COMMERCIAL BOND APPLICATION - Palmetto Surety Corporation

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Step 1 of 7

Agency Code:*
Agency Name:*
Applicant/ (Principal)*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Applicant Home Phone:*
Work Phone:*
Email:*
Company Name:*
Company Email:*
Address (Physical not Mailing) :*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Applicant’s Business or Occupation:*
Years in Business:*
Fed Tax ID:*
SS#:*
Company Phone:*
Fax:*
Obligee – party requiring the bond:*
Obligee Mailing Address:*
Phone Number:*
Bond/Penalty Amount*
Effective Date*
Bond Term (If known)*

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TOBACCO TAX BOND – FOLLOW UP QUESTIONS
Please provide your license number as it appears on your state forms. (If Applicable) Place N/A if not Applicable.
In what county will you be conducting business in (primary)?
Please select type of company structure.
- Sole Proprietor
- Limited Liability Company
- Partnership
- S-Corporation
- C-Corporation
What was your taxable income for prior year?
What is the current company assets?
What is the current outstanding liabilities?
What is your current account receivable?
Do you current have any material liens?
- Yes
- No
If “Yes”, please submit full details.
Do you currently have any labor liens?
- Yes
- No
If “Yes”, please submit full details.
Trade name (D/B/A)
Please provide the name of your general liability carrier.
Indemnity Agreement

The undersigned applicant and indemnitors hereby request Palmetto Surety Corporation (the “Company”) to become surety for the above bond. The undersigned hereby certify the truth of all statements in the application; authorize the Company to verify the information and to obtain additional information from any source, including obtaining a credit report 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 the usual premiums, including renewal premiums, 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 and surety or by reason of having been surety on the bond or any other bond issued for applicant, 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, attorney’s fees and expenses are caused, or alleged to be caused, 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 the Company in an 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. An itemized statement of loss and expense incurred by the Company, sworn to by an officer of the company, shall be primafacie 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 this agreement shall apply to any such altered bond.
8) That if a contract or performance bond is issued hereunder, the undersigned hereby assign to the Company any monies now due o r hereafter becoming due under the contract, including all deferred payments and retained percentage, supplies, tools, plants, equipment and materials due or used on the contract.
9) At the company’s discretion, this indemnity agreement shall be governed in all respects by the laws of the State of South Carolina and the undersigned applicant and indemnitors consent to the jurisdiction of the courts of the State of South Carolina and the United States District Court for the District of South Carolina in all actions or proceedings arising from or relating to this indemnity agreement.
10) That this indemnity may be cancelled as to subsequent liability by an Indemnitor upon written notice to the Company at 109 River Landing Drive, Suite 200 Charleston South Carolina 29492, effective ten (10) days after the earliest date hereafter upon which the Company could have cancelled all bonds in force for applicant.
11) In the event of any payment by the company, to pay the Company interest on each amount at the highest legal rate from the date such payments are made. By signing, you acknowledge acceptance of such conditions and agree to all terms. Any claims filed against this bond will be held liable by you in order to make the surety as a whole to the default of your action. By the signing of your name as Indemnitor you so agree to all terms and obligations.Applicant MUST sign this indemnity agreement.
Name of Applicant*
Date Signed*
Indemnitor Signature*
SS #*
Indemnitor 2
Date Signed
Indemnitor Signature
SS #
Indemnitor 3
Date Signed
Indemnitor Signature
SS #
Indemnitor 4
Date Signed
Indemnitor Signature
SS #
Name
This field is for validation purposes and should be left unchanged.

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Step 1 of 7

Indemnity Agreement

Indemnitor 2

Indemnitor 3

Indemnitor 4

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Step 1 of 7

Indemnity Agreement

Indemnitor 2

Indemnitor 3

Indemnitor 4

Need Help? Click to Call

Corporate Offices

Navigation

Surety Bonds

Bail Bonds

Ⓒ 2024 Palmetto Surety Corporation - All Rights Are Reserved

Site Design and Marketing By MassImpact​

Site Design and Marketing By MassImpact