Surety: Merchants Bonding Company
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COMMONWEALTH of PENNSYLVANIA
DEPARTMENT OF STATE
PENNSYLVANIA STATE ATHLETIC COMMISSION
BOND FORM FOR ATHLETE AGENT
Know all men by these presents, that we (Name of Athlete Agent) of
(Address, City, State, Zip)
hereinafter referred to as the principal, and (Bonding Co. - Surety), a corporation
organized and existing under the laws of the State of __________________ and authorized to do business in the State of
Pennsylvania, as surety, are held and firmly bound unto Commonwealth of Pennsylvania - State Athletic Commission herein
after referred to as obligee, in the sum of $20,000 lawful money of the United States of America, to the payment of which sum,
well and truly to be made, we bind ourselves, our executors, administrators, successors and assigns, firmly by these presents.
The condition of this obligation is such, that whereas, the principal has made application for a registration to the obligee for the
purpose of, or to exercise the vocation of Athlete Agent.
The bond shall be conditioned upon the following: 1) compliance with the Uniform Athlete Agents Act, 5 Pa.C.S. § 3101
et seq., 2) the payment of all sums due a person at the time the sums are due and payable, and 3) the payment of damages
suffered by any person as a result of intentional or unintentional misstatements, misrepresentation, fraud, deceit or
unlawful or negligent acts of the student athlete agent while acting as a student athlete agent. .
Now, therefore, if the principal shall faithfully comply with all laws, ordinances, rules and regulations which have been or may
hereafter be in force concerning said registration, and shall save and keep harmless the obligee from all loss or damage which it
may sustain or for which it may become liable on account of the issuance of said registration to the principal, then this obligation
shall be void; otherwise, to remain in full force and effect.
This bond will expire on (Date), but may be continued by continuation certificate signed
by principal and surety. The surety may at any time terminate its liability by giving thirty (30) days written notice to the obligee,
and the surety shall not be liable for any default after such thirty day notice period, except for defaults occurring prior thereto.
Signed, Sealed and Dated this day of , 20 .
EIN NUMBER (Federal ID Number) = 42-0410010 Surety:
Qualified Pennsylvania Resident Agent (if required) Title (Attach Attorney In Fact if required)
This bond form is approved as to form and legality by:
State Athletic Commission on (Date) by (Executive Director)
Department of State on (Date) by (Chief Counsel)
Office of the Attorney General 16-K-300 Office of General Counsel 16-K-300
COMMONWEALTH OF PENNSYLVANIA
STATE ATHLETIC COMMISSION
Instructions for Bond Form - Athlete Agent
If Principal is a partnership, please state all partners at beginning of Bond, and all partners shall
sign the Bond. If Principal is a corporation, the president or vice-president must sign for the corporation.
Their signatures shall be attested to by the Secretary, Asst. Secretary, Treasurer or Asst. Treasurer.
The Corporate Surety, if signing by an Attorney In Fact, shall have attached to the Bond a Power of
Attorney bearing a certification date the same as, or subsequent, to the date of the Bond. Out of state
corporate sureties signed outside of the Commonwealth of Pennsylvania, shall have said Bond
countersigned by a Qualified Pennsylvania Resident Agent.
** BOND MUST BE ON FILE WITH THE COMMISSION BEFORE REGISTRATION IS VALID **
City: State: Zip Code:
Amount $ 20,000
* Bond and filing Fee of $25.00 (Payable to the Commonwealth of PA) shall be sent to:
Pennsylvania State Athletic Commission
2601 North 3 Street
Harrisburg, PA 17110
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