Download PDFContractor Questionnaire "*" indicates required fields Name* First Last FEIN # Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Email* Phone*Website Business Type C-Corp S-Corp LLC Individual Partnership Joint Venture Contact person First Last Date Organized MM slash DD slash YYYY Fiscal Yr End FedEx # Area of operation Predecessor organizations Corporate Officers / Partners / Proprietors / OwnersNameAgeTitle%Spouse Please enter a value between 0 and 100. Add Remove% - Percentage of ownership.Contracting Firm Subsidiaries or AffiliatesFirm NameOwners / PCT. OwnedType of Business Add RemoveBuy / Sell Agreement or Continuation Plan* Yes No Buy / Sell Agreement or Continuation Plan in place in case of death or disability of owner?How many people does your firm employ?Number of work crews Bankruptcy, Failed in Business, or Defaulted? Yes No Has your firm, or any of its owners or affiliates, ever petitioned for bankruptcy, failed in business or defaulted so as to cause a loss to surety?Bankruptcy, Failed in Business, or Defaulted Explanation:*Please explain the circumstances above.Involved in Litigation? Yes No Is your firm, or any of its owners or officers, currently involved in any litigation?Involved in Litigation Explanation*Please explain the circumstances above. Type of Work Usually Performed Residential New Highway Electrical Apartment Public Building Plumbing School Bridges Excavation A/C Water Systems Landscaping Commercial Sewer Other Describe the Other Types of Work % As Prime ContractorPlease enter a number from 0 to 100.% As SubcontractorPlease enter a number from 0 to 100.% Public Work Sublet to OthersPlease enter a number from 0 to 100.% Private Work Sublet to OthersPlease enter a number from 0 to 100.What trades do you normally subcontract? What trades do you do yourself? Largest work program? $Please enter a number greater than or equal to 0.Year of largest work programPlease enter a number greater than or equal to 1991.Largest single job you expect to do during the next year? $Please enter a number greater than or equal to 0.Largest uncompleted work program expected during the next 12 months? $Please enter a number greater than or equal to 0.Expected annual sales volume over the next year? $Please enter a number greater than or equal to 0. Is your firm Union? Yes No Accountant / CPA Name Accountant / CPA Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Accountant / CPA PhoneAccountant / CPA FaxOn what basis are financial statements prepared? Cash Completed Job Accrual % of completion On what level of assurance are the Year End financial statements prepared? CPA audit Review Compilation Do you or your CPA prepare mid-year statements? Yes No Bank Name Bank Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Bank PhoneBank FaxLine of Credit Amount $Please enter a number greater than or equal to 0.Account Expiration Date MM slash DD slash YYYY How is the credit secured? Previous Bonding CompaniesNameReasons for leaving Add Remove Five Largest Contracts Below please list your five largest contracts.Contract 1Job 1 Name Job 1 PriceJob 1 Gross ProfitJob 1 Completion Date MM slash DD slash YYYY Job 1 Bonded? Yes No Job 1 Owner Job 1 Contact Job 1 PhoneJob 1 FaxJob 1 Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Contract 2Job 2 Name Job 2 PriceJob 2 Gross ProfitJob 2 Completion Date MM slash DD slash YYYY Job 2 Bonded? Yes No Job 2 Owner Job 2 Contact Job 2 PhoneJob 2 FaxJob 2 Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Contract 3Job 3 Name Job 3 PriceJob 3 Gross ProfitJob 3 Completion Date MM slash DD slash YYYY Job 3 Bonded? Yes No Job 3 Owner Job 3 Contact Job 3 PhoneJob 3 FaxJob 3 Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Contract 4Job 4 Name Job 4 PriceJob 4 Gross ProfitJob 4 Completion Date MM slash DD slash YYYY Job 4 Bonded? Yes No Job 4 Owner Job 4 Contact Job 4 PhoneJob 4 FaxJob 4 Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Contract 5Job 5 Name Job 5 PriceJob 5 Gross ProfitJob 5 Completion Date MM slash DD slash YYYY Job 5 Bonded? Yes No Job 5 Owner Job 5 Contact Job 5 PhoneJob 5 FaxJob 5 Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code List Five of your Major Suppliers Below please list five of your major suppliers.Supplier 1Supplier 1 Name Supplier 1 Contact Supplier 1 PhoneSupplier 1 Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Supplier 2Supplier 2 Name Supplier 2 Contact Supplier 2 PhoneSupplier 2 Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Supplier 3Supplier 3 Name Supplier 3 Contact Supplier 3 PhoneSupplier 3 Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Supplier 4Supplier 4 Name Supplier 4 Contact Supplier 4 PhoneSupplier 4 Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Supplier 5Supplier 5 Name Supplier 5 Contact Supplier 5 PhoneSupplier 5 Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Key Personnel, Foreman, or SupervisorsNamePositionYears ExperiencePrevious Employer Add Remove Life Insurance in Effect on Owners or Key Personnel Below please list any life insurance plans in effect on the owners or key company personnel.Life Insurance 1Life Insurance 1 Holder First Last Life Insurance 1 Company Life Insurance 1 Beneficiary Life Insurance 1 Amount $Life Insurance 1 Cash Value $Life Insurance 2Life Insurance 2 Holder First Last Life Insurance 2 Company Life Insurance 2 Beneficiary Life Insurance 2 Amount $Life Insurance 2 Cash Value $Life Insurance 3Life Insurance 3 Holder First Last Life Insurance 3 Company Life Insurance 3 Beneficiary Life Insurance 3 Amount $Life Insurance 3 Cash Value $ Insurance Coverage Currently in Effect OR attach copies of your current certificates:General LiabilityGeneral Liability Limits $Limits in '000'sGeneral Liability Insurance Company General Liability Expiration Date MM slash DD slash YYYY Automotive LiabilityAutomotive Liability Limits $Limits in '000'sAutomotive Liability Insurance Company Automotive Liability Expiration Date MM slash DD slash YYYY Workers CompWorkers Comp Limits $Limits in '000'sWorkers Comp Insurance Company Workers Comp Expiration Date MM slash DD slash YYYY Conclusion That concludes the questionnaire. 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