Performance and Payment Bonds Submission Requirements 1) Request for Performance and Payment Bonds. (Forms attached for your convenience, please return only with a Performance and or Payment Bond Request. Keep these as your originals) 2) Cost Breakdown (Form Attached to be submitted with specific job/bond request) 3) Contractors Questionnaire (Form Attached, please fill out completely, sign and return) 4) Business Bank Reference Letter (Form Attached. Please forward directly to your banker to complete and return to our office) OR current business bank, investment and line of credit statements. 5) CPA Prepared Business Financial Statements for the past three (3) years and a Current Interim Business Financial Statement (If you need a CPA, please feel free to contact me for a referral) 6) Personal Bank & Investment Statements 7) Personal Financial Statement for each owner (Form Attached if needed - It should be concurrent with business year end Please complete and sign where indicated) 8) Current Work on Hand Schedule (Form Attached) 9) Blanket Credit Authorization Letter (Form Attached) 10) Resume of all key personnel/owners (Form Attached if needed) 11) Copy of Contractors State License 12) Proof of General Liability and Workers Compensation Insurance CMGIA-SNIC-SUR-003-05/12
Principal: Address: Telephone: Contact Person: Performance/Payment Bond Request PRINCIPAL INFORMATION (Name as it is to appear on bond. Individual/Firm s legal name) Fax: Fed X # Obligee: Address: Contact Person: OBLIGEE INFORMATION Telephone: BOND INFORMATION Percentage of Payment Bond %: Percentage of Performance Bond %: Bond Amount: $ Needed: Job Description (As it is to appear on bond): Project # Engineers Estimate: $ Limited Warranty Liquidated Damages: $ per Start : Completion : Subcontractor: YES /NO Percentage Subbed: % Copy of the Contract Special Bond Forms Bid Results from the Obligee PLEASE ENCLOSE THE FOLLOWING DOCUMENTS OFFICE USE ONLY Received: Needed: Delivery Instruction: 1. Regular Mail 2. Client pick up 3. Fed Ex ( Overnight Standard) 4. Other Send To: CMGIA-SNIC-SUR-004-05/12
Contractor Questionnaire COMPANY INFORMATION Principal: Fed X # Business Address: City, State, Zip: Telephone: Ownership: Sole Proprietor Partnership Corporation Year Business Started: Year and State of Corporation (If applicable) Is there a Buy/Sell Agreement in Effect? Yes No What Continuity provisions do you have in place for the continuation of the company? County: Fax: Has there been any change in ownership in the past two Years? Company Specialty: List ALL Affiliated Companies: List all Owners (PROVIDE RESUMES): Name, Home Address & Phone % of Ownership Age Yes Title / Responsibility No Individual SS # Marital Status Spouse s Legal Name & SS# What is your geographic area of operation: Are Bonds required from subcontractors or suppliers? If Yes, over what amount? $ Yes No Do you presently own the equipment necessary to complete your work? Yes No If Not, will you be: Buying Leasing Renting What is the largest single contract amount $, and largest total program $ your company will require this year? List all Key Operating Personnel (PROVIDE RESUMES): Name Position / Responsibility Age Time in Position Time in Industry Has your company had any disputes or ever failed to complete a job on schedule? Yes No Has your company, or any of its principals ever petitioned for bankruptcy, failed in business, or defaulted on a contract, been in receivership, been liened by a taxing authority or caused a Surety to suffer a loss? Is there litigation, law suits, or claims pending on completed or uncompleted work? Yes Yes No No If you answer YES to any of these questions, please attach a detailed explanation. Has your company ever been bonded? Yes No If YES, with what Surety? Reason for changing Surety Company: Have you in the past, or do you plan to use more than one Surety at a time? Yes No Is collateral currently posted with any other Surety to secure bonds on behalf of your firm? Yes No What was your largest BONDED job: $ Largest Work program (Bonded & Unbonded): $ CMGIA-SNIC-SUR-008-05/12
