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Fillable Printable Form 500-019-000

Fillable Printable Form 500-019-000

Form 500-019-000

Form 500-019-000

F500-019-000 electrical telecommunications contractor’s bond 01-2007
Department of Labor and Industries
Electrical Licensing & Certification
PO Box 44460
Olympia WA 98504-4460
www.Lni.wa.gov/tradeslicensing/electrical
ELECTRICAL/TELECOMMUNICATIONS
CONTRACTOR'S BOND
TO THE STATE OF WASHINGTON
(This form must be typed)
UBI MASTER LICENSE #
ELECTRICAL CONTRACTOR #
BOND #
Firm name as shown on UBI Master Business License
Other Corporate Registered Trade Names under the above UBI # at Secretary of State
Corp LLC LLP
Partnership
Sole Proprietorship
Other Sole Proprietor or Partnership registered “Doing Business As” (DBA) Names
Mailing Address of Firm
City
State
ZIP + 4
Phone Number
Bonding Agent Information
Name of Bonding Company
Address
City
State
ZIP+ 4
Phone Number
Contact Name
The bonding company organized and existing under the laws of the state of , and authorized to
transact business in the state of Washington under the provision of chapter 19.28 RCW, as surety, are held and firmly bound to a bond
in the amount of $4,000.00, to be paid to the state of Washington. The conditions the principal, bonding company, and the state of
Washington agree to by taking out this bond are as follows:
(1) As a precondition to receiving an electrical/telecommunications contractor's license under chapter 19.28 RCW et seq., the license
holder must keep this bond in full force and effect. If any cancellation, revocation, or withdrawal by the surety/bonding company
occurs, the department will suspend the license until such time as a new bond for $4,000.00 is provided to the state of Washington.
(2) The license holder will pay for all labor, including employee benefits, and material furnished or used upon the work; taxes and
contributions to the state of Washington, and all, damages that may be sustained by any person, firm, corporation, or other entity due
to a failure of the principal to make the installation or maintenance in accordance with this chapter or any applicable ordinance,
building code, or regulation of a city or town adopted pursuant to RCW 19.28.010(3).
(3) Should the bond become owing due to failure to comply with section (2) above, the principal's electrical /telecommunications
contractors license is suspended until such time as a new bond is furnished by the license holder.
(4) The bond shall become effective , 20 , and is intended to cover any subsequent periods for which
the Electrical Section may issue a license to the principal under the provisions of chapter 19.28 RCW, or any amendments thereof.
This bond is to be construed as a continuing obligation until canceled by the surety.
RESET
F500-019-000 electrical telecommunications contractor’s bond 01-2007
(5) Upon request, the department will furnish any person, firm, partnership, corporation, or other entity a certified copy of the bond
upon payment of a fee set by the department by rule.
(6) Any person, firm or corporation sustaining any damage or injury by reason of the license holder’s breach of the conditions
mentioned in section (2) above may bring an action against the surety and the contractor. The action shall be brought: (a) in the
superior court of any county in which the principal on the bond or assignor of the account resides or transacts business; or (b) in the
county in which the work was performed which allegedly caused the breach of the conditions mentioned in (2) above. The action
shall be maintained and prosecuted as other civil actions.
(7) Claims or actions against the surety on the bond shall be paid in full in the following order of priority: (1) labor, including
employee benefits; (2) materials and equipment used upon such work; (3) taxes and contributions due to the state; (4) damages
sustained by any person, firm, or corporation due to the failure of the principal to make the installation in accordance with the
provisions of chapter 19.28. RCW, or any ordinance, building code, or regulation applicable thereto.
(8) The total liability of the surety on any bond shall not exceed the sum of $4,000.00 and the surety on the bond shall not be liable
for monetary penalties. Any action shall be brought within one year from the completion of the work in which the performance of
which the breach is alleged to have occurred. The surety shall mail a conformed copy of the judgment against the bond to the
department within seven days of the judgment.
(9) The surety must give 45 days written notice to the license holder and to the Department of Labor and Industries Electrical Section
prior to cancellation of the bond.
REFERENCES: chapter 19.28 RCW.
Dated
of , 20 .
Effective date of bond:
Note: The department will only accept an original bond document, no copies or faxes.
Bonding Company
Attorney-in-Fact for Bonding Company (signature required)
Agents Name
Address
City
State
ZIP + 4
Bonding Company
Seal
(required)
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