SUBMISSION CHECKLIST CONTRACT BONDS

Transcription

1 4446 State Route 42, Ste. B Monticello, NY T (845) / F (845) SUBMISSION CHECKLIST CONTRACT BONDS We appreciate this opportunity to earn your business. To ensure the expeditious review of your bonding submission, please be as complete and thorough as possible. Keep in mind that the following items are required only for the initial review, and upon approval, subsequent bonding requests will simply require job specific information and periodic updates. For your convenience, forms for Items 1-9 are either attached or can be made available to you. 1. Job Profile Form 2. Bond Request Form 3. Contractor Questionnaire 4. Resumes of Owners & Key Personnel 5. Any Reference Checks from Suppliers and/or Contractors/Owners 6. Schedule of Contracts (Work in Process Schedule) 7. Credit Authorization Form (completed & signed by all principals, spouses & indemnitors) 8. Personal Financial Statement (completed & signed by all principals, spouses & indemnitors) 9. Bank Reference Letter 10. Corporate Financial Statements (may be internally prepared statements such as Quickbooks) a. Past 2 Fiscal Years b. Interim Year-to-Date Statements (if fiscal statement is over six months old) 11. Tax Returns (signed copies) a. Personal for Past 2 Years b. Corporate for Past 2 Years 12. Proof of Insurance / Insurance Certificate 13. Copy of Project Contract 14. Job Cost Breakdown / Job Estimate 15. Any Specific Bond Forms or Bonding Requirements from Obligee (project owner or prime contractor) We strive to provide superior service, so your submission will be reviewed promptly. The above information can be submitted via either at underwriting@upperhudson.com or facsimile at (845) Rev. 08/10

2 4446 State Route 42, Ste. B Monticello, NY T (845) / F (845) Job Profile Contractor: Date: Project Name and/or Contract No.: Job Location: Job Description in Detail: Contract Price $ Job Breakdown Labor Cost Subcontractors Material/Supplies Cost General Conditions/Overhead Job Site Overhead Home Office Total Direct Job Cost Net Job Profit $ $ $ $ $ $ $ Is the job: Union Non-Union Prevailing Wage Public Private Anticipated Start Date: Completion Date: Describe work to be performed by direct labor: Describe work to be performed by subcontractors: Describe materials to be provided by suppliers: Rev. 8/10

3 4446 State Route 42, Ste. B Monticello, NY T (845) / F (845) BOND REQUEST FORM Agency Agency Contact Contractor Date Obligee Contact (Exactly as it is to appear on the bond) Obligee Address Telephone Project Name and/or Contract No. Job Location Job Description Architect/Engineer Telephone Anticipated Start Date Completion Time Design Build? Yes No Retainage % Warranty Period Penalties/Damages Bond Form: AIA Obligee Government Insurance Company (If included in the specifications, please provide bond forms or other requirements of the surety.) For Bid Bonds Bid Date & Time Estimated Bid $ Bid Bond Amount % or $ For Final Bonds Contract Date Contract Price $ Contract was: Bid Negotiated Low Bidder (Name) $ 2 nd Bidder $ (Name) 3 rd Bidder $ (Name) Comments/Special Instructions Delivery Instructions: No. of Original Copies Needed Date Needed Send via First Class Mail to Send via FedEx to FedEx Account No. Signature Print Name Date Rev. 08/10

4 CONTRACTOR QUESTIONNAIRE & APPLICATION GENERAL COMPANY BACKGROUND 4446 State Route 42, Ste. B Monticello, NY T (845) / F (845) ) Company Name 2) (Exact legal name as it appears on contractor s license) 3) Business Address Street City County State Zip 4) Phone ( ) Fax ( ) Mobile ( ) 5) Business Type Corporation (Sub S Corp? Yes No ) Partnership Sole Proprietor L.L.C. 6) Construction Specialty 7) Year Started: 8) Fed. Tax ID # 9) Construction License(s) 10) Website (List license no. and state) 11) List of Owners / Indemnitors (Please provide information below on all owners; use additional sheet if necessary) Name Address City/State/Zip DOB SS# Driver s License (State & No.) % Ownership Position/Title Spouse Name DOB SS# Name Address City/State/Zip DOB SS# Driver s License (State & No.) % Ownership Position/Title Spouse Name DOB SS# Name Address City/State/Zip DOB SS# Driver s License (State & No.) % Ownership Position/Title Spouse Name DOB SS# Name Address City/State/Zip DOB SS# Driver s License (State & No.) % Ownership Position/Title Spouse Name DOB SS# Rev. 08/10 1 of 5

