PRIVATE PAYMENT BOND DEMAND §779 035 Wis Stats by xrm18253

VIEWS: 69 PAGES: 1

More Info
									                                 PRIVATE PAYMENT BOND DEMAND
                                                               §779.035, Wis. Stats.

                                                                                NOTE TO CLAIMANT: Consult the terms of the Surety's bond
                                                                                for any notice requirements. It is recommended that this notice
                                                                                be sent by registered mail, return receipt
  Date:                                                                          requested, or hand delivered.



1.          SURETY:
            Name:
            Address:


2.          BOND NUMBER (if known):
3.          PRIME CONTRACTOR:
            Name:
            Address:

4.          OWNER:
            Name:
            Address:

5.          CLAIMANT CONTRACTED WITH:
6.          LOCATION OF PROJECT:


7.          CONTRACT DATE:
8.          DESCRIPTION OF LABOR AND/OR MATERIALS FURNISHED BY CLAIMANT:



9.          AMOUNT CLAIMED:                                                         $

         Claimant is informed and believes that the above-named Surety has issued one or more payment or
labor and material bonds as security for payment of the sums described above. Claimant hereby demands
that the Surety immediately pay Claimant the Amount Claimed, together with interest and any further sums
to which Claimant may be entitled.

                                    Claimant's Name:

                                    By:
                                                                                        (Signature)




                                    Authorized Agent's Name:
                                                                                        (print name of person signing above)




                                    Title:
                                    Address:


                                    Telephone Number:
Carbon set document - original and three copies - on bottom of original "FOR SURETY", first copy "FOR PRIME CONTRACTOR," second copy "FOR OWNER", third copy
"CLAIMANT'S COPY"
r:\xf\firm\99999\1702\prideman.pay

								
To top