4/10/2020
1.
PART 1 – APPLICANT GENERAL a.
Named of Applicant (attach list of all named insureds) b.
Address (City State Zip) c.
Web Site Address d.
FEIN Number e.
Duns Number f.
Submitting Broker (Name, Firm,
Address) g.
Primary Contact for SDI h.
Type of Entity i.
Fiscal Year End j.
Years in Business k.
Description of Operations
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4/10/2020
2.
PART 2 – COMPANY OVERVIEW a.
Revenue Last 3 Fiscal Years b.
Current Backlog $ c.
Estimate of Time to Work Through
Backlog d.
% Negotiated vs Lump Sum in
Backlog e.
% Public vs Private in Backlog
Months
%
% f.
g.
Business Plan Volume
Volume by
$ Current Year
$ Current Year + 1
CM
DB
GC
% h.
Of the CM Volume in letter g , what percent is at Risk i.
Jobs under way j.
Self Performed Work k.
Has the Applicant ever defaulted on or failed to finish a project? l.
Has the Applicant ever declared for bankruptcy protection? m.
Have any of the Applicant’s owners ever declared for bankruptcy protection?
Total Number
$ Average Job Size
% of Total
Types of Work
Yes/No
Yes/No
Yes/No
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4/10/2020 n.
Have any of the Applicant’s owners been convicted of a felony or other criminal conduct? o.
Has the Applicant’s Surety ever had to provide funding or take over a project?
Yes/No
Yes/No
3.
PART 3 SUB CONTRACT ADMINISTRATION a.
Sub Contract Volume
Current Year
Past Year b.
Vendor Volume
Current Year
Past Year c.
Sub Contract and Vendor Volume
Estimate in Business Plan d.
3 Largest Projects by Revenue,
State , Market Type & Duration e.
% of Sub Contracts that are
Bonded
$
1
2
3
% f.
% of Vendors that are Bonded % g.
Sub / Vendor Bonding
Requirements (e.g. Contract Size,
Special Trades, etc) h.
List all defaulted – terminated Contracts in the past 60 months. Include Name, Location,
Contract Value, Trade Type, and Loss Estimate over the Original Contract Value
Name Date Location Contract Value Loss Estimate
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4/10/2020 i.
Total Estimated Number of
Subcontractors j.
Largest Subcontractor Value k.
Total Estimated Number of
Vendors l.
Largest Vendor Value m.
Please Provide Information on the Size Distribution of Current Subcontractors and Vendors
Past 24 – 36 Months in an
compatible format of all subcontracts and vendor agreements, including volume Sample Shown
Job Name # Sub Name
10003-16010 XYZ Electric, Inc.
10003-06105 ABC Company, LLC
09011-16010 DEF Electric, Inc.
09010-15100 AAAenney's, Inc.
10003-15500 Engineering&Mechncl
10003-04010 Reliable , LLC
09011-15100 Mechanical, LLC
10003-09201 Drywall, LLC
10003-15400 Plumbing Co., Inc.
09011-08410 Glass ,Inc
09010-11400 Brothers Srvc
10003-02300 Civil Inc.
Date of Contract
1/1/2010
12/2/2012
3/4/2011
4/4/2010
3/1/2013
10/10/2011
1/1/2010
12/2/2012
3/4/2011
4/4/2010
3/1/2013
10/10/2011
Original
2,051,994.00
1,499,748.00
1,266,384.00
1,263,322.00
1,073,040.00
1,055,094.00
1,029,821.00
900,000.00
900,000.00
881,717.00
835,007.00
820,000.00
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4/10/2020
4.
PART 4 ADDITIONAL INFORMATION a.
Copies of Sub Contracts Short Form / Long Form b.
Copies of Purchase Orders c.
Company Org Chart d.
Personnel Org Chart e.
Audited Financials Last three years f.
Interim Financials g.
WIPS – Current & Most Recent Y/E h.
Risk Review Procedures i.
Go / No Project Selection Matrix j.
Contractor Default Procedures k.
List of 5 largest Sub Contracts and Aggregate Exposure on Each l.
List of 5 largest PO’s m.
Lending Line – Bank Name and Length Current Use n.
LOC Line & Current use o.
CPA Firm p.
Surety Line Job & Aggregate q.
P&C Carrier r.
10-year GL Loss Run s.
QA QC Manual t.
Lien Release Forms u.
Job Kickoff Protocols v.
Sub On Site Control – Communication Plan
Signature & Date
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