5 12) Will the above individuals and spouses personally indemnify the Surety? Yes No If no, please explain: 13) Is there a buy/sell agreement among the owners of the business? Yes No If yes, is this agreement funded by life insurance? Yes No 14) Please list key personnel to your operations: Name Position Birth Year Years Experience 15) Please list all subsidiaries and affiliated companies: Company Name Owner s Name % of Ownership Type of Business 16) List the three largest contracts completed in the last five years: Owner/ General Contractor Type of Work Location (City/State) Contract Amount Completion Date Final Gross Profit Contact (Name/Phone#) 17) List the two largest jobs you presently have underway: Owner/ General Contractor Type of Work Location (City/State) Contract Amount % of Completion Estimated Gross Profit Estimated Completion Date 18) Annual Volume: $ 19) Is your equipment: owned leased Rev. 08/10 2 of 5

6 20) Percentage of work performed: % Public % Private; as a General Contractor % Subcontractor % Percentage of work you: self-perform % sub out to others % 21) What trades do you perform? What trades do you sub out? 22) Territory in which you perform work (present & planned) 23) Please check yes or no to the following questions: Company Officer or Owner a. Have there been any changes in ownership control? Yes No Yes No b. Failed in business or declared bankruptcy? Yes No Yes No c. Failed to complete a contract or assessed with delay penalties? Yes No Yes No d. Been involved in any litigation in the past 5 years? Yes No Yes No e. Been in claims with a surety? Yes No Yes No Explain all yes answers below (use additional sheet if necessary) 24) List your three major suppliers: Supplier Name Address, City, State, Zip Contact Person Telephone & Fax FINANCIAL / ACCOUNTING INFORMATION 25) Do you use a CPA? Yes No 26) Date of Fiscal Year End If yes, please provide the following: Firm Name Address, City, State, Zip Contact Person Telephone & Fax 27) On what basis are financial statements prepared? Cash Accrual Completed Job % of Completion 28) Classification of financial statements In House Compilation Reviewed CPA Audit 29) How often are financial statements prepared? Annually Semi-Annually Quarterly Rev. 08/10 3 of 5

7 BANKING INFORMATION 30) Name of Bank 31) Contact 32) Address of Bank Street City State Zip 33) Phone ( ) Fax ( ) 34) Account Number(s) 35) Do you have a line of credit? Yes No Amount of Line $ Expiration Date Amount in Use $ How Secured? 36) Has your company ever been bonded? Yes No BONDING & INSURANCE INFORMATION If yes, previous surety company Reason for changing Largest single bonded contract $ 37) Has any collateral been deposited with any prior surety? Yes No If yes, amount $ Has collateral been released? Yes No N/A 38) Liability Insurance Company Coverage Limits $ Expiration Date 39) List any life insurance in effect on officers or key personnel: Policyholder Beneficiary Amount Insurance Company $ $ $ $ Rev. 08/10 4 of 5

8 The undersigned hereby affirms that the statements, information and responses contained herein are true and accurate, and are made to induce the Surety to execute surety bonds. The applicants and indemnitors authorize Hudson Underwriter Services, LLC, its affiliates, or sureties, to verify this information and to obtain additional information as it considers necessary from any source including obtaining a credit report. Any person who knowingly and with intent to defraud any insurance company or person files an application containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime under applicable law. Signature Date Printed Name Title Company Name AGENCY INFORMATION Agency Name Agency Code Address or Branch Rev. 08/10 5 of 5

