EXPRESSBONDINGAPPLICATION .pdf

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Original filename: EXPRESSBONDINGAPPLICATION.pdf
Title: Travelers Casualty and Surety Company of America
Author: Amanda Wick

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□ Bid Bond □ Final Bond
WORLD WIDE BONDING AGENCY
2846 WILLIAM STREET
BUFFALO, NY 14227
PH: 888-681-7685, FAX: 716-681-7683
www.wwbagency.com

Construction Services Express – BOND QUESTIONNAIRE
This application must be fully completed, as well as signed and dated by the Agent.
THIS IS A LEGAL DOCUMENT - PLEASE TYPE OR PRINT LEGIBLY.

Contractor’s License #:

Applicant’s Name (As it appears on the Contractor’s License):

Phone:
Fax:
Email:
Type of Business:
‘S’ Corp
‘C’ Corp
Partnership
Proprietorship
LLC
Other _________________

Business Address (Street Address, City, State and Zip Code):

1

Year Company Started:

How long has the business operated under current management?

Yes
No
Prior Surety?
If yes, give name of surety and reason for change.

Has the Applicant, Owner(s), or Management involved professionally or personally:
a. Ever failed in business or declared bankruptcy?
b. Ever defaulted on a surety bond or bank loan?

Yes
Yes

No
No

c. Ever had any lawsuits or judgments against them?
d. Been subject to any open claims or litigation with any surety?

Yes
Yes

No
No

(If any answers are yes, please provide details on a separate page.)

GIVE THE FOLLOWING INFORMATION ON EACH OWNER/STOCKHOLDER/SPOUSE

2

Owner Name

SSN

Physical Address

Position

Spouse Name

SSN

DOB

% Ownership

Owner Name

SSN

DOB

% Ownership

Physical Address

Position

Spouse Name

SSN

DOB

% Ownership

Owner Name

SSN

DOB

% Ownership

Physical Address

Position

Spouse Name

SSN

DOB

% Ownership

Owner Name

SSN

DOB

% Ownership

Physical Address

Position

Spouse Name

SSN

CONSTRUCTION OPERATIONS

3

Type of Construction Engaged In:

Geographic Area of Operations (State):

Largest Project Completed (Description):

Contract Price:
Gross Profit:
Year Completed:
Owner/Obligee:

DOB

% Ownership
Years Experience

Years Experience

Years Experience

Years Experience
DOB

% Ownership

BOND REQUEST
Obligee Name and Address (Who is requiring the bond?):

Total current work on hand/cost to complete (Not including this project request):

Project Description (Specify work Applicant is performing):

Bid Bond
Bid Date: _______________________ Estimated Contract Amount: $___________________ Bid Bond Amount: ____________________ ($ or %)
Start Date: ______________________ Completion Time: ___________________ Project Location (City, State): ____________________________
Liquidated Damages: $_____________________ Consequential Damages?
Warranty/Maintenance Bond Required?

Yes

Yes

No Warranty/Maintenance Period: ____________ years

No If so, what amount? _______________ ($ or %) Term of Bond: _____________________

4
Final Bond
Performance Bond Amount: $__________________ Payment Bond Amount: $____________________ Contract Price: $____________________
Date Contract Signed: ________________________ Start Date: _____________________________ Completion Time: ______________________
Project Location (City, State): _____________________________ Liquidated Damages: $____________ Consequential Damages?
Warranty/Maintenance Period: ______________ years
1st Low Bid Amount: $____________________
Was Bid Security Required?

Yes

Warranty/Maintenance Bond Required?

No

Was Project Bid?

Yes

Yes

No

No (If yes, provide results below.)

2nd Low Bid Amount: $____________________

3rd Low Bid Amount: $____________________

(If yes, what form of security?) _______________________________________________________

Yes

No If so, what amount? ________________ ($ or %) Term of Bond: ____________________

AGENCY INFORMATION
Agency Name:

Agency Code:

Producer Name:

Agency Email:

Agency Phone:

Agency Fax:

5
Is the Applicant an existing insurance account of your agency?
Yes
No
If yes, are all insurance premiums current?
Yes
No

Describe the length and nature of your relationship with the Applicant:
Why do you recommend the Applicant for this bond?

The Agent attests that the Applicant has represented that the above statements and responses are accurate. The Agent also attests that he/she has
informed all of the individuals listed above that as part of Travelers’ underwriting process, Travelers retains the right to investigate personal credit
history and that to the extent required by law, Travelers will, upon request, provide notice whether or not a consumer report has been requested by
Travelers, and if so, of the name and address of the consumer reporting agency furnishing the report.

DATE:

PREPARED BY:
(Print Agent Name)
(Position or Title)
AGENT SIGNATURE: _______________________________________________

CLICK TO

All applications are available online via the Bond Forms Library at www.travelersbond.com.
CSX-1002 (03/10)

IMPORTANT NOTICE REGARDING COMPENSATION DISCLOSURE

For information about how Travelers compensates independent agents, brokers, or other insurance producers, please
visit this website: www.travelers.com/w3c/legal/Producer_Compensation_Disclosure.html
If you prefer, you can call the following toll-free number: 1-866-904-8348. Or you can write to us at Travelers, Enterprise
Development, One Tower Square, Hartford, CT 06183.

ILT-1037 Ed. 01-09 Printed in U.S.A.
©2009 The Travelers Companies, Inc. All Rights Reserved

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