QUARTERLY REPORT OF FEDERAL BUSINESS

WRITTEN AND OUTSTANDING

CERTIFIED COMPANIES – PLEASE FILE WITH THE U.S. DEPARTMENT OF TREASURY,

BUREAU OF THE FISCAL SERVICE, SURETY BOND SECTION, ON A QUARTERLY BASIS,
THE FOLLOWING INFORMATION:

For the Quarter ended________________:

1) $____________________ PENAL SUM OF ALL SURETY BONDS WRITTEN DURING

THE QUARTER WHERE THE U.S. GOVERNMENT WAS THE OBLIGEE OR CO-
OBLIGEE.

2) $___________________PENAL SUM OF ALL SURETY BONDS OUTSTANDING AS

OF THE END OF THE QUARTER WHERE THE U.S. GOVERNMENT WAS THE
OBLIGEE OR CO-OBLIGEE.

3) CURRENTLY WRITING THE FOLLOWING TYPES OF FEDERAL SURETY BONDS

(i.e., Construction Contract, Customs, Land Reclamation, etc.):

Name of Reporting Surety Company:

Contact Person’s Printed Name and Title:

Phone Number_______________________

Date:_______________________________

RETURN THIS FORM TO:

surety.bonds@fiscal.treasury.gov
(and/or the financial analyst assigned to
examine the company)

SURETY BOND BRANCH ~ 6505 BELCREST RD, Rm 345 ~ FAX (202) 874-9978
INTERNET WEB SITE: https://www.fiscal.treasury.gov/fsreports/ref/suretyBnd/surety_home.htm

Rev. 01/2018