Please return check list with completed builder package and requested documents to:

E-mail: BuilderReview@fgmc.com

Builder/Contractor Profile

W-9

Assignment of Contracts Acknowledgment

Builder/Retailer State License(s)

Certificate of Insurance / General Liability (Declaration Page, Acord 25 Form)

Certificate of Insurance / Workman’s Compensation (Declaration Page, Acord 25 Form) ****If you are not required to carry this insurance, provide a signed explanation -Statement on Company Letterhead

Evidence of Builder’s Risk Insurance (carried by Builder or can be carried by Borrower as part of HOI policy w/“Under Construction” endorsement. Can be blanket policy or project specific.)

VA Builder Registration Number (if applicable) VA #

Most Recent Two Years of Tax Returns (first two pages of signed tax returns)

Most recent YTD Profit & Loss Statement

Most Recent YTD Balance Sheet

REQUIRED FOR SITE-BUILT AND MODULAR HOME BUILDERS

Dealer’s Open Lot/ Builders Risk insurance with Installation Coverage ***********(FGMC should be named as the Loss Payee or Certificate Holder

REQUIRED FOR MANUFACTURED HOME RETAILERS ONLY

Builder’s Risk Insurance – A special type of property insurance which indemnifies against damage to buildings while they are under construction.

Open Lot Policies – Coverage for manufactured homes during all stages including transport and installation.

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Construction to Permanent Builder/Retailer Acceptance Checklist

Builder/Retailer Name: Address: City/State/Zip: Point of Contact: Phone #: Email Address: Alternate #:

(Please Check Operating Business Model):

Corporation Individual General Partnership LLCPublicly Traded Corporation Sole Proprietorship Limited Partnership other/explain: Number of years organization has been in business under present name: Number of Locations: If Business operates under any DBA’s, Please List DBA(s):Federal Tax ID Number: License Number: Exp. Date:Principal Officers/Owners (SS# of officers/owners not required on publicly traded corporations)Name: Title: SS #: DOB: Name: Title: SS #: DOB:

Primary Type of Construction (check all that apply): Site-Built Manufactured ModularNumber of Homes Completed in the Past 5 Years: Number of Homes Completed in the Past 12 Months: Number of Homes Currently In Process: Number of Homes Completed But Not Yet Sold:

General Liability /Workers Comp. Provider: GL Policy #: WC Policy #: Open Lot/Builder’s Risk Provider: OL Policy #: BR Policy #:

Are there any judgments, claims, arbitration proceedings, or suits pending or outstanding against the organization or its officers? If so, describe in an attached document.

Has the organization filed any lawsuits or requested arbitration with regard to construction contracts within the last fiveyears? If so, please describe in an attached document.

BUILDER/RETAILER INFORMATION

ORGANIZATION (ANY LOCATION SEPARATELY LICENSED MUST COMPLETE A SEPARATE FORM)

LIST THE TYPES OF WORK PERFORMED BY YOUR ORGANIZATION (ROOFING, PLUMBING, ELECTRICAL, HVAC, ETC.):

CONSTRUCTION / SALES HISTORY

INSURANCES (OPEN LOT/BUILDER’S RISK POLICY IS REQUIRED FOR ALL MANUFACTURED HOMES)

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Builder / Retailer Profile Report

1. Customer Name: Phone #: Address: Contract Amount: Square Footage: Structure Type: Scope of Work: Completion Date:

1. Supplier Name: Phone #: Address: Email: Contact Person: Fax: Contract Amount:

Provide information on three sub-contractors used for projects completed by the organization within the last two years including sub-contractor name, phone #, location of the project, and contract amount.

2. Customer Name: Phone #: Address: Contract Amount: Square Footage: Structure Type: Scope of Work: Completion Date:

3. Customer Name: Phone #: Address: Contract Amount: Square Footage: Structure Type: Scope of Work: Completion Date:

4. Customer Name: Phone #: Address: Contract Amount: Square Footage: Structure Type: Scope of Work: Completion Date:

5. Customer Name: Phone #: Address: Contract Amount: Square Footage: Structure Type: Scope of Work: Completion Date:

2. Supplier Name: Phone #: Address: Email: Contact Person: Fax: Contract Amount:

3. Supplier Name: Phone #: Address: Email: Contact Person: Fax: Contract Amount:

BUILDER EXPERIENCE /PROJECT REFERENCES

TRADE REFERENCES

Provide information on 5 residential projects completed by the organization within the last 3 years including customer name and phone number.

Builder / Retailer Profile Report

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Signature: Date:

Printed Name: Title

1. Sub-Contractor Name: Phone #: Address: Email: Contact Person: Fax: Contract Amount:

2. Sub-Contractor Name: Phone #: Address: Email: Contact Person: Fax: Contract Amount:

3. Sub-Contractor Name: Phone #: Address: Email: Contact Person: Fax: Contract Amount:

Builder/Retailer: Address: City/State/Zip: Federal Tax I.D #:

Company Name:

Signature: Date:

Printed Name: Title

SUB CONTRACTOR REFERENCES

Provide information on three sub-contractors used for projects completed by the organization within the last two years including sub-contractor name, phone #, location of the project, and contract amount.

Builder/Retailer represents and warrants that all information in this Builder/Retailer Profile is complete and accurate. Builder/Retailer authorizes the borrower, and/or the lender, lender’s agent, authorized 3rd party vendor, and/or its successors or assigns, to request a credit report and to contact the references listed above to verify that the information represented in this Builder/Retailer Profile is complete and accurate. The verification of this information may be made at any time by lender whether directly or through a credit reporting bureau.

I/We, the undersigned Builder/Retailer(s), hereby agree that in the event of default by applicant(s) under loan documents executed to finance construction of improvements we shall, at above named lender’s option and direction, continue performance under our agreement with such applicant(s), provided that we are compensated for all work after said direction by lender, its successors and/or assigns or purchaser in accordance with the agreement with the applicant(s).

Lender: First Guaranty Mortgage Corporation, ISAOA/ATIMA 1900 Gallows Road, Suite 800, Tysons Corner, VA22182, and its successors and/or assigns, as their interests may appear

ASSIGNMENT OF CONTRACTS ACKNOWLEDGMENT

Builder / Retailer Profile Report

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