MCS-82 - Motor Carrier Public Liability Surety Bond unde

OMB No.: 2126-0008

FORM MCS-82

USDOT Number:

Expiration: 01/31/2020

Date Received:

A Federal Agency may not conduct or sponsor, and a person is not required to respond to, nor shall a person be subject to a penalty for failure to comply
with a collection of information subject to the requirements of the Paperwork Reduction Act unless that collection of information displays a current
valid OMB Control Number. The OMB Control Number for this information collection is 2126-0008. Public reporting for this collection of information
is estimated to be approximately 2 minutes per response, including the time for reviewing instructions, gathering the data needed, and completing and
reviewing the collection of information. All responses to this collection of information are mandatory. Send comments regarding this burden estimate or
any other aspect of this collection of information, including suggestions for reducing this burden to: Information Collection Clearance Officer, Federal
Motor Carrier Safety Administration, MC-RRA, Washington, D.C. 20590.

United States Department of Transportation
Federal Motor Carrier Safety Administration

Motor Carrier Public Liability Surety Bond
under Sections 29 and 30 of the Motor Carrier Act of 1980

FORM MCS-82
PARTIES
SURETY COMPANY

MOTOR CARRIER

COMPANY NAME

COMPANY NAME

STREET ADDRESS

CITY

STREET ADDRESS

CITY

American
Alberta
Alaska
Alabama
British
Arkansas
Arizona
District
Delaware
Connecticut
Colorado
California
Marshall
Manitoba
Maine
Louisiana
Kentucky
Kansas
Iowa
Indiana
Illinois
Idaho
Hawaii
Guam
Georgia
Florida
Nevada
Nebraska
Montana
Missouri
Mississippi
Minnesota
Micronesia
Michigan
Massachusetts
Maryland
New
Newfoundland
North
Northern
Northwest
Nova
Prince
Pennsylvania
Palau
Oregon
Ontario
Oklahoma
Ohio
Nunavut
Puerto
Rhode
Quebec
Saskatchewan
South
Virgin
Vermont
Utah
Texas
Tennessee
West
Washington
Virginia
Yukon
Wyoming
Wisconsin
Brunswick
Hampshire
Jersey
Mexico
Virginia
Scotia
Carolina
Dakota
Carolina
Dakota
Edward
Island
Islands
Columbia
Rico
ofIslands
Marianas
Samoa
Columbia
Territories
Island
and Labrador
STATEYork
ZIP CODE

TELEPHONE NUMBER

American
Alberta
Alaska
Alabama
British
Arkansas
Arizona
District
Delaware
Connecticut
Colorado
California
Marshall
Manitoba
Maine
Louisiana
Kentucky
Kansas
Iowa
Indiana
Illinois
Idaho
Hawaii
Guam
Georgia
Florida
Nevada
Nebraska
Montana
Missouri
Mississippi
Minnesota
Micronesia
Michigan
Massachusetts
Maryland
New
Newfoundland
North
Northern
Northwest
Nova
Prince
Pennsylvania
Palau
Oregon
Ontario
Oklahoma
Ohio
Nunavut
Puerto
Rhode
Quebec
Saskatchewan
South
Virgin
Vermont
Utah
Texas
Tennessee
West
Washington
Virginia
Yukon
Wyoming
Wisconsin
Brunswick
Hampshire
Jersey
Mexico
Virginia
Scotia
Carolina
Dakota
Carolina
Dakota
Edward
Island
Islands
Columbia
Rico
ofIslands
Marianas
Samoa
Columbia
Territories
Island
and Labrador
STATEYork
ZIP CODE

TELEPHONE NUMBER

(type or print Principal Officer’s name and title)

(type or print Principal Officer’s name and title)

PURPOSE
This is an agreement between the Surety and the Principal under which the Surety, its successors and assignees, agree to be responsible
for the payment of any final judgment or judgments against the Principal for public liability, property damage, and environmental
restoration liability claims in the sums prescribed herein; subject to the governing provisions and the following conditions.

GOVERNING PROVISIONS
1. Sections 29 and 30 of the Motor Carrier Act of 1980 (49 U.S.C. 13906).
2. Rules and regulations of the Federal Motor Carrier Safety Administration (FMCSA).

CONDITIONS
The Principal is or intends to become a motor carrier of property subject to the applicable governing provisions relating to financial
responsibility for the protection of the public.
This bond assures compliance by the Principal with the applicable governing provisions, and shall insure to the benefit of any person or
persons who shall recover a final judgment or judgments against the Principal for public liability, property damage, or environmental
(continued on next page)
FORM MCS-82 Page 1 of 2

