Eligibility by qingyunliuliu


									                           WORK IN PROGRESS PROGRAM

CBIC is a market for a variety of artisan contractors performing work on residential and small
commercial projects that meet the following eligibility requirements:

 1.   License bond must also be written with CBIC

 2.   Contractors that have formed an LLC or Corporation to reduce their personal liability

 3.   Contractors engaged in residential and “small” commercial projects (excluding
 4.   10 or less full time employees

 5.   Job (project) size $1,000,000 or less

 6.   Annual gross receipts $1,500,000 or less

 7. All contractors subcontracting work to others (regardless of the amount subbed) must:
   a. Obtain certificates of insurance from all subcontractors indicating occurrence limits equal to
   b. Obtain hold harmless agreements from all subcontractors
   c. Be named as additional insured on subcontractors policy

 8.   Business must be owner-operated

 9.   New ventures must have minimum 3 years construction experience

 10. Acceptable credit

 11. Maximum one loss/claim no greater than $2500. Three years prior carrier loss runs &/or "No
      loss letter"

Eligible Contractors:
         General Contractors (construction work exceeds the scope of our Contrac Pac Program)
         Doors/windows or assembled millwork
         Insulation contractors


Contractors Bonding and Insurance Company has offered this work in progress general liability insurance form with less
coverage than our standard policy in an effort to address the lack of available liability insurance for construction
contractors in Oregon. The following are among the governmental expressions of concern over this issue:

1. Chapter 766 Oregon Laws 2003 Effective date September 17, 2003, "AN ACT SB 943 Relating to construction
contractors; creating new provisions; amending ORS 701.105; and declaring an emergency." and "(2) The Construction
Contractors Board by rule, in consultation with the Department of Consumer and Business Services, may allow a general
or specialty contractor that is a residential-only contractor to provide an alternative form of security approved by the board
instead of procuring a public liability, personal injury and property damage insurance policy."

2. Chapter 283 Oregon Laws 2003 Effective date January 1, 2004 AN ACT HB 3145 Relating to home protection
insurance; amending ORS 731.164. "731.164. (1)(a) “Home protection insurance” means that part of casualty insurance
that includes only insurance which undertakes to perform or provide repair or replacement service or indemnification
therefore for the operational or structural failure of the insured home, components of the home or personal property
relating to the home or its components, and does not include protection against consequential damage from the
operational or structural failure."
3. The Oregon Office of Insurance Division's Market Assistance Plan (MAP) for contractors' liability insurance. "A MAP is
a clearinghouse formed by insurers at the request of the Department of Consumer & Business Services (DCBS) to match
businesses — in this case construction contractors — with insurance companies that can offer them coverage. ORS
735.210 provides for the creation of a MAP if businesses are having difficulty obtaining commercial liability insurance, and
if a MAP could help them do so." from the Oregon Department of Consumer and Business Services Office of Insurance
Division web site at: http://www.cbs.state.or.us/external/ins/docs/contractors_liability/map_q-a.htm
4. The Oregon Construction Contractors Board minutes of March 23, 2004 stated:
"Board member Mike Smith stated that someone has to do something about the liability insurance. I am not saying it is
not, it is a legislative mandate, it is not our mandate, we understand that. The Insurance Division manages it and they
have affect over it. But this is where the rubber meets the road for these people. I don’t see anyone else and I don’t see
any other place where the rubber meets the road. If that is where the problem is, then my own feeling is that is where the
solution has to come from. Somebody has to take leadership and I think it needs to be us."
"We have the ear of the legislature and of the Governor’s office in a unique way that none of the particular industry groups
have. We have relationships with lobbyists and we have relationships with the association groups. We could declare an
emergency. This is an emergency situation; we need a high level commitment to this problem. We want the Governor to
recognize that we have declared that and made a high level commitment to it and we want the legislature to do the same
and we want all the power and resources of government to pull together the people necessary to really sit down and solve
this problem. I mean you talk about economic impact and regulatory streamlining, you know, well I can’t find a better
example for need for that than this problem." Board members determined that the liability insurance problem is an
emergency, that the agency sees this as its top priority to resolve this issue and they are directing staff to use their time as
well to find and research this problem in its totality and to wobe improved on my base. With the Coast Guard tightining
possibilities, and find a solution."
"MOTION: Board member Mike Smith moved the adoption of the following resolution: "That this organization finds that
the cost and availability of state mandated liability insurance for CCB licensees constitutes an emergency and has
directed staff to prioritize their efforts and dedicate all available resources to finding a solutions to this problem." "VOTE:
6-0, Ayes—Fairchild, Gamble, Harkins, Smith, Tolvstad and Trainor."
5. Contractors Bonding and Insurance Company, has taken a leadership role in the Oregon Market Assistance Plan,
MAP,      by     producing   Internet   database     tools    for    locating   available   insurance     markets,
http://www.pj6.com/or/1LookUpOrIndex.htm, in response to requests from Oregon Insurance Division Administrator Joel

