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(FEIN/Social Security #) Tj
ET
EMC
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/TT2 1 Tf
7 0 0 7 401.5557 593.9482 Tm
(Social Security #) Tj
1.438 -9.801 Td
(Yes) Tj
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(Other Surety Bonds in force?) Tj
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(No) Tj
2.172 0.073 Td
(If Yes, provide name of Surety:) Tj
-59.421 -48.275 Td
[( A facsimile copy of this document or the signature\(s\) thereon, shall be deemed ) -2(t) -2(o ) -2(be ) -2(an original and/or original signature\(s\) for all purposes.)] TJ
/TT3 1 Tf
8 0 0 8 37.2109 488.1377 Tm
(NOTICE: ) Tj
/TT2 1 Tf
[( The undersigned individual\(s\) hereby gives consent to MERCHAN) -4(TS BONDING COMPANY \(MUTUAL\), and it subsidiaries, to obtain a )] TJ
0 -1.2 TD
(consumer credit report about the individual in connection with this application for insurance. This authorization extends to subsequent consumer credit ) Tj
T*
(reports obtained for the purpose of reviewing, increasing the amount of, or any other legitimate purpose associated with the bond.) Tj
ET
/OC /MC7 BDC
BT
/TT4 1 Tf
10 0 0 10 246.127 453.8589 Tm
(INDEMNITY AGREEMENT) Tj
/TT5 1 Tf
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[(This Agreement entered into by and between the undersigned applicant or applica) -5(n) -4(t) -5(s) -4( ) -5(and/or indemnitors, hereinafter called the undersigned, and Merchants Bonding)] TJ
0 -1.166 TD
(Company \(Mutual\), hereinafter called the Company, witnesseth:) Tj
-0.103 -1.785 Td
[( The undersigned certifies that the foregoing statements and declarations are tru) -2(e) -1( ) -2(and, in consideration of the Company executing as surety the herein bond applied for,)] TJ
-0.001 -1.131 Td
[(does hereby promise and agree to pay an annual premium to the Company until suc) -4(h)] TJ
0.004 Tw
37.803 0 Td
( t) Tj
0 Tw
0.564 0 Td
(ime as the undersigned shall furnish the Company with evidence satisfactory to it of) Tj
-38.367 -1.131 Td
(the complete termination of its liability on said bond.) Tj
0.034 -1.133 Td
[( The undersigned further agrees to indemnify and save harmless the said Co) -3(m) -2(p) -1(any,) -3( in connection with any bond executed on behalf of the person or entity named as)] TJ
0 -1.131 TD
(applicant, for, from and against any and all losses, costs, damages and expenses o) Tj
0.003 Tc
-0.003 Tw
36.855 0 Td
(f ) Tj
0 Tc
0 Tw
0.562 0 Td
[(a) 1(ny) -2( ) -3(nature whatsoever, including counsel fees and expenses, and reimburse said)] TJ
-37.417 -1.131 Td
[(Company for loss adjusting expenses and compensation at the rate of $100.00 pe) -4(r) -2( ) -4(day) -4( for officers and $50.00 per day for all other personnel, which may accrue to the said)] TJ
-0.001 -1.131 Td
(Company by reason of the said Company having become surety on said bonds.) Tj
-0.069 -1.279 Td
( The undersigned hereby further agrees that the vouchers or other evidence o) Tj
0.002 Tc
-0.002 Tw
35.799 0 Td
(f ) Tj
0 Tc
0 Tw
0.56 0 Td
(payments made by the said Company under its obligation of suretyship shall be conclusive) Tj
-36.359 -1.131 Td
[(evidence against the undersigned of the fact and extent of the undersigned's liabilit) -4(y)] TJ
0.004 Tw
37.108 0 Td
( t) Tj
0 Tw
0.564 0 Td
[(o ) -4(the said Company under said obligation of the undersigned, whether said payments)] TJ
-37.672 -1.131 Td
[(were made to discharge a penalty thereunder, incurred in the investigation of a c) -4(l) -3(a) -2(i) -1(m ) -4(made thereon or adjusting a loss or claim in connection therewith, or in completing the)] TJ
T*
(work covered thereby, and whether voluntarily made or paid after suit and judgmen) Tj
0.004 Tc
-0.004 Tw
36.687 0 Td
(t ) Tj
0 Tc
0 Tw
0.564 0 Td
[(a) -1(gainst said Company.)] TJ
-37.285 -1.267 Td
[( If the Company shall set up a reserve to cover any claim, suit or judgment under an) -2(y) -1( ) -2(such bonds, the undersigned will, immediately upon demand, deposit with the)] TJ
0.003 -1.166 Td
[(Company a sum of money equal to such reserve, such sum to be held by the Com) -2(p) -1(a) -1(ny) -2( ) -2(as collateral security on such bonds, and such sum and any other money or property)] TJ
0 -1.166 TD
[(which shall have been, or shall hereafter be, pledged as collateral security on any ) -4(s) -4(u) -2(c) -4(h ) -5(bond shall, unless otherwise agreed in writing by the Company, be available, in the)] TJ
T*
[(discretion of the Company, as collateral security on any other bonds coming within) -4( ) -4(t) -3(h) -1(e ) -4(scope of this Agreement.)] TJ
-0.067 -1.243 Td
[( This Agreement shall constitute a Security Agreement to the Company and also ) -2(a)] TJ
0.002 Tw
37.465 0 Td
( F) Tj
0 Tw
0.893 0 Td
(inancing Statement, both in accordance with the provisions of the Uniform Commercial) Tj
-38.358 -1.131 Td
[(Code of every jurisdiction wherein such Code is in effect. This Agreement shall, if re) -3(c) -2(o) -1(rded, constitute a consensual lien upon any and all real estate owned by the)] TJ
-0.003 -1.131 Td
(undersigned at the time of such recording. However, the filing or recording of this) Tj
0.003 Tw
35.741 0 Td
( A) Tj
0 Tw
0.951 0 Td
(greement shall be solely at the option of the Company, and the failure to do so shall not) Tj
-36.694 -1.131 Td
[(release or impair any of the obligations of the undersigned under this Agreement or ) -4(o) -3(t) -4(h) -1(erwise arising, nor shall such failure be in any manner in derogation of the rights of the)] TJ
