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The California Contractor’s License Bond Proof of Claim Form is a crucial document used by individuals and businesses seeking financial redress in the event of a breach of contract by a licensed contractor. It is essential that claimants provide detailed personal and company information, including their mailing addresses and contact numbers, as well as comprehensive details about the contractor involved. The form inquires about the nature of the agreement, specifically if it pertains to work on a residence, and requests the physical location of the project. To substantiate claims, detailed documentation such as contracts, bids, change orders, and correspondence is necessary. The form guides claimants in outlining various scenarios that may warrant a claim, such as abandonment of the project, misappropriation of funds, or failure to meet accepted trade standards. Each section uniquely serves to clarify the basis of the claim, requiring factual descriptions and supporting evidence like photographs, contractor evaluations, or repair estimates. Additionally, the form emphasizes the importance of notifying American Contractors Indemnity Company of any ongoing legal proceedings against the contractor. Compliance with California law is also highlighted, ensuring claimants acknowledge the legal implications of providing false information. This structured approach aids in the thorough evaluation of claims, facilitating the resolution process for parties involved.
American Contractors Indemnity Co Example
Surety Group
801 South Figueroa Street, Suite 700
Los Angeles, CA 90017
Tel:
American Contractors Indemnity Company
California Contractor’s License Bond
Proof of Claim Form: Breach of Contract
1.Please provide us with your name(s), company name (if company is the claimant), mailing address, telephone number(s), fax number, and email address.
2.Please provide us with the contractor’s license number, name(s), mailing address, telephone number(s), fax number, email address, and website address.
3.Does your claim relate to an agreement between you and the contractor for work upon your residence? __ Yes ___ No. Please provide us with the physical address of the location(s) of the project(s):
_____________________________________________________________________________________
____________________
4.Please provide us with legible copies of the agreement(s) and any related documentation such as bids, estimates, proposals, change orders and/or building permits.
5.If the agreement was oral or if there were oral modifications please provide the details below. Examples include: the date the agreement was entered into, the scope of work, the start and completion date of performance, the amount to be paid and the timing of payments under the agreement.
6.If not already included in the documentation requested above, please provide us with the original amount of the agreement, the amount of any changes, and the amount paid to date.
7.Please provide us with your estimate of the percentage of work completed by the contractor to date: _____% Labor + _____% Materials = _____ % Total
A member of the Tokio Marine HCC group of companies
8.If you assert you were damaged by the contractor abandoning your construction project without legal excuse, provide us with the following: the date(s) of abandonment; copies of correspondence or other documentation that relate to this assertion; a description of the history and circumstances; and the amount of damages you assert that were caused by the abandonment.
9.If you assert you were damaged by the contractor diverting contract funds paid to it for use on your construction project and/or failing to account for the use and application of payments received, provide us with the following: dates of the payments; copies of the payments; copies of preliminary notices, mechanic’s liens and related correspondence from the contractor’s subcontractors and suppliers; a description of the history and circumstances; and the amount of damages you assert that were caused by the diversion of funds and/or failure to account.
10.If you assert you were damaged by the contractor failing to follow accepted trade standards for good and workmanlike construction, provide the following: a description of what work you believe was performed poorly; written evaluations of the contractor’s work from other licensed contractors; written estimates to repair or replace the contractor’s work; if you believe pictures or diagrams would assist us in understanding the poor work, we invite you submit those pictures along with this claim form, or you can email them to the claim examiner assigned to your claim after we receive your claim package.
11.After we receive your claim package and confer with the contractor, we may retain an independent construction consultant to inspect the contractor’s work under certain circumstances. If you elect to proceed to have the work completed before such an inspection may be performed, if possible, take pictures of the first contractor’s work that you elect to repair or replace. Also, please provide us with the contact information of the subsequent licensed contractor you utilize to perform the work and copies of the related documentation.
12.If you assert you were damaged by the contractor materially breaching the contract, provide us with the following: the date(s) of the material breach; copies of correspondence or other documentation that relate to this assertion; a description of the history and circumstances; and the amount of damages you assert that were caused by the material breach.
A member of the Tokio Marine HCC group of companies
13.If you assert you were damaged by the contractor failing to progress with construction with reasonable diligence, provide us with the following: the date(s) the work stopped progressing with reasonable diligence; copies of correspondence or other documentation that relate to this assertion; and a description of the history and circumstances.
14.If you have filed a complaint with the Contractor’s State License Board (“CSLB”), please provide us with copies of your complaint form and any correspondence between you and the CSLB to date and subsequent to your submission of this claim form.