Construction contractors doing business with the Work in Progress Policy Form, or with other insurance forms containing
policy exclusions, do so with the risk that claims filed against them or their business may not be covered by insurance. In
this event, the contractor will have to retain their own lawyer, and will have to pay the amount of any judgment awarded
against them out of their own assets. Depending upon the amount of the claim and the legal fees and expenses involved,
the contractor may have no choice but to file bankruptcy.

Contractors can reduce their exposure to the most common source of uncovered liability by taking the following steps,
under the guidance of their attorney, before a claim arises:
1. Form an LLC or Corporation. Contractors can reduce their personal liability by operating their business as a Limited
Liability Company or Corporation. These entities can be created with a single sheet of paper and can protect the
contractor’s personal assets in the event uncovered claims are made against the contractor’s business. The protection is
not complete, however, the additional time, risk, and expense necessary for claimants to pierce the corporate veil can
provide substantial negotiating leverage to the contractor.
2. Liability Releases. Most states recognize enforcement of releases whereby one party to a contract releases the other
from liability for certain risks. Based on the difficulty or impossibility of contractors obtaining liability insurance to cover
many construction defect claims, it may be appropriate for contractors to include release provisions in their contracts with
homeowners. Contract language which prohibits or limits homeowner claims to risks covered by the contractor’s liability
insurance can protect the contractor against uncovered liability, and will put the homeowner on notice that they and their
homeowners insurance are assuming these risks. Although these clauses are not always enforceable under state law,
contractors can take advantage of whatever release protection is available by including liability release provisions in their
3. Subrogation Waivers. Subrogation waiver clauses protect the contractor from being sued by the homeowner’s
insurance carrier in the event the carrier pays a water damage, fire loss, or other claim which can be blamed on the
contractor. Since homeowners already pay insurance premiums covering such damages, subrogation waiver clauses
protecting the contractor are uncontroversial. The following is an example of a typical subrogation waiver clause:
Subrogation Waiver: All parties to this contract waive their rights against each other for any damages caused by fire or
other peril covered by any property insurance. This waiver of subrogation shall be effective as to a person or entity even
though that person or entity would otherwise have a duty of indemnification, contractual or otherwise. These clauses are
4. Additional Insureds. Many subcontractors have insurance policies which automatically make the general contractor an
insured on the subcontractor’s policy if there is a clause in the subcontract requiring the subcontractor to do so. Although
these clauses are not always present or enforceable under state law, any contractor who hires subcontractors can take
advantage of whatever additional insured protection may be available by including an additional insured requirement in
their contract.
5. Indemnity Agreements. Many states recognize enforcement of indemnity provisions which require one party to a
contract to defend and indemnify the other party against certain risks. Although these clauses are not always enforceable
under state law, contractors can take advantage of whatever indemnity protection is available by including an indemnity
provision in their contract.
6. Guard Against Water Intrusion Claims. The majority of uncovered construction defect claims arise out of slowly
progressing water or moisture damage to a customer’s residence. These claims most frequently arise out of improper
caulking, flashing, or lapping of building paper at window, door, or deck openings. These claims are exacerbated when
mold occurs and by the presence of OSB plywood and other engineered wood products which often must be replaced
rather than merely dried out after a water problem is solved. Based on the lack of insurance coverage for claims of this
type, prudent contractors take every possible precaution to assure that moisture intrusion or buildup never becomes an
issue on their projects.
                                       Work in Progress Policy Limitations
*** Separate Notarized Signatures Required from Insured and Agent ***

This Notice is incorporated into and becomes part of your insurance policy identified as “Commercial General Liability
Coverage Form – Coverage for Work in Progress”. This policy is not effective unless this Notice is separately signed by
Named Insured and Agent and notarized prior to the effective date in the policy declaration sheet.

