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The American Contractors Indemnity Company (ACIC) Proof of Claim Form serves as a crucial tool for claimants seeking restitution in response to contractor-related issues. This form facilitates the process of filing claims arising from breaches of contract, particularly within the context of construction projects impacting residential property. Essential information required for the claim includes details about the claimant and contractor, the specific nature of the agreement, and any relevant project documentation. Claimants must address whether the claim pertains to an agreement for work on their residence, providing specifics such as the physical address of the project, contact information, and the contractor's license number. Additionally, the form prompts the claimant to outline the circumstances surrounding their claims, whether related to abandonment, fund diversion, non-compliance with trade standards, or other breaches. Supplementary details, such as the history of the project and supporting documentation like photographs, can help clarify claims and strengthen the case. A distinct feature of the form is the requirement for sworn certification, ensuring that all information presented is accurate and truthful, reinforcing its integrity in line with California law. Prompt completion and submission of this form can significantly impact the resolution of disputes, underscoring its value in the realm of construction law and contractor accountability.

American Contractors Indemnity Co Example

Surety Group

801 South Figueroa Street, Suite 700

Los Angeles, CA 90017

Tel: 310-649-0990 Fax: 213-652-1982

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

Click for American Contractors Indemnity Co File

File Breakdown

Fact Title Details
Company Information American Contractors Indemnity Company is located at 801 South Figueroa Street, Suite 700, Los Angeles, CA 90017.
Contact Details Phone: 310-649-0990, Fax: 213-652-1982.
Form Purpose This form is a Proof of Claim for breach of contract related to California Contractor’s License Bond.
State Governing Law California law governs this form, specifically California Business and Professions Code, Division 3, Chapter 9.
False Claims Warning California law states that presenting a false claim may result in criminal charges and penalties.
Certification Requirement The claimant must certify under penalty of perjury that the information provided is true and correct.

Guide to Using American Contractors Indemnity Co

Completing the American Contractors Indemnity Co form is essential for filing a claim related to a contractor's breach of contract. Follow the steps below to ensure that you provide all required information accurately.

  1. Provide your name(s), company name (if applicable), mailing address, telephone number(s), fax number, and email address.
  2. Enter the contractor’s license number, name(s), mailing address, telephone number(s), fax number, email address, and website address.
  3. Indicate if your claim relates to an agreement regarding work on your residence. Select Yes or No, and provide the physical address of the project(s).
  4. Attach legible copies of the agreement(s) and related documentation such as bids, estimates, proposals, change orders, and/or building permits.
  5. If the agreement was oral or modified orally, detail the date the agreement was made, the scope of work, start and completion dates, payment amounts, and timing.
  6. Specify the original amount of the agreement, any changes, and the total amount paid to date.
  7. Estimate the percentage of work completed by the contractor to date, breaking it down into labor and materials.
  8. If applicable, provide details about damages caused by the contractor abandoning the project, including dates, correspondence, a description of circumstances, and asserted damages.
  9. If your claim involves diversion of funds or failure to account for payments, provide payment dates, documentation, a description of circumstances, and asserted damages.
  10. Describe any work you believe was performed poorly, attaching evaluations, repair estimates, and any relevant pictures or diagrams.
  11. If you proceed with repairs before an inspection, take pictures of the original contractor’s work and provide contact information for the subsequent contractor.
  12. If claiming damages from a material breach, detail the dates of breach, supporting documentation, and asserted damages.
  13. If your claim involves the contractor failing to progress with construction diligently, describe relevant dates and circumstances.
  14. If you have filed a complaint with the Contractor’s State License Board (CSLB), include copies of the complaint form and any correspondence.
  15. If you are involved in legal proceedings with the contractor related to the claim, inform the company and provide related documentation.

Complete the certification stating that all information provided is true and correct, and fill in the date and place of execution. Remember to sign the form before submission. After submission, the claims team may follow up to gather more information if needed, and this process will help facilitate the resolution of your claim.

Get Answers on American Contractors Indemnity Co

What information do I need to provide to submit a claim using the American Contractors Indemnity Co form?

To successfully submit a claim, you must provide several details. First, include your full name, the name of your company (if applicable), and your contact information including your mailing address, phone numbers, fax number, and email address. Additionally, you'll need to supply the contractor's license number, name, and contact details. Make sure to specify if the claim is related to work done on your residence and provide its physical address. Lastly, gather legible copies of all relevant agreements and documents, such as bids and permits.

How do I prove there was a breach of contract by the contractor?

Proving a breach of contract involves detailing the specific circumstances around the issue. You should provide the date(s) of the breach, any correspondence regarding the matter, and a clear description of the events that led to the breach. It's important to detail the damages caused by this breach, as well, which may include financial losses or incomplete work. Supporting documents and evidence can strengthen your claim.

What should I do if my contractor abandoned the project?

