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Bond Claim - LA

NOTICE OF CLAIM ON BOND


TO: CONTRACTOR:

{1246:Name and address of the company that obtained the bond for the project}

TO: SUBCONTRACTOR (IF ANY):

{1214:Enter the Name and Address of the Subcontractor}

SURETY:

{1199:If known, the name and address of the company that issued the bond for the project (the surety)}

FROM: CLAIMANT

{1193:company:Contact Details}
{1193:address:Contact Details}
{1193:city:Contact Details}, {1193:zone:Contact Details} {1193:pincode:Contact Details}


NOTICE IS HEREBY GIVEN that the undersigned claimant has a claim against the above named surety for labor or materials furnished by the undersigned for the public work described as follows:  

The name and location of the project is as follows:

{1244:What is the name of the project?}

{1245:Project Address}

The labor or materials were furnished pursuant to a contract or agreement with:

{1592:Name of the company that hired you to perform work on the project}

The nature of the labor or materials furnished is as follows:

{1218:Describe the materials you furnished and the work you performed on the project}

The amount of the claim is:

${1226:Unpaid amount due to you}

The date the claimant last furnished labor or materials to this public work is:

{1219:Last date you provided Labor and/or Materials}

Claimant seeks payment of said claim according to the law.

 

{1193:company:Contact Details}

 

By:____________________________
{1236:Name of duly authorized company officer entitled to sign the bond claim}, {1237:Position with Company}

                                                                                                 

STATE OF _____________
ss.
COUNTY OF ____________

Subscribed and sworn to before me this ____ day of _____________, 20__.

 

_________________________
NOTARY PUBLIC

$279.00