Application for Bond Form 10

By the Applicant and its owners submitting this application, 1st Atlantic Surety may obtain a credit report on the applicant and the owners to confirm the information below. For new applicants, complete and sign the General Indemnity Agreement. If any indemnitors have previously executed an indemnity agreement in favor of Surety, this Agreement shall be in addition to and not in lieu of or in replacement of such other agreement.

Complete Name and Address of Obligee

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Total Liabilities

The undesigned applicant and indemnitors hereby request 1st Atlantic Surety and any affiliated company, their successors or assigns (with such company/companies referred to herein as the “Company”) to become their surety. The undersigned applicant and indemnitors hereby represent and warrant: (a) they have a substantial, material, and/ beneficial interest in obtaining bonds; (b) all information provided to the Company is true, accurate and complete; and (c) they hold the title shown with their signature and that they are authorized by the business entity to execute this document. The undersigned applicant and indemnitors authorize the Company to verify this information at the time of application and as needed, on an ongoing basin and to obtain additional information from any source, including obtaining credit reports at the time of application, in any review or renewal, at the time of any potential or actual claim, or for any other legitimate purposes as determined by the Company in its reasonable discretion, and jointly and severally agree:
1) To pay premiums, including renewal premiums and any other charges, to the Company or its agents, when due.
2) To completely INDEMNIFY the Company from and against any liability, loss, cost, attorney’s fees and expenses whatsoever which the Company shall at any time sustain as surety or by reason of having been surety on this bond or any other bond issued for any applicant and or indemnitor, or for the enforcement of this agreement, or in obtaining a release or evidence of termination under such bonds, regardless of whether such liability, loss, costs, damages, attorneys’ fees and expenses are ensured, or alleged to be ensured, by the negligence of the Company.
3) To furnish the Company with satisfactory and conclusive termination evidence that there is no further liability on this bond or any other bond issued for applicant.
4) Upon demand by the Company for any reason whatsoever, to deposit current funds with Company in any amount sufficient to satisfy any claim against the Company by reason of such suretyship.
5) That the Company shall have the right to handle or settle any claim or suit in good faith and the Company’s decision shall be binding and conclusive on the undersigned. An itemized statement of loss and expense incurred by the Company shall be prima facie evidence of the fact and extent of the liability of the undersigned to the Company.
6) That the Company may decline to become surety on any bond and may cancel or amend any bond without cause and without any liability which might arise therefrom.
7) That the Company shall, without notice, have the right to alter the penalty, terms and conditions of any bond issued for undersigned, and the agreement shall apply to any such altered bond. The liability for the undersigned shall not be affected by the failure of the undersigned to sign any bond, nor only claim that other indemnity or security was obtained, nor by the release of any indemnity, nor the return or exchange of any collateral obtained and if any party signing this agreement is not bound for any reason, this agreement will still be binding on each and every other party.
8) This is a contract or performance bond is issued hereunder, the undersigned hereby assign to the company any monies now due or hereafter becoming due under the contract, including all deferred payments and retained percentage, supplies, tools, [?], equipment and materials due or used on the [?].
9) At the Company’s discretion, this indemnity agreement shall be governed in all respects by the laws of the State of North Carolina and the undersigned applicant and indemnitors consent to the jurisdiction of the courts of the State of North Carolina and the United States District Court for the District of North Carolina in all nations or proceedings arising from or relating to this indemnity agreement.
10) That this indemnity may be terminated by the undersigned, or any one or more parties so designated, upon written notice sent registered mail to the office of the Company at 1033 wade ave STE 200 Raleigh, NC 27605, of not less than twenty (20) days. In no event shall any termination notice operate to modify, bar, discharge, limit, affect or impair the liability of any party hereto, for any bonds, untakings and obligations executed prior to the date of the Company’s recaint and notice of such termination.
11) In the event of any payment by the Company, to pay the Company interest on such amounts at the highest legal rate from the date such payments are made.
The above electronic signatures are legally binding signatures acknowledging your approval of this document.
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