Service Insurance Co Bond Request Form

Bond Request Form

Use This Form Only If You Have Been Previously Approved For A Bonding Line
Are you working with an insurance agency for this bond?*

YesNo
Name of Insurance Agency*
Name of Agent*

First NameLast Name
Agent's Email*
example@example.com
Business Name (Bonded Principal)*
Your Company Name As It Appears On Your Business Tax Return
Phone Number*
Please Enter a Valid Phone Number.Format: (000) 000-0000.
Business Email*
example@example.com
Bond Information
Type of Bond Needed*

BidPerformance/ Payment (Final Bond, Indicate The Bid Bond Number Below)Maintenance/ Consent to Final PaymentOther
Other Type
Total Amount of Bond Needed*
Is Bond Amount the same as the Bid/Contract Amount?*

YesNo
Total Bid/Contract Amount (if bid/contract amount is different than bond amount, please provde amount and explanation below)
Explanation why bond needed is different than bid/contract amount
If bid/contract amount is different than bond amount, provide details here
Is this a Multiyear Contract?*

YesNo
Year 1 Price
Year 2 Price
Year 3 Price
Year 4 Price
Add Additional Years?

YesNo
Year 5 Price
Year 6 Price
If Bid Bond is Needed, Please Provide Bid Percentage %
Provide Bid Bond Number if Applicable
Obligee Information
Obligee Name (Entity Requiring The Bond, Enter As It Should Appear On Bond Form)*
Name
Contact Number
Please enter a valid phone number.Format: (000) 000-0000.
Obligee Email Address
example@example.com
Project Name
Project Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Project Scope*
Provide a Description of the Work to Be Performed
Date of Bid or Award*

MonthDayYear
Date
Contract Start Date*

MonthDayYear
Date
Estimated Contract Completion Date*

MonthDayYear
Date
Are There Delay Damages/ Liquidated Damages?*

YesNo
If Yes to Above, Provide Amount Per Day
Warranty Period (number of years of warranty if applicable)
Select Number of Years
Next Two Lowest Bidders:

(If You are Low Bid and This is a Performance Bond Request)
2nd Low Bidder
Provide Name of 2nd Low Bidder
Bid Amount of 2nd Low Bid
3rd Low Bidder
3rd Low Bidder
Bid Amount of 3rd Low Bid
Does This Bond Have A Maintenance Obligation Greater Than Two Years?*

YesNo
Has the Contract Started?*

YesNo
If Yes to Above, Provide the Percentage of Project Completed to Date
Does the Principal Have Any Pending Low Bids*

YesNo
Does The Principal Have Any Bonds Outstanding Issued By Another Bonding Company?*

YesNo
Confirmation and Consent
FRAUD STATEMENT*

I have reviewed all bonds and related documents prior to the bid. I have notified/ will notify The Service Insurance Company if any special forms are needed or if any clauses and requirements that apply to the Surety are required. I have/will upload or email all required documents and forms to The Service Insurance Company. I acknowledge that The Service Insurance Company is not liable for rejected bonds and I will review all final bonds and documents prior to furnishing bonds.
Upload Any Supporting Documentation Needed:

Upload All Special Forms/ Required Documents Or Any Other Items Related To This Project
Cancelof
Principal Signature*
Name*

First NameLast Name
Date*

MonthDayYear
Date
Please Verify That You are Human*
New Jersey Office
80 Main Street, Suite 330
West Orange, NJ 07052
N.J. Phone: (973) 731-7650
N.J. Fax: (973) 731-7889

Long Island Office
35 Pinelawn Road, Suite 111-E
Melville, NY 11747
N.Y. Phone: (631) 343-4305

The Service Insurance Company, Inc.
(in CT, GA, KY, MA, MD, MS, NH, NJ, NY, PA, RI, TN & WV)

Service Guarantee and Surety Company
(in AL, FL and VA by: The Service Insurance Company, Inc.)

The Service Insurance Company, Inc.
d/b/a Service Guarantee and Surety Company
(in DE, NC, SC and the District of Columbia)
Should be Empty:

Bond Request Form

Bond Information

Obligee Information

Next Two Lowest Bidders:

Confirmation and Consent