Surety Action Request Form

Type of Surety Review Request:

Annual Registration for Surety over 4 Years Old

Adjustment of a Posted Surety (Please note, a copy of the initially recorded plat and subsequent revisions, if any, must be included with all adjustment requests. No credit allowed for installed storm drainage or BMPs until as-built plan is approved. To receive credit for stone base, asphalt, curb & gutter, or sidewalk, 100% of the item must be installed unless this Form is accompanied by a scaled plan delineating the limits of work for which credit is requested.)

Adjustment of a Surety Estimate

Replacement

Surety Information

Subdivision Name

Phase

Map

Associated Accela Record Number

Surety

Subdivision

Sidewalk

ROW

BMP

Other

Surety Type

Letter of Credit

Surety Bond

Cash Surety

Bond or LOC #

Site Inspector Name

Applicant Information

Organization

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Fee Information

Annual Registration for Surety over 4 Years (from the Original Effective Date) - $650.00

Adjustment of a Posted Surety - $650

Adjustment of a Surety Estimate - $650

Replacement of a Surety - $650

Payment Information

Check (made payable to the City of Charlotte)

Online Payment at https://aca-prod.accela.com/CHARLOTTE/Default.aspx

Please note that we will not accept the surety review request until payment is received.