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Online Contractor's Questionnaire


Fill out the following form as completely as possible. Once you have completed the form, click the Submit button to send your information. Your request will be handled promptly.

Legal Business Name
Required
First Name
Required
Last Name
Required
Street
Required
City
Required
State / Province
Required
ZIP / Postal Code
Required
Primary Phone Number
Required
E-Mail Address
Required
Corporation
Optional



Social Security Number
Optional
Federal Tax Number
Optional
Bank Account Number
Optional
Date Business Formed
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Date Incorporated
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If successor to prior business, name of predecessor
Optional
List of Officers/Owners and Key Personnel (Include name, position, % of ownership, age and years and experience in construction.)
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List of affiliated, subsidiary or related companies in which this firm or its stockholders have an interest. (List name & address, stock ownership, scope of operations and endorsement by principal or stockholders.)
Optional
Name surety company presently providing contract bonds and through which agency
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What company (or companies) was Surety prior to present one?
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State limits and carrier of Liability and Compensation Insurance
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Type of Construction
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Territory
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What percentage of work is as Prime?
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What percentage of work is as sub?
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How much of an average job is subbed?
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How much of an average job is made up of materials?
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Are bonds required from subcontractors?
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If yes, when?
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What was largest work-on-hand handled in the past?
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What size jobs and total work program does contractor feel best able to handle?
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Approximately what percent of work required contract bond?
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Is this a union or non-union contractor?
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Has contractor or any of its owners ever defaulted on a contract? (If yes, give details.)
Optional
Has contractor or any of the owners ever caused a Surety to pay a loss? (If ye, give details.)
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Has contractor or any of the owners ever declared bankruptcy? (If yes, give details.)
Optional
List Largest Jobs Completed. Include contract price, year, type of work, name and address of architect/engineer, owner or general contractor and description of job.
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List Uncompleted Work on Hand at Present. Include owner, kind of work and location, name and address of architect/engineer, contract price, percent complete and date to be completed.
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In regards to present work on-hand, select all that apply.
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In regard to contractor's equipment:
Is equipment adequate for work program desired?
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If not, what expenditures are anticipated?
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Is equipment owned or leased?
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List suppliers from whom contractor buys most materials. (Include name, address and phone number.)
Optional
Are bills paid in a prompt manner?
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If no, give reason why.
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Bank Information: List bank(s) name and address, bank officer, line of credit established, and nature of security and/or name of endorser.
Optional
Life Insurance: List amount, insured, beneficiary, insurer and cash surrender value.
Optional
We will need the last three (3) fiscal year-end financial statements. Please mail them to us at your earliest convenience.
What is fiscal year-end?
Optional
If statements are not audits, will one be considered?
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Name and address of present accountant
Optional
What method of accounting is used in preparing statements?
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One what basis of accounting are taxes paid?
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Have stockholders elected to be considered a "Sub Charter 'S' Corporation"?
Optional

In what year was contractor last checked by I.R.S.?
Optional
What portion of inventory shown on financial statement is material for jobs in progress?
Optional
Is personal indemnity of the owners/stockholders available?
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If yes, whose?
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Please send us personal statements of indemnitors concurrent with fiscal year-end of contractor.
Is a buy-sell agreement in effect?
Optional

If yes, how is it funded?
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Have operations been profitable since statement date?
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Have any changes occurred since statement date that would significantly affect financial condition of contractor?
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If yes, please list in detail.
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Are any new ventures or investments contemplated? (Please explain.)
Optional
Desired annual volume
Optional
Desired maximum uncompleted work-on-hand at any one time
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Desired maximum size of single job
Optional
The answers given on this questionnaire are true to the best of my knowledge and belief. Type name if you agree.
Required
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Important Notice
Any submissions or payments made via this website do not constitute a binding agreement to your policy or coverages. Changes and payments to policies are not effective or binding until you, or any party involved, receive official notice from either your insurance agent, or your insurance company. If you have any questions, please feel free to contact us.

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