9 4446 State Route 42, Ste. B Monticello, NY T (845) / F (845) CONTRACTOR RESUME Resume for (Name) Company Position/Title PERSONAL INFORMATION Home Address Street City State Zip Phone ( ) Date of Birth SS# Spouse SS# EDUCATION High School Diploma? Yes No College or Tech School Degree or Certificate WORK EXPERIENCE No. of Years with Current Company Starting Position with Company Current Responsibilities During the time I have been with the current company, we have successfully completed approximately projects ranging in size from $ to $. Past Experience Company Name Address From To Position/Responsibilities Signature Date Rev. 08/10

10 4446 State Route 42, Ste. B Monticello, NY T (845) / F (845) REFERENCE CHECK We are a surety bonding company with whom the below applicant has applied for a surety bond. The applicant has furnished your name as a reference. We would appreciate the courtesy of a prompt reply to the following brief questions and wish to assure you that any information provided will be kept confidential and without responsibility on your part. Contractor/Applicant Date Name of Reference (Company) (Supplier Subcontractor ) Contact Person Name Phone QUESTIONS How long have you known the applicant? Supplier: What was the largest credit extended? When? Does applicant pay/settle promptly? Yes No Have you ever limited applicant s purchases? Yes No Contractor/: What was the largest job performed? When? Owner Does applicant manage jobs professionally and satisfactorily? Yes No Does applicant pay/settle with suppliers/subs promptly? Yes No What is your general opinion regarding the applicant s general reputation, financial responsibility and ability as a contractor? Completed by: Signature Date Printed Name Internal PLEASE FAX BACK TO (845) OR TO UNDERWRITING@UPPERHUDSON.COM Rev. 06/10

11 SCHEDULE OF CONTRACTS 4446 State Route 42, Ste. B Monticello, NY T (845) / F (845) (Include All Bonded & Unbonded Jobs If Cost Plus, Indicate Up-Set Price) Name of Contractor Date Owner/Job Description Start Date Estimated Complete Date Bonded? Y/N Contract Price (incl. Approved Change Orders) Original Estimated Costs (incl. Approved Change Orders) Total Billed To Date Total Costs To Date Total Revised Estimated Costs to Complete Totals $ $ $ $ $ Contracts Completed Since Last Fiscal Closing Statement or Last Report Job Description Owner Final Contract Price Total Cost Gross Profit/Loss Total Uncompleted Work $ Total Uncompleted Work by Subcontractors $ Subcontractors Bonded $ Subcontractors Unbonded $ Signature: Totals $ $ $ Printed Name: Title: Rev. 08/10

12 4446 State Route 42, Ste. B Monticello, NY T (845) / F (845) CREDIT AUTHORIZATION FORM I hereby authorize Hudson Underwriter Services Group, LLC ( HUSG ), its affiliates, or sureties to request and review all data you deem appropriate about me, including credit, background and driver s license reports from agencies, now and for all future reviews, extensions, or renewals of surety credit to me or others. Such information will only be shared with HUSG, its affiliates, sureties or authorized agents for the purposes of underwriting and issuing surety bonds to me or my affiliates. Contractor/Company Name Signature Printed Name Home Address DOB SS# Driver s License (State & No.) Signature Printed Name Home Address DOB SS# Driver s License (State & No.) Signature Printed Name Home Address DOB SS# Driver s License (State & No.) Signature Printed Name Home Address DOB SS# Driver s License (State & No.) Signature Printed Name Home Address DOB SS# Driver s License (State & No.) Signature Printed Name Home Address DOB SS# Driver s License (State & No.) Rev. 08/10

