CONTRACTORS SURETY APPLICATION
Email already registered, please enter verification code from your email.
Please fill out your name and email.
Invalid code, please try again.
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
Please update required fields to continue.
Owner Name | Owner DOB | Position | Percentage Ownership | Spouse Name |
|---|
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?
Year Ending | Annual Sales |
|---|---|
LIST THE FOUR LARGEST CONTRACTS COMPLETED IN THE LAST 3 YEARS:
Contact Email Address | Contract Price | Bonded | Date Completed |
|---|---|---|---|
No | |||
No | |||
No |
This contract was bonded
LIST THE THREE LARGEST CONTRACTS IN PROCESS:
Contact Email Address | Contract Price | Bonded | Amount Billed To Date | Estimated Completion Cost |
|---|---|---|---|---|
No | ||||
No | ||||
No |
This contract is bonded
1. Has this principal including any member, or any prior company you were employed by or have or had ownership in (or any owner including family members)
2. Ever received notice of default or defaulted on a contract forcing a surety to suffer a loss or pay a claim (including receiving written notice of failure to perform to pay suppliers & subcontractors)
3. Are you currently on notice of a pending default (failure to perform or to make payments) on a bonded project?
4. Ever filed bankruptcy?
5. Ever had a criminal conviction?
6. Are there any unresolved lawsuits involving applicant/principal or spouse or a related business or any unpaid judgments or liens against applicant/principal or spouse, including judgments or liens in favor of any tax authority, IRS, any state agency or vendor or any pending or prior disputes or civil litigation?
7.Have you been bonded or applied to other surety companies within the last twelve (12) months?
8.Any disputes on contracts including money due to your firm in excess of 120 days?
9.Any disputes with vendors or money you owe vendors/suppliers in excess of 120 day?
10. Are there any past due notices for prevailing wages, labor , union benefits, or suppliers notices against your company?
If yes to any of the above, please explain:
11. Bank Credit Line?
Bank Name | Amount Available |
|---|---|
LIST TOP SUPPLIERS AND SUB CONTRACTORS:
Name | Material/Service | City | State | Email |
|---|---|---|---|---|
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.