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FOR CONTRACT BONDS UP TO $750,000 SINGLE JOB <br />AND $750.000 BONDED AGGREGATE <br />(fWESTBEND" - Rapid Bond Account Application <br />FOR A FIRST-TIME RAPID BOND REQUEST <br />"Please note that this Raid fond &Iplication is only required at the time of initial contractor account setup, with a first-time <br />Rapid Bond request. For subsequent bond requests, the separate RAPID BoNo REQUEST FORM may be utilized."'` <br />Contractor: Complete this application in its entirety and return to your agent. All owners and spouses must sign the indemnity <br />agreement on pages 3-4. Only one signed agreement is required per contractor, and is valid for all Rapid Bonds with West <br />Bend. <br />Agent: Once logged into West Bend, use this completed application to submit a bond request in eSURETY. Refer to the Bonds <br />home page for access to eSURETY and instructions. Please send in a copy of the signed indemnity agreement. <br />• CrOlti#�'RACT{7tt tM�R�'.lR7N, '.: .. _ J . _ ..-. G� .�roi��E�i�3i:lh>Eiltt��n� •: <br />Company Legal Name Reliable Roofing and Construction <br />Address ' 2048 E Ireland Road City/State/Zip South Bend IN 46614 <br />Type of Business ❑ Proprietorship ❑ Partnership is (S) Corporation ❑ (C) Corporation ❑ LLC <br />Year Established 2014 Geographic Area of Operation Indiana <br />Normal Type of Worts ; General Construction <br />Has the business been profitable for at least one of the past two years? YES j'e, : NO <br />Largest Project Completed $ 313296.80 <br />Description <br />Completion Date: 06/30/2025 <br />Any outstanding tax liens, collections, judgments, or lawsuits? YES _i NO <br />If yes, please attach explanation(s). <br />Has this company/indemnitor(s) been in claims with a previous Surety? YES s_wi NO WV <br />IN[BIEMHI OR. WFOkMATIIQN <br />Please provide complete information on @J1 owners. Attach additional sheets if necessary. <br />(1) Name <Abraham Gordillo Percentage of Ownership ;100.00 % <br />Address 68146 U.S. 31 City/State/Zip Lakeville .46536 <br />SS# Spouse Name <br />(2) Name Percentage of Ownership % <br />Address City/State/Zlp <br />SS# Spouse Name <br />(3) Name Percentage of Ownership ; % <br />Address City/State/Zip <br />SS# Spouse Name <br />(4) Name ; Percentage of Ownership % <br />Address City/State/Zip <br />SS# Spouse Name <br />THE APPLICANTS) AND INDEMNITOR(S) HAS/HAVE AUTHORIZED WEST BEND TO OBTAIN PERSONAL AND/OR BUSINESS CREDIT <br />REPORTS OR BY SUBMITTING THIS APPLICATION, THE AGENT HEREBY CERTIFIES THAT HE/SHE HAS OBTAINED AUTHORIZATION <br />FROM THE APPLICANT(S) AND INDEMNITOR(S) TO OBTAIN PERSONAL AND/OR BUSINESS CREDIT REPORTS. <br />NB 0070 0125 Page 1 of 5 <br />1900 S 18th Avenue I West Bend, WI 63095 1 Phone: (800) 236-5010 1 Fax: (877) 674-2663 1 www.thesilverlining.com <br />