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tr� 0 <br />BiD BOND REQUEST FORM i ) <br />To be completed by the Principal. Please allow two business days to process. ' <br />Fax or a - mall Io (715) 346 -8958 or BPBonds@sentry.com /` 0 <br />1 0 1 <br />� <br />PRINCIPAL INFORMATION � 1" G SENRT <br />(party performing the obligation or Sentry's Insured) <br />Company /Dealer Name BEN MYNATT CHEVROLET f ��s, <br />Principal Contact Name (ptease print) LYNN ST N Bond Account Number 25-13658 <br />Principal Contact Signature - <br />Required - electronic is acceptable <br />Phone (704)786 -2151 <br />OBLIGEE INFORMATION <br />Name of Entity <br />Address <br />City <br />BOND REQUIREMENTS <br />L-y(/ <br />Date <br />FAX 704 793 -4301 ` <br />(entity requiring the bond) <br />State <br />Zip <br />D YG :) "0'7 <br />Bid Date (set by Obligee, see Bid instructions) /¢42 / ,S' / <br />Scope of work/type of equipment bidding to «,z <br />Total Bid Value <br />Bid Bond Percent o <br />/a or Flat Amount <br />Example: Plymouth County Sheriff's Department (Obligee) Invitation for Bid — 2009 Model Year Public Service Vehicles. <br />Bid Is for 5 estimated vehicles at $10,000 each, and 3 estimated vehicles at $20,000 each. Bid Bond required would be: <br />5 vehicles x $10,000 each equals Bid of $50,o00 on Vehicle A <br />3 vehicles x $20,000 each equals Bid of $60,000 on Vehicle B <br />Total Bid Value $110,000 <br />Bid Bond (10% set) $ 11,000 <br />Is a Consent of Surety required? <br />Performance Bond required if job awarded ?' <br />❑ Yes ❑ No <br />❑ Yes �o <br />If Yes, percent required on Pe f <br />r ormance Bond <br />Any of the following required by the Obligee; <br />Manufacturer's Guarantee <br />Buy Back/Repurchase <br />X No <br />Warranty <br />O Yes gi# o <br />Maintenance <br />Lames ❑ No <br />❑ Yes �N <br />'1f yes, provide a copy of tiie Bid fnvitalion 8 instructions. <br />Term /Commitment Period <br />Term /Commitment Period 3 - — <br />o Term /Commitment Period `�' °4 �� '�' •c vd,otU <br />If job is not service related, does the Principal have the eq ment/material in stock? �rprrn <br />Deliver time if not in stock (Example 60 days, 3 months) ❑Yes [a-iQo <br />MAILING INSTRUCTIONS <br />❑ R gutar Mail <br />Federal Express <br />❑ UPS <br />❑ FAX a Copy to { } <br />Overnight Delivery Account Number <br />Send Bond To;' Compan <br />COMMENTS <br />80.618 <br />F -11 <br />ARn: <br />F�� wce Of e <br />Address <br />C <br />AO" number 5 <br />2 -08 <br />