Merchants Bonding

Rapid Access Program (RAP) Application

Agent: Acrisure Southeast Partners Insurance Services LLC (305-722-2663)
Submission Type: RAP for Developers
Producer: Christian Collins

Please fill out the form below and click Review. If you have any questions please contact your agent.

A note from your agent:

If you have any question please contact Christian Collins at cell:561-634-6100 Email: [email protected]

Business Name

DBA

Address

Address 2

City

State

ZIP

Legal Structure

Individual Signing for the Applicant

Title of Individual Signing for the Applicant

Email of Individual Signing for the Applicant

Type of Work

Does the applicant have any of the following exclusions?YesNo

The company, owner or predecessor has:
- ever declared bankruptcy
- defaulted on a contract
- been involved in a surety claim
- been involved with any lawsuits or liens in the last five years
- open bonds with another surety
Contractors and bonds within:
- Alaska
- Hawaii
- the five boroughs of New York City
Forfeiture or pay-on-demand language in bond, municipal code, or development agreement
Strict financial guarantee obligations including but not limited to:
- Bonds issued to utility companies as guarantees for utility connections
Environmental/Remediation Bonds including but not limited to:

If yes to any, please describe

Subdivision Project Information

Bond Type

Does this principal/applicant hold the title to the property requiring improvements?YesNo

Bond Amount

Maintenance Period Years

Maintenance Amount (if different from Bond Amount)

Estimated Completion Date

Bond Improvements Amount

Financing Type

Value of Funds Available for Construction

Has the project been completed and accepted?YesNo

Did the project require a performance bond?YesNo