This insurance policy contains significant non-standard restrictions on coverage and is offered in response to notice
of the lack of availability of contractor liability insurance from the Oregon Construction Contractor Board and Oregon
Department of Consumer and Business Services Insurance Division. This policy is intended for contractors unable to
obtain affordable insurance elsewhere, and the undersigned prospective insured represents that they have read the
policy and have made a diligent search for unrestricted liability insurance coverage.

The undersigned hereby acknowledges the following specific limitations on their liability coverage:
Completed Operation and Latent Injury Claims:
 This policy does not cover claims for bodily injury or property damage unless it is discovered before your work at
 the jobsite is completed or abandoned.
Contractual liability Coverage:
 The policy provides coverage for your contractual assumption of someone else's liability only to the extent that an
 owner or general contractor is held liable for your own negligence in injuring one of your employees.
Allocation Between Covered and Uncovered Damages and Arbitration of Coverage Disputes:
  In the event the insured determination of the amount of damages to be allocated between covered and uncovered
  claims, or regarding our determination of the insured's entitlement to a defense against any claim, the insured's sole
  means of disputing our decision is via the arbitration provisions set forth in the policy. The insured has no right to
  litigate coverage disputes in court, and no right to assign any claim against us to others.

This Notice does not change the terms of coverage set forth in the attached policy forms. This Notice is meant only
to call your attention to some of the significant coverage limitations. The attached policy forms contain other
significant limitations on coverage and you must read the attached policy forms that determine the extent of your
By signing below the insured also acknowledges that the premium rate charged for this policy may be different
from the rate on file with the Department of Insurance as allowed by ORS 737.325(2), and the insured hereby
requests, based on the lack of availability of admitted carriers writing these risks, that the following rate be used on
this specific risk: per quote attached .

Insured                                                            Agent
By:                                                                By:
State of                                                           State of
County of                                                          County of
      On this    day of                ,   20      , before me           On this    day of                ,   20      , before me

personally appeared                                         , to   personally appeared                                         , to
me known and known to be the person(s) described in and who        me known and known to be the person(s) described in and who
executed the foregoing instrument, and s(he)/they thereupon duly   executed the foregoing instrument, and s(he)/they thereupon duly
acknowledged to me that s(he)/they executed the same.              acknowledged to me that s(he)/they executed the same.

Notary Public:                                                     Notary Public:
In and for the State of:                                           In and for the State of:
My Commission Expires:                                             My Commission Expires:

AGL 00 01 04 05                                                                                                          Page 1 of 1

Important: This Affects the Validity of Your Policy Please Read Before Signing

The undersigned, as a condition precedent to issuance of an insurance policy, hereby states that within the last 5
(five) years the Company listed below has made no claims against their insurance, has had no claims made against
their insurance, has had no lawsuits or counterclaims filed against them, and has had no claims made against them
which were tendered to, adjusted by, received by any insurance carrier, except as described below in
"Exceptions/Claims History".

The undersigned acknowledges that this Certification is being relied upon by CBIC and is submitted to induce
CBIC to issue insurance for the undersigned, and that if an undisclosed claim has occurred within the last 5 years,
the submission of this Certification by the undersigned constitutes a material misrepresentation that will void or
rescind their policy and eliminate insurance coverage (both for defense and indemnity), that they might otherwise
have. In the event that CBIC were to make any payments under these circumstances CBIC will seek
reimbursement for such payments from the undersigned to the fullest extent allowed by law.