If your contractor has abandoned the project, document the dates of abandonment and gather all correspondence related to this situation. You'll need to outline the circumstances surrounding the abandonment and estimate the damages incurred as a result. This may include additional costs you will incur to hire a new contractor or delays caused by the abandonment.

Can I file a complaint with the Contractor’s State License Board while submitting my claim?

Yes, you can and should file a complaint with the Contractor's State License Board (CSLB) if you believe there have been violations. When you submit your claim, make sure to include copies of your complaint form and any communications you have had with the CSLB. This can provide additional support and context for your claim with American Contractors Indemnity Company.

What happens after I submit my claim?

Once you submit your claim, it will be reviewed by the claims team. They might reach out to the contractor for their side of the story. In some cases, an independent construction consultant may be assigned to inspect the work. If you choose to proceed with repairs before the inspection, it's advisable to document the original contractor's work – including taking pictures – and provide information about any new contractors hired.

It’s important to disclose any ongoing legal proceedings related to your claim. This includes litigation, arbitration, or any other legal disputes with the contractor. You do not need a final judgment against the contractor before filing your claim, but providing pertinent legal documents will be relevant to your claim assessment. This helps in consolidating all aspects of the issue for thorough investigation.

Common mistakes

Completing the American Contractors Indemnity Company form accurately is crucial for ensuring that claims are processed smoothly. However, many individuals make common mistakes during this process that can hinder their claims. Identifying and addressing these errors can significantly improve the likelihood of a successful resolution.

One frequent mistake is incomplete contact information. Claimants often overlook including all necessary details, such as multiple phone numbers and email addresses. It is vital to provide full contact information for both the claimant and the contractor involved in the claim. Missing or incorrect information can lead to delays in communication regarding the claim status.

Another common error involves failing to include key documents. Claimants sometimes do not attach the required agreements or related documentation, such as bids and permits. Providing clear and legible copies of these documents is essential to substantiate the claim. Without appropriate documentation, the claim may be dismissed or returned for further information.

Many individuals also underestimate the importance of fully detailing oral agreements or modifications. In cases where discussions took place without written documentation, it is critical to describe the specifics of those conversations accurately. This includes dates, the scope of work, and payment terms. Excluding this information may result in misunderstandings regarding the nature of the agreement.

Providing vague estimates regarding the percentage of work completed can lead to complications as well. Claimants frequently fail to break down their estimates of labor and materials, which can obscure the understanding of what has transpired on the project. Clear and precise percentages help illustrate the current status of the work performed.

Furthermore, not mentioning if a complaint was filed with the Contractor’s State License Board is a significant oversight. Claimants often do not include this information, which can impact the investigation of the claim. Submitting documented evidence of any complaints can provide crucial context and strengthen the claim.

It is also a mistake to ignore the repercussions of pending litigation. Claimants sometimes forget to inform American Contractors Indemnity Company if they are involved in ongoing legal proceedings related to the claim. This can impact how the claim is assessed, as the insurer needs to understand all aspects of any disputes.

Lastly, some individuals submit documents without verifying that they are complete and accurate. Providing a thorough and truthful account under penalty of perjury is a legal requirement. Failing to do so can not only jeopardize the claim but may also incur legal consequences. Ensuring that all information is precise and complete will foster a stronger relationship with the insurer and facilitate a smoother claims process.

Documents used along the form

The American Contractors Indemnity Company (ACIC) form serves as a vital document in the realm of surety bonds and claims. When engaging with this form, several additional documents can facilitate a clearer understanding and processing of the claims related to contractor performance. Below are four commonly used forms and documents that accompany the ACIC form.

  • Contractor's License Verification: This document serves to confirm that the contractor holds a valid license for the work being performed. Verification may include checking the license status through state boards to ensure compliance with regulatory requirements.
  • Proof of Payment Records: This document details the payments made to the contractor for the project. It typically includes invoices, receipts, and bank statements, which provide a transparent record of financial transactions related to the contract.
  • Change Order Documentation: Change orders are written agreements that alter the original terms of a contract. This documentation outlines modifications to the project scope, pricing adjustments, and timelines, clarifying any changes made during the construction process.
  • Correspondence and Communication Records: This may encompass emails, letters, or notes exchanged between the claimant and contractor. Maintaining these records is essential for establishing a timeline and context for any disputes or claims made.

Understanding these additional forms and documents is essential for a streamlined claims process with the American Contractors Indemnity Company. Having this information ready not only supports the claim but also can facilitate a smoother resolution between parties involved in the construction agreement.

