Construction Bonding & Management Services of Washington, Inc.
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License Bond Application
Click for a Blank Printable Form

PO Box 75715 CB&MS
Seattle, WA  98175 Construction Bonding & Management
(206) 361-9693 Services of Washington, Inc.
1-(800) 742-8815
Fax: (206) 365-5014

BUSINESS INFORMATION
1) Type of Bond
2) Bond Effective Date
3) Contractor's Registration No.
4) Number of Owners
5) Type of Business
6) Applicant's Name (Must be exactly as it is to appear on Bond)
7) Business Phone Number
8) Date Business Established
9) Business Address
10) Business City, State Zip
11) Previously Bonded by
12) Nature of Business
13) UBI Number
14) Business Experience
15) Union or Non-Union
16) Have You (or any other Partner or Officer)
a) Failed in Business? e) Ever had prior/pending tax liens?
b) Ever Declared Bankruptcy? f) Ever had any other liens?
c) Ever had a bond cancelled? g) Ever had claims against your bond?
d) Ever been convicted of a felony? h) Ever been declined by another bonding Co.?
If you answered yes to any of the above, explanation must be included with this application.
17) Business Bank Reference
a) Branch
b) Address
c) City
d) Savings Account #
e) Checking Account #
18) Business Trade Reference
a) Name
b) Address
c) City
d) Phone

PERSONAL INFORMATION FOR APPLICANT, PARTNERS, STOCKHOLDERS, AND SPOUSES
Person 1.
Name of Indemnitor
Marital Status
SSN
Date of Birth
Home Phone
Name of Spouse
Personal Bank Name and City
Bank Phone Number
Checking Account # Checking Current Balance
Savings Account # Savings Account Balance
Residence Address
Residence Owned?
Date Purchased Current Value
Purchase Price 1st Mortgage Balance
1st Mortgage Holder 1st Mortgage Phone #
Balance of all other loans against residence (excluding 1st MTG)
Do you own additional real estate?
If yes, please include a schedule of properties listing values and all mortgages below.
Person 2.
Name of Indemnitor
Marital Status
SSN
Date of Birth
Home Phone
Name of Spouse
Personal Bank Name and City
Bank Phone Number
Checking Account # Checking Current Balance
Savings Account # Savings Account Balance
Residence Address
Residence Owned?
Date Purchased Current Value
Purchase Price 1st Mortgage Balance
1st Mortgage Holder 1st Mortgage Phone #
Balance of all other loans against residence (excluding 1st MTG)
Do you own additional real estate?
If yes, please include a schedule of properties listing values and all mortgages below.
Please select the program below that you qualify for:



INDEMNITY AGREEMENT

The undersigned Applicant and Indemnitor(s) all hereinafter called the Indemnitor(s) hereby certify that the foregoing declarations made and answers given, are the truth without reservation, and are made for the purpose of inducing TRAVELERS CASUALTY AND SURETY COMPANY OF AMERICA, One Tower Square, Hartford, Connecticut 06183 for itself and its affiliates, parents, and subsidiaries, hereinafter called Surety, to issue the bond(s) or undertaking(s) applied for and any renewal and increase of the same or of any bond(s) or undertaking(s) of similar nature given in substitution or renewal thereof (all comprehended in the word “bond(s)” or “undertaking(s)” as herein used). The Indemnitor(s) agree that the Surety may decline the Bond(s) applied for or may cancel or terminate same without incurring liability whatsoever to the Indemnitor(s). In consideration of the Surety executing said bond(s) or undertaking(s) or the forebearance of cancellation of any bond(s), the Indemnitor(s) do undertake and agree as follows:

To pay the Surety all premiums when due and annually in advance of each renewal thereafter, until the Indemnitor(s) shall serve upon the Surety, at its said office, competent written legal evidence, satisfactory to the Surety, of it being duly discharged from such bond or undertaking. Indemnitor(s) hereby expressly authorize Company to access its credit records and to make such pertinent inquiries as may be necessary from third party sources for the following purposes: (a) to verify information supplied to Company; (b) for underwriting purposes; and (c) upon establishment of a reserve, for debt collection. The Indemnitor(s) will at all times indemnify, and keep indemnified, the Surety, and hold and save it harmless from and against any and all damages, loss, costs, charges and expenses of whatsoever kind or nature, including counsel and attorney’s fees, whether incurred under retainer or salary or otherwise, which it shall or may, at any time, sustain or incur by reason or in connection with furnishing any bond or undertaking. To deposit with the Surety on demand an amount sufficient to discharge any claim made against the Surety on the bond(s) or undertaking(s). The sum maybe used by Surety to pay such claim or be held by Surety as collateral security against loss or cost on the bond(s) or undertaking(s).

Regardless of the date of signature(s), this indemnity agreement is effective as of the date of execution of aforementioned bond(s) or undertaking(s) and is continuous until Surety is satisfactorily discharged from liability pursuant to the terms and conditions contained herein.

A duplicate or facsimile copy or electronic reproduction of the original document shall have the same force and effect as the original.

Signed this_____________ day of ____________. ___________
                                                    (month)          (year)

 
Applicant and Business Indemnitor(s):

___________________________________________________

(Print name of company or business)
By: ________________________________________________

Signature of Owner/Partner/Officer (must also sign below)
Individual Signature _____________________________________ Individual Signature ___________________________________

Spouse Signature     _____________________________________

Spouse Signature     ___________________________________
Individual Signature _____________________________________

Individual Signature ___________________________________

Spouse Signature     _____________________________________

Spouse Signature     ___________________________________
Entering your initials in the box below and clicking the Submit Application button signifies:
  • You have read and accepted the Indemnity Agreement
  • You agree to the Terms and Conditions of Use applicable to this site.
  • Principals, indemnitors, applicants and their spouses hereby expressly authorize CB&MS or applicable underwriting company to access credit records and to make such pertinent inquiries as may be necessary from third parties sources for underwriting purposes.

Your Initials:

Email Address:

Note: Please use the email address you would like us to send a response to.

Have you printed your application? Print before submitting as all entered data will erase.


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Copyright © 2003, Construction Bonding and Management Services of Washington, Inc.