* Fed Tax No.
* License No.
A. Date Business Formed
B. Date Incorporated
C. If SUCCESSOR to Prior Business,
Name of Predecessor
D. List of Officers/Owners and Key Personnel
NAME AND SOCIAL SECURITY NO.
POSITION & RESPONSIBILITY
% OF OWNERSHIP
DATE OF BIRTH
YEARS OF EXPERIENCE IN CONSTRUCTION
E. List of Affiliated, Subsidiary or Related Companies in which this firm or its Stockholders have an interest.
NAME & ADDRESS
SCOPE OF OPERATIONS
ENDORSEMENT BY PRINCIPAL
Name of Surety Company presently providing contract bonds, through which agency, and length of time with them.
Current Surety Company
Length of time
F. State limits and name of carrier of liability and workers’ compensation insurance
Employer Liability Limits
A. Type of Contractor
B. What percentage of work is as prime contractor?
C. How much of an average job is subbed?
% What trades?
D. Are bonds required from subcontractors?
E. What trades do you undertake with your own forces?
F. What was largest work on hand handled in the past?
G. What is the largest job you would like to do in the coming year?
H. What is your expected annual volume next year?
I. What percent of work is for Government Agencies?
J. Is this a union or non-union contractor?
K. Has contractor or any of the owners ever
1. defaulted on a contract?
If yes, give details
2. caused Surety to pay a loss?
3. petitioned for bankruptcy?
A. Creditors: List of Suppliers from whom Contractor buys most materials
CITY & STATE
PHONE & FAX
B. Subcontractors/General Contractors (if subcontractor)
C. Are bills paid in a discount/prompt manner?
If not, why?
LINE OF CREDIT
NATURE OF SECURITY
AND/OR NAME OF ENDORSER
E. Life Insurance
CASH SURRENDER VALUE
A. What is fiscal year-end?
1. Financial Statement Presentation:
2. How often does CPA prepare statements?
B. What method of accounting is used in preparing statements?
% of Completion
C. On what basis of accounting are taxes paid?
D. Are Individual Job Cost records kept?
How often reviewed?
How often updated?
E. Have stockholders elected to be considered a "Sub Chapter ‘S’ Corporation?"
F. In what year was contractor last checked by I.R.S.?
G. Is a buy-sell agreement in effect?
Funded by Life Insurance?
H. Have operations been profitable since statement date?
I. Have any changes occurred since statement date such as acquisition of additional equipment, purchase of fixed assets, loans to officers, investment, withdrawals, or dividends that would significantly affect financial condition of contractor?
Are any new ventures of investments contemplated?
The above answers are true to the best of my knowledge and belief,
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