SMA Insurance :: Performance/Payment Bond Request

Please complete this Performance/Payment Bond Request Form and click the SUBMIT button at the bottom of the page and forward along a copy of the complete contract or purchase order and any provided bond forms. Bonds will be issued on the AIA312 form unless a specified form is provided. Please note that additional information may be required when the bid spread is greater than 10%, the Owner is a Private Owner, or at the request of the Surety. Bonds will be returned via the US Postal Service unless indicated otherwise.

Name of Contractor

Bond form to be used

please forward form if provided

Project Owner

Address

Telephone Number

Name of Contact Person

Project Name

City

State

Description of Project

Amount of Contract

Contract Date

Amount of Performance Bond

Payment Bond

Number of Original Bonds Requested

Mailing Instructions

Name of Architect or Engineer

Address

Telephone Number

Architect or Engineer's Estimate

Anticipated Starting Date

Estimated Completion Date

Penalty Clause

$ per
If the contractor has started job, a letter from the Obligee is mandatory, stating the percentage of satisfactory work completed and that to the best of the Obligee's knowledge, there are no problems or liens filed.

Does the contract specify a Maintenance Guarantee Period?

If yes, how long?

What are the terms of payment on this contract?

Retained Percentage %

Bid Bond Results

Please complete Bid Bond Results Form, if not previous submitted

10.

Work on hand

$ (Estimated costs to complete all jobs)

11.

Contact Name

Title

Email Address

REQUIRED

Fax Number

Phone

Name & Title for Corporate Signature

Delivery Instructions

Additional Comments