List the Five Largest Contracts completed within the past FIVE Years: Phone/Fax/Contact Contract Obligee, Address, City, State, Zip Person Amount Project Name & Description Completed List THREE Prime Suppliers: Supplier Name / Contact City / State Phone # Fax # FINANCIAL BANKING INSURANCE DATA of Fiscal Year End: On what Basis are Business Financial Statements Prepared? Cash Accrual Percentage Completion Completed Contract Classification of Year-End Financial Statements: CPA Audit Reviewed Compilation How often are Financial Statements Prepared? Annually Semi Annually Quarterly Please provide the name, address and phone number of your Accountant: Are any of your Accounts Receivable or retentions assigned, pledged, hypothecated, sold or discounted (other than for your present bank line of credit and bonded contracts) or do you plan to do this in the future? If YES, please explain: Yes No Bank Name: Contact: Address: Phone # City, State, Zip: Do you have an established Line of Credit? Yes How much is currently available: $ No Amount$ Expiration : This Line is: Unsecured Secured Type of Security: General Liability Carrier: Hazardous Liability Insurance Carrier (if applicable): Worker s Compensation Insurance Carrier: Provide a Current Certificate of Insurance The undersigned hereby represents that the herein statements are true and authorizes any bank, creditor or other reference to verify correctness of items in the above statement to the surety. d this Day of, 20 (Name of Company) By: (Signature & Title) CMGIA-SNIC-008-05/12
Job Cost Breakdown Company Name Page of Project Description INCOME AND EXPENSES INCOME EXPENSES Contract Revenue $ 100 % Contractor s Labor Materials / Supplier Total from Attached Sheets Sub-Contractor Labor Total from Attached Sheets OVERHEAD Total Expense $ < > Profit $ Name / Title Signature CMGIA-SNIC-SUR-001-05/12
Business Bank Reference (Bank Name) (Bank Address) Phone #: - Fax #: - Depositor: Account # s: (1) (2) (3) TO BE FILLED OUT AND SIGNED BY A BANK REPRESENTATIVE TO BANK REPRESENTATIVE: The above depositor has given your name as his banking reference in regard to his bonding application. In addition to the following information, any comments would be most helpful in determination of his bonding eligibility. Please use actual dollar amount. 1. Length of time with bank: 2. Total Current Cash Balance: $ 3. Total average account balance for the past six (6) months: 4. Exact amount and terms of existing loans (if any): 5. Amount of established line of credit (if any): 6. Amount of Line of credit used (if any): 7. How is the Line of credit secured?: 8. Line of credit date of expiration: 9. Loans? 10. High: 11. How handles: Comments By: Title: : Thank you for taking the time to complete this information. You can be assured any information given to our company will be held in the strictest confidence. CMGIA-SNIC-SUR-006-05/12
Personal Financial Statement To induce COMPANY to become surety for the Undersigned, or to accept the Undersigned as Indemnitor, the Undersigned submits the following Personal Financial Statement. NOTE: This form to be used ONLY as a Personal Financial Statement. NOT TO BE USED AS A BUSINESS STATEMENT Personal Financial Statement of S.S. # (Name) (Street Address, City, State, Zip) Home Phone No. - Bus. Phone No. -. (Name of Wife/Husband) Current Assets As of, 20 () Current Liabilities Cash on Hand (not in bank).. Cash in following banks (Names & Addresses) Stocks and Bonds (Schedule 1).. Accounts Receivable (Schedule 2). Notes Receivable (Schedule 3)... Other Current Assets (Itemize) : Notes Payable to (Names and Addresses):....... Sales Contracts & Chattel Mtgs (Schedule 6).. Accounts Payable. Current Portion of Long Term Debt Other Current Liabilities (Schedule 6).. Current Year s Income Taxes Unpaid Prior Year s Income Taxes Unpaid. Real Estate Taxes Unpaid... Total Current Assets Total Current Liabilities Fixed Assets Long Term Liabilities Real Estate (Schedule 4) Real Estate (Schedule 4) Residence. Residence Other.. Other. Cash Value of Life Insurance (Schedule 5) Borrowed on Life Insurance (Schedule 5). Other Long Term Debt (Schedule 6) Other Assets and Investments (Schedule 6)... Total Fixed Assets Total Assets Total Long Term Liabilities Net Worth Total Liabilities and Net Worth CONTINGENT LIABILITIES: FOR ENDORSEMENTS OR GUARANTEES $ FOR OTHER PURPOSES $ GIVE DETAILS: CMGIA-SNIC-SUR-007-05/12
