Surety Bond Application

SURETY BOND APPLICATION

Application Date:

APPLICANT INFORMATION

Individual Corporation Partnership LLC Other:

OBLIGEE / CONTRACT INFORMATION

Bond Type: Performance Payment Bid Maintenance Other:

EXISTING SURETY BONDS / BONDING HISTORY

List bonds issued in the last five years. Attach additional schedule if necessary.

FINANCIAL INFORMATION — UNDERWRITING

COLLATERAL, GUARANTY & SECURITY

Collateral offered (check all that apply): Cash / Deposit Irrevocable Letter of Credit Real Estate Lien UCC Filing Personal Guarantee Other:

Applicant acknowledges and agrees that, if a bond is issued, Applicant will execute and deliver to the surety company an indemnity agreement and such security instruments as the surety requires. Applicant hereby agrees to indemnify, defend and hold harmless the surety from and against any and all losses, damages, costs, expenses (including attorneys' fees and litigation costs), judgments and claims incurred by the surety in connection with the issuance, enforcement or defense of any bond on behalf of Applicant. Applicant grants the surety a continuing lien on any collateral identified above and authorizes filing of financing statements as may be required to protect the surety's interests.

REPRESENTATIONS, WARRANTIES & AUTHORIZATION

Applicant represents and warrants that all information provided in this application and in any attachments is true, complete and correct. Applicant understands that the surety will rely on these representations in determining whether to issue a bond. Applicant authorizes any person or entity to release to the surety or its representatives any credit, bank, employment, tax or financial information necessary to evaluate Applicant's credit, financial condition and bonding eligibility. Applicant consents to periodic audits and to the surety's use of credit reports and public records in underwriting and administering bonds.

CLAIMS, DEFAULT & REMEDIES

In the event of default by Applicant under the bonded obligation or under the indemnity agreement, Applicant agrees that the surety shall have all rights and remedies available at law or equity, including without limitation the right to set off, payment of premiums, reimbursement of losses and to commence legal action to recover all amounts owing to the surety. Applicant understands that the surety may take control of, complete or settle bonded obligations subject to the terms of applicable bond forms.

PREMIUMS, FEES & BILLING

Premiums are earned in accordance with the surety's rate schedule and are due upon issuance of the bond unless otherwise agreed in writing. Applicant agrees to pay premium, commission, inspection fees, audit fees and any other charges required by the surety. Applicant understands that adjustments to premium may be made following audit or at bond termination.

MATERIAL FACTS & DECLARATIONS

Has Applicant or any principal been involved in bankruptcy, receivership, or insolvency proceedings in the past ten years? Yes No

Has Applicant been the subject of a surety claim or payment under a bond in the past five years? Yes No If yes, provide details:

NOTICE, GOVERNING LAW & JURISDICTION

This application, and any bond and indemnity obligations arising from issuance of any bond, shall be governed by and construed in accordance with the laws of the state specified in the bond or, if not specified, the state of the surety's principal place of business. Applicant consents to jurisdiction and venue in the appropriate state or federal courts within that jurisdiction for any disputes arising out of the indemnity agreement, bond, or related matters.

CERTIFICATION & AUTHORIZATION

By signing below, Applicant certifies that the information provided in this application and all attachments is true, correct and complete to the best of Applicant's knowledge. Applicant authorizes the surety and its agents to obtain credit reports, verify references, inspect records and otherwise conduct such investigations as the surety deems necessary. Applicant agrees that the execution of any bond by the surety in reliance upon this application does not constitute a waiver of any of the surety's rights under the indemnity agreement or applicable law.

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