CONTRACTOR QUESTIONNAIRE FOR SURETY QUESTIONNAIRE FOR ... bankruptcy or held a senior management ... base certificate to this questionnaire accounts receivables,

Download CONTRACTOR QUESTIONNAIRE FOR SURETY   QUESTIONNAIRE FOR ... bankruptcy or held a senior management ... base certificate to this questionnaire accounts receivables,

Post on 06-Mar-2018

212 views

Category:

Documents

0 download

Embed Size (px)

TRANSCRIPT

<ul><li><p>1. Phone:</p><p>Address: Federal Tax ID #:City State Zip</p><p>ORGANIZATION</p><p>2. Type of Business:</p><p>Year Business Started: # of years business controlled by current ownership:</p><p>3. Please list all individuals who have an ownership interest in the business listed above:</p><p>Name SS# Signature Title Date</p><p>Name SS# Signature Title Date</p><p>Name SS# Signature Title Date</p><p>Name SS# Signature Title Date</p><p>The Mechanic Group, Inc.One Blue Hill Plaza, Suite 530 * Pearl River NY 10965(800) 214 0207 * (845) 735 0700 * Fax (845) 735 8383</p><p>CONTRACTOR QUESTIONNAIRE FOR SURETY CREDITName of your business:</p><p>Name of SpouseSocial Security # Years in SecYears w/Co.Name Date of Birth % Ownership Position</p><p>I hereby authorize The Mechanic Group, Inc. and/or Carolina Casualty Insurance Company to conduct a comprehensive review of my background and credit history causing a consumer report and/or an investigative consumer report to be generated for surety credit purposes. I understand that the scope of the consumer report/investigative consumer report may include, but is not limited to, the following areas: Verification of social security number; current and previous residences; employment history including all personnel files; education including transcripts; character references; credit history and reports; criminal history records from any criminal justice agency in any or all federal, state, county jurisdictions; birth records; motor vehicle records to include traffic citations and registration; and any other public records or to conduct interviews with third parties relative to my character, general reputation, personal characteristics or mode of living. I further authorize any individual, company, firm, corporation, or public agency (including the Social Security Administration and law enforcement agencies) to divulge any and all information, verbal or written, pertaining to me to The Mechanic Group, Inc. and/or Carolina Casualty Insurance C</p><p>I hereby release Carolina Casualty Insurance Company &amp; The Mechanic Group, Inc. its agents, employees, officers, owners and representatives from any andall liability for damages of whatever kind, which may, at any time, result to me, my heirs, family, or associates because of the authorization i have given. I understand this authorization automatically expires 90 days from the date executed below and that I have the right to revoke the authorization at any time, provided I do so in writing.</p><p>AUTHORIZATION TO CONDUCT CREDIT AND BACKGROUND CHECKeach and every owner and their spouse must sign below for your request for surety credit to be processed</p><p>Corporation PartnershipCorporation Partnership Limited Liability Company Proprietorship</p><p>Yes No</p></li><li><p>4. Will Shareholders and spouses personally indemnify Surety?5. Are any shareholders assets held in trusts?</p><p>If trusts exist, will they indemnity Surety? If no, explain:6. Is a formal continuity plan in place for the succession of future management? 7. Is a formal buyout plan in place?</p><p>If so, is the buyout plan fully funded by life insurance or other means?8. Please list all businesses that any shareholder has an ownership interest in:</p><p>9. Has any individual or company listed above ever filed for bankruptcy or held a senior management position with a firm that has caused a surety or a bank a loss?If yes, explain:</p><p>EXPERIENCE AND OPERATIONS</p><p>10. What percentage of the firm's work is normally performed as: Prime Contractor Subcontractor11. Type(s) of Contracts Sought?12. What type of work do you subcontract?13. What percentage of the firm's work is typically subcontracted?14. Do require your subcontractors to be bonded?</p><p>15. 16.