TIA Home
Applicant Information
Company Name:
*
DBA/Trade Name
(if applicable):
Legal Status:
*
State of Inc:
*
Physical Address:
*
City:
*
State/Province:
*
ZIP/Postal Code:
*
Country:
*
Mailing Address:
*
City:
*
State/Province:
*
ZIP/Postal Code:
*
Country:
*
Phone #:
*
Fax #:
Email:
*
Contact Name:
*
Contact Title:
*
If different from above, name and title of corporate officer who will sign the bond:
Date Company began operating:
Calendar
*
If less than 5 years ago, note years in industry for senior officer:
Do you have additional locations?
*
Number of offices:
DOT #:
Broker MC#:
*
Federal Tax ID:
*
Do you have a TIA Member ID?
*
List any previous names used in the past five years, along with city and state where located (attach a separate list if necessary):
Who referred you to the TIA bond program?
Company Owner(s)
Owner One:
Owner Name:
*
Title:
*
Address:
*
City:
*
State/Province:
*
ZIP/Postal Code:
*
Country:
*
Date of Birth:
Calendar
Owner Two:
Owner Name:
Title:
Address:
City:
State/Province:
ZIP/Postal Code:
Country:
Date of Birth:
Calendar
Surety/Insurance Related Information
Surety Level Needed ($):
*
Desired Effective Date:
Calendar
*
Are you interested in a separate SDDC bond to transport military freight?
*
Has any surety paid claims on your company's behalf?
*
Has your company ever been cancelled by any surety?
*
Has applicant or any partner/officer ever filed any form of bankruptcy?
*
Insurance and Risk Management Information. If you answer "Yes", attach evidence in the form of a Policy, Declaration Page or Acord form. Coverage is not a requirement, but you receive an underwriting "credit" for the types of insurance you hold.
Do you maintain Errors and Omissions Insurance coverage?
*
Do you maintain "non-following form" Contingent Cargo Liability Insurance?
*
Do you maintain Contingent Auto Insurance?
*
Do you maintain General Liability Insurance?
*
Do you maintain Primary Cargo Insurance?
*
Do you maintain Accounts Receivable Insurance?
*
Do you use a Carrier Monitoring Service?
*
Required Documents
Before any bond can be quoted or processed, the below listed documents must be submitted. Please note applying does not guarantee approval. After all documents are submitted, we will review the information and an agent will contact you within 48 hours.
  • Completed and signed Indemnity
  • Completed, signed and notarized Power-of-Attorney
  • Financial statements (e.g., balance sheet, income statement, accountant's notes)
  • Insurance and Risk Management evidence (e.g., Declaration page, Acord form)
Document Type:
Description:
File Name:
Additional Comments
TIA Bond v1.2.4