Paul Dole Insurance Agency
Application for Contractor’s License Bond
5130 Bonita Road, Suite A Bonita, CA 91910
Post Office Box 400 Bonita, CA 91908
P (619) 475-5200
F (619) 475-5258
Name of Applicant:
Individual
Partnership
State License Number:
Address (St. & No., City, State &Zip Code)
Corporation
LLC
Phone Number:
Amount of Bond
$
1. Owner’s Name
LLP
Effective Date
Soc. Sec. #
Spouse’s Name
Soc. Sec. #
Spouse’s Name
Soc. Sec. #
Residence Address:
Is the company owned by more than one person?
2. Second Owner’s Name
Soc. Sec. #
Residence Address:
Year
Description and Address of Owned Real Estate Purchased
1.
1.
2.
2.
3.
3.
Current
Fair Market Value
1.
2.
3.
Total Remaining
Mortgages/Encumbrances
1.
2.
3.
3. Number of years in business:
4. Have you ever been bankrupt, or compromised any creditors?
YES NO
5. Has a surety ever paid a bond claim on you or any business you were involved in or any current claims in
progress?
YES
NO
Any open or closed complaints filed against you or your business with the State Contractors Board?
YES
6. Any pending litigation against you or your company?
YES
NO
7. If you answered yes to 4, 5, or 6 above, give details on separate sheet.
8. Is bond replacing one of another surety?
YES
NO Company:
Why?
*All Applicants are subject to Standard Underwriting Guidelines
*Agreement to Indemnify to Surety Company may be necessary to acquire bond.
NO