15.If you are or become involved in litigation, arbitration or other legal proceeding with the contractor regarding this claim, please inform us of same and provide us with copies of the paperwork relating to that legal proceeding. You are not required to obtain a judgment against the principal prior to asserting a claim on the bond, but legal proceedings between the claimant and the contractor are relevant to our investigation of your claim.
FOR YOUR PROTECTION, CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM:
(California Insurance Code Section 1871.2)
“...Any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of
a crime and may be subject to fines and confinement in State Prison.”
CERTIFICATION
The answers to this Proof of Claim form being the basis for a claim for payment of money under the terms and provisions of the California Business and Professions Code, Division 3, Chapter 9, beginning with Section 7000, et seq., and the undersigned hereby certifies and declares under penalty of perjury that the foregoing is true and correct.
Dated: ________________, _______ (Month - Day) |
(Year) |
Place of Execution: __________________, California |
|
(City) |
|
Signature of Complainant: ________________________________
A member of the Tokio Marine HCC group of companies
Form Characteristics
| Fact Name | Details |
|---|---|
| Company Information | American Contractors Indemnity Company is located at 801 South Figueroa Street, Suite 700, Los Angeles, CA 90017. |
| Form Purpose | This form serves as a Proof of Claim for breach of contract related to California Contractor’s License Bonds. |
| Legal Provision | The form operates under California law, specifically the California Business and Professions Code, Division 3, Chapter 9, beginning with Section 7000. |
| False Claims Warning | The form includes a warning that presenting a false claim may result in criminal prosecution, as mandated by California Insurance Code Section 1871.2. |
| Claim Documentation | Claimants must provide detailed supporting documents, including contracts, correspondence, and evidence of damages to support their claims. |
Guidelines on Utilizing American Contractors Indemnity Co
Filling out the American Contractors Indemnity Company form requires careful attention to detail. It is important to provide accurate and complete information to ensure a smooth processing of your claim. Follow the steps below to successfully fill out the form.
- Provide your name(s) and company name (if applicable), along with your mailing address, telephone number(s), fax number, and email address.
- Fill in the contractor's license number, name(s), mailing address, telephone number(s), fax number, email address, and website address.
- Indicate whether your claim relates to an agreement for work on your residence by choosing "Yes" or "No." If yes, enter the physical address of the project location(s).
- Attach legible copies of all agreements and related documentation such as bids, estimates, proposals, change orders, and building permits.
- If any agreements were oral or modified orally, provide details like the date entered into, scope of work, start and completion dates, amount to be paid, and timing of payments.
- If not already included, specify the original amount of the agreement, any changes, and the amount paid to date.
- Estimate the percentage of work completed by the contractor, breaking it down into labor and materials.
- If the contractor abandoned the project, detail the date(s) of abandonment and provide related correspondence, descriptions, and amount of damages incurred.
- If the contractor diverted funds, provide the dates of payments, copies of payment records, and any notices or correspondence, along with a description of damages incurred.
- If applicable, describe any work that was performed poorly and include written evaluations from other licensed contractors, repair estimates, and any supporting pictures or diagrams.
- If you intend to repair or replace the contractor’s work before an inspection, document the work and provide the contact information for the new licensed contractor along with related documents.
- If the contractor materially breached the contract, provide dates of breach, related correspondence, and a description of circumstances, including the amount of damages claimed.
- If the contractor failed to progress with construction, provide dates of halted work, correspondence, and a description of events.
- If you have filed a complaint with the Contractor’s State License Board (CSLB), include copies of your complaint form and any correspondence.
- If you are involved in litigation, arbitration, or other legal proceedings with the contractor, inform the company and include relevant paperwork.
Once all the information is filled out and documents are attached, review the form for any inaccuracies. Make sure to sign the form, indicating that your answers are true and correct under penalty of perjury. Finally, submit the completed form as per the instructions provided by the American Contractors Indemnity Company.
What You Should Know About This Form
What is the purpose of the American Contractors Indemnity Company form?
This form is used to file a claim related to a breach of contract with a contractor. It allows individuals or entities who have suffered damages due to a contractor's actions to seek compensation. The form collects essential details to assess the validity of the claim and gather necessary documentation.
Who should complete the form?
The claim form should be completed by the individual or entity (known as the claimant) that has experienced damages due to the actions of a contractor. This could be a homeowner, a business, or anyone who has entered into a contract with the contractor for construction-related work.
What information is required from the claimant?