By signing this Certification the representative of the undersigned Company warrants that they have the knowledge
and authority to bind the Company and to truthfully make the representations herein, and that for any claim or
matter for which they are uncertain, they will not omit the matter but will instead state "unknown" in the
appropriate line below.
Exceptions/Claims History (attach additional sheet if necessary):
Year                           Nature of Loss or Claim                                        Outcome

                               Print or Type Full Business Name
           Print Name                                    Signature
                                                Contractors Bonding and Insurance Company
 1. Agent/Broker Name
 2. Agent/Broker Phone         (        )              -                    3. Agent/Broker FAX         (                )                -
 4. Agent E-mail
 5. Address
 6. City                                                         7. State                                    8. Zip Code                             -
 1. Type of Bond        General             Specialty            Limited              Landscape         Janitorial
 2. Bond Amount                                  3 Effective Date                                           1 Year           2 Year           3 Year       4 Year
 4. Previous Bonding Company
 5. Reason for changing Bonding Company:

 6. Any prior Bond losses?                      If yes, provide details.

 1. Company Name

 2. Business License Number (UBI)
 3. Contractors Registration Number
 4. Business Phone       (          )              -                      5. E-mail
 6. Web Site
 7. Company Address
 8. City                                                         9. State                                   10. Zip Code                             -
11. Form of Business     Proprietorship                Partnership               Corporation                 Limit Liability Corporation (LLC)

      No. of Owners/Shareholders, Partners or LLC Members                                         Date Formed                         /                /
      No. of Inactive Owners
12. How Long in Business            Years                  Months          13. How Many Years Experience?                       Years
             Personal Information
A Personal Information Section must be completed for each owner, partner, stockholder or LLC member
 1. Individual's Name
 2. Social Security Number                  -              -                  3. Date of Birth          /            /
 4. Are you employed other than self-employed?                               If yes, advise employer?
                                                                                                     5. Monthly Income
 6. Spouse's Name
 7. Spouse's Social Security Number                        -          -                   8. Spouse's Date of Birth                       /          /
 9. Spouse's Employer
10. Employer's Phone       (        )              -                       11. Length of Employment                      Years                Months
12. Monthly Income                        13. Residence Address

14. City                                                       15. State                                    16. Zip Code                             -
17. Residence Phone      (          )              -                       18. How long at Residence                     Years                Months
19. Residence Status                        Type
20. Current Market Value                                                   21. Loan Balance
22. Are you the Trustee, Trustor or Beneficiary of any Trust?
23. Have You Ever Declared Bankruptcy?                                     24. Any Pending or Prior IRS Liens?
25. Any Lawsuits Pending Against You?                                      26. Have You Ever Failed in Business?
      Bank/Branch (Personal Accounts)                                 Account Number                   Type of Account                        Balance
27.                                                                                                   Checking
28.                                                                                                   Savings

29. Nearest Relative
      Relationship                                                                                 Phone        (               )                -
30. Address
31. City                                                       32. State                                    33. Zip Code                             -

                                                                     Page 6 of 10                                                                           Edition 04/05
1. General Liability Limits and Property Damage Deductible Requested

                 Each Occurrence,                      General Aggregate,                             PD Deductible

     Prior Carrier/Loss Information            Attach copy of Prior Carrier Dec Page &/or Copy of Recent Quote
1. Prior Insurance Carrier
2. Policy Number                                   3. Policy Term from                     to
4. List losses/claims past 5 years (please attach 3 years prior carrier loss runs &/or signed No Loss Letter):

      Date         Paid/Reserved                                         Loss/Claim Description

       Check if no losses/claims past 5 years
5. Prior insurance cancelled, declined or non-renewed?                      If yes, explain.