13 4446 State Route 42, Ste. B Monticello, NY T (845) / F (845) PERSONAL FINANCIAL STATEMENT Person Name Address Phone Company Position/Title Name Address I authorize Hudson Underwriter Services Group, LLC ( HUSG ), its affiliates, or the sureties to request and review all data you deem appropriate about me, including credit reports from agencies, now and for all future reviews, extensions, or renewals of surety credit to me or others. I am sole owner of all assets listed in this statement. Except as disclosed in this statement, no one else has any interest in or claim on these assets, and none of the assets listed has been assigned, pledged, or mortgaged. I certify that the information herein is complete and true as of the date opposite by signature, or as of / /. I understand that HUSG, its affiliates and sureties may rely upon this information from time to time in extending credit to me or others and may continue to so rely until (a) I notify HUSG in writing of any material adverse change in such information; or (b) HUSG is provided with new financial statements. BY SIGNING BELOW, I EXPRESSLY PERMIT HUSG TO SHARE WITH ITS AFFILIATES AND SURETIES ANY AND ALL OF MY PERSONAL FINANCIAL INFORMATION OBTAINED IN CONNECTION WITH THIS TRANSACTION, INCLUDING ANY INDIVIDUAL CONSUMER CREDIT REPORT OBTAINED NOW OR IN THE FUTURE. I UNDERSTAND THAT I AM NOT REQUIRED TO AUTHORIZE THE SHARING OF SUCH INFORMATION IN ORDER TO TRANSACT BUSINESS WITH HUSG. Signature Date ASSETS LIABILITIES Cash on hand & in Banks (Schedule A) $ Notes Payable to Banks (Schedule E) $ Stocks & Bonds- at market (Schedule B) Notes Payable to Others (Schedule E) Real Estate- at market (Schedule C) Real Estate Mortgages Payable (Schedule C) Autos & Trucks Charge Accounts & Bills Payable (Schedule F) Accounts or Notes Receivable Loans on Cash Value of Life Insurance (Schedule D) Cash Value of Life Insurance (Schedule D) Other Liabilities (Itemize) Other Assets (Itemize) Total Liabilities $ Net Worth (Total Assets Minus Total Liabilities) Total Assets $ Total Liabilities & Net Worth $ INCOME INFORMATION Gross Salary- Annual $ Date of Birth Bonus Social Security Number PERSONAL INFORMATION Dividends Have you ever been bankrupt? Yes No Rental Income Are you a defendant in any legal action? Yes No Other Income (Itemize) Are you an owner, partner or officer of any other venture? Yes No Total Income $ Do you endorse, guaranty, or co-sign any loan not listed above (Schedule G)? Are you under indictment, on probation or parole, or ever been charged or convicted for a criminal offense? Yes Yes No No Are any of your taxes past due? Yes No Do you have any corporate or personal assets held in trust or escrow accounts? If you answered yes to any of the above questions, please explain below (use additional sheet if necessary): Yes No COMPLETE INFORMATION ON PAGE 2 WHERE APPLICABLE Rev. 08/10 1of 2

14 SCHEDULE A CASH ON HAND & IN BANKS Name of Bank Type of Account Maturity (if any) Assigned to (if any) Amount $ Total $ SCHEDULE B STOCKS & BONDS No. of Shares Description Owner(s) of Record Assigned to (if any) Market Value $ Total $ SCHEDULE C Location & Property Use REAL ESTATE Owner(s) of Record Year Acquired Mortgage Mortgage Cost Mortgage Held By Market Value Balance Maturity $ $ $ Total $ Total $ SCHEDULE D LIFE INSURANCE Face Amount Insurance Company Beneficiary $ $ $ Loans on Cash Value of Policy Assigned to (if any) Cash Value Total $ Total $ SCHEDULE E NOTES PAYABLE TO BANKS & OTHERS Name of Creditor Type of Note Maturity Secured By Endorsed or Guaranteed by Present Value $ Total $ SCHEDULE F CHARGE ACCOUNTS & BILLS PAYABLE (list only amounts over $500) Owed To Type of Account Secured by Present Balance $ Total $ SCHEDULE G Name of Borrower LOANS ENDORSED, GUARANTEED OR CO-SIGNED How Obligated Type of Loan (endorser, guarantor or co-signer) Secured by $ Present Balance Total $ Rev. 08/10 2 of 2

