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I have attached a PROVEN self insurance bond.

The reason i am saying "proven" is that i got stopped for

expired stickers on the license plates and I showed an unfiled, notarized, original. Because it was not filed with
the county clerk, the officer gave me a ticket for "no proof of insurance". When i went to court this morning and
finally sat down with the DA chick, she asked me if i had proof of insurance and i gave her a certified copy of the
filed bond. The only thing she asked me was "where did you get this??" I asked her what did she mean and she
just repeated the question. I knew better than to say "I got it from __________ or off the internet" so i said "I
wrote it and submitted it to the County Clerk for recording". She asked if i had showed it to the officer and i said i
had but it was not recorded at the time. She said since it was recorded now, it was sufficient!! Nov. 2009


upper lower name

C/O Street

City, Colorado


Written Undertaking/Surety Bond — Financial Responsibility

Form #mmv-101010-SB (Private Number was assigned)

I, upper lower name, hereinafter “the Undersigned” do hereby promise to pay “pledge”
myself as surety as follows:

Whereas: There exists a requirement in the State of Colorado pursuant to CRS 42-7-103
14(a) that drivers of motor vehicles have evidence of financial responsibility and;

Whereas: The Undersigned may operate a motor vehicle, and or may be subject to Vehicle
Code 42-7-103 14(a) and its related provisions, and;

Whereas: The Undersigned has not been able to locate any lawful money of account in
circulation (Gold or Silver coin or bullion) in this State, and;

Whereas: Public Policy as established with House Joint Resolution 192 of June 5, 1933 states
in part:

That (a) Every provision contained in or made with respect to any

obligation which purports to give the obligee a right to require payment in

gold or a particular kind of coin or currency, or in an amount of money of

the United States measured thereby, is declared to be against public policy;

and no such provision shall be contained in or made with respect to any

obligation hereafter incurred. Every obligation, heretofore or hereafter

incurred, whether or not any such provision is contained therein or made

with respect thereto, shall be discharged upon payment, dollar for dollar,
in any coin or currency which at the time of payment is legal tender for

public and private debts. Any such provisions contained in any law

authorizing obligations to be issued by or under authority of the United

States, is hereby repealed:

Form # _____________ Page 1 of 2

Now therefore and in consideration thereof, the Undersigned does hereby promise to pay i.e.
undertakes, “bonds” UPPER CASE NAME'S commercial activity for the following amount: Five
Million Dollars.

In the event that any person is damaged and can demonstrate a bona fide claim of injury or
loss, the Undersigned shall discharge all obligations dollar for dollar by and through tender
of payment pursuant to public policy, HR-192.

Dated the 9th day of the 10th month, Two Thousand Nine.

upper lower name
city, CO
Colorado Republic


State of Colorado )
County of El Paso )

Subscribed and sworn to at Colorado Springs before me this ________ Day of

_____________________, A.D. 20____.

Notary public______________________

My Commission Expires: ______________

WITNESS my hand and official seal,

Signature of Notary Public


Form # ___________ Page 2 of 2 Witness___________________________________