The claimant must provide their name, contact details, and the name and details of the company if applicable. This includes mailing address, phone number, fax number, email address, and relevant identification about the contractor involved in the dispute.
What additional documentation is needed to support my claim?
Along with the completed form, claimants must submit legible copies of all relevant documentation. This includes agreements, bids, estimates, change orders, building permits, and any other related correspondence that supports the claim. If there were any oral agreements or modifications, detailed information about these should also be included.
What if my agreement was oral?
If the agreement was made orally, claimants are expected to provide a detailed account of the terms discussed. This should include the date of the agreement, the scope of work, payment amounts, and other relevant details that clarify the arrangement with the contractor.
How do I estimate the percentage of work completed?
The claimant should assess the contractor's performance based on evidence and records available, including their own observations. The estimated percentages for labor and materials should reflect the actual work performed versus what was initially agreed upon in the contract.
What should I do if the contractor abandoned the project?
If you believe the contractor has abandoned the project without justification, provide details such as the date(s) of abandonment and related correspondence. Documenting the history and circumstances, as well as any damages incurred, will strengthen your claim.
What happens if I am involved in litigation with the contractor?
If legal proceedings are underway, claimants must inform American Contractors Indemnity Company and provide documentation related to the case. This information is important for evaluating the claim and understanding any legal implications that may arise.
What penalties could I face for filing a fraudulent claim?
California law has strict penalties for individuals who knowingly submit false claims. Those who present fraudulent information may be subject to fines and imprisonment. It is crucial to provide accurate and honest information when completing the claim form.
What should I do if I have additional questions about the form?
If you have questions or require assistance while completing the form, it is advisable to contact American Contractors Indemnity Company directly at their provided telephone number or fax. Their representatives can guide you through the process and clarify any uncertainties.
Common mistakes
Filling out the American Contractors Indemnity Co form can be tricky, and people often make mistakes that can delay their claims. One common error is failing to provide complete contact information. It’s essential to include your name, phone number, and email address, as missing details can hinder communication. If the contractor's information is also incomplete, it can cause further delays. Ensure that every piece of information is accurate and legible.
Another frequent mistake is neglecting to include necessary documentation. The form requests various papers, such as contracts, bids, and change orders. Without these, your claim might be processed slowly or even denied. For instance, if you assert that the contractor abandoned a project, you must attach correspondence that supports this claim. Don't overlook this vital step; gathering all related documents can make the difference in how your claim is handled.
Many individuals also struggle with providing sufficient details about their claims. For example, people often answer questions too vaguely, particularly those that ask about specifics like the scope of work or dates of material breaches. Providing detailed accounts and examples makes it easier for the claims team to understand your situation. Using clear descriptions and documented evidence will strengthen your claim significantly.
Lastly, there's the issue of updates regarding other legal proceedings. If you've begun litigation or filed a complaint with the Contractor's State License Board, you must disclose this information. Failing to do so can lead to complications later on. Keeping the indemnity company informed about your case status can help ensure that they have a complete picture as they investigate your claim.
Documents used along the form
When dealing with claims related to construction contracts, several documents may be necessary alongside the American Contractors Indemnity Co form to ensure the process is thorough and organized. Understanding these documents can help clarify relationships and obligations between parties involved.
- Contract Agreement: This document outlines the specifics of the agreement between the contractor and the client. It typically includes details like the scope of work, payment terms, timelines, and other critical conditions necessary for coverage during disputes.
- Bids and Estimates: These are proposals provided by the contractor before job commencement. They help establish the expected costs and timelines for the project and can be referenced to evaluate claims against inaccuracies or deviations from the original plan.
- Change Orders: Any adjustments made to the initial contract are documented through change orders. They detail modifications in scope, price adjustments, or changes to the project timeline, which may be essential in supporting a claim or defense.
- Building Permits: This official approval from the local municipality is necessary for construction work. Permits prove the contractor complies with local codes, and lacking them can be significant in determining the validity of a claim.
- Preliminary Notices: These notifications inform involved parties of any potential issues that could lead to a claim. They serve as early warning signals related to payments or other disputes and can be critical in establishing a timeline of communication.
- Mechanic’s Liens: If payments are not made, subcontractors may file mechanic’s liens against the property. This serves as a legal claim for payment, and presenting them relative to the contractor's performance can bolster a claim.
- Correspondence with the Contractor’s State License Board (CSLB): Communication with the CSLB, if a complaint has been filed, is essential. It indicates any regulatory issues regarding the contractor’s license and provides legal context for the claim.
