HomeMy WebLinkAboutMATTHEW D WORTHLEY -001543 -1/27/2011 CARMEL REDEVELOPMENT COMMISSION 0015 4 3 Matthew D Worthley Check: 1543 5711 11th Street, NW Date: 1/27/2011 Carmel, IN 46032 Vendor: WORTHL1 Prior Invoice P.O. Num. Invoice Amt Balance Retention Discount Amt. Paic 01142011 56.12 56.12 0.00 0.00 56.12 notary Bond and fees 56.12 56.12 0.00 0.00 56.12 HYLANT www.hylant.com A GROUP 301 Pennsylvania Parkway,Suite 201 P.O.Box 40925 Indianapolis,IN 46280-0925 1-800-678-0361 Local:317-817-5000 Fax:317-817-5151 January 14, 2011 Matthew D. Worth ley 57 11th St. NW Carmel, IN 46032 Re: Notary Bond Bond#6746890 Bond Date: 1/14/11-19 Dear Matt: Enclosed please find your Notary Bond and Notary Public Errors&Omissions Policy. Now that the bond has been executed, you will need to apply for the notary commission at www.sos.in.gov. On this website,the State will accept payment for the fees via Master Card,Visa or an IN gov subscriber account. ($5.00 fee) • Should you have any questions, please do not hesitate to contact me. Sincerely, Marianne Uban, CIC, CISR �)� / Sr.Client Service Specialist Direct: 317-817-5136 Fax:317-817-5151 Email: marianne.uban @hylant.com Director of Redevelopment 5'2 3 a 9 y Risk Management • Insurance • 401' (k) • Investments • Benefits. - -7111yLANT P.O.Box 40925 , .• , Indianapolis, 46280-0925 • IN INVOICE # 749542 ..Parge ' Local: 317-817-5000 GROUP MATTH06 79 01/14/11 BOND • • 6746890 W. Michael Wells 01/14/11 01/14/19 -01/14/11 Matthew D. Worth ley ..,F;;;,., AMOUNT"PAID - OUNT DUE ' 57 II th St NW 50.00 Carmel,IN 46032 . ••••••• INVOICE# 749542 01/14/11 NEW BOND 6746890 NOTARY BOND American States Insurance Co 50.00 NOTARY BOND FOR MATTHEW D.WORTHLEY Invoice Balance: 50.00 301Pennsylvania Parkway • Suite 201 • P.O.Box 40925 • Indianapolis,IN 46280-0925 Toll Free: 800-678-0361 • Local: 317-817-5000 • Fax:317-817-5151 . , • Riski/Vlana•ement:•:Insurance k 6 ' - " - I Indiana Payment Portal Page 1 of 1 Your transaction is complete Your transaction is complete. Print this receipt for your records. Your receipt identification number is 1285501. Please reference this number in any correspondence regarding your transaction. Payer Information ? MATTHEW WORTHLEY 57 11TH STREET NW CARMEL, IN 46032 Phone : 317 - 205 - 7030 Email : mworthley @carmel.in.gov Account Information ? Transaction Details Description Unit Extended Quantity Price Price Instant Access Fee $1.12 1 $1.12 Notary Application Fee $5.00 1 $5.00 Total : $6.12 The following amounts have been charged to your credit card. Your credit card statement will show the following merchant name(s) and amount(s) for this transaction. Merchant Amount IN Sec of State 800-236-5446 $6.12 The total amount charged to your credit card is $6.12. Privacy Statement https://secure.in.gov/apps/kwikekard/checkout/servlet/receipt?token=9A 103760088940F7... 1/17/2011 M- wW, Liberty Liberty Mutual Surety 1001 4h Avenue, F, �y/ ''`u ual'" Seattle,WA 98154 Suite 1700 NOTARIAL BOND Bond No. 6746890 KNOW ALL MEN BY THESE PRESENTS, That we MATTHEW D WORTHLEY (Name of Applicant) as principal(Applicant) and AMERICAN STATES INSURANCE COMPANY, as corporate surety, are held and firmly bound unto the State of Indiana, in the penal sum of FIVE THOUSAND DOLLARS ($5,000), the payment of which, well and truly to be made, we bind ourselves, our heirs, executors and administrators, firmly by these presents. WHEREAS, the above bound principal has applied for appointment by the Governor of the State of Indiana as a Notary Public, in and for the State of Indiana, for an eight year term. Now, if the said principal shall truly and faithfully perform and discharge the duties of said office of Notary Public, in all things according to law, then the above obligation to be null and void, otherwise to remain in full force and virtue in law. The term of this bond is from the effective date of the principal commission to the expiration date of the same: COI VSEAL P��S INSU Timothy A. Mikolajewski,Vice-President � ., =�-0 '/NDIANP'- Congratulations, you have successfully obtained a notary bond for the State of Indiana. Bond# 6746890 Surety Company:American States Insurance Company, a member of Liberty Mutual Group To obtain the notary commission: Each notary applicant must now access the Indiana Notary Public Application online at www.in.gov to complete the pre- qualification, training and oath agreement. After successfully completing, the applicant must pay the application fees to the State of Indiana via MasterCard or Visa. Once the fees are paid, your client can download a file that contains the Notary Commission Certificate. S-6080/DA 4/10 XDP AMERICAN STATES INSURANCE COMPANY NOTARY PUBLIC ERRORS AND OMISSIONS POLICY POLICY NO. E&0 6746890 AMERICAN STATES INSURANCE COMPANY will pay on behalf of MATTHEW D WORTHLEY of 57 11th Street NW Carmel,IN 46032 (Address) (hereinafter called the insured), all sums which the insured shall become obligated to pay by reason of liability for breach of duty while acting as a