Name
of Firm:
|
| Address: |
| City: |
| State: |
| Zip: |
| E-Mail Address: |
| Phone: -- |
| Fax:
-- |
|
Contact Person:
|
|
Type of Business:
Proprietorship Partnership
Corporation Sub
S
|
|
Year Business Started:
|
| Year Present Management
Started:
|
|
Is
your operation:
Union Non-Union
|
|
#
of Employees:
|
|
#
of Crews:
|
|
State(s)
in which licensed:
|
|
State
of Incorporation:
|
|
Geographical area
of operation:
|
|
Geographical expansion
anticipated?
Yes
No
|
|
If yes, comments:
|
|
What
trades do you undertake with your own forces?
|
|
What
trades do you subcontract?
|
|
Work subcontracted:
%
|
|
Are
bonds required of subs?
Yes
No
|
|
Do
you do design and build work?
Yes
No
|
|
What
portion of work is normally for:
|
General Contractors: %
|
Government Agencies: %
|
Private Owners: %
|
Bonded Projects: %
|
|
Is
equipment adequate for normal purposes?
Yes
No
|
|
Anticipated
equipment needs:
|
|
Do
you lease equipment?
Yes
No
|
|
If yes, What Type?
|
|
What are the terms?
|
|
What
is your projected annual volume? $
|
|
Largest
Upcoming Job?
$
|
|
Do
you have a buy/sell agreement in effect?
Yes
No
|
|
Is
it funded by life insurance?
Yes
No
|
|
List
any key man life insurance in effect:
|
|
Name: |
| Beneficiary: |
| Amount $ |
| Cash
Value $ |
Insurance
Company:
|
|
List
any subsidiaries/affiliates:
|
| Name: |
| Ownership: % |
| Relationship: |
| Type
of business: |
|
Will
the above subsidiaries/affiliates indemnify the surety?
Yes
No
|
|
Corporate
officers/Key Personnel (attach resumes if available)
|
|
1.
Name: |
|
Social
Security Number: |
|
Date
of Birth: |
|
Position (Title): |
|
Amount of Stock: % |
|
Name
of Spouse: |
|
Will
the stockholders and spouses personally indemnify the Surety?
Yes
No
|
|
2.
Name: |
|
Social
Security Number: |
|
Date
of Birth: |
|
Position (Title): |
|
Amount of Stock: % |
|
Name
of Spouse: |
|
Will
the stockholders and spouses personally indemnify the Surety?
Yes
No
|
|
3.
Name: |
|
Social
Security Number: |
|
Date
of Birth: |
|
Position (Title): |
|
Amount of Stock: % |
|
Name
of Spouse: |
|
Will
the stockholders and spouses personally indemnify the Surety?
Yes
No
|
|
Do you have a full-time
accountant on staff?
Yes
No
|
|
CPA
Firm:
|
|
Address:
|
|
Phone:
|
|
Contact
Person:
|
|
What
is your fiscal year end?
|
|
How
often and at what times do you usually prepare a financial statement?
|
|
What
quality is your fiscal report?
|
|
If "Other",
please describe:
|
|
On
what basis are taxes paid?
|
|
On
what basis is income recognized?
|
|
Are
job costs records kept?
Yes
No
|
|
How often reviewed?
|
|
How often updated for labor?
|
|
Name
of Bank:
|
|
Address:
|
|
Phone:
|
|
Contact
Person:
|
|
Amount
of line of credit?
$
|
|
How
secured?
|
|
What
is interest rate?
%
|
|
Expiration
Date:
|
|
Number
of years affiliated:
|
|
Previous
Bonding Companies:
|
|
Name: |
|
Reason
for leaving: |
|
Year left: |
|
Lines
of credit (Single/Aggregate): $
|
|
What
is largest amount of uncompleted work on hand at one time in the past?
|
|
Amount:
$
|
|
Year:
|
|
Largest
job bid:
$
|
|
Bid
Price:
$
|
|
Date:
|
|
Description:
|
|
List
5 of your largest contracts:
|
| 1.
