Contract Bond Information Form

Contract Bond Information Form

Please provide your contract bond details for MSB Insurance Group. Complete all required sections and upload supporting documents.
CONTRACTOR INFORMATION
Company name
Entity type
Full address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Construction specialty
Year started
Largest project completed in last 3 years
Contract price
Project description
Unfinished bonded contracts with other sureties?
If yes, explanation
OWNERS/OFFICERS (1 of 3)
Owner name
% ownership
SSN
Phone number
Please enter a valid phone number.Format: (000) 000-0000.
Married?
Spouse name
Spouse % ownership
Spouse SSN
Home address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Own your home?
OWNERS/OFFICERS (2 of 3)
Owner name
% ownership
SSN
Phone number
Please enter a valid phone number.Format: (000) 000-0000.
Married?
Spouse name
Spouse % ownership
Spouse SSN
Home address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Own your home?
OWNERS/OFFICERS (3 of 3)
Owner name
% ownership
SSN
Phone number
Please enter a valid phone number.Format: (000) 000-0000.
Married?
Spouse name
Spouse % ownership
Spouse SSN
Home address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Own your home?
BACKGROUND QUESTIONS
Failed in business or bankruptcy?
If failed in business or bankruptcy, explanation
Failed to complete a contract or had a paid claim with a surety?
If failed to complete a contract or had a paid claim with a surety, explanation
Involved in any litigation or delinquent with any payroll?
If involved in litigation or delinquent with payroll, explanation
Had state or federal tax liens within the last 3 years?
If had state or federal tax liens within the last 3 years, explanation
Were you bonded in the past – by whom?
If bonded in the past, name of surety
Explanation for any Yes answers
Applicant consent to credit check/information verification (I AGREE)
Contractor Prequalification For Bonding

If no bonded is needed at this time, skip the project information request. If yes, please proceed.
Name of owner/obligee needing bond
Project description/location
Bid due date

MonthDayYear
Date
Bid bond amount or %
Performance/Payment bond amount or %
Estimated bid/contract price
Start date

MonthDayYear
Date
Completion date

MonthDayYear
Date
Maintenance term
Liquidated damages/penalties
Total cost to complete work on hand (without this job)
If project already bid – bid results
Bid result 1
Bid result 2
Bid result 3
If low bidder – engineer’s estimate and date
Bid secured by
If Other bond form, upload file or describe other bond form

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Contractor prequalification for bonding – no bond needed at this time
FINANCIAL INFORMATION
Provide latest fiscal year-end company financial statement (and interim if older than 6 months), or in-house financials/most recent tax return if no CPA statement
Upload company financial statement

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Upload interim financials (if applicable)

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Personal financial statements
Upload Current personal financial statement for each owner

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Upload Government Identification for each owner

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Does the contractor have a formal bank line of credit?
If yes, amount of line of credit
If yes, amount currently borrowed
EXPERIENCE INFORMATION
Largest project completed in last 3 years (Owner/GC)
Contract price
Profit
Project description
Contact person
Contact phone
Please enter a valid phone number.Format: (000) 000-0000.
Contact email
example@example.com
Largest project currently underway (Owner/GC)
Contract price
Profit
Project description
Contact person
Contact phone
Please enter a valid phone number.Format: (000) 000-0000.
Contact email
example@example.com
Applicant Certification
By signing below, I certify that all information provided in this application is true, complete, and accurate to the best of my knowledge and belief. I understand that any omission, misrepresentation, or false statement may affect the processing of my application, insurance quote, policy, or bond request.

I acknowledge that MSB Insurance Group and its insurance carriers, brokers, or surety companies may rely on the information I have provided in evaluating my request.

Electronic Signature Certification

By typing my name, drawing my signature, or electronically signing this form, I agree that my electronic signature has the same legal effect as my handwritten signature and that I certify the information provided above is true and correct to the best of my knowledge.
Owner 1 Signature
Owner 2 Signature
Owner 3 Signature
Should be Empty:

Contract Bond Information Form

CONTRACTOR INFORMATION

Largest project completed in last 3 years

OWNERS/OFFICERS (1 of 3)

OWNERS/OFFICERS (2 of 3)

OWNERS/OFFICERS (3 of 3)

BACKGROUND QUESTIONS

Contractor Prequalification For Bonding

If project already bid – bid results

FINANCIAL INFORMATION

Personal financial statements

EXPERIENCE INFORMATION

Largest project completed in last 3 years (Owner/GC)

Largest project currently underway (Owner/GC)