Finance Bond Request

Finance Bond Request

Purpose: This Finance Bond Request is submitted to request issuance or procurement of a surety bond for obligations described below. Completion of this form, and the certifications therein, authorizes the Finance Department and its designated surety or agent to evaluate credit, request underwriting documentation, and take such steps as necessary to obtain bonding on the Applicant's behalf.

Applicant Information

Applicant Name:

Individual    Corporation    LLC    Partnership    Other:

Bond Details

Performance    Payment    Bid    Maintenance    Other:

Project / Contract Reference:

Obligee / Beneficiary:

Bond Effective Date:

Principal / Contractor Information

Surety / Premium & Security

Cash    Wire Transfer    Check    Credit Card

Yes    No

Underwriting Checklist (Attach Copies)

Financial Statements (last 2 years)

Personal/Corporate Guarantee

Bank Reference

Copy of Contract / Procurement Documents

Applicable Licenses and Registrations

Legal Terms, Representations and Indemnity

Representations and Warranties: The Applicant represents and warrants that all information submitted in this request and any supporting documentation is true, complete and correct. Applicant will promptly notify the Finance Department of any material change in financial condition or in the facts provided.

Indemnity: To induce any surety to execute or procure any bond in connection with this request, Applicant hereby agrees to indemnify, defend and hold harmless the Finance Department, its surety, and their respective officers, agents and employees from and against any and all losses, liabilities, claims, damages, costs and expenses (including attorneys' fees) arising out of, resulting from, or connected with the issuance, enforcement, or attempted enforcement of any bond, unless caused by the gross negligence or willful misconduct of the indemnitee.

Security Interest: Applicant grants, to the extent permitted by law, a security interest in any collateral delivered or maintained with the Finance Department or the surety as security for obligations related to the bond, together with any premiums, fees, and costs.

Default; Remedies: In the event of default on underlying obligations or failure to pay premium, fees, or to provide required collateral, Finance Department and surety may pursue any remedies available at law or equity including, without limitation, collection of amounts due, liquidated damages to the extent contractually permitted, and offset against Applicant funds or credits held by the Finance Department.

Governing Law and Venue: This request and any bond issued pursuant to it shall be governed by the laws of the jurisdiction where the obligation is to be performed. Applicant submits to the exclusive venue and jurisdiction of the courts in that jurisdiction for resolution of disputes.

Notices: All notices relating to this request shall be in writing and delivered to the addresses supplied in this form or to such other address as a party specifies in writing.

Request Certification

By signing below, Applicant certifies under penalty of perjury that Applicant is authorized to make this request, that the information provided is true and accurate to the best of Applicant's knowledge, and that Applicant accepts the terms and conditions set forth in this document. Applicant authorizes the Finance Department and its designated surety or underwriting agent to obtain credit reports and other information necessary to evaluate this request.

Internal Use Only

Approve    Decline    Pending - Conditions

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