Contractor Questionnaire

Latge Vortex

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(a red asterisk * denotes a required field)

1. Name of Firm:	*
2. Address:	*
3. City:	*
4. State:	*
5. Zip:	*
6. Phone:	*
7. Fax:
8. Fiscal Year End:	*
9. Contracting Specialty:	*
10. Contact Person:	*
11. Title:	*
12. Year Business Started:	*

13. Type of Business	* Corp. Part. Prop. Sub. S. Corp.
14. State of Incorporation:	*
15. Area of Operation:	*

16. List the corporate officers, partners or proprietors of your firm:
Name:	D.O.B.	Position	% Owned	Name of Spouse

17. Will the above individuals and spouses personally indemnify Surety?	Yes No
18. If no, please explain:
19. Is there a buy/sell agreement among the owners of the business?	Yes No
20. Is this agreement funded by life insurance?	Yes No
21. Corp. Indemnity?	Yes No
22. Cross/Corp. Indemnity?	Yes No
23. How many people does your firm employ?
24. How many work crews?
25. Has your firm or any of its principals ever petitioned for bankruptcy, failed in business or defaulted so as to cause a loss to a Surety?	Yes No
26. If yes, please explain:

27. What is the largest job you expect to do during the next year?
28. What is the largest uncompleted work program expected during the next year?
29. What is your expected annual volume next year?
30. What trades do you normally undertake with your own forces?
31. SIC Code:
32. Do you lease equipment?	Yes No
33. Type of Lease?
34. What are the terms of the lease?

35. Name of your CPA:
36. Address:
37. City:
38. State:
39. Zip:
40. Phone:
41. Contact Person:
42. On what basis are taxes paid?	Cash Completed Job Accrual % of Completion
43. On what basis are financial statements prepared?	Cash Completed Job Accrual % of Completion
44. On what level of assurance are financial statements prepared?	CPA Audit Review Compilation
45. How often are financial statements prepared?	Annually Semi-annually Quarterly Monthly
46. Do you have a full time accountant on staff?	Yes No
47. Years of experience:
48. Are job cost records kept?	Yes No
49. How often reviewed?
50. How aften updated?
51. Do they show job detail?	Yes No
52. Frequency?

53. Name of your Bank:
54. Address:
55. City:
56. State:
57. Zip:
58. Phone:
59. Contact Person:
60. Amount of line of credit?
61. Expiration Date:
62. What is the interest rate?
63. UCC Filing?	Yes No
64. How is credit secured?
65. Is your firm union?	Yes No
66. What is your firm's Dun and Bradstreet Number?
67. D&B Rating:
68. Pay Record:
69. Remarks:

70. Previous Bonding Companies
Name:	Reason for Leaving:

71. List five of your largest contracts:
A.
Job Name:		Contract Price:
Gross Profit:		Completion Date:
Owner:		Design Professional:
Bonded:	Yes No

B.
Job Name:		Contract Price:
Gross Profit:		Completion Date:
Owner:		Design Professional:
Bonded:	Yes No

C.
Job Name:		Contract Price:
Gross Profit:		Completion Date:
Owner:		Design Professional:
Bonded:	Yes No

D.
Job Name:		Contract Price:
Gross Profit:		Completion Date:
Owner:		Design Professional:
Bonded:	Yes No

E.
Job Name:		Contract Price:
Gross Profit:		Completion Date:
Owner:		Design Professional:
Bonded:	Yes No

72. List five of your major suppliers:
A.
Name:		Telephone:
Address:		Contact:
Job:


B.
Name:		Telephone:
Address:		Contact:
Job:


C.
Name:		Telephone:
Address:		Contact:
Job:


D.
Name:		Telephone:
Address:		Contact:
Job:


E.
Name:		Telephone:
Address:		Contact:
Job:

73. List three architects you have done business with:
A.
Name:		Telephone:
Address:		Contact:
Job:


B.
Name:		Telephone:
Address:		Contact:
Job:


C.
Name:		Telephone:
Address:		Contact:
Job:

74. List key personnel, foreman, or supervisors:
Name:	Position:	D.O.B.	Yrs. of Exper.	Previous Employer

75. List key personnel, foreman, or supervisors:
Name:	Beneficiary:	Amount:	Cash Value:	Insurance Company:

76. List other insurance coverage in effect:
Limits in '000's'	B1	PD	Carrier	Expir. Date
A. General Liability $
B. General Liability $
C. General Liability $
D. General Liability $

77. List any subsidiaries and affiliates of the contracting firm:
	Firm Name:	Ownership:	Type of Business:	NANDA Code:
A.
B.
C.
D.
E.

Remarks:

Completed by:
Title:
Date:

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