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bank indemnity agreement

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					                  Application for Title Agents Fidelity and Surety Bonds
                     The Hanover Insurance Company/Massachusetts Bay Insurance Company
                                   440 Lincoln Street, Worcester, MA 01653

Insured        Legal Name of Applicant: ______________________________________________________________
               Year Established:___________ Tax I.D. Number: ____________________________________________
               Street Address:________________________________________________________________________
               City: _____________________________________________ State_________ Zip Code: ____________
               Contact Name: __________________________ Phone: _________________ Fax: __________________
               E-Mail Address: _______________________________________________________________________
               Name of Affiliated Interest(s) (i.e. law firm, realtor, builder, mortgage company, etc.) if any:
               ____________________________________________________________________________________
               Form of Organization: Proprietorship____ Partnership____ C or S-Corporation____ LLC____ LP____

Coverage       Surety Bond Amount $_________________________ State_____
               Have you been declined by another Surety for this Bond?___________

List Owners/   Name(s): _______________________________________________ Percentage Ownership: __________
Stockholders   _______________________________________________________                        __________
               _______________________________________________________                        __________

Professional   Advisor:                       Contact:                     Phone:
Advisors       Accounting Firm: ______________________________________________________________________
               Banking (Escrow): _____________________________________________________________________

Insurance      Errors & Omissions Insurance Carrier:_____________________________________________________
Information    Term of Coverage: __________________ Limit: $____________________ Deductible: $____________

Internal       Are your financial statements: Audited? ____ Reviewed? ____ Compiled?____ Internally prepared? ____
Controls       Do checks require two or more signatures? Yes____ No ____ If yes, over what amounts?_____________
               Who besides the owners/stockholders can sign escrow checks? (Names and Positions)
               ____________________________________________________________________________________
               Does the person(s) who signs the checks also approve the invoices for payment? Yes ______ No ______
               Is there a reconciliation of the bank accounts at least monthly? Yes ______ No ______
               Does the person who reconciles the accounts also make deposits or withdraws? Yes ______ No ______
               Are electronic funds transfer (EFT) systems utilized? Yes ______ No ______
               Who has the power to authorize EFTs? (Names and Positions)
               ___________________________________________________________________________________

Escrow         Do you deposit and disburse funds for closings or settlements? Yes ______ No ______
Account        Is a separate file set up a each closing containing the following information:
Information     Closing instructions? Yes ______ No ______
                Documentation of compliance with the instructions including transfers between accounts? Yes___ No__
               Are funds received for closings deposited in a trust bank account separate from operating funds and
               identified as such on bank statements? Yes ______ No ______
               Are separate accounting records maintained for each transaction? Yes ______ No ______
               Are the escrow of the trust bank accounts reconciled monthly? Yes ______ No ______
               How many employees have access to the Escrow Account Funds? ___________

Title          Company:                     Contact:                     Phone:      Date of last Audit:
Companies      ____________________________________________________________________________________
Represented    ____________________________________________________________________________________
               ____________________________________________________________________________________

               Fidelity Coverage Form A – Employee Dishonesty
Data           Total Employees: _______ Number of Officers: _______
               Number of employees who handle, have custody of money, or are directly or indirectly responsible for
               controlling records of money, securities or other property: _______

Losses         Have you sustained any employee dishonesty losses in the past three years? Yes_______ No ______
               If yes, please explain in a separate attachment.

