Date: 02/23/ /25/2015. Integro, as agent of Navigators Insurance Company (A New York Corporation) on behalf of. Everson CHB, Inc.

Size: px

Start display at page:

Download "Date: 02/23/ /25/2015. Integro, as agent of Navigators Insurance Company (A New York Corporation) on behalf of. Everson CHB, Inc."

Gerald Blankenship
5 years ago
Views:

Date: U.S. Customs & Border Protection delivered via email to cbp.bondquestions@dhs.

1 Date: U.S. Customs & Border Protection delivered via to Revenue Division Bond Team 6650 Telecom Drive Indianapolis, IN RE: New Bond Submission Importer Number: Requested Effective Date: Dear Bond Team: 02/25/2015 It is respectfully requested the attached bond be filed with the effective date referenced above. Please provide notice of approval or rejection of this bond to the undersigned. Your cooperation is greatly appreciated. Sincerely, Christian Burbano Surety Bond Administrator Integro 1 State Street Plaza, 9th Floor, New York, Office: Christian.Burbano@integrogroup.com Integro, as agent of Navigators Insurance Company (A New York Corporation) on behalf of Filer Code:

DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection CUSTOMS BOND 19 CFR Part 113 CBP USE ONLY OMB No. 1651-0050 Exp.

2 DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection CUSTOMS BOND 19 CFR Part 113 CBP USE ONLY OMB No Exp. 05/31/2017 BOND NUMBER (Assigned by CBP) Broker Filer Code: In order to secure payment of any duty, tax or charge and compliance with law or regulation as a result of activity covered by any condition referenced below, we, the below name principal(s) and surety(ies), bind ourselves to the United States in the amount or amounts, as set forth below. SECTION I Select Single Transaction OR Continuous Bond (not both) and fill in the applicable blank spaces. SINGLE TRANSACTION BOND Identification of transaction secured by this bond (e.g., entry number, seizure number, etc.) Transaction Date Execution Date Port Code CONTINUOUS Effective Date This bond remains in force for one year beginning with the effective date and for each succeeding BOND annual period, or until terminated. This bond constitutes a separate bond for each period in the amounts listed below for liabilities that accrue in each period. The intention to terminate this bond 02/25/2015 must be conveyed within the period and manner prescribed in the CBP Regulations. SECTION II This bond includes the following agreements. Check one box only. (Except 3a may be checked independently or with 3.) Activity Code Activity Name and CBP Regulations Limit of Liability Activity Activity Name and CBP Regulations in which conditions codified Code in which conditions codified 1 Importer or broker Detention of Copyrighted Material a Drawback Payments Refunds Neutrality Custodian of Bonded Merchandise Court Costs for Condemned Goods (Includes bonded carriers, freight forwarders, cartmen and lightermen, all classes of warehouse, container station operators) 3 International Carrier Airport Security Bond Part 113 App A 3a Instruments of International Traffic Foreign Trade Zone Surety Reference Number: CTB International Trade Commission (ITC) Exclusion Bond..Part 113 App B 14 In-Bond Export Consolidation Bond Limit of Liability 5 Public Gauger Intellectual Property Rights (IPR) 6 Wool & Fur Products Importer Security Filing (ISF) Labeling Acts Importation Part 113 App D 7 Bill of Lading Marine Terminal Operator PRINCIPAL By checking the box you agree that you have a seal in accordance with 19 CFR AFFIX SEAL or Name and Physical Address (including legal description CBP Identification Number: (A New York Corporation), William Everson Principal and surety agree that any charge against the bond under any of the listed names is as Mailing Address Requested by the Surety though it was made by the principal(s). Principal and surety agree that they are bound to the Navigators Insurance Company same extent as if they executed a separate bond covering each set of conditions incorporated c/o Navigators Management Co. Inc. by reference to the CBP regulations into this bond. If the surety fails to appoint an agent under 1375 E Woodfield Rd, Suite 720 Title 31, United States Code, Section 9306, surety consents to service on the Clerk of any Schaumburg, IL United States District Court or the U.S. Court of International Trade, where suit is brought on this bond. That clerk is to send notice of the service to the surety at: SURETY Name and Physical Address (including legal description Surety Number Agent ID Number Navigators Insurance Company ML-3616 (A New York Corporation) 400 Atlantic Street, 8th Floor Stamford, CT, Michelle E Lucaccioni CBP Form 301 (06/12)

