Rose & Kiernan Inc.

Contractor’s Questionnaire

 

NAME:

STREET:

CITY/STATE/ZIP:

 

Fiscal year end:

 

Phone #:

        

Fax #:

        

  Email:

 

Contact Person/Title:

 

Contracting Specialty:

 

Year business started:

 

Type of Business:

 Corporation  Partnership  Prop  Sub.S. Corp

State of Incorporation:

 

Area of Operation:

 

SIC code/Desc

 

Fed ID#

 

 List the corporate officers, partners or proprietors of your firm:

Name

Yr. of Birth

SS#/Fed ID #

Position

Percent Owned

Name of Spouse

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 List Key Personnel

Name

Position

Previous Employer

Years Experience

 

 

 

 

 

 

 

 

 

 

 

 

 Is there a buy/sell agreement among the owners of the business?            CYes  CNo

 Is this agreement funded by life insurance?            CYes              CNo

 How many people does your firm employ? ________            How many work crews? ___                               

 Is your firm or any of its owners or officers currently involved in any litigation?  

 If yes, explain  ________________________________________________________

__________________________________________________________________  

 

Bonding Needs

Single

$

Aggregate

$

 

Name of Bank:

 

Address:

 

Phone #:

(    )     -

Contact:

 

Amount of line of credit:

$

Expiration Date:

 

                   

Name of CPA:

 

Address:

 

Phone:

 

Contact:

 

 

Tax Basis?

 Cash   Completed Job  Accrual  %of Completion

Financial Basis?

 Cash   Completed Job  Accrual  %of Completion

Quality?

 CPA Audit    Review   Compilation

 Frequency?

 Annually   Semi-annually  Quarterly   Monthly

 

Is your firm union:

Yes   No

 List three of your largest completed contracts:  

Owner/Project

Contract Price

Gross Profit

Completed

Date?

Bonded

Yes/No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 Traded References:

Name

Address

Telephone

Contact

 

 

 

 

 

 

 

 

 

 

 

 

 List any subsidiaries and affiliates of the contracting firm:

Firm Name

Ownership

Type Business

 

 

 

 

 

 

 

 

 

 

 

 

 Please attach copy of current insurance certificate.

 Remarks:

 

 

 

 

Completed by:___________________________________ Date:_________________ 

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