Read Carefully and Sign Below (All Owners, Partners, and Stockholders Must Sign):___________________________ Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance containing any false information or conceals
for the purpose of misleading information concerning any fact material thereto commits a fraudulent insurance act, which may be a crime and may subject such person to
criminal and civil penalties.
Indemnification Agreement – Read Carefully and Sign
The undersigned, and each of them, hereby declare that the above statements are true and correct. The undersigned, jointly and severally, and as individuals and authorized
agents of the business identified above, agree to indemnify, defend and hold harmless Surety/Agent from and against any monetary loss due to, 1) a claim or demand against
the bond, 2) legal and/or collection expenses incurred by Surety/Agent relating to any bond issued pursuant to this agreement, and 3) the undersigned’s failure to indemnify
Surety/Agent according to the terms hereof.. At any time, Surety/Agent may demand from the undersigned a monetary sum not to exceed 125% of the principal amount of
the bond to secure any actual or contingent liability or claim pertaining to the bond. The undersigned shall immediately provide Surety/Agent said sum and the Surety/Agent
at its sole discretion and without the consent of the undersigned, may use said sum to pay or otherwise settle the liability or claim. No interest or other compensation shall be
paid to the undersigned as a result of the foregoing. The undersigned agree and acknowledge that no legal action related to this Indemnity Agreement may be filed or
maintained in any other location. In the event that Surety/Agent is awarded a judgment against the undersigned, it is agreed that the judgment shall include, in addition to all
other damages awarded, a sum equal to twenty-five (25) percent of the principal amount of the bond issued pursuant to the above application and this agreement as liquidated
damages for reimbursement of associated expenses to obtain said judgment. The undersigned authorizes Surety/Agent to obtain all credit information pertaining to the
undersigned for any business purpose relating to this application and Agreement. "On approval of credit".
The undersigned agree that the first year’s premium shall be fully earned by and paid to Surety/Agent upon issuance of requested bond.
