U.S. SMALL BUSINESS ADMINISTRATION
EXP. DATE: 3-31-2007
APPLICATION FOR SURETY BOND GUARANTEE ASSISTANCE
See Reverse Side for
Public Comment Information
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TRADE NAME OF PRINCIPAL
TO BE COMPLETED BY PRINCIPAL
SBA Form 994 (3-04) Previous Editions Obsolete
1. Applicant hereby states and affirms the following:
Corporation, Type of Corp ____, Joint Venture
TO BE COMPLETED BY BROKER / AGENT (Producer)
PRINCIPAL'S HOME ADDRESS: STREET, CITY, STATE & ZIP
PRINCIPAL'S BUSINESS ADDRESS: STREET, CITY, STATE, ZIP & COUNTY
PRINCIPAL'S EMPLOYER ID NUMBER
NAME OF SURETY
NAME OF BROKER / AGENT (Producer)
BROKER / AGENT (Producer's) ADDRESS: Street, City, State, Zip and County
BROKER / AGENT (Producer's) TELEPHONE NUMBER (Include Area Code)
BROKER / AGENT (Producer's) EMPLOYER ID NUMBER
The annual gross receipts of my business (including affiliates, as set forth in Part 121 of SBA's Rules and Regulations) as annually averaged over the past 3
fiscal years, was $
(to the nearest hundreds).
t, delineating annual gross receipts of each as
their interests appear.
specifying what their shares of the organization(s) are.
Type of business:
Month, Date and Year Business Formed: Venture Number of Employees _________
b. A bid, payment or performance bond is required on the following project in order for me to serve as a
primary contractor or
c. Contractor certifies having attempted (and failed) to obtain the required bonds without the SBA's guarantee: furthermore, the contractor certifies being aware that
some sureties charge higher premiums rates for bonds than other do, in accordance with premium rate schedules filed in various States.
(2) Contract have liquidated damages? Yes No
If "yes", how much? $
per calendar or wkg. day.