Gsa Form 527 - Contractor'S Qualifications And Financial Information Page 6
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6LIST COMPANIES FROM WHOM YOU OBTAIN SURETY BONDS
ITEM
62. SURETY COMPANY 1
63. SURETY COMPANY 2
A. Company Name
B. Contact's Name
AREA CODE
NUMBER
EXT.
AREA CODE
NUMBER
EXT.
C. Telephone
AREA CODE
NUMBER
AREA CODE
NUMBER
D. Fax
STREET ADDRESS
STREET ADDRESS
E. Address
CITY
STATE
ZIP CODE
CITY
STATE
ZIP CODE
64. PRESENT AMOUNT OF BONDING
65. HAS YOUR APPLICATION FOR SURETY
66. DURING THE PAST 2 YEARS, HAVE YOU BEEN CHARGED WITH A
COVERAGE ($)
BOND EVER BEEN DECLINED? (If Yes,
FAILURE TO MEET THE CLAIMS OF YOUR SUBCONTRACTORS OR
please provide detailed information in Remarks)
SUPPLIERS? (If Yes, please provide detailed information in Remarks)
YES
NO
YES
NO
SECTION VIII - REMARKS
REMARKS (Cite those sections of the form relating to your remarks. If additional space is required, attach additional sheet(s).)
CERTIFICATION
For the purpose of establishing financial responsibility with, or procuring credit from the General Services Administration, we furnish the above
as a true and correct statement of our financial condition and further certify that all other statements are true and correct. There has been no
material change in the applicant's financial condition since the date of the above statement. We agree to notify you immediately in writing of
any materially unfavorable change in our financial condition. In the absence of such notice or of a new and full financial statement, this is to be
considered as a continuing statement.
NAME OF BUSINESS
BY (Signature of Authorized Official)
NAME OF AUTHORIZED OFFICIAL (Type or print)
DATE
TITLE OF AUTHORIZED OFFICIAL (Type or print)
GSA
527
PAGE 6
FORM
(REV. 3-99)
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