Common Contracts
1 similar Application and Indemnity Agreement contracts
ContractApplication and Indemnity Agreement • May 23rd, 2012
APPLICATION AND INDEMNITY AGREEMENTFOR ABUSINESS SERVICE SURETY BOND LICENSED PRODUCER (required): Salvad or Richard Mena (Rick Mena) Agency Name: Sanguinetti & Co. Insurance Bro Billing Method: Agency BilledPrincipal Name: Business Address: Street AddrePredominant nature of your business activity:How long in this business? (Indicate Dates) Bond Limit Requested? $ Number of Employees is less than or equal to 251. Does the Applicant have any other Surety bonds2. Has another Surety company declined to write thi3. Have you ever had a bond or fidelity policy involu4. Has there ever been a claim or legal action agains5. Do you or any of your companies have any pendi6. Have you or any of your companies declared ban7. Have you or any of your companies been the subj resulting in disciplinary action? 8. Have you ever been convicted of a felony? kers Agency Code: 57-128439 Direct Billed Agency Billed with Direct Billed at Renewal ss City, State Zip Code ($100,000 MAXIMUM)? No Yesor fidel