Rev 9/9/2019

OMB No.: 2126-0008

FORM MCS-82

Expiration: 01/31/2020

restoration liability claims (excluding injury to or death of the Principal’s employees while engaged in the course of their employment,
and loss of or damage to property of the principal, and the cargo transported by the Principal). If every final judgment shall be paid for
such claims resulting from the negligent operation, maintenance, or use of motor vehicles in transportation subject to the applicable
governing provisions, then this obligation shall be void, otherwise it will remain in full effect.
Within the limits described herein, the Surety extends to such losses regardless of whether such motor vehicles are specifically described
herein and whether occurring on the route or in the territory authorized to be served by the Principal or elsewhere.
The liability of the Surety on each motor vehicle subject to the financial responsibility requirements of Sections 29 and 30 of the Motor
Carrier Act of 1980 for each accident shall not exceed $
, and shall be a continuing one notwithstanding any
recovery hereunder.
The surety agrees, upon telephone request by an authorized representative of the FMCSA, to verify that the surety bond is in force as of a
particular date. The telephone number to call is
.
(12:01 a.m., standard time, at the address of the Principal as stated herein) and
This bond is effective from
shall continue in force until terminated as described herein. The principal or the Surety may at any time terminate this bond by giving
(1) thirty–five (35) days notice in writing to the other party (said 35 day notice to commence from the date the notice is mailed, proof
of mailing shall be sufficient proof of notice), and (2) if the Principal is subject to the FMCSA’s registration requirements, by providing
thirty (30) days notice to the FMCSA (said 30 days notice to commence from the date notice is received by the FMCSA at its office in
Washington, D.C.). The Surety shall not be liable for the payment of any judgment or judgments against the Principal for public liability,
property damage, or environmental restoration claims resulting from accidents which occur after the termination of this bond as
described herein, but such termination shall not affect the liability of the Surety for the payment of any such judgment or judgments
resulting from accidents which occur during the time the bond is in effect.

(affix Motor Carrier
corporate seal)

SURETY

DATE

CITY

American
Alaska
Alabama
District
Delaware
Connecticut
Colorado
California
Arkansas
Arizona
Marshall
Maine
Louisiana
Kentucky
Kansas
Iowa
Indiana
Illinois
Idaho
Hawaii
Guam
Georgia
Florida
Nevada
Nebraska
Montana
Missouri
Mississippi
Minnesota
Micronesia
Michigan
Massachusetts
Maryland
New
North
Northern
Puerto
Pennsylvania
Palau
Oregon
Oklahoma
Ohio
Rhode
South
Virgin
Vermont
Utah
Texas
Tennessee
West
Washington
Virginia
Wyoming
Wisconsin
Hampshire
Jersey
Mexico
Virginia
Carolina
Dakota
Carolina
Dakota
Island
Islands
Rico
ofIslands
Marianas
Samoa
Columbia
STATEYork
(Principal Officer’s signature)

ACKNOWLEDGMENT OF SURETY
COUNTY OF

American
Alaska
Alabama
District
Delaware
Connecticut
Colorado
California
Arkansas
Arizona
Marshall
Maine
Louisiana
Kentucky
Kansas
Iowa
Indiana
Illinois
Idaho
Hawaii
Guam
Georgia
Florida
Nevada
Nebraska
Montana
Missouri
Mississippi
Minnesota
Micronesia
Michigan
Massachusetts
Maryland
New
North
Northern
Puerto
Pennsylvania
Palau
Oregon
Oklahoma
Ohio
Rhode
South
Virgin
Vermont
Utah
Texas
Tennessee
West
Washington
Virginia
Wyoming
Wisconsin
Hampshire
Jersey
Mexico
Virginia
Carolina
Dakota
Carolina
Dakota
Island
Islands
Rico
ofIslands
Marianas
Samoa
Columbia
STATEYork
OF

On this
day of
,
, before me personally came
, who,
31st
30th
29th
28th
27th
26th
25th
24th
23rd
22nd
21st
20th
19th
18th
17th
16th
15th
14th
13th
12th
11th
10th
9th
8th
7th
6th
5th
4th
3rd
2nd
1st
December
November
October
September
August
July
June
May
April
March
February
January
2020
2019
2018
2017
being by me duly sworn, did depose and say the he resides in
; that he/she is
of the
American
Alaska
Alabama
District
Delaware
Connecticut
Colorado
California
Arkansas
Arizona
Marshall
Maine
Louisiana
Kentucky
Kansas
Iowa
Indiana
Illinois
Idaho
Hawaii
Guam
Georgia
Florida
Nevada
Nebraska
Montana
Missouri
Mississippi
Minnesota
Micronesia
Michigan
Massachusetts
Maryland
New
North
Northern
Puerto
Pennsylvania
Palau
Oregon
Oklahoma
Ohio
Rhode
South
Virgin
Vermont
Utah
Texas
Tennessee
West
Washington
Virginia
Wyoming
Wisconsin
Hampshire
Jersey
Mexico
York
Virginia
Carolina
Dakota
Carolina
Dakota
Island
Islands
Rico
ofIslands
Marianas
Samoa
Columbia
, the corporation described in and which executed the foregoing instrument; that he knows
the seal of said corporation; that the seal affixed to said instrument is such corporate seal; that it was so affixed by order of the board of
directors of said corporation; that he/she signed his/her name thereto by like order, and he/she duly acknowledged to me that he/she
executed the same for and on behalf of the said corporation.

(type or print Surety Officer’s name and title)
(affix Surety
corporate seal)

(Surety Officer’s signature)
(Surety Company File Number)

Filings must be transmitted online via the Internet at http://www.fmcsa.dot.gov/urs.

FORM MCS-82 Page 2 of 2