15 [Bank Letterhead] [Insert Date] [Contractor Name] [Address] [City, State, Zip] To Whom It May Concern: As requested by our depositor [Contractor Name] the following information is provided from our records. [Contractor Name] is a valued customer of our branch. They have maintained accounts with our bank since [Date]. They currently have a balance of [Amount] on account and maintain an average annual balance of [Amount]. The above noted client has always maintained their accounts in a very satisfactory manner. [Information on credit line, if any] We are pleased to be of service to you. Should you require any additional information, please feel free to contact the undersigned. Very truly yours, [Bank Officer] [Title] [Phone #]

16 4446 State Route 42, Ste. B Monticello, NY T (845) / F (845) Job Profile Contractor: Date: Project Name and/or Contract No.: Job Location: Job Description in Detail: Contract Price $ Job Breakdown Labor Cost Subcontractors Material/Supplies Cost General Conditions/Overhead Job Site Overhead Home Office Total Direct Job Cost Net Job Profit $ $ $ $ $ $ $ Is the job: Union Non-Union Prevailing Wage Public Private Anticipated Start Date: Completion Date: Describe work to be performed by direct labor: Describe work to be performed by subcontractors: Describe materials to be provided by suppliers: Rev. 8/10

17 4446 State Route 42, Ste. B Monticello, NY T (845) / F (845) BOND REQUEST FORM Agency Agency Contact Contractor Date Obligee Contact (Exactly as it is to appear on the bond) Obligee Address Telephone Project Name and/or Contract No. Job Location Job Description Architect/Engineer Telephone Anticipated Start Date Completion Time Design Build? Yes No Retainage % Warranty Period Penalties/Damages Bond Form: AIA Obligee Government Insurance Company (If included in the specifications, please provide bond forms or other requirements of the surety.) For Bid Bonds Bid Date & Time Estimated Bid $ Bid Bond Amount % or $ For Final Bonds Contract Date Contract Price $ Contract was: Bid Negotiated Low Bidder (Name) $ 2 nd Bidder $ (Name) 3 rd Bidder $ (Name) Comments/Special Instructions Delivery Instructions: No. of Original Copies Needed Date Needed Send via First Class Mail to Send via FedEx to FedEx Account No. Signature Print Name Date Rev. 08/10

18 CONTRACTOR QUESTIONNAIRE & APPLICATION GENERAL COMPANY BACKGROUND 4446 State Route 42, Ste. B Monticello, NY T (845) / F (845) ) Company Name 2) (Exact legal name as it appears on contractor s license) 3) Business Address Street City County State Zip 4) Phone ( ) Fax ( ) Mobile ( ) 5) Business Type Corporation (Sub S Corp? Yes No ) Partnership Sole Proprietor L.L.C. 6) Construction Specialty 7) Year Started: 8) Fed. Tax ID # 9) Construction License(s) 10) Website (List license no. and state) 11) List of Owners / Indemnitors (Please provide information below on all owners; use additional sheet if necessary) Name Address City/State/Zip DOB SS# Driver s License (State & No.) % Ownership Position/Title Spouse Name DOB SS# Name Address City/State/Zip DOB SS# Driver s License (State & No.) % Ownership Position/Title Spouse Name DOB SS# Name Address City/State/Zip DOB SS# Driver s License (State & No.) % Ownership Position/Title Spouse Name DOB SS# Name Address City/State/Zip DOB SS# Driver s License (State & No.) % Ownership Position/Title Spouse Name DOB SS# Rev. 08/10 1 of 5

19 12) Will the above individuals and spouses personally indemnify the Surety? Yes No If no, please explain: 13) Is there a buy/sell agreement among the owners of the business? Yes No If yes, is this agreement funded by life insurance? Yes No 14) Please list key personnel to your operations: Name Position Birth Year Years Experience 15) Please list all subsidiaries and affiliated companies: Company Name Owner s Name % of Ownership Type of Business 16) List the three largest contracts completed in the last five years: Owner/ General Contractor Type of Work Location (City/State) Contract Amount Completion Date Final Gross Profit Contact (Name/Phone#) 17) List the two largest jobs you presently have underway: Owner/ General Contractor Type of Work Location (City/State) Contract Amount % of Completion Estimated Gross Profit Estimated Completion Date 18) Annual Volume: $ 19) Is your equipment: owned leased Rev. 08/10 2 of 5

