Page 266 - Urban Construction Project Management

Insurance and Bonds 221
Exhibit 10-6
1. Name of Firm: __________________________________________________________
Contractor bonding
2. Address:
questionnaire.
3. Fiscal Year End ________
4. Phone: ________________________________ 4a. Fax: _______________________
5. Contracting Specialty:
6. Contact Person:
7. Title
8. Year Business Started: _________________________
9. Type of Business __ Corp __ Part. __ Prop. __ Sub S. Corp
10. State of Incorporation: _________________________
11. Area of Operation ____________________________
12. List the corporate officers, partners or proprietors of your firm:
Name Position Owner Percent Date Name of Spouse
A)
B)
C)
D)
E)
13. Will the above individuals and spouses personally indemnify Surety?
__ Yes __ No
14. If no, explain: ___________________________________________________________
________________________________________________________________________
15. Is there a buy/sell agreement among the owners of the business?
__ Yes __ No
16. Is this agreement funded by life insurance? __ Yes __ No
17. Corp. Indemnity? __ Yes __ No
18. Cross Corp. Indemnity? __ Yes __ No
19. How many people does your firm employ? _________________
20. How many work crews? ____________
21. 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
22. If yes, please explain: ____________________________________________________
________________________________________________________________________
23. Is your firm or any of its owners or officers currently involved in any litigation?
__ Yes __ No
24. If yes, please explain: ___________________________________________________
________________________________________________________________________
25. What percentage of the firm’s work is normally for:
26. Government Agencies: _______ % Private Owners: _______ %
27. What percentage of the firm’s work is normally subcontracted: _______ %
28. Are bonds required of subs? ___ Yes ___ No
(Continued)