Wholesaler Or Nonresident Wholesaler Surety Bond For Entities With Gross Annual Receipts Of 10000 Or Less

California State Board of Pharmacy Fax (916) 574-8618 www.pharmacy.ca.gov DEPARTMENT OF CONSUMER AFFAIRS WHOLESALER or NONRESIDENT WHOLESALER SURETY BOND FOR ENTITIES WITH GROSS ANNUAL RECEIPTS OF $10,000,000 OR LESSBusiness and Professions Code Sections 4162, 4162.5 Bond No. Application/License No. KNOW ALL PERSONS BY THESE PRESENTS: That, doing business as a wholesaler, whose address for purposes of service is (Applicant), , as PRINCIPAL, and (address of Applicant) (Surety Company), a corporation organized under the laws of and authorized to transact a general surety business in the State of (state of incorporation) California, whose address for purposes of service is, (address for Surety Company) as SURETY, are held and firmly bound unto the People of the State of California, and to the Pharmacy Board Contingent Fund, for the penal sum of TWENTY FIVE THOUSAND DOLLARS ($25,000.00), for which payment we bind ourselves, our heirs, executors, administrators, successors and assigns jointly and severally, by these presents. This bond term shall become effective on . (effective date) WHEREAS, the provisions of Sections 4162 and/or 4162.5, Business and Professions Code, require that the Applicant file or have on file with the California State Board of Pharmacy (Board) a bond in the sum of $25,000.00 payable to the Pharmacy Board Contingent Fund, and this bond is executed and tendered in accordance therewith. The purpose of the bond is to secure payment of any administrative fines imposed on Applicant by the Board, and/or any cost recovery owed by Applicant to the Board under Business and Professions Code Section 125.3. NOW THEREFORE, the conditions of the foregoing obligation are that if the Applicant shall comply with and be subject to the provisions of Division 2, Chapter 9 (commencing with Section 4000) of the Business and Professions Code, then this obligation shall be null and void; otherwise it shall remain in full force and effect. PROVIDED HOWEVER, this bond is subject to the following express conditions: (1)This bond shall be deemed continuous in form and shall remain in full force and effect and shall run concurrently with the license period forwhich the license is granted and each and every succeeding license period or periods for which said Applicant may be licensed, after which liabilityhereunder shall cease except as to any liability or indebtedness therefore incurred or accrued hereunder.(2)This bond is executed by the Applicant and the Surety to comply with the provisions of Division 2, Chapter 9 (commencing with Section 4000) ofthe Business and Professions Code and of Chapter 2, Title 14, Part 2 (commencing with Section 995.010) of the Code of Civil Procedure and saidbond shall be subject to all of the terms and provisions thereof.(3)The Surety, its successors and assigns, are jointly and severally liable on the obligations of the bond, in conformity with Chapter 2, Title 14, Part2 (commencing with Section 995.010) of the Code of Civil Procedure and Division 2, Chapter 9 (commencing with Section 4000) of the Businessand Professions Code.(4)The limitations of the liability of the Surety and the conditions of the bond are set forth in Business and Professions Code Sections 4162 and4162.5. The Board may make a claim against the bond for any administrative fine imposed on Applicant by the Board pursuant to Division 2,Chapter 9 (commencing with Section 4000) of the Business and Professions Code, or for any cost recovery ordered payable by Applicant pursuantto Business and Professions Code Section 125.3, if Applicant fails to pay to the Board the fine or cost recovery within thirty (30) days of the orderimposing the fine or cost recovery. Any such claim may be made directly to the Surety and need not be preceded by the filing of any action in aproper court. Payment of any such claim shall be payable to the Pharmacy Board Contingent Fund.Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com (5) The aggregate liability of the Surety hereunder on all claims whatsoever shall not exceed the penal sum of this bond in any event. (6) This bond may be cancelled by the Surety in accordance with the provisions of Article 13 (commencing with Section 996.310), Chapter 2, Title 14, Part 2 of the Code of Civil Procedure. (7) The Applicant and Surety may be served with notices, papers and other documents under the provisions of Chapter 2, Title 14, Part 2 (commencing with Section 995.010) of the Code of Civil Procedure at the addresses given above. I certify (or declare) under penalty of perjury, under the laws of the State of California, that I have executed the foregoing bond on behalf of the Surety under an unrevoked power of attorney. In witness whereof, each party to this bond has caused it to be executed on this day of, 20. PRESCRIPTION DRUG WHOLESALER or OUT-OF-STATE PRESCRIPTION DRUG WHOLESALER Principal222s Authorized Representative SIGNED and SEALED in the presence of: Witness Witness SURETY COMPANY Surety Company222s Representative , Attorney-in-Fact print name SIGNED and SEALED in the presence of: Witness Witness Countersigned by: California Resident Agent Page 2 of 2 American LegalNet, Inc. www.FormsWorkFlow.com