Contractor’s Questionnaire

GENERAL BUSINESS INFORMATION

Name of Firm

Website

Street Address

Telephone

Fax

Contact Person/Title

Year Business Started

State of Incorp

Date of Incorp

Fed Tax ID No.

Certifications

8A
Hub Zone
SDVOSB

Fiscal Year End:

LIST OF CORPORATE OFFICERS, PARTNERS OR PROPRIETORS OF THE FIRMS:

Name

SS#

Home Address

Date of Birth

Position

% Owned

Name of Spouse

SS#

Name

SS#

Home Address

Date of Birth

Position

% Owned

Name of Spouse

SS#

Name

SS#

Home Address

Date of Birth

Position

% Owned

Name of Spouse

SS#

Name

SS#

Home Address

Date of Birth

Position

% Owned

Name of Spouse

SS#

Has your firm or any of it’s principals ever petitioned for bankruptcy, failed in business or defaulted so as to cause a loss to Surety?

Is your firm or any of its principals or officers currently involved in any litigation?

Contracting Specialty:

Geographic Area of Operation:

LIST ANY SUBSIDIARIES AND AFFILIATES:

Name

Ownership

Type of Business

Name

Ownership

Type of Business

Name

Ownership

Type of Business

What percentage of the firm’s work is normally for:

Government Agencies

Private Owners

How many people does your firm employ?

Office

Field

On average, how many work crews?

What percentage of the firm’s work is normally subcontracted?

What trades do you subcontract?

Explain the firm’s policy for Bonding back subcontractors:

What trades do you normally perform with your own forces?

Is your firm Union?

If so, which Unions?

What is the largest amount of Backlog that the firm had at any one time in the past?

Amount of Backlog

No. of Projects

What is the largest project that you expect to do within the next twelve months?

What is your average job size?

What is your expected annual volume (Sales/Revenues) next year?

What is the largest job you have ever completed?

LIST THE FIRM’S KEY PERSONNEL — OFFICE AND FIELD:

Name

Position

Years Experience

Previous Employer

Name

Position

Years Experience

Previous Employer

Name

Position

Years Experience

Previous Employer

Explain the firm’s Business Continuity Plan. Who will complete the current projects should something happen to the Owners and/or Key Employees?

Is there a buy/sell agreement among the owners of the business?

(Check one)

Is the buy/sell agreement financed by life insurance?

(Check one)

FINANCIAL INFORMATION

Do you have a full time accountant on staff?

How often are financial statements prepared?

Annually
Semi-annually
Quarterly
Monthly

On what basis are your Financial statements prepared?

Cash
Accrual
Completed Project
% of Project

Are taxes current?

Name of your Bank

Address

Amount of Line of Credit

Attach the letter from the Bank confirming the Credit Agreement.

Click or drag a file to this area to upload.

What type of Accounting System/Software do you use?

BONDING INFORMATION

Previous Bonding Companies

(last five years) List the most current first

Years with this Bonding Company

Bonding Agent

Previous Bonding Companies

Years with this Bonding Company

Bonding Agent

Previous Bonding Companies

Years with this Bonding Company

Bonding Agent

Has the firm had major disputes or ever failed to complete a job on schedule?

Are there any liens, lawsuits or claims pending on completed or uncompleted?

REFERENCE INFORMATION

List your three largest completed projects:

1. Description & Location of the Work

Owner/GC

Contact Name

Telephone

Gross Profit

Final Contract Price

Year Completed

Bonded?

2. Description & Location of the Work

Owner/GC

Contact Name

Telephone

Gross Profit

Final Contract Price

Year Completed

Bonded?

3. Description & Location of the Work

Owner/GC

Contact Name

Telephone

Gross Profit

Final Contract Price

Year Completed

Bonded?

List your three of your major Suppliers

1. Name

Contact Person

Telephone

Address

2. Name

Contact Person

Telephone

Address

3. Name

Contact Person

Telephone

Address

List three Subcontractors/General Contractors that you do business with

1. Name

Contact Person

Telephone

Address

2. Name

Contact Person

Telephone

Address

3. Name

Contact Person

Telephone

Address

This application consists of this instrument, the financial statement and all indemnity, security, and trust agreement signed by the applicant with regard to the bond or bonds hereby requested such financial statement and agreement being incorporated herein by reference.

In addition to routine verification of information pertinent to the bond applied for, if application is by an individual primarily for personal purposes, or, if the application is for bond primarily for the benefit of a corporation and the said application be also executed for the officers of the corporation in a personal not a corporate capacity thereby acting as a CO-guarantor thereof Surety may have an investigative consumer report make including information bearing on the character, general reputation, personal characteristics of mode of living of said individual(s), and, upon written request of said individuals(s) will disclose in writing the nature and scope of the investigation request-ed, if such investigative consumer report is in fact secured.

The representations contained in this instrument an in the financial statement are warranted by the applicant to be true. Such representations are made as material inducements to be relied upon by the Surety in issuing the bond or bonds hereby requested.

Signature

By initialing here you authorize this form.

Name — Typed of Printed

Date

Any persons who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits application or files claim containing a false or deceptive statement is guilty of insurance fraud.