Form F207-120-000 "Pension Bond Rider" - Washington

What Is Form F207-120-000?

This is a legal form that was released by the Washington State Department of Labor and Industries - 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 October 1, 2000;
  • The latest edition provided by the Washington State Department of Labor and Industries;
  • 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 F207-120-000 by clicking the link below or browse more documents and templates provided by the Washington State Department of Labor and Industries.

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Download Form F207-120-000 "Pension Bond Rider" - Washington

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PENSION BOND RIDER
Department of Labor and Industries
Self-Insurance Section
PO Box 44891
Olympia WA 98504-4891
TO BE ATTACHED TO AND FORM A PART OF BOND NUMBER_____________________
EXECUTED BY__________________________________________________ , AS PRINCIPAL,
AND BY_________________________________________________, AS SURETY, IN FAVOR
OF THE STATE OF WASHINGTON, DEPARTMENT OF LABOR AND INDUSTRIES;
WHICH IS EFFECTIVE AS OF ____________________________________________________.
CLAIMANT’S NAME _____________________________________ CLAIM # _____________ .
In consideration of the mutual agreements herein contained, the Principal and the Surety hereby
consent to (INCREASE / DECREASE) the AMOUNT OF THE PENAL SUM OF SAID BOND
FROM:
TO:
The Surety undertakes and agrees that the obligation of this endorsement and the above
referenced bond shall fully cover and extend to all of the pension benefits designated in the
bond. The aggregate liability for said acts and defaults shall in no event exceed the last sum
named, it being the intent hereof to preclude cumulative liability.
Nothing herein contained shall vary, alter or extend any provision or condition of this bond
except as herein expressly stated.
Signed and sealed this ______________day of ___________________________________ .
Principal
Name
Date
Title
Signature
Accepted by the State of Washington
Department of Labor and Industries
Surety
Date
Program Manager for Self-Insurance
Name
Date
Title
Signature
RESET
F207-120-000 pension bond rider 10-00
PENSION BOND RIDER
Department of Labor and Industries
Self-Insurance Section
PO Box 44891
Olympia WA 98504-4891
TO BE ATTACHED TO AND FORM A PART OF BOND NUMBER_____________________
EXECUTED BY__________________________________________________ , AS PRINCIPAL,
AND BY_________________________________________________, AS SURETY, IN FAVOR
OF THE STATE OF WASHINGTON, DEPARTMENT OF LABOR AND INDUSTRIES;
WHICH IS EFFECTIVE AS OF ____________________________________________________.
CLAIMANT’S NAME _____________________________________ CLAIM # _____________ .
In consideration of the mutual agreements herein contained, the Principal and the Surety hereby
consent to (INCREASE / DECREASE) the AMOUNT OF THE PENAL SUM OF SAID BOND
FROM:
TO:
The Surety undertakes and agrees that the obligation of this endorsement and the above
referenced bond shall fully cover and extend to all of the pension benefits designated in the
bond. The aggregate liability for said acts and defaults shall in no event exceed the last sum
named, it being the intent hereof to preclude cumulative liability.
Nothing herein contained shall vary, alter or extend any provision or condition of this bond
except as herein expressly stated.
Signed and sealed this ______________day of ___________________________________ .
Principal
Name
Date
Title
Signature
Accepted by the State of Washington
Department of Labor and Industries
Surety
Date
Program Manager for Self-Insurance
Name
Date
Title
Signature
RESET
F207-120-000 pension bond rider 10-00