General Surety Bond Claim

This form is for the submission of a claim on a surety bond. If you are the claimant and are owed money by a principal that is bonded by Allegheny Casualty Company, please complete the following claim form.

If you are a shipper or carrier and you are owed money by a freight broker/freight forwarder, please complete the Freight Broker (BMC-84) Bond Claim Form located here: Freight Broker (BMC-84) Bond Claim Form – Allegheny Casualty Company.

All fields marked with an asterisk* are required.

Claimant Information

The company/person filing the claim is considered the "Claimant." The contact information below should be that of the Claimant. The provided information will be used to contact you regarding the claim.

Contact first name*
Contact last name*

Company name*

Address*

City*
State*
ZIP*

Email*
Phone number

Principal Information

The company/person responsible for facilitating the transaction and for issuing payment upon completion of the work or service provided is the "principal." The provided information should be that of the principal.

Company Name*

Contact first name*
Contact last name*

Address*

City*
State*
ZIP*

Email
Phone number

Bond Number
License Number (if known/applicable)

Claim Information

Amount*

Total Claim Amount Owed to you (claimant)

Description of Claim*

Please provide as much information as possible.

Nature of the transaction between you (claimant) and the principal.
- Example: contract for purchase of goods with information about the types of goods purchased.
- Example: contract for services provided with information about the types of services provided.
Date of Transaction/Contract.
Date of the Incident, including date of principal’s failure to pay (if applicable).
Any attempt(s) to reach the principal and any response(s) received.

Upload the Documentation Surrounding this Claim

Upload a copy of any documents referenced in the "description of claim" above. This includes but is not limited to: agreement(s)/contract(s), invoice(s) and correspondence.

Document 1 (45MB max)

Document 2 (45MB max)

Contact information for general claim related matters:

Email: [email protected]
Phone Number: (973) 200-6496
Fax Number: (973) 339-5884
Mailing Address: 1 Baxter Way, Suite 130, Westlake Village, CA 91362
Attn: James Portman, Chief Legal Officer

Our claims team is committed to providing you with the fastest and most efficient claims process possible. Whether you would like to file a new claim or inquire regarding an existing claim, simply call our team directly at (973) 200-6496. You satisfaction is always our number one goal.

Delivering the Future of Surety

General Surety Bond Claim