) Nonpayment of premium;
(b) Material misrepresentation;
(c) Breach of contractual duties, conditions or warranties;
(d) Substantial change in the risk assumed, except to the extent that we (the insurer) should reasonably have foreseen
the change or contemplated the risk in writing the contract.

We will mail or deliver written notice of cancellation under this item B. to the entity named in Item 1 of the Declarations
at least:
(1) 10 days before the effective date of cancellation; or
(2) 60 days before the anniversary date for policies with a term longer than one year or written for an indefinite term.

2. The following is added and supersedes any other provision to the contrary:

NONRENEWAL
If we decide not to renew this Policy, we will mail or deliver written notice of nonrenewal to the entity named in Item 1 of the
Declarations at least:
(1) 10 days but not more than 75 days before its expiration date, or its anniversary date if it is a Policy written for a term
of more than one year or with no fixed expiration date if we are nonrenewing for nonpayment of premium; or
(2) 60 days before such date if we are nonrenewing for any other reason.

Termination of an insurance marketing intermediary’s contract (agency agreement termination) with an insurer is permissible.
The cancellation is effective only if the notice includes a statement offering to continue the policy if the insurer receives a written
request from the insured prior to the cancellation date that coverage be continued. If the insurer does not receive such written
request for continued coverage, the policy terminates on the effective date of cancellation.

3. Any cancellation or nonrenewal notice shall be sent by first class mail.

Nothing herein contained shall be held to vary, alter, waive or extend any of the terms, conditions, exclusions or limitations of the
above mentioned policy, except as expressly stated herein. This endorsement is effective at the inception date stated in the
Declarations and this endorsement is part of such policy and incorporated therein.

ILT-5100 (08-10)
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ISSUED BY: POLICY NO:
ISSUED TO:

THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

CANCELLATION/NONRENEWAL – WISCONSIN
CANCELLATION FOR NONPAYMENT OF PREMIUM
Preview

It is agreed that:

1. The policy provisions regarding cancellation by the Company are deleted and replaced with the following:

A. We may cancel this Policy for nonpayment of premium by mailing or delivering to the entity named in Item 1 of the
Declarations written notice of cancellation at least 10 days before the effective date of cancellation.

2. The following is added and supersedes any other provision to the contrary:

NONRENEWAL
If we decide not to renew this Policy, we will mail or deliver written notice of nonrenewal to the entity named in Item 1 of the
Declarations at least:
(1) 10 days but not more than 75 days before its expiration date, or its anniversary date if it is a Policy written for a term
of more than one year or with no fixed expiration date if we are nonrenewing for nonpayment of premium; or
(2) 60 days before such date if we are nonrenewing for any other reason.

Termination of an insurance marketing intermediary’s contract (agency agreement termination) with an insurer is permissible.
The cancellation is effective only if the notice includes a statement offering to continue the policy if the insurer receives a written
request from the insured prior to the cancellation date that coverage be continued. If the insurer does not receive such written
request for continued coverage, the policy terminates on the effective date of cancellation.

3. Any cancellation or nonrenewal notice shall be sent by first class mail.

Nothing herein contained shall be held to vary, alter, waive or extend any of the terms, conditions, exclusions or limitations of the
above mentioned policy, except as expressly stated herein. This endorsement is effective at the inception date stated in the
Declarations and this endorsement is part of such policy and incorporated therein.

ILT-5101 (08-10)