SCHEDULES: 1. STOCKS AND BONDS Name of Security No. Shares If any Pledged, State to Whom & For what Purpose Dividends Paid Last TWO Years Market Value Book Value 2. ACCOUNTS RECEIVABLE Totals: Name & Address (Street & City) From Whom Due For What is it Due When Sold When Due Amount Name & Address (Street & City) From Whom Due 3. NOTES RECEIVABLE Total: For What Due How secured Maturity Amount Total: 4. REAL ESTATE Description / Address of Property Title in Name of Market Value Cost Acquired Amount Encumbrance Monthly Payments Monthly Income Totals: 5. LIFE INSURANCE CASH VALUE Name of Company Policy Number Name of Insured Beneficiary Face Value Cash Value Amount Borrowed 6. DETAILS RELATIVE TO OTHER IMPORTANT ASSETS AND LIABILITIES Authority is hereby granted to any individual, firm or corporation, and any financial institution to furnish Contractors Best Insurance Services Inc. upon its request with any information concerning the above statement or pertaining to the Undersigned s financial standing, credit or manner of meeting obligations. Signed & Sealed this Day of, 20 (Signature) (Typed or Printed Name) (Company Name) CMGIA-SNIC-SUR-007-05/12
Schedule of Contracts (Include Bonded and Unbonded if Cost Plus, indicate up-set Pricing) Contractor Name: Prepared: 1 Owner / Job Description 2 Starting 3 Bonded Yes No 4 Contract Price Plus Change Orders 5 Original Estimated Cost Plus Cost of Change Orders 6 Total Billed to Incl. Retainage 7 Total Costs (Direct) to 8 * Total Revised Estimated Cost to Complete 9 Estimated Completion Totals: $ $ $ $ $ *MUST BE A NEW ESTIMATE OF REMAINING COSTS AS OF THIS DATE. INCLUDING UNRECOVERABLE COSTS (NOT COLUMN 5 MINUS 7) CONTRACTOS 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 $ Totals: $ $ $ Subcontractors Unbonded $ PHONE # 866-363-2642 FAX # 866-234-0415 CMGIA-SNIC-SUR-010-05/12
State National Insurance Company administered by: Blanket Authorization Form Authority is hereby granted to any individual, firm or corporation, and any financial institution to furnish State National Insurance Company administered by: Contractor Managing General Insurance Agency, Inc. upon its request, with any information concerning or pertaining to the undersigned s financial standing, credit or manner of meeting obligations. This authorization to remain in force until rescinded by the applicant in writing. A copy of this agreement shall be considered the same as the original. To become a part of and attached to the application for: (Name of Business) (Tax ID #) (Business Address, Street, City, State, Zip) (Principal) (Social Security #) (Home Address, Street, City, State, Zip) (Principal s Signature) () (Name of Business) (Tax ID #) (Business Address, Street, City, State, Zip) (Principal) (Social Security #) (Home Address, Street, City, State, Zip) (Principal s Signature) () CMGIA-SNIC-SUR-005-05/12
Name Company Work Experience: Resume Employment s Company / Institution Name City/State Job Title Work Experience: Details of Position, Awards, or Achievements Employment s Company / Institution Name City/State Job Title Work Experience: Details of Position, Awards, or Achievements Employment s Company / Institution Name City/State Job Title Work Experience: Details of Position, Awards, or Achievements Employment s Company / Institution Name City/State Job Title Details of Position, Awards, or Achievements CMGIA-SNIC-SUR-009-05/12
Work Experience: Employment s Company / Institution Name City/State Job Title Details of Position, Awards, or Achievements Education: s Attended Institution Name City/State Degree/Major Details of Awards or Achievements Accreditations: Professional Memberships: Awards Received: CMGIA-SNIC-SUR-009-05/12