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Performance & Payment Bond Order
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Section I

Upon submission of this form, please send a fax to (206) 365-5014 with a copy of the contract and special bond forms, then complete Section II and Section III below.

Section II

1) Company Name:

2) Phone (w/area code): 3) Fax (w/area code):

4) Obligee: 5) Project Number:

6) Summary of Work:

7) Completion Time: 8) Liquidated Damages per day

9) Approximate Start Date: 10) Work on Hand:

11) Total % Subcontracted: 12) Major Sub No. 1: 13) % 14) Bonded?
15) Major Sub No. 2: 16) % 17) Bonded?
18) Major Sub No. 3: 19) % 20) Bonded?

Section III

Bid Results: 21) Engineer's Estimate $
22) 1- 23) Bid Amount $
24) 2- 25) Bid Amount $
26) 3- 27) Bid Amount $

28) Ordered By: 29) Phone (w/area code): 30) Date & Time:

31) Delivery Instructions: Mail Overnight Pickup

The following statement must be acknowledged by an owner or officer.

I acknowledge that all information is complete and correct. I understand that false information may constitute misrepresentation or fraud. I authorize you to investigate the credit, character, capacity and capital of our company and its employees and owners.

32) Name: 33) Date: 34) Title:

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