6. Have any persons or entities named in the application:                                                          Yes/No
  a. Operated for any period without insurance?
  b. Ever been sued or had a demand for arbitration regarding faulty/defective construction?
  c. Have knowledge of any existing problem or construction defect on one of your jobs that
     may potentially give rise to any future claim or legal action against such person or entity?
  d. Have any lawsuits or arbitrations or disputes pending in which you are being assisted by a lawyer?
  e. Filed any mechanics liens against customers?                    If yes, how many?
  Please explain all yes responses:

       Type of Work Performed
1. Describe your operations in detail:

2. Please check √ the following that describes your operation:
       General contractor (hired by homeowner)              Subcontractor (performs one or two trades)
       General contractor (hired by developers)             Developer of land only
       General contractor (speculative builder)             Developer/owner of land/buildings (hire general contractor)
       General contractor (homeowner hires the subcontractors)
       Construction consultant to owners (you do not perform direct labor or hire employees &/or subcontractors)

3. List construction trades performed by you or your own employees:

4. Are any persons or entities named in application involved in:                                          Yes/No
  a. Property management for others?
  b. Subdivision of property?
  c. Renovation of buildings for resale or rental?
  d. Do you own rentals? If yes, how many rental units owned?
  Please explain all yes responses:

5. Has any work performed by persons or entities named in the application ever included new construction of
   condominium, townhouses, apartments, planned developments, tract homes (5 or more homes at one
   location) or similar projects?
  If yes, was work performed for;
       Individual unit owner (within their unit)                   General Contractor               Association
       Other (Describe)

                                                          Page 7 of 10                                                 Edition 04/05
 6. State the percentage of work performed:
    a. Residential              %     Commercial                %       Industrial          %    Manufacturing             %      = 100%
    b. New construction                   %   Remodel               %       Repair          %                                     = 100%
    c. New construction (if any):         (total of c. should equal 100%)
      Houses                %       Apartments (12 units and under)                    %    Apartments (over 12 units)                %
      Condos, townhouses/co-op buildings                        %       Tract work (5 or more homes @ one location                    %
    d. Exterior work performed above two stories                        %     Maximum stories
 7. Check if any work is done in or around the following exposures:
         Airport construction or repair                                 Hospitals
         Dam, bridge or river related construction                      Public roads or highway construction or work adjacent
         Petrochemical Plants                                           Swimming pools

 8. Check if any person or entity named in this application has or will perform any of the following:
         Draw plans, designs or specifications for others               Installation of emergency back up equipment
         Blasting or utililize or store explosive material              Hazardous material abatement incuding lead paint & asbestos
         Excavation, tunneling, underground work                        Demolition or wrecking work (other than tearing down w/hand tools)
         Equipment leased or loaned to others                           Use of cranes or booms

         Applied or installed any exterior insulation or finishing systems (EIFS)

 9. List 3 largest jobs in the past 5 years (include approximate date, description of work and revenue):

       Date                                                  Description of Work                                                Revenue

10. For each of the past 4 years, provide:
       Year               Annual Employee Payroll                   Annual Gross Receipts                      Subcontracting Costs
                                                                                                            (including labor & materials)

    Estimate for the next 12 months:
                      Annual Employee Payroll                       Annual Gross Receipts                      Subcontracting Costs
                                                                                                            (including labor & materials)

    # Owners, Partners, Officers or Members                          # Active Owners, Partners, Officers or Members
                                                                                         Expense for casual labor
    # Full-time Employees                          # Part-time Employees                 or leased employees $

11. List 2 largest jobs currently underway or planned for next year (include description of work and revenue):


12. Maximum number of jobs running at the same time?

13. Maximum number of new houses built in any one year?

            Subcontract Work                                                                                                     Yes/No
 1. If subcontractors used, advise if:
    a. Certificates of Insurance are obtained from all subcontractors (indicating limits equal to yours)?
    b. Additional Insured endorsements are obtained from all subcontractors?
    c. Hold-harmless or indemnification agreements are obtained in your favor?
    d. Standard contracts are used with all subcontractors?
    e. Waiver of Subrogation clauses used in your contracts with project owners?