-0.001 -1.131 Td
(Company under this Agreement or otherwise. The use of this Agreement as a Securit) Tj
0.002 Tc
-0.002 Tw
37.686 0 Td
(y ) Tj
0 Tc
0 Tw
0.782 0 Td
[(A) -2(greement, Financing Statement or consensual lien shall in no way abrogate, restrict)] TJ
-38.469 -1.131 Td
[(or limit the rights of the Company under this Agreement or at law or in equity. The ) -2(u) -1(ndersigned waive all right to claim any property, including homestead, as exempt from)] TJ
-0.002 -1.131 Td
(levy, execution, sale or other legal process.) Tj
2.057 -1.234 Td
[(It is further agreed that the terms and conditions of this application shall also ) -2(a) -2(p) -1(ply ) -3(to increases and/or decreases in the amount of any and all bonds, and shall also apply)] TJ
-2.058 -1.058 Td
[( to all renewals whether the bond is continuous, renewed by Continuation Certificat) -4(e) -3( ) -4(o) -1(r ) -4(by the filing of a new bond.)] TJ
-0.068 -1.239 Td
[( The Company shall have the right, and is hereby authorized, but not required to f) -2(i) -1(ll ) -2(up any blanks left herein, and to correct any errors in the description of any of said)] TJ
-0.001 -1.132 Td
[(bonds, or in said premium or premiums, or in any name or names, it being agreed t) -3(h) -2(at) -3( ) -3(such insertion or corrections, when so made, shall be prima facie correct. This)] TJ
0 -1.131 TD
[(application shall be liberally construed so as to fully protect and indemnify the Co) -4(m) -3(p) -1(a) -3(ny) -4(, its successors, assigns and reinsurers. The undersigned appoints any officer of the)] TJ
-0.003 -1.131 Td
[(Company as the attorney-in-fact of the undersigned with full right to execute on beha) -3(l)] TJ
0.003 Tc
-0.003 Tw
37.635 0 Td
(f ) Tj
0 Tc
0 Tw
0.562 0 Td
[(of) -3( the undersigned any document necessary to carry into effect the intent and purposes)] TJ
-38.197 -1.131 Td
(of this Agreement.) Tj
8 0 0 8 56.918 172.499 Tm
(Dated the ________ day of ______________________ , __________. ) Tj
/TT4 1 Tf
32.363 0 Td
(Sign Application Twice - as Applicant and Indemnitor) Tj
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252 0.375 m
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q
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262.32 0.375 m
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(Applicant's Signature) Tj
7.35 0 0 7 36.7588 144.1768 Tm
(Witness) Tj
/TT5 1 Tf
9 0 0 9 35.7988 132.1719 Tm
[(In consideration of the MERCHANTS BONDING COMPANY \(Mutual) -1(\) executing the bond herein applied for, I \(we\) jointly and severally)] TJ
0 -1.04 TD
(join in the above indemnity agreement.) Tj
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(Name & Address of Owner or Co-Applicant or Indemnitor) Tj
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($) Tj
ET
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98.48 531.9 m
91.49 531.9 l
91.49 524.91 l
98.48 524.91 l
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92.24 525.66 m
92.24 531.15 l
97.73 531.15 l
97.73 525.66 l
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92.24 525.66 m
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117.63 531.92 l
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124.62 524.93 l
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118.38 525.68 m
118.38 531.17 l
123.87 531.17 l
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118.38 525.68 m
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410.28 531.96 m
403.29 531.96 l
403.29 524.97 l
410.28 524.97 l
h
404.04 525.72 m
404.04 531.21 l
409.53 531.21 l
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404.04 525.72 m
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434.29 531.99 m
427.3 531.99 l
427.3 525 l
434.29 525 l
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428.05 525.75 m
428.05 531.24 l
433.54 531.24 l
433.54 525.75 l
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428.05 525.75 m
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/TT2 1 Tf
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(Yes) Tj
-52.792 -0.011 Td
[(Has the applicant had any bankruptcies, liens, or judgments or compromises with any c) -4(r) -3(editors in the past 5 years?)] TJ
56.299 0.007 Td
(No If Yes, submit for underwriting.) Tj
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395.29 509.29 l
395.29 502.3 l
402.28 502.3 l
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396.04 503.05 m
396.04 508.54 l
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396.04 503.05 m
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426.29 509.32 m
419.3 509.32 l
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426.29 502.33 l
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420.05 503.08 m
420.05 508.57 l
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420.05 503.08 m
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(Witness) Tj
7.77 0 0 7 276.0371 99.5732 Tm
(Indemnitor) Tj
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/TT6 1 Tf
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(Witness) Tj
7.77 0 0 7 276.2778 73.9873 Tm
(Indemnitor) Tj
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(Witness) Tj
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(Witness) Tj
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