duly commissioned and sworn Notary Public, claim for which is made against the insured by reason of any negligent act,error or omission,committed or alleged to have been committed by the insured, arising out of the performance of notarial service for others in the insured's capacity as a duly commissioned and sworn Notary Public. POLICY PERIOD:This policy applies only to negligent acts, errors or omissions which occur during the policy period and then only if claim, suit or other action arising therefrom is commenced during the policy period, and is not barred by the applicable Statute of Limitations pertaining to the insured.The Policy Period commences on the effective date of the insured's commission as a Notary Public and terminates upon the expiration of the Insured's commission as a Notary Public unless cancelled earlier as provided in this policy.This policy is not valid for more than one commission term. LIMITS OF LIABILITY: The liability of this company shall not exceed in the aggregate for all claims under this insurance the amount of Five Thousand Dollars And Zero Cents ($ 5,000.00 In addition to the limit of liability and in accordance with the other provisions of this policy,this company will pay costs and expenses paid and incurred in investigating, contesting or settling liability in an amount not to exceed, in the aggregate, one-half of the limit of this policy. INSURED'S DUTIES IN THE EVENT OF OCCURRENCE, CLAIM, OR SUIT: (a) Upon knowledge of any occurrence which may reasonably be expected to result in a claim or suit,written notice containing particulars sufficient to identify the Insured and also reasonably obtainable information with respect to the time, place and circumstances thereof, and the names and addresses of the potential claimant and of available witnesses,shall be given by or for the Insured to the Company or any of its authorized agents as soon as practicable, but in no event longer than forty-five(45)days after discovery. (b) If claim is made or suit is brought against the Insured,the Insured shall immediately forward to the Company every demand, notice,summons or other process received by him or his representative. (c) The Insured shall cooperate with the Company and, upon the Company's request, assist in making settlements, in the conduct of suits and the Insured shall attend hearings and trials and assist in securing and giving evidence and obtaining the attendance of witnesses. The Insured shall not,except at his own cost,voluntarily make any payment, assume any obligation or incur any expense except with the prior written consent of the Company. EXCLUSIONS: Coverage under this policy does not apply to any dishonest, fraudulent, criminal or malicious act or omission of the insured. CO-INSURANCE: If the insured has other insurance against a loss covered by this policy,the company shall not be liable under this policy for a greater proportion of such loss, cost and expenses than the limit of liability stated in this policy bears to the total limit of liability of all valid and collectible insurance against such loss. CANCELLATION: This policy may be cancelled by the Company by mailing thirty(30)days written notice to the Insured and may be cancelled by the Insured by surrender thereof to the Company or any of its agents or by mailing to the Company thirty (30)days written notice and this policy shall be deemed cancelled and the Policy Period terminated upon such return or at the expiration of said thirty(30)days.A pro rata return premium shall be allowed on cancellation. Dated,signed and sealed this 14th day of January , 2011 AMERICAN STATES INSURANCE COMPANY Address Claims to: g INSU _ Liberty Mutual Surety � ' , y�, /I • , 1001 4th Avenue, Suite 1700 Seattle,WA 98154 g By 'o � J� Tim Mikolajewski Senior Vice-President,Surety /NDIANP' S-6835/DA 06/03 XDP ' 4 tkkt N.,...m, (ivia . /7„---c...r...4, .--4-,\:..,...000 : -----mb.. . . ..j ‘4/ 411/ -:- .1.--••-..... 44; ''' ,;(1'4 -- — ;- nit11, ,, --,,;''.7: .2:_:::: cal oiiiii.-iNiittrilrt: v*I.,:,,,„,,,-. '0.1:;" ,,,,.„k:s1;q11`",, ;174,.1', ' % -. ."--.- - i , ‘ A\MI. "It*:'4%.::::!!.............. ',,:f:t) diV'' .44) • • '':• AI Ititd; .■;' .. ' 1-PI "''. ,. 4.; 4'1N, CAN ' A ito.."/c "ana -� TO ALL WHO SHALL SEE THESE PRESENTS aCi e c 5.. is--- -,tiliel— iL-L._i'.-7(ne tS q . •at i'T`" .:S % I XV JAC=1.) THAT IN THE,NAME,AND BY THE AUTHORITY OF THE,STATE,OF INDIANA, I DO HEREBY APPOINT AND COMMISSIONS AS A Notary Public COMMISSION NUMBER.: 623604 MATTHEW DANE WORTH.LE.Y 57 11TH STREET NW CARMEL, IN 46032 WITHIN AND FOR.THE COUNTY OF HAMILTON AND THE STATE. OF INDIANA FROM JANUARY 17, 2011 UNTIL.AND EXPIRING ON JANUARY 16, 2019 5__. 318 esti tnoiz n hereof ,,t -1.i...s; I RAVE. HEREUNTO SET MY HAND AND ``a " ...* CAUSED TO $E. AFFIXED THE SEAL.OF THE. r•4,.....041/X914- •a '=„ '�'••'',�� STATE, AT THE CITY OF INDIANAPOLIS, ON : . �_. , ,.."4.,' '.1_�js Q JANUARY 17, 2011 `4l: ~ • . ' ti, :� MITCH. 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