                                                                 Page 8 of 10                                                             Edition 04/05
           Additional Personal Information Applications
            Personal Information
A Personal Information Section must be completed for each owner, partner, stockholder or LLC member
 1, Individual's Name
 2. Social Security Number              -        -                 3. Date of Birth          /          /
 4. Are you Employed other than self-employed?                    If yes, who is employer?
                                                                                        5. Monthly Income
 6. Spouse's Name
 7. Spouse's Social Security Number              -        -                 8. Spouse's Date of Birth               /        /
 9. Spouse's Employer
10. Employer's Phone         (     )        -                   11. Length of Employment                    Years       Months
12. Monthly Income                     13. Residence Address

14. City                                              15. State                                  16. Zip Code                -
17. Residence Phone      (         )        -                   18. How Long at Residence                   Years       Months
19. Residence Status                    Type
20. Current Market Value                                        21. Loan Balance
22. Are you the Trustee, Trustor or Beneficiary of any Trust?
23. Have You Ever Declared Bankruptcy?                          24. Any Pending or Prior IRS Liens?
25. Any Lawsuits Pending Against You?                           26. Have You Ever Failed in Business?
      Bank/Branch (Personal Accounts)                     Account Number                 Type of Account                Balance
27.                                                                                     Checking
28.                                                                                     Savings
32. Nearest Relative
      Relationship                                                                    Phone         (           )        -
33. Address
34. City                                              35. State                                  36. Zip Code                -

                                                                                                                     Version 5-5
        9 of 10                                                                                                     Edition 12/04
IMPORTANT! Signature Instructions - The individual who completes this form must also sign the indemnity agreement below. If married, spouse must also sign; however, no
missing signature shall invalidate this agreement. Sole Proprietorship - Owner must sign below. If married, spouse must also sign. Partnership - Partners are signing as
authorized agents of the partnership and as individually liable indemnitors. If married, spouse must also sign. Corporation or LLC - If corporate officer or LLC member or
manager signs indicating his or her LLC capacity, it is nonetheless specifically understood that such individual is signing in his or her corporate or LLC capacity and as an
individually liable indemnitor. If married, spouse must also sign. Complete a separate application for each owner, partner, stockholder or LLC member.

INDEMNITY AGREEMENT                                                                            **Insert Principal's name exactly as it is to appear in Bond
 I request that Contractors Bonding and Insurance Company ("CBIC") execute a Bond and consider executing future Bonds for (Company Name)