3 Broker Filer Code: CO-PRINCIPAL Name and Physical Address (including legal description Surety Reference Number: CBP Identification Number: CBP Identification Number: CTB AFFIX SEAL or By checking the box you agree that you have a seal in accordance with 19 CFR SECTION III List below the complete name of all trade names or unincorporated divisions that will be permitted to obligate this bond in the principal s name including their CBP Identification Number(s). CBP Identification Number Name CBP Identification Number Name Total Number of Importer Names listed in Section III: CO-SURETY Name and Physical Address (including legal description Surety Number Agent ID Number CBP Form 301 (06/12)

4 APPLICATION TO U.S. CUSTOMS SERVICE - REVENUE DIVISION TO FILE CBP CONTINUOUS CHB Name: Filer Code: Corporation/LLC Partnership Importer Number: State of Incorporation: Sole Proprietorship Individual Street: City: State/Province: Zip: Country: United States of America Description of Merchandise Country of Origin CLOTHES Korea, South Values: Duties, Taxes & Fees: Previous 12 Months Next 12 Months (Estimated) Bond Liability Amount: (Activity Code 1-19 CFR ) CERTIFICATION I certify that the factual information contained in this application is true and accurate and any information provided which is based upon estimates is based upon the best information available on the date of this application. BY: William Everson TITLE: () DATE:

5 DEPARTMENT OF HOMELAND SECURITY U.S. Customs and Border Protection IMPORTER ID INPUT RECORD 19 CFR IMPORTER NUMBER (Fill in one format):-- Approved OMB NO Exp See back of form for Paperwork Reduction Act Notice. 1. TYPE OF ACTION (Mark all applicable) Notification of Change of address* importer's number Check here if you also want your address Change of name* updated in the Fines, Penalties, and Forfeitures Office *NOTE--If a continuous bond is on file, a rider must accompany this change document. 2A. I.R.S. Number 2B. Social Security Number 2C. Check here if requesting a CBP-assigned number and indicate reason(s). I have no IRS No. (Check all that apply.) I have no Social Security No. I have not applied for either number. I am not a U.S. resident 2D. CBP-Assigned Number 3. Importer Name 4. DIV/AKA/DBA DIV AKA DBA 5. DIV/AKA/DBA Name 6. Type Corporation Partnership Sole Proprietorship Individual U.S. Government State/Local Governments Foreign Governments 7. Importer Mailing Address (2 32-character lines maximum) 8. City 11. Country ISO Code (Non-U.S. Only) 9. State Code 10. ZIP 12. Importer Physical Location Address (2 32-character lines maximum, see instructions) 13. City 16. Country ISO Code (Non-U.S. Only) 14. State Code 15. ZIP 17a. Has importer ever been assigned a CBP Importer Number using the same name as in Block 3? No Yes (List number(s) and/or name(s) in Block 17c.) 17b. Has importer ever been assigned a CBP Importer Number using a name different from that in Block 3? No Yes (List number(s) and/or name(s) in Block 17c.) 17c. If ''Yes'' to 17a and/or 17b, list number(s) and/or name(s) I CERTIFY: That the information presented herein is correct; that if my Social Security Number is used it is because I have no IRS Employer Number, that if my CBP assigned number is used it is because I have neither a Social Security Number nor an IRS Employer Number, that if none of these numbers is used, it is because I have none, and my signature constitutes a request for assignment of a number by CBP. 22. Broker Use Only 18. Printed or Typed Name and Title 19. Telephone No. Including Area Code William Everson, Date Previous Editions are Obsolete CBP Form 5106 (05/13)

DEPARTMENT OF HOMELAND SECURITY. U.S. Customs and Border Protection. Announcement of ebond Test

DEPARTMENT OF HOMELAND SECURITY. U.S. Customs and Border Protection. Announcement of ebond Test This document is scheduled to be published in the Federal Register on 11/28/2014 and available online at http://federalregister.gov/a/2014-28146, and on FDsys.gov 9111-14 ADM-9-03 OT:RR:RD:TC H259009 SKK