Contractor’s Questionnaire



* Name

* Address

* Telephone

Fax

* Fed Tax No.

* Email

Website

* License No.

I. ORGANIZATION AND BACKGROUND


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

STOCK OWNERSHIP

SCOPE OF OPERATIONS

ENDORSEMENT BY PRINCIPAL
OR STOCKHOLDERS

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

Workers’ Compensation

Employer Liability Limits

Expiration

General Liability

Liability Limits

Expiration

II. SCOPE OF OPERATIONS


A. Type of Contractor

Territory

B. What percentage of work is as prime contractor?

Subcontractor?

C. How much of an average job is subbed?

% What trades?

D. Are bonds required from subcontractors?
YesNo

* When?

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?

Private Owners?

J. Is this a union or non-union contractor?

K. Has contractor or any of the owners ever

1. defaulted on a contract?
YesNo

If yes, give details

2. caused Surety to pay a loss?
YesNo

If yes, give details

3. petitioned for bankruptcy?
YesNo

If yes, give details

III. CREDIT INFORMATION


A. Creditors: List of Suppliers from whom Contractor buys most materials

NAME

STREET ADDRESS

CITY & STATE

PHONE & FAX

B. Subcontractors/General Contractors (if subcontractor)

NAME

STREET ADDRESS

CITY & STATE

PHONE & FAX

C. Are bills paid in a discount/prompt manner?
YesNo

If not, why?

D. Bank

NAME & ADDRESS

BANK OFFICER

LINE OF CREDIT

NATURE OF SECURITY
AND/OR NAME OF ENDORSER

E. Life Insurance

AMOUNT

INSURED

BENEFICIARY

INSURER

CASH SURRENDER VALUE

IV. FINANCIAL DATA


Current CPA

Contact

A. What is fiscal year-end?

1. Financial Statement Presentation:

Audit

Review

Compilation

2. How often does CPA prepare statements?

B. What method of accounting is used in preparing statements?

Completed Contract

% of Completion

Simple Accrual

C. On what basis of accounting are taxes paid?

Completed Contract

% of Completion

Simple Accrual

Cash

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,

Signature

Date

*Please Enter Security Code:
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