Instructions for RD0440-0024

POSITION FIDELITY SCHEDULE BOND DECLARATIONS

Insurance companies use this form to issue surety bonds to public bodies and/or non-profit organizations for coverage against dishonest or fraudulent acts of employees resulting in a financial loss.

Submit the original of the completed form to the insured party.  A copy of the bond is also mailed to the Rural Development office responsible for making or servicing the loan.  The insurance company retains a copy for their records.

 

Features for transmitting the form electronically are available to those customers with access credentials only.  If you would like to establish online access credentials with USDA, follow the instructions provided at the USDA eForms web site.

A representative of the surety or insurance company must complete all items defined in the following table.

General Instructions

Fld Name /
Item No.

Instruction

Bond number

The insurance company inserts the policy or bond identification number.

 

Item 1

Fld Name /
Item No.

Instruction

Name of surety

Insert the legal name of the insurance company in the same manner as used for other insurance policies.

Home office address

Insert the complete address including the zip code as shown on the form.

 

Item 2

Fld Name /
Item No.

Instruction

Name of insured

The insurance company or agent of the insurance company inserts the legal name of the organization obtaining position fidelity coverage.

 

Item 3

Fld Name /
Item No.

Instruction

Bond period - from the beginning of

Insert the date when coverage begins.

 

Item 4.  Schedule of employees and limit of liability

Fld Name /
Item No.

Instruction

Position

Coverage is listed by position such as “treasurer” or “office manager.”.

Location

Insert the location where the position is located.

Total number of employees in each position

For each separate position, insert the number of employees for that position.

Amount of indemnity for each position

For each position, insert the maximum amount of coverage for each employee in that position.

Premium

The insurance company may use its discretion in inserting a premium for each position or a total for all positions for the premium charged.

 

The liability of the surety is subject to the terms of the following attached riders:

Fld Name /
Item No.

Instruction

Item 5

The insurance company will list their forms or riders that affect coverage and attach copies of the rider to the policy.

 

The insured, by acceptance of this bond, gives notice to the surety terminating or canceling prior bond(s) or policy(ies) number(s).

Fld Name /
Item No.

Instruction

Item 6

The insurance company or surety will list prior fidelity bonds or policies being replaced by the current position fidelity bond.

 

Item 7.  Notices are to be sent to the following addresses:

Fld Name /
Item No.

Instruction

Rural Develop­ment

Insert the complete mailing address for the Rural Development office responsible for servicing the loan.  Obtain this from Rural Development.

Signed, sealed, and dated this

Insert the day of the month when this bond is signed.

Day of

Insert the month when signed.

20

Insert the remaining 2 digits for the year when signed.

Company

Insert the name of the surety above the line.

By

An authorized agent of surety must sign the bond.

Title

Type or print the full legal name and title of the agent signing the bond.