20 20) Percentage of work performed: % Public % Private; as a General Contractor % Subcontractor % Percentage of work you: self-perform % sub out to others % 21) What trades do you perform? What trades do you sub out? 22) Territory in which you perform work (present & planned) 23) Please check yes or no to the following questions: Company Officer or Owner a. Have there been any changes in ownership control? Yes No Yes No b. Failed in business or declared bankruptcy? Yes No Yes No c. Failed to complete a contract or assessed with delay penalties? Yes No Yes No d. Been involved in any litigation in the past 5 years? Yes No Yes No e. Been in claims with a surety? Yes No Yes No Explain all yes answers below (use additional sheet if necessary) 24) List your three major suppliers: Supplier Name Address, City, State, Zip Contact Person Telephone & Fax FINANCIAL / ACCOUNTING INFORMATION 25) Do you use a CPA? Yes No 26) Date of Fiscal Year End If yes, please provide the following: Firm Name Address, City, State, Zip Contact Person Telephone & Fax 27) On what basis are financial statements prepared? Cash Accrual Completed Job % of Completion 28) Classification of financial statements In House Compilation Reviewed CPA Audit 29) How often are financial statements prepared? Annually Semi-Annually Quarterly Rev. 08/10 3 of 5

21 BANKING INFORMATION 30) Name of Bank 31) Contact 32) Address of Bank Street City State Zip 33) Phone ( ) Fax ( ) 34) Account Number(s) 35) Do you have a line of credit? Yes No Amount of Line $ Expiration Date Amount in Use $ How Secured? 36) Has your company ever been bonded? Yes No BONDING & INSURANCE INFORMATION If yes, previous surety company Reason for changing Largest single bonded contract $ 37) Has any collateral been deposited with any prior surety? Yes No If yes, amount $ Has collateral been released? Yes No N/A 38) Liability Insurance Company Coverage Limits $ Expiration Date 39) List any life insurance in effect on officers or key personnel: Policyholder Beneficiary Amount Insurance Company $ $ $ $ Rev. 08/10 4 of 5

22 The undersigned hereby affirms that the statements, information and responses contained herein are true and accurate, and are made to induce the Surety to execute surety bonds. The applicants and indemnitors authorize Hudson Underwriter Services, LLC, its affiliates, or sureties, to verify this information and to obtain additional information as it considers necessary from any source including obtaining a credit report. Any person who knowingly and with intent to defraud any insurance company or person files an application containing any materially false information or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime under applicable law. Signature Date Printed Name Title Company Name AGENCY INFORMATION Agency Name Agency Code Address or Branch Rev. 08/10 5 of 5

23 4446 State Route 42, Ste. B Monticello, NY T (845) / F (845) CONTRACTOR RESUME Resume for (Name) Company Position/Title PERSONAL INFORMATION Home Address Street City State Zip Phone ( ) Date of Birth SS# Spouse SS# EDUCATION High School Diploma? Yes No College or Tech School Degree or Certificate WORK EXPERIENCE No. of Years with Current Company Starting Position with Company Current Responsibilities During the time I have been with the current company, we have successfully completed approximately projects ranging in size from $ to $. Past Experience Company Name Address From To Position/Responsibilities Signature Date Rev. 08/10

