GENE LILLY SURETY BONDS CONTRACTOR QUESTIONNAIRE

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GENE LILLY SURETY BONDS CONTRACTOR QUESTIONNAIRE Powered By Docstoc
					    GENE LILLY SURETY BONDS CONTRACTOR QUESTIONNAIRE
         3440 ‘0’ St., PO Box 30553 Lincoln, NE 68503 Phone: 402 475-7700, 800 659-4445, Fax: 402 475-5043
                                             www.genelillysuretybonds.com

1. GENERAL INFORMATION                                                                            _________________________
                                                                                                    DATE



COMPLETE NAME OF ENTITY________________________________________                                        PHONE_______________________________________

                                                                                                       FAX__________________________________________
ADDRESS___________________________________________________________

CITY_________________________________STATE_______ZIP CODE________                                      CONTACT____________________________________


                                                                                                       TITLE________________________________________

2. COMPANY STRUCTURE
CONTRACTING SPECIALTY__________________________________________                                        YEAR STARTED IN BUSINESS________________

AREA OF OPERATION_______________________________________________                                       FISCAL YEAR END__________________________

TYPE OF ORGANIZATION____________________________________________


List Corporate Officers

NAME                           SSN                     AGE              POSITION               %OWNED           NAME OF SPOUSE__________________

NAME                           SSN                     AGE              POSITION               %OWNED           NAME OF SPOUSE__________________

NAME                           SSN                      AGE             POSITION               %OWNED           NAME OF SPOUSE__________________


3. COMPANY BACKGROUND
Is there a current buy/sell agreement among the owners of the business?              YES               NO

Is this agreement funded by life insurance?                                          YES               NO

How many people does your firm employ?                        How many work crews?                     Is your firm union?        YES        NO


4. OWNER BACKGROUND
Has your firm or any of its principals ever petitioned for bankruptcy, failed in business or
defaulted so as to cause a loss to a Surety?                                                           YES                   NO

Is you firm or any of its owners or officers currently involved in any litigation?                     YES                   NO
If yes, please provide an explanation in an attachment.


5. PREVIOUS BONDING INFORMATION                                         NAME OF PREVIOUS BONDING COMPANY
 NAME OF PREVIOUS BONDING COMPANY                                            REASON FOR LEAVING

A.___________________________________________________                   _______________________________________________________________________


6. COMPANY INFORMATION
What percentage of the firm’s work is normally for:                     Government Agencies:                 % Private Owners:                %
What percentage of the firm’s work is normally subcontracted:                %

Are bonds required of subcontractors? YES          NO                   What trades do you normally subcontract?

7. COMPANY ACCOUNTING INFORMATION
Name of your CPA Firm:                                        Contact Person:
         Phone Number:
How often are financial statements prepared?       Annually             Semi-Annually          Quarterly                     Monthly

Do you have an accountant on staff?                YES                  NO
8. COMPANY BANKING INFORMATION
Name of your Bank:                                                                     Contact Person:
         Address:                                                                      Phone Number:

Amount of line of credit:         $                                Expiration Date:

9. LARGEST CONTRACTS                                      List three of your largest contracts
A. Job Name:                                                                    Project Contact:

   Owner:

   Contract Price:                              Gross Profit:                   Completion Date:                            Bonded?           Yes / No


B. Job Name:                                                                    Project Contact:

   Owner:

   Contract Price:                              Gross Profit:                   Completion Date:                            Bonded?           Yes / No


C. Job Name:                                                                     Project Contact:

   Owner:

   Contract Price:                              Gross Profit:                    Completion Date:                           Bonded?           Yes / No

10. SUPPLIER REFERENCES                                   List three of your major suppliers

A. Company:                                                                  Phone Number:

                                                                             Contact Name:

B. Company:                                                                  Phone Number:

                                                                             Contact Name:

C. Company:                                                                  Phone Number:

                                                                             Contact Name:

11. SUB-CONTRACTOR / CONTRACTOR REFRENCES
List three subcontractors (or contractors if you are a subcontractor) that you do business with:

A. Name:                                                  Phone Number:                             Company:
   Job Name:

B. Name:                                                  Phone Number:                             Company:
   Job Name:

C. Name:                                                  Phone Number:                             Company:
   Job Name:

12. ENGINEER or ARCHITECT REFERENCES                                                   List three Engineers or Architects you have done business with

A. Firm :                                                                    Phone Number:

   Contact:                                                                  Job Name:

B. Firm:                                                                     Phone Number:

   Contact:                                                                  Job Name:

C. Firm:                                                                     Phone Number:

   Contact:                                                                  Job Name:

Completed by:                                                     Title:                                                        Date:         .
Please attach additional sheets if necessary.

				
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