                                                        (1)
                                              AGREEMENT OF INDEMNITY
           WHEREAS, at the request of the undersigned (hereafter referred to as “Indemnitors”), and upon the condition
precedent that this Agreement be executed, The Hanover Insurance Company and/or Massachusetts Bay Insurance
Company, 100 North Parkway, Worcester, Massachusetts 01605 (hereafter individually and collectively referred to as
“Surety”), has executed, or may in its discretion hereafter execute certain surety contracts (hereafter referred to as “bonds”)
on behalf of any one or more of the Indemnitors, in which bonds the Indemnitors hereby affirm they have a substantial,
material and beneficial interest.
           NOW THEREFORE, in consideration of the execution, continuance or extension of such bonds, the Indemnitors,
jointly and severally, agree in favor of the Surety as follows.
           1. The Indemnitors shall exonerate, indemnify, and save harmless the Surety from and against all loss, cost and
expense which the Surety may pay or incur, including, but not limited to, interest, court costs and attorney fees resulting
from its having executed or procured the execution of the bonds, or in enforcing the Indemnitor’s obligations under the
terms of this Agreement. The Indemnitors will promptly pay to the Surety all premiums for such bonds, and will continue
to pay the same where such bonds are continued, until the Indemnitors shall serve evidence satisfactory to the Surety of its
bond discharge or release.
           2. Payment shall be made to the Surety by the Indemnitors as soon as liability exists or is asserted against the
Surety, whether or not the Surety shall have made any payment therefor, in an amount deemed necessary by the Surety to
indemnify it from any loss, cost, or expense. The Surety may adjust, settle or compromise any claim, suit, or other
proceeding arising out of any bond against the Surety and/or any Indemnitor. In the event of any payment by the Surety,
the Indemnitors agree to immediately reimburse the Surety for any and all payments made under the Surety’s belief that
liability for the payment existed or that payment was necessary or expedient, whether or not such liability, necessity, or
expediency existed. Vouchers or other evidence of payment by the Surety shall be prima facie evidence of the fact and
amount of such liability, necessity, or expediency and of the Indemnitors’ liability to the Surety therefor.
           3. The Indemnitors hereby authorize the Surety or its authorized agent to make any inquiry which it deems
necessary of any financial or credit institutions, persons, firms, and corporations in order to obtain all information relating
to the Indemnitors’ payment history and credit status in order to verify or obtain information concerning the Indemnitors’
credit history or any other information submitted in connection with the application for bonds. The Surety may decline to
execute any bond without impairing the validity of this Agreement, and the Indemnitors agree not to make claim against the
Surety due to its refusal or failure to so execute.
           4. This Agreement applies to bonds written by the Surety on behalf of the Indemnitors and any of their wholly or
partially owned subsidiary companies, subsidiaries of subsidiaries, divisions or affiliates, partnerships, joint ventures or co-
ventures in which any of the Indemnitors, their wholly or partially owned subsidiary companies, subsidiaries of
subsidiaries, divisions or affiliates have an interest or participation, whether open or silent; jointly, severally, or in
combination with each other; now in existence or which may thereafter be created or acquired.

Applicable in New York State - Any person who knowingly and with intent to defraud any insurance company or
other person files an application for insurance or statement of claim containing any materially false information, or
conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent
insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the
stated value of the claim for each such violation.

IN WITNESS WHEREOF, the Indemnitors have executed or have caused the Agreement to be duly executed by their
authorized representatives on the ______ day of ___________________, in the year of _________.

___________________________________                                    _______________________________________
Witness to Individual or Proprietorship                                Individual and Proprietorship applicant sign here

                                                                       __________________________________________ (seal)
                                                                       Name of Corporation or Partnership applicant typed or printed here

______________________________________                                 ______________________________________
Attest by Corporate Officer or Witness to Partner signature            Corporate Officer or Partner sign here

                                                    Third Party Indemnitor(s) sign below:

In Consideration of The Hanover Insurance Company / Massachusetts Bay Insurance Company executing the bond(s)
hereinabove applied for, we jointly and severally join in the foregoing indemnity agreement.

__________________________________                                     ________________________________________________
Witness                                                                Indemnitor – Include Social Security # / Tax ID # (                  )
                                                                       Residence Address:

__________________________________                                     ________________________________________________
Witness                                                                Indemnitor – Include Social Security # / Tax ID # (                  )
                                                                       Residence Address:
                                                                     (2)
__________________________________     ________________________________________________
Witness                                Indemnitor – Include Social Security # / Tax ID # (   )
                                       Residence Address:

__________________________________     ________________________________________________
Witness                                Indemnitor – Include Social Security # / Tax ID # (   )
                                       Residence Address:




                                     (3)

				
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