CONTRACTOR QUESTIONNAIRE
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1 CONTRACTOR QUESTIONNAIRE 1100 Via Callejon Suite A San Clemente, CA surety@southcoastsurety.com (949) Fax (949) DOI Lic# 0B Name of Firm: Tax I.D. #: Fiscal 2. Address: 3. Yr. End 4. Phone: ( ) (city) (state) (zip) 5. Fax: ( ) Contact: 8. Contracting Specialty: 9. Year Business Started: 10. Type Business:! Corp.! Part.! Prop.!Sub.S.Corp! Other 11. State of Incorporation: 12. Area(s) of Operation 13. List the corporate officers, partners or proprietors of your firm: Date of Percent Name Birth Position Owned Name of Spouse A. % B. % C. % D. % E. % 14. Will the above individuals personally indemnify Surety?! Yes! No 15. Is there a buy/sell agreement among the owners of the business?! Yes! No 16. Is the buy/sell funded by life insurance?! Yes! No 17. Corp. Indemnity?! Yes! No 18. Cross / Corp. Indemnity?! Yes! No 19. How many people does your firm employ? 20. How many work crews? If no, explain: 21. Has your firm or any of its principals ever petitioned for bankruptcy, failed in business or defaulted so as to cause a loss to Surety?! Yes! No If yes, please explain:
2 22. Is your firm or any of its owners or officers currently involved in any litigation?! Yes! No If yes, please explain: 23. What percentage of firm's work is for: Gov't Agencies % Private Owners % 24. What percentage of firm's work is normally subcontracted: % 25. Are bonds required of subs?! Yes! No. 26. What trades do you normally subcontract? 27. What has been the largest amount of uncompleted work on hand? Amt. $ Year 28. What is the largest single job you expect to do in the next year? $ 29. What is the largest uncompleted work program expected next year? $ 30. What is expected annual volume next year? $ 31. What trades do you normally undertake with your own forces? 32. SIC CODE: Do you lease equipment?! Yes! No Type of Lease? What are the terms of the lease? 33. Name of your CPA: 34. Address: city-state-zip 36. Phone: ( ) Contact Person: 37. On what basis are taxes paid?! Cash! Completed Job! Accrual! % of Completion 38. On what basis are financial statements prepared?! Cash! Completed Job! Accrual! % of Completion 39. How are financial statements prepared?! CPA Audit! Review! Compilation 40. How often are financial statements prepared?! Annually! Semi-annually! Quarterly! Monthly 41. Do you have a full time accountant on staff?! Yes! No 42. Yrs. experience 43. Are job cost records kept?! Yes! No 44. How often reviewed? 45. How often updated? 46. Do they show job detail?! Yes! No 47. Frequency? 48. Name of your Bank: Address: Phone: ( ) Contact: 49. Line of credit Amount: $ 50. Exp. date: 51. Interest rate: % 52. UCC Filing?! Yes! No 53. How is credit secured? 54. Is your firm union?! Yes! No 55. Dun & Bradstreet #: 56. D & B rating: 57. Pay record: 58. Rating date: Remarks:
3 59. Bonding Companies: Current Company Current Bond Line A. Previous Companies Reason for Leaving A. B. C. 60. List five largest contracts: Gross Completion Job Name Contract Price Profit Date Bonded? A. $ $! Yes! No B. $ $! Yes! No C. $ $! Yes! No D. $ $! Yes! No E. $ $! Yes! No 61. List five major suppliers: Name Address Telephone Contact A. ( ) B. ( ) C. ( ) D. ( ) E. ( )
4 62. List five subcontractors that you do business with: A. Name: B. Name: C. Name: D. Name: E. Name: 63. List three Architects you have done business with: A. Name: B. Name: C. Name: 64. List key personnel, foremen or supervisors: Yr. of Yrs. of Name Position Birth Exper. Previous Employer A. B. C. D. E. 65. List any life insurance in effect on key personnel: Name Beneficiary Amount Cash Value A. $ $ B. $ $ C. $ $
5 D. $ $ E. $ $ 66. List other insurance coverage currently in effect: Limits in '000's Bodily Property Expiration Injury Damage Carrier Date A. General Liability: $ $ B. Auto Liability: $ $ C. Umbrella: $ $ D. Owner's Protection: $ $ E. Other: $ $ 67. List any subsidiaries and affiliates of the contracting firm: NANDA Firm Name Ownership Type of Business Code A. B. C. D. E. Remarks: Completed by: Signature: Title: Date: South Coast Surety Insurance Services, Inc. Contractor Questionnaire (NASBP ver.) Ques.ltrt.frm 02/08
CONTRACTOR QUESIONNAIRE. 1. Name of Firm: 2. Address: 3. Fiscal Year End. (City) (State) (Zip. 4. Phone: ( ) 5. Contracting Specialty:
CONTRACTOR QUESIONNAIRE 1. Name of Firm: 2. 3. Fiscal Year End (City) (State) (Zip 4. Phone: ( ) 5. Contracting Specialty: 6. Contact Person: 7. Title: 8. Year Business Started: 9. Type of Business: Corp
CONTRACTOR QUESTIONNAIRE
CONTRACTOR QUESTIONNAIRE 1. Name of Firm: 2. Address: 3. Fiscal Year End (City) (State) (Zip) 4. Phone: ( ) 4a. Fax: ( ) 5. Contracting Specialty: 6. Contact Person: 7. Title: 8. Year Business Started:
CONTRACTOR QUESTIONNAIRE
CONTRACTOR QUESTIONNAIRE 1. of Firm: 2. 3. Fiscal Yr. End: (City) (State) (Zip) 4. 5. Contracting Specialty: Fax: 6. Contact Person: 7. Title: 8. Year Business Started: 9. Type of Business: Corp. Part.
CONTRACTOR QUESTIONNAIRE
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707 Philadelphia Pike Wilmington DE 9809 Phone: (0) 76-799 - Fax: (0) 76-799 surety@acsurety.com CONTRACTOR QUESTIONNAIRE nasbp.org/toolkit Business name: Contact name: Firm address: I. BUSINESS INFORMATION
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