Louisiana Pest Control Insurance Company
P.O. Box 80663 Baton Rouge, LA 70898-0663


Pest Control Company:
  ( If applicant is a Partnership, give names of all partners, if a Corporation, give names of all officers below. )
Street Address:
City, State, Zip
Parish/County: Phone: () -
Effective Date of Bond:
Categories Licensed In (Please check all that apply):
General Pest Control Commercial Vertebrate Control Weed Control Landscape Gardening
Termite Control Fumigation Tree Surgery  
1. How many years has your firm been in business? years.
2. Has any type bond claim ever been made against you?
Yes No
  If yes, give details here:
3. Have you, or has any business in which you were an owner, ever failed, or applied for bankruptcy?
Yes No
  If yes, give details here:
4. Give details of any lawsuits, judgements or liens pending against you:
5. Amount of liability where you are endorser or surety for others: $
6. Give details about any other outstanding surety bonds on your behalf as principal:
7. Do you carry fidelity bonds on your employees who handle funds?
Yes No
8. Total Assets: $ Total Liabilities: $
Annual Premium: $100.00

INDEMNITY AGREEMENT: Please Complete and Sign as outlined below:

The undersigned, and each of them, hereby certify that the statements contained herein or attached her to are true, and are made to induce LOUISIANA PEST CONTROL INSURANCE COMPANY (herein called SURETY) to execute or continue the suretyship described herein.

In consideration of the execution by SURETY upon demand:

  1. To pay to SURETY upon demand:
    1. All loss and expense, including attorney's fees, for which SURETY shall become liable by reason of such suretyship, whether or not SURETY shall have paid such loss and expense at the time of demand.
    2. The annual premiium for such suretyship until satisfactory evidence of termination of liability shall be furnished to SURETY.
    3. All attorney's fees and costs incurred by SURETY in enforcing this agreement.
    4. An amount sufficient to discharge any claim against SURETY by reason of such suretyship. This sum may be used by SURETY to pay such claim or be held by SURETY as collateral security against loss.
  2. SURETY shall have the exclusive right to determine whether any claim or suit shall, on the basis of liability, expediency or otherwise, be paid, compromised, defended or appealed.
  3. An itemized statement of loss and expense incurred by SURETY, sworn to by an officer of SURETY, shall be prime facie evidence of the fact and extent of my obligation to SURETY.
  4. SURETY may procure as release from said suretyship under any law for release of sureties without liability to me for any damages I sustain therefrom.
  5. That this agreement shall apply to all renewals, continuations, substitutions and extensions of the suretyship herein applied for.

DATE Name of Firm:

If your firm is a Corporation, the Secretary needs to sign below: by:
(Corporation Secretary)    
Agent Email: