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GENERAL BUSINESS INFORMATION

Form of Business
Certifications

LIST OF CORPORATE OFFICERS, PARTNERS OR PROPRIETORS OF THE FIRMS:





Has your firm or any of it’s principals ever petitioned for bankruptcy, failed in business or defaulted so as to cause a loss to Surety?
Is your firm or any of its principals or officers currently involved in any litigation?

LIST ANY SUBSIDIARIES AND AFFILIATES:




What percentage of the firm’s work is normally for:

How many people does your firm employ?

What is the largest amount of Backlog that the firm had at any one time in the past?

LIST THE FIRM’S KEY PERSONNEL — OFFICE AND FIELD:




Is there a buy/sell agreement among the owners of the business?
(Check one)
Is the buy/sell agreement financed by life insurance?
(Check one)

FINANCIAL INFORMATION

Do you have a full time accountant on staff?
How often are financial statements prepared?
On what basis are your Financial statements prepared?
Are taxes current?
Click or drag a file to this area to upload.

BONDING INFORMATION

(last five years) List the most current first



Has the firm had major disputes or ever failed to complete a job on schedule?
Are there any liens, lawsuits or claims pending on completed or uncompleted?

REFERENCE INFORMATION

List your three largest completed projects:




List your three of your major Suppliers




List three Subcontractors/General Contractors that you do business with




This application consists of this instrument, the financial statement and all indemnity, security, and trust agreement signed by the applicant with regard to the bond or bonds hereby requested such financial statement and agreement being incorporated herein by reference.

In addition to routine verification of information pertinent to the bond applied for, if application is by an individual primarily for personal purposes, or, if the application is for bond primarily for the benefit of a corporation and the said application be also executed for the officers of the corporation in a personal not a corporate capacity thereby acting as a CO-guarantor thereof Surety may have an investigative consumer report make including information bearing on the character, general reputation, personal characteristics of mode of living of said individual(s), and, upon written request of said individuals(s) will disclose in writing the nature and scope of the investigation request-ed, if such investigative consumer report is in fact secured.

The representations contained in this instrument an in the financial statement are warranted by the applicant to be true. Such representations are made as material inducements to be relied upon by the Surety in issuing the bond or bonds hereby requested.

By initialing here you authorize this form.

Any persons who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits application or files claim containing a false or deceptive statement is guilty of insurance fraud.

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