Quote #: Requested Effective Date:
Business/License Holder Information
Business/License Name
Contractor’s License Number or
Application Fee Number
Street Address
City/State/Zip Business Phone Business Fax
Have you ever had a Bond Payout? Yes No
Indemnitor/Guarantor Information
First Name/Middle Name/Last Name Driver’s License Number Date of Birth Social Security Number
Home Address E-Mail Address
City/State/Zip
Do you own your home? Yes No
Mobile Phone Number
Indemnification Agreement – Read Carefully and Sign
In consideration of the execution, renewal, assumption, continuation, or reissuance of a bond or bonds for the undersigned, or either of
them (collectively, the “Undersigned”), the Undersigned promise and agree, jointly and severally, with SureTec Insurance Company,
SureTec Indemnity Company, and/or any other surety executing or renewing a bond for the Undersigned at the request of either of
them (collectively, “Surety”), as follows:
1. That, all information provided herein is represented by Undersigned is true and correct.
2. To reimburse, hold harmless, and indemnify Surety upon demand for all loss, liability, claim, expense, including but not limited
to attorneys’ fees, expert’s fees, investigative fees and claims handling fees, and any other cost which Surety shall pay or incur
in defense, adjustment, or settlement of such claims/suits by reason of such suretyship, whether or not Surety shall have paid
same at the time of demand.
3. That, Surety has the exclusive right to determine whether or not any claim or suit shall be paid or compromised.
4. To pay Surety an advance premium for the first year upon execution of the bond and to pay premium annually until such time
that bond liability is extinguished.
5. That the place for performance of this agreement, including the promise to pay Surety, as well as venue for any action to
enforce same shall be in Los Angeles County, California. Surety shall be entitled to recover its reasonable attorneys’ fees
incurred in the enforcement of this agreement. That, Surety is authorized to investigate, at any time, the undersigned’s credit,
references, employment history and Department of Motor Vehicle records.
6. That, the Undersigned grant to Surety a security interest in and to all equipment, inventory, receivables, accounts, and
intangibles of the Undersigned to secure Surety against loss.
7. That, we may do business electronically with the undersigned and that, any signature via fax, email, text message, click
through endorsement, electronic or otherwise, by the Undersigned or his/her/its agent, shall be binding on the Undersigned.
Signed this __________ day _________________ , _________.
X
X
(Authorized Representative and Individually)
(Authorized Representative and Individually)
. Agency:
Phone:
Address:
Fax:
City, State, Zip:
Agency No.
California Contractors License Bond Application
and Indemnit
A
reement