24 4446 State Route 42, Ste. B Monticello, NY T (845) / F (845) REFERENCE CHECK We are a surety bonding company with whom the below applicant has applied for a surety bond. The applicant has furnished your name as a reference. We would appreciate the courtesy of a prompt reply to the following brief questions and wish to assure you that any information provided will be kept confidential and without responsibility on your part. Contractor/Applicant Date Name of Reference (Company) (Supplier Subcontractor ) Contact Person Name Phone QUESTIONS How long have you known the applicant? Supplier: What was the largest credit extended? When? Does applicant pay/settle promptly? Yes No Have you ever limited applicant s purchases? Yes No Contractor/: What was the largest job performed? When? Owner Does applicant manage jobs professionally and satisfactorily? Yes No Does applicant pay/settle with suppliers/subs promptly? Yes No What is your general opinion regarding the applicant s general reputation, financial responsibility and ability as a contractor? Completed by: Signature Date Printed Name Internal PLEASE FAX BACK TO (845) OR TO UNDERWRITING@UPPERHUDSON.COM Rev. 06/10

25 SCHEDULE OF CONTRACTS 4446 State Route 42, Ste. B Monticello, NY T (845) / F (845) (Include All Bonded & Unbonded Jobs If Cost Plus, Indicate Up-Set Price) Name of Contractor Date Owner/Job Description Start Date Estimated Complete Date Bonded? Y/N Contract Price (incl. Approved Change Orders) Original Estimated Costs (incl. Approved Change Orders) Total Billed To Date Total Costs To Date Total Revised Estimated Costs to Complete Totals $ $ $ $ $ Contracts Completed Since Last Fiscal Closing Statement or Last Report Job Description Owner Final Contract Price Total Cost Gross Profit/Loss Total Uncompleted Work $ Total Uncompleted Work by Subcontractors $ Subcontractors Bonded $ Subcontractors Unbonded $ Signature: Totals $ $ $ Printed Name: Title: Rev. 08/10

26 4446 State Route 42, Ste. B Monticello, NY T (845) / F (845) CREDIT AUTHORIZATION FORM I hereby authorize Hudson Underwriter Services Group, LLC ( HUSG ), its affiliates, or sureties to request and review all data you deem appropriate about me, including credit, background and driver s license reports from agencies, now and for all future reviews, extensions, or renewals of surety credit to me or others. Such information will only be shared with HUSG, its affiliates, sureties or authorized agents for the purposes of underwriting and issuing surety bonds to me or my affiliates. Contractor/Company Name Signature Printed Name Home Address DOB SS# Driver s License (State & No.) Signature Printed Name Home Address DOB SS# Driver s License (State & No.) Signature Printed Name Home Address DOB SS# Driver s License (State & No.) Signature Printed Name Home Address DOB SS# Driver s License (State & No.) Signature Printed Name Home Address DOB SS# Driver s License (State & No.) Signature Printed Name Home Address DOB SS# Driver s License (State & No.) Rev. 08/10

27 4446 State Route 42, Ste. B Monticello, NY T (845) / F (845) PERSONAL FINANCIAL STATEMENT Person Name Address Phone Company Position/Title Name Address I authorize Hudson Underwriter Services Group, LLC ( HUSG ), its affiliates, or the sureties to request and review all data you deem appropriate about me, including credit reports from agencies, now and for all future reviews, extensions, or renewals of surety credit to me or others. I am sole owner of all assets listed in this statement. Except as disclosed in this statement, no one else has any interest in or claim on these assets, and none of the assets listed has been assigned, pledged, or mortgaged. I certify that the information herein is complete and true as of the date opposite by signature, or as of / /. I understand that HUSG, its affiliates and sureties may rely upon this information from time to time in extending credit to me or others and may continue to so rely until (a) I notify HUSG in writing of any material adverse change in such information; or (b) HUSG is provided with new financial statements. BY SIGNING BELOW, I EXPRESSLY PERMIT HUSG TO SHARE WITH ITS AFFILIATES AND SURETIES ANY AND ALL OF MY PERSONAL FINANCIAL INFORMATION OBTAINED IN CONNECTION WITH THIS TRANSACTION, INCLUDING ANY INDIVIDUAL CONSUMER CREDIT REPORT OBTAINED NOW OR IN THE FUTURE. I UNDERSTAND THAT I AM NOT REQUIRED TO AUTHORIZE THE SHARING OF SUCH INFORMATION IN ORDER TO TRANSACT BUSINESS WITH HUSG. Signature Date ASSETS LIABILITIES Cash on hand & in Banks (Schedule A) $ Notes Payable to Banks (Schedule E) $ Stocks & Bonds- at market (Schedule B) Notes Payable to Others (Schedule E) Real Estate- at market (Schedule C) Real Estate Mortgages Payable (Schedule C) Autos & Trucks Charge Accounts & Bills Payable (Schedule F) Accounts or Notes Receivable Loans on Cash Value of Life Insurance (Schedule D) Cash Value of Life Insurance (Schedule D) Other Liabilities (Itemize) Other Assets (Itemize) Total Liabilities $ Net Worth (Total Assets Minus Total Liabilities) Total Assets $ Total Liabilities & Net Worth $ INCOME INFORMATION Gross Salary- Annual $ Date of Birth Bonus Social Security Number PERSONAL INFORMATION Dividends Have you ever been bankrupt? Yes No Rental Income Are you a defendant in any legal action? Yes No Other Income (Itemize) Are you an owner, partner or officer of any other venture? Yes No Total Income $ Do you endorse, guaranty, or co-sign any loan not listed above (Schedule G)? Are you under indictment, on probation or parole, or ever been charged or convicted for a criminal offense? Yes Yes No No Are any of your taxes past due? Yes No Do you have any corporate or personal assets held in trust or escrow accounts? If you answered yes to any of the above questions, please explain below (use additional sheet if necessary): Yes No COMPLETE INFORMATION ON PAGE 2 WHERE APPLICABLE Rev. 08/10 1of 2