Gathering these documents not only strengthens the claim but also provides a clearer picture of the contractual relationship and responsibilities. Proper documentation is key to navigating the complexities of construction claims effectively.
Similar forms
The American Contractors Indemnity Company (ACIC) form is essential for contractors and clients involved in construction projects. There are several other documents that serve similar purposes in addressing claims and responsibilities between parties. Here’s a closer look at five of these important documents:
- Performance Bond: This is a guarantee provided by a surety that the contractor will fulfill their obligations under the contract. Like the ACIC form, it protects the project owner from financial loss if the contractor fails to complete the work or meets the required standards.
- Contractor's License Bond: This form ensures that the contractor adheres to state regulations and standards. Both the Contractor's License Bond and the ACIC form require documentation related to claims and emphasize the contractor's accountability for their work.
- General Release of Liens: This is used when all parties agree that a project is complete and payments have been made. Similar to the ACIC form, it requires a formal acknowledgment that no further claims will be made against the contractor or project, providing protection to both the property owner and the contractor.
- Mechanic's Lien: This document allows contractors and subcontractors to claim a legal right against the property if they are not paid for work done. It shares a common goal with the ACIC form, which is to address financial disputes arising from construction work and ensure that parties receive due compensation.
- Dispute Resolution Agreement: This outlines the process for resolving conflicts that may arise during a construction project. Similar to the ACIC form, it sets expectations for communication and documentation, promoting clarity and accountability.
Dos and Don'ts
When filling out the American Contractors Indemnity Company form, it's important to approach the process carefully. Below is a list of actions to take and avoid.
- Do provide accurate and complete contact information including your name and company name if applicable.
- Do ensure all documentation related to the claim is clear and legible.
- Do specify the physical address where the work was performed.
- Do include details of the agreement, including dates and payment amounts, especially if it was verbal.
- Don't omit any relevant documents that support your claim, such as contracts and correspondence.
- Don't provide false information, as this could lead to serious legal consequences.
- Don't skip over providing your estimate of the percentage of work completed by the contractor.
- Don't forget to communicate any ongoing legal proceedings related to your claim.
Misconceptions
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Misconception 1: The American Contractors Indemnity Co form is only for contractors.
Many people believe this form is exclusively for contractors. In reality, it is designed for any individual or entity that files a claim against a contractor. Homeowners, subcontractors, and suppliers can all utilize this form to assert their claims.
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Misconception 2: You must have a written contract to file a claim.
While having a written contract can strengthen a claim, it is not a strict requirement. The form allows for claims based on oral agreements and modifications. Providing clear details about verbal agreements can support the claim.
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Misconception 3: Claims can only be submitted after a judgment is reached.
Some individuals think they must first obtain a judgment before submitting a claim. However, it is not necessary to secure a judgment against the contractor prior to filing. Timely filing can lead to faster resolution of claims.
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Misconception 4: You need to provide extensive documentation.
While it's beneficial to submit comprehensive documentation, the form provides a clear list of required items. Only specific documents, such as contracts and correspondence related to your claim, are necessary for us to start investigating.
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Misconception 5: My claim will be rejected if the contractor responds negatively.
Some applicants worry that negative feedback from the contractor will automatically result in a claim denial. The claims process evaluates all submissions impartially. A negative response does not preclude the possibility of a valid claim.
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Misconception 6: All claims take a long time to process.
Many believe that claims submitted with the American Contractors Indemnity Co form take a long time to process. The duration can vary, but the company aims for efficiency. Prompt and complete submissions help expedite the investigation and resolution process.
Key takeaways
Filling out the American Contractors Indemnity Co form is a crucial step for those looking to lodge a claim for breach of contract. Here are some key takeaways to keep in mind:
- Gather all necessary information before starting. This includes personal details, contractor's info, and any agreements or documentation related to the project.
- Clearly indicate whether your claim pertains to work done at your personal residence. Providing the correct project address is essential.
- Attach legible copies of all relevant agreements and documents. Items like change orders and building permits can significantly support your claim.
- Be specific when detailing the nature of any oral agreements or modifications that were made. Inclusion of key dates and the scope of work can strengthen your case.
- If you believe damages occurred due to issues like abandonment or deviation from accepted construction standards, document everything thoroughly. This includes dates, correspondence, and descriptions of the circumstances.
- Understand that any legal proceedings related to your claim should be disclosed. This transparency aids in the investigation of your claim.
Following these guidelines will help ensure that your claim is processed smoothly and effectively.
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