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Contractors Questionnaire

Contractors Questionnaire
Fields marked with * are required.
*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? Yes No * 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? Yes No * If yes, give details

2. caused Surety to pay a loss? Yes No * If yes, give details

3. petitioned for bankruptcy? Yes No * If yes, give details

L. Completed Jobs : Please Provide Schedule

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? Yes No
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 the security code correctly) Click here if you can’t read.

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