28 SCHEDULE A CASH ON HAND & IN BANKS Name of Bank Type of Account Maturity (if any) Assigned to (if any) Amount $ Total $ SCHEDULE B STOCKS & BONDS No. of Shares Description Owner(s) of Record Assigned to (if any) Market Value $ Total $ SCHEDULE C Location & Property Use REAL ESTATE Owner(s) of Record Year Acquired Mortgage Mortgage Cost Mortgage Held By Market Value Balance Maturity $ $ $ Total $ Total $ SCHEDULE D LIFE INSURANCE Face Amount Insurance Company Beneficiary $ $ $ Loans on Cash Value of Policy Assigned to (if any) Cash Value Total $ Total $ SCHEDULE E NOTES PAYABLE TO BANKS & OTHERS Name of Creditor Type of Note Maturity Secured By Endorsed or Guaranteed by Present Value $ Total $ SCHEDULE F CHARGE ACCOUNTS & BILLS PAYABLE (list only amounts over $500) Owed To Type of Account Secured by Present Balance $ Total $ SCHEDULE G Name of Borrower LOANS ENDORSED, GUARANTEED OR CO-SIGNED How Obligated Type of Loan (endorser, guarantor or co-signer) Secured by $ Present Balance Total $ Rev. 08/10 2 of 2

29 [Bank Letterhead] [Insert Date] [Contractor Name] [Address] [City, State, Zip] To Whom It May Concern: As requested by our depositor [Contractor Name] the following information is provided from our records. [Contractor Name] is a valued customer of our branch. They have maintained accounts with our bank since [Date]. They currently have a balance of [Amount] on account and maintain an average annual balance of [Amount]. The above noted client has always maintained their accounts in a very satisfactory manner. [Information on credit line, if any] We are pleased to be of service to you. Should you require any additional information, please feel free to contact the undersigned. Very truly yours, [Bank Officer] [Title] [Phone #]

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40 4446 State Route 42, Ste. B Monticello, NY T (845) / F (845) Job Profile Contractor: Date: Project Name and/or Contract No.: Job Location: Job Description in Detail: Contract Price $ Job Breakdown Labor Cost Subcontractors Material/Supplies Cost General Conditions/Overhead Job Site Overhead Home Office Total Direct Job Cost Net Job Profit $ $ $ $ $ $ $ Is the job: Union Non-Union Prevailing Wage Public Private Anticipated Start Date: Completion Date: Describe work to be performed by direct labor: Describe work to be performed by subcontractors: Describe materials to be provided by suppliers: Rev.6/10