Word-Import - 1

Firm Name:

Address:

Phone: Fax:

E-Mail: ___________________________ Website:

Year Business Started: _____________ Federal I.D. No:

Past or present projects with Brown Construction:

___________________________________________________________________________

Contractor’s License:

State: ______ No.: __________ Classification ________

State: ______ No.: __________ Classification ________

State: ______ No.: __________ Classification ________

Subcontractor: Yes No [ ] Vender / Supplier: Yes [ ] No [ ]

Union / Signatory: Yes No [ ] If yes, Union Affiliation(s): ___________________

Affiliation (ABC, AGC etc.) __________________________________________________

All financial information is confidential and will be shredded once reviewed by our CFO.

Please attach a copy of your most recent audited or reviewed financial statements for your last fiscal year including an income statement , balance sheet, statement of changes in owner’s equity and statement of cash flows.  In addition to these statements, please provide a copy of your most recent interim financial statements for this activity year-to-date. 

What is your projected volume of work completed for this fiscal year? $

What was your company’s revenue for the last three years?

20___ _______________ 20___ ______________ 20___ ________________

What was your company’s net income for the last three years?

20___ _______________ 20___ _______________ 20___ ________________

Company’s Dun & Bradstreet No.: ______________________

Has your company (either under current or previous name) ever filed for bankruptcy protection with the U.S. Bankruptcy Court? Yes [ ] No

If yes, Date of Filing _______________ Classification of Filing ________________

Have any principals of your company, been affiliated with any type of bankruptcy? Yes [ ] No

If yes, please provide a complete explanation, including dates, on a separate page.

Banking

Name & Branch Years with Bank

Address ________________________________________________________________________

Contact Person ______________________________________ Phone No. ___________________

Please attach a letter from your bank confirming your relationship with them, including

whether or not you have a line of credit and if all accounts have been handled as agreed.

Bonding

Are you bondable ? Yes [ ] No If yes, what is your current bonding rate ? _______%

Bonding Company ________________________________________ Years with Surety_________

Surety Broker / Agent _____________________________________ Years with Agent _________

Contact Person _________________________________________ Phone No. ________________

Bonding Capacity – Per Project $ _______________________ Aggregate $ _________________

Last Bond Issued – Date ________________ Amount $ _________________ Rate % _________

Please attach a current reference letter from your bonding company stating your single and aggregate bonding limits

Insurance

Insurance Broker/Agent ______________________________________ Years with Agent ________

Contact Person __________________________________ Phone No. ________________________

Please attach sample Certificate of Insurance as verification of your current policies and limits.

Suppliers

Supplier Name ____________________________________ Contact _________________________

Address ___________________________________________________ Phone No ______________

Supplier Name ____________________________________ Contact _________________________

Address ___________________________________________________ Phone No ______________

Supplier Name ____________________________________ Contact _________________________

Address ___________________________________________________ Phone No ______________