HomeMy WebLinkAboutSURETY BOND TRIMBLE CONSTRUCTION
RELEASE AND ASSIGNMENT
(Misc. Bond Form)
Claim #:
00182248
KNOW ALL MEN BY THESE' PRESENTS THAT :
WHEREAS, heretofore RLI Insurance Company, a Surety corporation
with principal offices in Peoria, Illinois (hereinafter called
"Surety") executed, as surety, a bond for Trimble Construction in
favor of .County of Richmond covering RSB0786383. , and
WHEREAS, the undersigned has made claim against the Surety under
said bond for the sum of $3,200.00 Dollars, and does covenant and
. warrant that this sum is now justly due and owing the said undersigned ..........
~~by'..-sala~.-...prIncJ.pal above"'all"c-reaIts~- off se't~"payments;----ana'-- .,
counterclaims of whatsoever nature or kind; and
NOW THEREFORE, in consideration of the premises and of the
payment by the Surety of the sum of $3,200.00 Dollars, as full
settlement and compromise of said claim, the undersigned hereby
releases and forever discharges the said Surety, its successors and
assigns, from any and all claim and demands of whatsoever nature or
kind, and does hereby sell, assign, transfer, and set over unto said
Surety all rights, title, and interest in and to said claim and all
sums of money due and payable thereon, and does give and grant to it
full power and authority to demand and receive the same for its use
and upon receipt thereof to give discharge of the same or any part
thereof.
ANY PERSON WHO KNOWINGLY AND WITH INTENT TO INJURE, DEFRAUD OR DECEIVE
ANY INSURER FILES A STATEMENT OF CLAIM OR APPLICATION CONTAINING ANY
FALSE, INCOMPLETE. OR MISLEADING INFORMATION MAY BE GUILTY OF A
CRIMINAL ACT.
- ~_"ga,,<t;-aea'1_~~il..,.,ec>-.thi~~ ~day~~e~~~~-
J~,4
day of
~.scribed and sworn
t'OV'LrJ'<./U, 20f21.
to
dk~91~&/
Pr1"l~ r ..
C<...iiI\"(\ tJ P. c J~V1..(, ~ f", eoN
I .
~ . U 7nf)1~
~otary Public
State of ~LI:>>f1/cU.
My Commission Expires:
County of r:~u~x~
Notary Public, Columbia County, Georgia
My Commission Expires Aug. 1. 2006
i'.
RELEASE AND ASSIGNMENT
- (Misc. Bond Form)
Claim #:
00182248
KNOW ALL MEN BY THESE PRESENTS THAT:
WHEREAS, heretofore RLI Insurance
with principal offices in Peoria,
"Surety") executed, as surety, a bond
favor of County of.. Richmond covering
Company, a Surety corporation
Illinois (hereinafter called
for Trimble Construction in
RSB0786383 , and
WHEREAS, the undersigned has made claim against the Surety under
said bond for the sum of $3,200.00 Dollars, and does covenant and
warra:q5thatthis sum is now justly due and owing the saiciundersigned
......."".--"';"t:,-y=-saiCi principal C:th~ve---';;-al1"';" 01. t::<llLSI"7'Offset8,' "Payments.,'~--and .~..
counterclaims of whatsoever nature or kind; and
NOW THEREFORE, in consideration of the premises and of the
payment by the Surety of the sum of $3,200.00 Dollars, as full
settlement and compromise of said claim, the undersigned hereby
releases and forever discharges the said Surety, its successors and
assigns, from any and all claim and demands of whatsoever nature or
kind, and does hereby sell, assign, transfer, and set over unto said
Surety all rights, . title, and interest in and to said claim and all
sums of money due and payable thereon, and does give and grant to it
full power and authority to demand and receive the same for its use
and upon receipt thereof to give discharge of the' same or any part
thereof.
ANY PERSON WHO KNOWINGLYANDWITB INTENT TO INJURE, DEFRAUD OR DECEIVE
ANY :INSURER l"XLES A STATEMENT 01" CLA:IMOR APPL:ICAT:ION CONTA:INXNG ANY
FALSE, INCOMPLETE OR MISLEADING INFORMATION MAY BE GUILTY OF A
CR:IM:INAL ACT.
Signed, sealed and delivered this
ie Rivera
and sworn to before me
20
day of
, 20_
By:
of
Notary Public
State of
County of
.
My Commission Expires: