Merchants Bonding

Rapid Access Program (RAP) Application

Agent: Acrisure Southeast Partners Insurance Services LLC (305-722-2663)
Submission Type: RAP
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

Program Limits

Request a higher limit by selecting "Higher limit, up to $2,000,000" below and providing details on past projects.

$1,000,000 — standard

Higher limit, up to $2,000,000 — based on largest recent project

Please provide details on the applicant's largest completed project in the past three years.

Project Owner

Contract Amount

Project Description

How long has this company been in business or under current management?Less than three yearsMore than three years

Has this company, owner or predecessor ever declared bankruptcy?YesNo

Has this company, owner or predecessor ever defaulted on a contract?YesNo

Is this contractor or project located within the five boroughs of New York City?YesNo

Do any of the following apply to the company, owner or predecessor?

YesNo

If yes to any, please describe