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
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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. DANIELS - GOVERNOR.
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