CONTRACTORS SURETY APPLICATION

Name of business (Known as Principal as name appears on tax return)

Please enter the the main address of the business.

Mailing Address.

Mailing Address Same as Business Address

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Is the principal or its owners or family members connected with other companies as a subsidiary, parent, holding or affiliate in any way,including prior companies?

In what class of construction do you specialize in?

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LIST THE FOUR LARGEST CONTRACTS COMPLETED IN THE LAST 3 YEARS:

This contract was bonded

LIST THE THREE LARGEST CONTRACTS IN PROCESS:

This contract is bonded

11. Bank Credit Line?

LIST TOP SUPPLIERS AND SUB CONTRACTORS:

This is to certify that all of the above statements are true and correct and to the best of my/our knowledge there are no prior, pending, or notices of any defaults or claims on this or any related entity, except for what has been previously disclosed to service insurance company. The foregoing statement applies to any other or prior business(es) i/we or any immediate family member has/had ownership in.

 

I/we authorize the company to investigate/verify all business and personal documentation submitted with and representations made in connection with any surety request and to check my/our credit with any creditors and/or lending institutions or credit bureaus .

 

Errors & ommissions

 

I/we will verify the accuracy of all bonds and related documents and will notify service insurance company prior to their submission. I/ we understand that service insurance company is not responsible or liable for rejected bonds or any mistakes, errors or ommissions made and I/we agree to hold service insurance company harmless should a bid or bond be rejected.

 

Fraud statement

 

Any person who knowingly and with intent to defraud any insurance company (including any surety company) or who files an application for surety bonding containing any false or misleading information or conceals any fact for the purpose of misleading, commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.

The Service Insurance Company, Inc.

(used in CT, GA, KY, MD, MA, MS, MT, NH,

NJ, NY, PA, RI, TN & WV) 

DBA Service Guarantee and Surety

Company in AL, DE, FL, NC, SC, VA

and the District of Columbia.

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