Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 501 (2004/07)
Surety Report of Execution
Use ACORD 501, Surety Report of Execution to notify a carrier that a bond has been
executed.
IDENTIFICATION SECTION Date
Month/day/year (MM/DD/YYYY) on which the form is completed.
IDENTIFICATION SECTION Producer
Agency's name and address.
IDENTIFICATION SECTION Phone No.
Agency's telephone number. (Include area code and extension if applicable)
IDENTIFICATION SECTION Fax No.
Agency's fax number. (Include area code)
IDENTIFICATION SECTION Code
Identification code assigned to the agency or brokerage firm by the insurance company
receiving this form.
IDENTIFICATION SECTION Sub Code
If the agency or brokerage uses a sub-code identification system with the company, enter
the appropriate code.
IDENTIFICATION SECTION Agency Customer ID
Customer's identification number assigned by the agency or brokerage.
IDENTIFICATION SECTION Address
Account Name and Mailing
Enter the account name and address to which the principal belongs.
IDENTIFICATION SECTION Phone Number
Telephone number at which the account contact may be reached. Include area code and
extension, if applicable.
IDENTIFICATION SECTION E-mail Address
Indicate the e-mail address where the account contact may be reached.
PRINCIPAL
#
Enter a number in chronolgical order to identify the principal.
PRINCIPAL
Name (As it Appears on Bond)
Enter the name of the principal as it appears on the bond.
PRINCIPAL
Address
Enter the address of the principal as it appears on the bond.
OBLIGEE
#
Enter a number in chronolgical order to identify the obligee.
OBLIGEE
Name (As it Appears on Bond)
Enter the name of the obligee as it appears on the bond.
OBLIGEE
Address
Enter the address of the obligee as it appears on the bond.
COUNTERSIGNING AGENT Agent Name
Enter the name of the countersigning agent.
COUNTERSIGNING AGENT Agency Code
Identification code assigned to the countersigning agency or brokerage firm by the
insurance company receiving this form.
COUNTERSIGNING AGENT Address
Enter the address of the countersigning agent. (Include county and zip+4)
501 (2004/07)
UNDERWRITING
SURETY/REMITTANCE
SURETY
Name
Enter the name of the Underwriting or Remittance Surety Company
UNDERWRITING
SURETY/REMITTANCE
SURETY
Address
Enter the address of the Underwriting or Remittance Surety Company
UNDERWRITING
SURETY/REMITTANCE
SURETY
Name Type Code
Enter the name of the Underwriting or Remittance Surety Company
UNDERWRITING
SURETY/REMITTANCE
SURETY
Bond Percent
Enter the percentage of the contract for which the Surety Company receiving this form will
be held liable.
UNDERWRITING
SURETY/REMITTANCE
SURETY
Bond Amount
Enter bond amount for which the Surety Company receiving this form will be held liable.
UNDERWRITING
SURETY/REMITTANCE
SURETY
Branch Office Code
Enter the branch office of the Surety Company to which this form should be routed.
BASIC BOND AND
EXECUTION INFORMATION Description
Enter the bond description
BASIC BOND AND
EXECUTION INFORMATION Bond Form Number
Enter the bond form number
BASIC BOND AND
EXECUTION INFORMATION Bond Number
Enter the bond number for this bond assigned by the Surety Company receiving this form.
BASIC BOND AND
EXECUTION INFORMATION Execution Date
Enter the date the bond was executed
BASIC BOND AND
EXECUTION INFORMATION Bond Term Code
Term Code For Bond. Codes:
CON..Continuous
NRN..Non-renewing
REN..Renewable
501 (2004/07)
BASIC BOND AND
EXECUTION INFORMATION Renewal Method Code
The method by which the bond should renew. Codes:
ATAutomatic
CR..Continuation Certificate
MS..Miscellaneous
NBNew Bond
NRNot renewable
BASIC BOND AND
EXECUTION INFORMATION Current Term Amount Premium
Enter the total premium amount being billed for the current term of this bond.