Job
Name: |
|
Contract
Price: $ |
|
Original
Gross Profit: $ |
|
Final
Gross Profit: $ |
|
Completion
Date: |
|
Owner:
|
|
Address: |
|
Phone: |
|
Contact Person:
|
|
Engineer/Architect:
|
|
Address: |
|
Phone: |
| 2.
Job
Name: |
|
Contract
Price: $ |
|
Original
Gross Profit: $ |
|
Final
Gross Profit: $ |
|
Completion
Date: |
|
Owner:
|
|
Address: |
|
Phone: |
|
Contact Person:
|
|
Engineer/Architect:
|
|
Address: |
|
Phone: |
| 3.
Job
Name: |
|
Contract
Price: $ |
|
Original
Gross Profit: $ |
|
Final
Gross Profit: $ |
|
Completion
Date: |
|
Owner:
|
|
Address: |
|
Phone: |
|
Contact Person:
|
|
Engineer/Architect:
|
|
Address: |
|
Phone: |
| 4.
Job
Name: |
|
Contract
Price: $ |
|
Original
Gross Profit: $ |
|
Final
Gross Profit: $ |
|
Completion
Date: |
|
Owner:
|
|
Address: |
|
Phone: |
|
Contact Person:
|
|
Engineer/Architect:
|
|
Address: |
|
Phone: |
| 5.
Job
Name: |
|
Contract
Price: $ |
|
Original
Gross Profit: $ |
|
Final
Gross Profit: $ |
|
Completion
Date: |
|
Owner:
|
|
Address: |
|
Phone: |
|
Contact Person:
|
|
Engineer/Architect:
|
|
Address: |
|
Phone: |
|
List
4 of your major suppliers:
|
|
1.
Name:
|
|
Address: |
|
Phone: |
|
Contact: |
|
At
present, your firm is: Discounting
bills Paying in 30 days Over
30 days
|
|
Over
30 days, explain:
|
|
2.
Name:
|
|
Address: |
|
Phone: |
|
Contact: |
|
At
present, your firm is: Discounting
bills Paying in 30 days Over
30 days
|
|
Over
30 days, explain:
|
|
3.
Name:
|
|
Address: |
|
Phone: |
|
Contact: |
|
At
present, your firm is: Discounting
bills Paying in 30 days Over
30 days
|
|
Over
30 days, explain:
|
|
4.
Name:
|
|
Address: |
|
Phone: |
|
Contact: |
|
At
present, your firm is: Discounting
bills Paying in 30 days Over
30 days
|
|
Over
30 days, explain:
|
|
List
4 subcontractors or contractors (if you are a subcontractor)
with which you do business:
|
| 1.
Subcontractor Contractor
|
|
Name:
|
|
Address:
|
|
Phone:
|
|
Contact: |
| 2.
Subcontractor Contractor
|
|
Name:
|
|
Address:
|
|
Phone:
|
|
Contact: |
| 3.
Subcontractor Contractor
|
|
Name:
|
|
Address:
|
|
Phone:
|
|
Contact: |
| 4.
Subcontractor Contractor
|
|
Name:
|
|
Address:
|
|
Phone:
|
|
Contact: |
|
List
3 Architects/Engineers with which you do business:
|
| 1.
Name:
|
|
Address:
|
|
Phone:
|
|
Contact: |
| 2.
Name:
|
|
Address:
|
|
Phone:
|
|
Contact: |
| 3.
Name:
|
|
Address:
|
|
Phone:
|
|
Contact: |
|
Does the company,
including any affiliates, officers or stockholders engage in real estate
development and/or
Investment? Yes
No
|
|
Has your firm or any of
its principals, officers or partners ever petitioned for bankruptcy?
Yes
No
|
|
Has your firm or any of
its principals, officers or partners ever failed in business so as to
cause loss to a surety?
Yes
No
|
|
Have any of the
principals, officers, or partners of your firm ever been associated
with, while in a management position, any firm which petitioned for
bankruptcy and/or caused a loss to a surety?
Yes
No
|
|
If yes to any of the
above questions, please explain.
|
|
|
