General Surety Bond Claim

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.

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.

    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.

    Claim Information

    Total Claim Amount Owed to you (claimant)

    Please provide as much information as possible. You (claimant) may want to include:

    • Nature of the transaction between you (claimant) and the principal.
      • Ex. contract for purchase of goods (w/info on good type)
      • Ex. contract for purchase of services (w/info on service)
    • Date of Transaction/Contract
    • Date of the Incident (which includes failure to pay)
    • 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.

    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.

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