BASIC BOND AND
EXECUTION INFORMATION Cancelable
Check the applicable box.
CONTRACT INFORMATION Project Description
Enter a description of the project being bonded.
CONTRACT INFORMATION Contract Price
Enter the price stated on the contract.
CONTRACT INFORMATION Estimated Completion Date
Enter the estimated completion date of the project.
CONTRACT INFORMATION Maintenance Term - Years
Indicate the number of years.
CONTRACT INFORMATION Maintenance Term - Month
Indicate the number of months.
LOCATION OF RISK
Street
Indicate the street name where the risk is physically located.
LOCATION OF RISK
City
Indicate the city where the risk is physically located.
LOCATION OF RISK
State/Province
Indicate the state or province name where the risk is physically located.
LOCATION OF RISK
Zip Code
Indicate the zip or postal code where the risk is physically located.
LOCATION OF RISK
County
Indicate the county (if applicable) where the risk is physically located.
LOCATION OF RISK
Country
Indicate the country where the risk is physically located.
501 (2004/07)
SURETY TERMS AND
PREMIUM BILLING
INFORMATION
Type of Surety Terms Code
Enter the sub-classfication of the type of bond. Codes:
ADPAY.Advanced Payment Bond
ANBBD.Annual Bid Bond
BCombination - Left To Bill and Cost To Complete
CCost To Complete
COME..Commercial
COMPLCompletion Bond
DESGN.......Design Bond
EFFC..........Efficiency Bond
L.................Left To Bill
MAINT.........Maintenance
OT..............Other
PERFM.......Performance
PMT............Payment
PYMPF.......Payment/Performance
SURETY TERMS AND
PREMIUM BILLING
INFORMATION
Effective Date
Enter the effective date of the bond.
SURETY TERMS AND
PREMIUM BILLING
INFORMATION
Expiration Date
Enter the expiration date of the bond.
SURETY TERMS AND
PREMIUM BILLING
INFORMATION
Bond Amount
Enter the full amount of the bond.
501 (2004/07)
SURETY TERMS AND
PREMIUM BILLING
INFORMATION
Charge Type Code
Enter the individual charges being reported with this bond. Codes:
ATTIFF Agent Filing Fee
BND Bond Premium
CANCE Cancel/Close
CTSGN Countersigning Fee
DIVND Dividend
ICCFE Interstate Commerce Handlign Fee
MLMTX Municipal Tax
NOTFF Notary Filing Fee
OT Other
SBAFE SBA Fee
SERFE Service Fee
STSR State Surcharge
SURTM Time Surcharge
SURTX Tax Surcharge
TAX Tax
SURETY TERMS AND
PREMIUM BILLING
INFORMATION
Gross Amount Premium
Enter the full premium amount of the premium transaction, including pre-paid terms.
SURETY TERMS AND
PREMIUM BILLING
INFORMATION
Commission Amount
Enter the full commission amount of the premium transaction.
SURETY TERMS AND
PREMIUM BILLING
INFORMATION
Commission Percent
Enter the commission percent that applies to the Gross Premium Amount
SURETY TERMS AND
PREMIUM BILLING
INFORMATION
Net Amount
Enter the net premium amount after commission is subtracted from the gross premium.
SURETY TERMS AND
PREMIUM BILLING
INFORMATION
Currency Code
Currency Code. The applicable codes are defined by
International Standards Organization (ISO-4217).
SURETY TERMS AND
PREMIUM BILLING
INFORMATION
Premium Transaction Effective
Date
Enter the effective date of the premium transaction.
501 (2004/07)
SURETY TERMS AND
PREMIUM BILLING
INFORMATION
Premium Transaction Expiration
Date
Enter the expiration date of the premium transaction.
REMARKS
Use this space for any additional remarks or comments.
501 (2004/07)