  I make the following promises so that CBIC will execute a Bond and consider executing future Bonds:
 1. I agree that the following definitions apply: (a) Bond means (i) any surety bond, undertaking, or other express or implied obligation of guaranty or suretyship, signed or
 committed to by CBIC at the request of Principal, or any of the indemnitors (regardless of what business entity is named on the Bond), on, before, or after the date of this
 agreement pursuant to which CBIC is or may be made liable for Loss, whether or not Principal is also liable; and (ii) all riders, endorsements, continuations, renewals,
 substitutions, modifications, extensions, replacements and reinstatements thereto; and changes in the penal sum thereto; and (b) Loss means any payment or expense
 either incurred or anticipated by CBIC in connection with any Bond or this agreement, including but not limited to: payment of bond proceeds or any other expense in
 connection with claims, potential claims, or demands; claim fees; penalties; interest; court costs; collection agency fees; costs related to taking, protecting, administering,
 realizing upon, or releasing collateral; and attorneys' fees (including but not limited to those incurred in defense of bond claims or pursuing any rights of indemnification or
 subrogation and in obtaining and enforcing any judgment arising from those rights).
 2. I, individually, and jointly and severally with Principal and all other indemnitors, agree to hold CBIC harmless from all Loss and to pay back or reimburse CBIC for all Loss,
 plus interest thereon at the highest legal rate allowed by law from the date CBIC sustained the Loss until CBIC has been paid in full.
 3. I agree to provide adequate collateral to CBIC in the event that CBIC is required or deems it necessary to establish a reserve for Loss for any Bond. The reserve for Loss
 may vary from time to time as CBIC deems necessary to protect itself from Loss. Cash collateral equal to the reserve for Loss shall be adequate. Other collateral shall be
 adequate if the net equity value of the collateral is equal to 166% of the reserve for Loss and the collateral is otherwise acceptable to CBIC. CBIC may insist upon cash
 collateral. Collateral may be held by CBIC until CBIC has determined it is no longer exposed to Loss as a matter of law, and CBIC may retain or sell collateral to reimburse
 itself for Loss. Specific performance of this paragraph shall be a remedy available to CBIC, and all procedures for executing on judgments may be used to enforce CBIC's
 decree(s) of specific performance. In the event that CBIC suffers a Loss, prior to being provided with collateral, CBIC may enforce any decree of specific performance, up to
 the amount of such decree, as a money judgment (in addition to any other judgments) to reimburse itself for such Loss without further notice or motion.
 4. I agree that premium for a Bond is fully earned upon execution of a Bond and is not refundable.
 5. I agree that a facsimile copy of this agreement shall be considered an original and shall be admissable in a court of law to the same extent as the original agreement.
 6. I agree that CBIC may obtain a release from its obligations as surety on a Bond whenever any such release is authorized by law.
 7. Unless a Bond specifically states (i) that it cannot be cancelled, or (ii) the manner in which notice of cancellation must be given, CBIC may cancel a Bond by mailing a
 notice of cancellation in the regular U.S. Mails to the obligee and to Principal, or Principal's representative, at the latest address provided to CBIC, and I agree to accept
 service of notice in such manner. I designate my insurance agent as my representative and Principal's representative for such service. Unless a Bond, statute or lawful
 governmental regulation specifically provides otherwise, cancellation shall be effective 30 days after CBIC deposits the requisite notice of cancellation in the U.S. Mails. I
 WAIVE ANY CLAIM AGAINST CBIC FOR DAMAGES which I may suffer as a result of cancellation of a Bond or any release from any obligation of CBIC on any Bond.
 8. I agree that CBIC has the exclusive right to decide whether to pay, compromise, defend, or appeal any claim against a Bond.
 9. I agree that I CANNOT TERMINATE my LIABILITY to CBIC created by this agreement except by sending written notice of intent to terminate to CBIC. Written notice to
 terminate shall be sent to CBIC at its home office, 1213 Valley Street, P.O. Box 9271, Seattle, WA 98109-0271. I AGREE that the termination will be effective thirty working
 days after actual receipt of such notice by CBIC, but only for Bonds signed or committed to by CBIC after the effective date. Thus, I agree that I will REMAIN LIABLE to CBIC
 10. I agree that CBIC can bring any legal action arising out of or in any way related to any Bond or this agreement in Multnomah County, Oregon, and that Oregon law shall
 apply where CBIC makes such election.
 11. I agree that CBIC shall have the right to fill in any blanks left herein and to correct any errors made by me in filling in any blanks.
 12. I agree that I have READ AND UNDERSTOOD this agreement, that I am signing as a PERSONAL INDEMNITOR, on behalf of my MARITAL COMMUNITY, and in
 my CORPORATE, PARTNERSHIP, or LLC CAPACITY, if any. The invalidity or unenforceability of any provision hereof shall in no way affect the validity or
 enforceability of any other provision. No missing signature shall invalidate this agreement.

I understand that my insurance agent has no authority to bind coverages, I will know applicant has the bond only when applicant receives the bond, and I will know applicant
has the insurance only when applicant receives either the insurance certificate signed by an employee of Contractors Bonding and Insurance Co. or a copy of the insurance
policy itself. I understand that my insurance agent has no authority to issue policy endorsements. I acknowledge that applicant received a copy of the application, of which my
signature below is part. I agree to pay to CBIC each annual premium due according to the rates in effect when each payment is due.

I authorize CBIC or its agents to periodically investigate and review my credit, and Principal's/Insured's credit, with any credit reporting agency or any other person or entity.
Authorization is hereby granted to any of the aforementioned, now and at any time in the future, to release information to CBIC pertaining to credit.

 SIGNATURES                   are for this page as well as all parts of the Application and worksheet
Date:                             COMPANY NAME
          /           /           (Print)
Signature*     X                                                                           Indemnitor's
                                                                                           Name* (Print)
Spouse Indemnitor's
Signature*                X                                                                Spouse Indemnitor's
                                                                                           Name* (Print)
*Each indemnitor and spouse is signing in his and her individual capacity and also in his and her capacity as an owner and/or officer and/or stockholder and/or
partner and/or joint venturer and/or LLC member and/or Manager.
Premium Payment Method:           Account No.                                                                                                      Expiration Date:
                                                                                                                                                             /              /

                                                                                   Page 10 of 10

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