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Click ‘Get Form’ to open the Resident Fund Surety Bond in the editor.
Begin by filling in the 'BOND NUMBER' and 'COUNTY OF' fields at the top of the form. This information is essential for identifying your bond.
In the section labeled 'Name of Legal Entity', enter the name of the entity providing Medicaid Nursing Facility Services. Follow this with the 'Name of Facility', 'Vendor Number', and complete address details.
Proceed to fill out the penal sum amount in dollars, which should reflect either the maximum dollar amount of resident funds managed or estimated for the upcoming year, as specified in Schedule A.
Ensure that all parties involved, including both Principal and Surety, sign and date where indicated at the bottom of the form. This finalizes your bond agreement.
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The bond must be payable to the commission to compensate residents of the bonded provider for trust funds that are lost, stolen, or otherwise unaccounted for ifRead more
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