</p><p>Fixed PriceCost - PlusCost - Plus A fixed FeeCost - Plus with a Max. Upset price</p><p>17.billed in one calender year?What year was that?</p><p>18. List your 5 largest on going contracts:</p><p>12345</p><p>19. List the 5 largest contracts you have completed - finished </p><p>12345</p><p>Name of Client Annual Revenue Year Completed Any dispute with client after completion date?</p><p>Cost of GoodsDirect Labor</p><p>% of Common OwnershipName Function/Purpose of Company Operating Company</p><p>0% 0%</p><p>Name of Client</p><p>What is the largest amount of revenue you ever </p><p>%%</p><p>0%</p><p>List the approximate % of work annually performed for the following types of owners:</p><p>List the approximate % of contracts undertaken using the following types of payment terms:</p><p>100%</p><p>Commercial Industrial</p><p>InstitutionsFederal Government</p><p>State and Local GovernmentResidential</p><p>TOTAL</p><p>%</p><p>Other : __________________</p><p>Annual Revenue</p><p>%%</p><p>%</p><p>%</p><p>%%%%</p><p>Yes No</p><p>YesYes</p><p>No</p><p>No</p><p>Yes NoYes No</p><p>Yes No</p><p>Yes No</p><p>Yes No</p><p>Yes No</p><p>Yes No</p><p>Yes No</p><p>Yes No</p><p>Yes No</p><p>Yes No</p><p>Yes No</p></li><li><p>20 Describe the 2 most technically difficult projects (regardless of size) undertaken by the applicant. Why was the job technically difficult?</p><p>Name of Project:</p><p>Why:</p><p>Name of project:</p><p>Why:</p><p>20. Does your business have unionized labor? </p><p>21. In what geographic area do you work? </p><p>23. What is the name of your outside Accounting firm:</p><p>Name of Accountant within firm:</p><p>Telephone #</p><p># of years as your Accountant:</p><p>24. On what level of assurance are financial statements prepared:CPA Audit: CPA Review: CPA Compilation: Internal:</p><p>How often are financial statements prepared?</p><p>25. Who manages the finances of your business:</p><p>Name of person responsible for business finances Years Experience College &amp; Degree</p><p>26. What is the name of your scheduling software? (if none so state)</p><p>What is the name of your accounting software package?</p><p>Are job records kept? If yes, how often reviewed? </p><p>Do they show job detail? Frequency?</p><p>BANK LINE(S) OF CREDIT</p><p>27 Name of your Bank:</p><p>1 Current MAX $ Line of Credit</p><p>2 How much of your credit line is currently being used</p><p>3 How much cash is available to start new jobs</p><p>4 How do you collatoralize the line?</p><p>* Please attach a bank reference letter to this questionnaire</p><p>City, State , Zip Code</p><p>$</p><p>$</p><p>$</p><p>* Please attach a currently dated borrowing base certificate to this questionnaire</p><p>accounts receivables, personal guarantee etc.</p><p>Telephone #Contact Person Address</p><p>Union Non-Union Union only for select contracts</p><p>Yes NoYes No</p><p>Monthly Quarterly Semi-Annually Annually</p><p>Chief Financial Officer Controller Bookeeper Owner / President</p></li><li><p>REFERENCES</p><p>29. List 3 Industry References</p><p>1</p><p>2</p><p>3</p><p>30. List 2 Major Suppliers:</p><p>1</p><p>2</p><p>PREVIOUS BONDING COMPANIES</p><p>32.</p><p>LIFE INSURANCE IN PLACE FOR OWNERSHIP</p><p>33.</p><p>INSURANCE</p><p>34.</p><p>1</p><p>2</p><p>3</p><p>4</p><p>5</p><p>6</p><p>7</p><p>Name</p><p>Workers Compensation</p><p>Property</p><p>Years known State relationship to your business</p><p>Name of Supplier # of years you have done business with this entity Max Credit Extended ($ amount)</p><p>Name of Surety How Long? Reason for Leaving</p><p>NAME OF OWNER Amount Beneficiary</p><p>-$ </p><p>-$ </p><p>-$ </p><p>-$ </p><p>Coverage Limit of Insurance Broker Name of Carrier Expiration Date</p><p>Umbrella</p><p>Commercial Liability</p><p>Fidelity</p><p>Auto</p><p>Employment Practices</p></li><li><p>35 What is the amount of the surety line of credit you are applying for: $100,000 to $500,000</p><p>$500,000 to $1,000,000</p><p>$1,000,000 to $2,000,000</p><p>$2,000,000 to $3,000,000</p><p>$3,000,000 to $5,000,000</p><p>$5,000,000 to $10,000,000</p><p>Over $10,000,000</p><p>36</p><p>I have read and understand this statement (must be majority shareholder)</p><p>Name Title Date Witness(print name and sign) (print name and sign)</p><p>MISCELLANEOUS</p><p>37 Are the companies or shareholders listed above acting as guarantors for bank, surety, or other obligations for companies not already listed on this questionnaire?If yes, please provide the details:</p><p>COMMENTS</p><p>38. Please use this space to provide additional information regarding your work experiences, history, unique, capabilities, level and degree of computerization, etc., which would permit the surety company to have a more completeunderstanding of your company.