Form CA-643-002 "Collection Agency or out-Of-State Collection Agency Surety Bond" - Washington

What Is Form CA-643-002?

This is a legal form that was released by the Washington State Department of Licensing - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 1, 2019;
  • The latest edition provided by the Washington State Department of Licensing;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form CA-643-002 by clicking the link below or browse more documents and templates provided by the Washington State Department of Licensing.

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Download Form CA-643-002 "Collection Agency or out-Of-State Collection Agency Surety Bond" - Washington

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Click here to START or CLEAR, then hit the TAB button
Collection Agency or
Out-of-State
Collection Agency
Surety Bond
Use this form when a bond is required for licensing.
Complete this form and mail to:
Collection Agency Board
Department of Licensing
PO Box 9012
Olympia, WA 98507-9012
For questions or language help call: (360) 664-1388
Business information
TYPE or PRINT Bond number
Legal entity name
Doing Business As (DBA) or trade name
Address
City
State
ZIP code
Bonding agent information
TYPE or PRINT Name
Address
City
State
ZIP code
(Area code) Phone number
Email
The bonding company organized and existing under the laws of the state of
and authorized to
transact business in the state of Washington, as surety, are held and firmly bound to a bond in the amount of
to be paid to the state of Washington. The conditions the principal, bonding company and the state of
Washington agree to by taking out this bond are as follows:
1. As a precondition to receiving and maintaining a license, the license holder must keep this bond in full force and effect.
If any cancellation, revocation, or withdrawal by the surety/bonding company occurs, or if the entire bond amount is
exhausted, the Department will terminate the license until such time as a new bond for
is provided
to the state of Washington with no lapse in coverage.
2. The bond shall become effective,
, 20
, and is intended to cover any subsequent periods
for which the Collection Agency section may issue a license to the principal. This bond is to be accepted as a continuing
obligation until cancelled by the surety with thirty (30) days written notice of cancellation received by the Department of
Licensing of the state of Washington, in accordance with the provisions of the Revised Code of Washington.
3. The license holder will comply with all the provisions of Chapter 19.16 RCW of the State of Washington and with all
rules and regulations adopted by the Director of the Department of Licensing, of said state pursuant to the provisions
of Chapter 19.16 RCW and will pay all amounts that may be adjudged against license holder by reason of violation
of Chapter 19.16 RCW or any rules or regulations adopted pursuant to the conduct of license holder’s business as
a Collection Agency or Out-of-State Collection Agency then the above obligation shall be null and void; otherwise to
remain in full force and effect.
4. Any person having a claim against the license holder for damage as a result of any violation by license holder or his/her
agent of Chapter 19.16 RCW or any rules or regulations adopted pursuant thereto may bring a suit on this bond in the
Superior Court of the County in which the license holder’s business is located, or of any county in which jurisdiction of
the license holder may be had.
(continued on next page)
CA-643-002 (R/9/19)WA Page 1 of 2
Click here to START or CLEAR, then hit the TAB button
Collection Agency or
Out-of-State
Collection Agency
Surety Bond
Use this form when a bond is required for licensing.
Complete this form and mail to:
Collection Agency Board
Department of Licensing
PO Box 9012
Olympia, WA 98507-9012
For questions or language help call: (360) 664-1388
Business information
TYPE or PRINT Bond number
Legal entity name
Doing Business As (DBA) or trade name
Address
City
State
ZIP code
Bonding agent information
TYPE or PRINT Name
Address
City
State
ZIP code
(Area code) Phone number
Email
The bonding company organized and existing under the laws of the state of
and authorized to
transact business in the state of Washington, as surety, are held and firmly bound to a bond in the amount of
to be paid to the state of Washington. The conditions the principal, bonding company and the state of
Washington agree to by taking out this bond are as follows:
1. As a precondition to receiving and maintaining a license, the license holder must keep this bond in full force and effect.
If any cancellation, revocation, or withdrawal by the surety/bonding company occurs, or if the entire bond amount is
exhausted, the Department will terminate the license until such time as a new bond for
is provided
to the state of Washington with no lapse in coverage.
2. The bond shall become effective,
, 20
, and is intended to cover any subsequent periods
for which the Collection Agency section may issue a license to the principal. This bond is to be accepted as a continuing
obligation until cancelled by the surety with thirty (30) days written notice of cancellation received by the Department of
Licensing of the state of Washington, in accordance with the provisions of the Revised Code of Washington.
3. The license holder will comply with all the provisions of Chapter 19.16 RCW of the State of Washington and with all
rules and regulations adopted by the Director of the Department of Licensing, of said state pursuant to the provisions
of Chapter 19.16 RCW and will pay all amounts that may be adjudged against license holder by reason of violation
of Chapter 19.16 RCW or any rules or regulations adopted pursuant to the conduct of license holder’s business as
a Collection Agency or Out-of-State Collection Agency then the above obligation shall be null and void; otherwise to
remain in full force and effect.
4. Any person having a claim against the license holder for damage as a result of any violation by license holder or his/her
agent of Chapter 19.16 RCW or any rules or regulations adopted pursuant thereto may bring a suit on this bond in the
Superior Court of the County in which the license holder’s business is located, or of any county in which jurisdiction of
the license holder may be had.
(continued on next page)
CA-643-002 (R/9/19)WA Page 1 of 2
5. The aggregate liability of the Surety for any and all claims presented shall not exceed the penal sum of this bond.
The Business and Professions Divisions shall be notified prior to the cancellation of this bond, along with the reason
for cancellation or termination. No bond filed shall be approved unless it expressly provides that it will be effective for
one year following the effective date of its cancellation or termination, whether because of expiration, suspension,
or revocation of the license, or otherwise, as to any covered act or acts and omission or omissions of the licensee
occurring on, or prior to, the effective date of cancellation or termination.
TYPE or PRINT Name of owner/ each partner/ corporate officer/ member/ manager of LLC
X
Owner/each partner/corporate officer/member/manager of LLC signs and dates here.
Signature of owner/ each partner/ corporate officer/ member/ manager of LLC
Date
Bonding company seal
TYPE or PRINT Name of owner/ each partner/ corporate officer/ member/ manager of LLC
X
(Required)
Owner/each partner/corporate officer/member/manager of LLC signs and dates here.
Signature of owner/ each partner/ corporate officer/ member/ manager of LLC
Date
TYPE or PRINT Name of owner/ each partner/ corporate officer/ member/ manager of LLC
X
Owner/each partner/corporate officer/member/manager of LLC signs and dates here.
Signature of owner/ each partner/ corporate officer/ member/ manager of LLC
Date
TYPE or PRINT Name of owner/ each partner/ corporate officer/ member/ manager of LLC
X
Owner/each partner/corporate officer/member/manager of LLC signs and dates here.
Signature of owner/ each partner/ corporate officer/ member/ manager of LLC
Date
TYPE or PRINT Name of Attorney in Fact
X
Attorney in Fact signs and dates here.
Signature of Attorney in Fact
Date
CA-643-002 (R/9/19)WA Page 2 of 2
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