Similar forms

  • Surety Bond Forms: Similar to the American Contractors Indemnity Co form, surety bond forms serve to guarantee the fulfillment of contracts. Both require detailed information about the parties involved and the contractual obligations at stake.
  • Claim Forms for Insurance: These forms ask for a clear outline of the claim details, including the claimant's identity and the nature of the loss or breach, mirroring the requirement for documentation and substantiation found in the indemnity form.
  • Construction Contracts: Typical construction contracts include provisions for breach of contract claims. They usually specify the responsibilities and consequences if one party fails to meet agreed-upon terms, much like how the indemnity form does.
  • Mechanic’s Lien Forms: When contractors and subcontractors claim unpaid work, these forms also gather information similar to the indemnity claim, focusing on payment disputes and project details.
  • Dispute Resolution Forms: Used to facilitate negotiation or mediation, these forms require basic details about the parties and the nature of the dispute, akin to sections in the indemnity form that seek background information and claims for damages.
  • Contractor Complaint Forms: Issued to regulatory bodies like the Contractor’s State License Board, these forms gather similar information regarding complaints, project details, and contractor performance, emphasizing accountability.
  • Litigation Response Forms: These are involved in legal disputes and require complainants to provide details about the case. They often parallel the documentation and claims process outlined in the indemnity claim form.
  • Subcontractor Agreement Forms: Aimed at defining the relationships and responsibilities between contractors and subcontractors, these agreements must include similar details about project scope and obligations.
  • Consumer Complaint Forms: Used in various industries to report issues with services or products, these documents solicit similar information from consumers about their experiences and grievances, reflecting the claim verification process in the indemnity form.
  • Property Damage Claim Forms: These forms focus on claims regarding physical damages to property, requiring specific details of the damages, timelines, and responsible parties, analogous to the data requested in the contractor indemnity form.

Dos and Don'ts

  • Do provide your complete contact information, including name, company name, mailing address, and email address.
  • Don't leave any section incomplete; this may delay your claim processing.
  • Do submit clear and legible copies of relevant agreements and documents.
  • Don't forget to include oral agreements and modifications; detail matters crucial for your claim.
  • Do state the projects' physical addresses clearly to avoid confusion.
  • Don't assert claims without adequate documentation or evidence; ensure you have all necessary supporting materials.
  • Do include the percentage of work completed to provide context for your claim.

Misconceptions

  • Misconception 1: The claim form is too complex to understand.

    The American Contractors Indemnity Company form is designed to be user-friendly, with clear instructions. It's important to read each section carefully before filling it out.

  • Misconception 2: Once I file my claim, the process will take forever.

    While claims can take time, providing complete and accurate information can significantly speed up the review process.

  • Misconception 3: You need a lawyer to submit a claim.

    Although legal advice can be valuable, you can file a claim on your own, provided you follow the instructions carefully.

  • Misconception 4: The company will automatically side with the contractor.

    The review process is impartial. Claims are evaluated based on the merits of the evidence submitted, regardless of who is at fault.

  • Misconception 5: I must have a formal contract to file a claim.

    Oral agreements are still valid, but you must provide evidence that clearly outlines the terms of your agreement.

  • Misconception 6: You can submit your claim whenever you want.

    There are timelines for filing claims, so it is crucial to act quickly to avoid missing deadlines.

  • Misconception 7: Supporting documentation isn't that important.

    Documentation strengthens your claim. Be sure to gather all relevant paperwork before submission.

  • Misconception 8: Submitting pictures of poor work is unnecessary.

    Pictures can provide valuable context and evidence of your claims, helping the review team understand the issues better.

  • Misconception 9: All claims will receive the same priority.

    The urgency of your claim can affect its processing speed. Providing clear evidence of urgency can help elevate priority.

  • Misconception 10: Once I submit my claim, I'm done.

    Staying engaged is vital. Be ready to answer follow-up questions or provide additional documentation if requested.

Key takeaways

Filling out the American Contractors Indemnity Co form is a crucial step for individuals seeking relief due to contractual disputes with contractors. Here are key takeaways to consider:

  • Info Gathering is Essential: Start by collecting essential information about yourself, your company, and the contractor involved. This includes contact details, contractor's license number, and project location.
  • Documentation Matters: Provide clear copies of any agreements, proposals, change orders, and permits related to your claim. Documentation can greatly strengthen your case.
  • Be Specific: When describing oral agreements or modifications, include detailed information such as dates, scope of work, payment schedules, and through what means the agreement was made.
  • Assess Work Completion: Estimate the percentage of work that has been completed by the contractor. Breaking this down into labor and materials can provide clarity.
  • Address Abandonment Claims: If you believe the contractor abandoned the project, document everything—dates of abandonment, correspondence, and your assessment of damages.
  • Account for Diverted Funds: In cases where funds were misused, list out payment dates, copies of those payments, and any related notices. This helps outline the financial damages suffered.
  • Evaluate Construction Standards: If the work done was subpar, obtain written evaluations from other licensed contractors and consider including photos that illustrate the poor workmanship.
  • Legal Proceedings Matter: If you are involved in any litigation or arbitration regarding your claim, keep records and inform the indemnity company about these developments, as they are relevant for your claim review.

By carefully following these guidelines, individuals can enhance the likelihood of a successful claim, leading to a resolution of any disputes with contractors.