Self-Insurers Surety Bond General Purpose Rider {IC53}

IC53 - SELF-INSURER’S SURETY BOND GENERAL PURPOSE RIDER. This form is used to modify the terms of an existing self-insurer’s surety bond on file with the Commission. This form allows for changes such as updating the name of the employer (Principal), changing the bond amount, or adding or removing employers covered under the bond. It is executed by both the employer and the surety company to officially authorize and document these updates. The rider ensures that any adjustments to the bond are properly recorded and legally recognized while affirming that all other provisions of the original bond remain unchanged unless specifically noted. This document must be signed by a representative of the employer and the attorney-in-fact for the surety and affixed with the appropriate corporate seals. www.FormsWorkflow.com