</p><p>The undersigned hereby represents that the above statements and responses are accurate and authorizes the Surety Company and/or its Affiliated Companies to conduct the references listed above. The undersigned also provides permission to procure credit report and reference information as we deem necessary.</p><p>PREPARED BY (NAME) POSITION SIGNATURE DATE</p><p>An important note about surety bonds: Surety Bonds which include Bid, Performance or Payment Bonds are NOT insurance policies. They are financial guarantees. The Surety Insurance Company requires reimbursement and indemnification from both the corporation and each principal owner of the business listed above in the event of a contract default. In the event of a default the surety insurance company will look to the assets of the business and if inadequate require personal reimbursement by each owner of the business. Please be sure you are 100% confident in your ability to do the work that has a bond attached to it. Surety Bond Insurance Companies can and do go after your personal assets in the event of a contract default</p><p>Yes No</p><p>Check Box2: Check Box5: Text1: Text2: Text5: Text6: Text7: Text8: Text9: Text10: Text11: Text12: Text13: Text14: Text15: Text16: Text17: Text18: Text19: Text20: Text21: Text22: Text23: Text24: Text25: Text26: Text27: Text28: Text29: Text30: Text31: Text32: Text33: Text34: Text35: Text36: Text37: Text38: Text39: Text40: Text41: Text42: Text43: Text44: Text45: Text46: Text47: Text48: Text49: Text50: Text51: Text52: Text53: Text54: Text3: Text4: Text55: Text56: Text57: Text58: Text59: Text60: Text61: Text62: Text63: Text64: Text65: Text66: Text67: Text68: Text69: Text70: Text71: Text72: Text73: Text74: Text75: Text76: Text77: Text78: Text79: Text80: Text81: Text82: Text83: Text84: Text85: Text86: Text87: Text88: Text89: Text90: Text91: Text92: Text93: Text94: Text95: Text96: Text97: Text98: Text99: Text100: Text101: Text102: Text103: Text104: Text105: Text106: Text107: Text108: Text109: Text110: Text111: Text112: Text113: Text114: Text115: Text116: Text117: Text118: Text119: Text120: Text121: Check Box122: Check Box123: Check Box124: Check Box125: Check Box126: Check Box127: Check Box128: Check Box129: Check Box130: Check Box131: Check Box132: Check Box133: Check Box134: Check Box135: Check Box136: Check Box137: Check Box138: Check Box139: Check Box140: Check Box141: Check Box142: Check Box143: Check Box144: Check Box145: Check Box146: Check Box147: Check Box148: Check Box149: Check Box150: Check Box151: Check Box152: Check Box153: Check Box154: Check Box155: Check Box156: Check Box157: Check Box158: Check Box159: Check Box160: Check Box161: Check Box162: Check Box163: Check Box164: Check Box165: Check Box166: Check Box169: Check Box170: Check Box171: Check Box172: Check Box173: Check Box174: Check Box175: Check Box176: Check Box177: Check Box178: Check Box179: Check Box180: Check Box181: Text122: Text123: Text124: Text125: Text126: Text127: Text128: Text129: Text130: Text131: Text132: Text133: Text134: Text135: Text136: Text137: Text138: Text139: Text140: Text141: Text142: Text143: Text144: Text145: Text146: Text147: Text148: Text149: Text150: Text151: Text152: Text153: Text154: Text155: Text156: Text157: Text158: Text159: Text160: Text161: Text162: Text163: Text164: Text165: Text166: Text167: Text168: Text169: Text170: Text171: Text172: Text173: Text174: Text175: Text176: Text177: Text178: Text179: Text180: Text181: Text182: Text183: Text184: Text185: Text186: Text187: Text188: Text189: Text190: Text191: Text192: Text193: Text194: Text195: Text196: Text197: Text198: Text199: Text200: Text201: Text202: Text203: Text204: </p></li></ul>

Recommended

View more >