H&H InsuranceAbout US Agency Directory Bonds Client ServicesEmploymentInsurance Contact Use-Mail H & H Insurance!
 
H & H Insurance Services
3160 Campus Drive, Suite 100
Norcross, GA 30071
Telephone (770) 409-0014
Facsimile (770) 368-0404
H & H Insurance can assist you with all of your bond and insurance needs. Please contact us today!


ONLINE CONTRACTOR PROFILE

 

 
Jerry Boutwell Christopher Wortham
  Michael Jones
Name:
Contractor Address:
Type: Proprietorship S Corp.
Partnership Corporation
Company:
Address:
City/State/Zip:
Phone:
Fax:
E-mail:
Date Business Started:
Date Incorporated:
Tax ID #:
Type of Work Performed:
Territory of Operations:
Name of Prior Business
(if applicable):

Owners, Officers, Partners
List All Owners, Officers, Partners, and Spouses.
Name: Name:
Title: % Ownership: Title: % Ownership:
Address: Address:
City/State/Zip: City/State/Zip:
SS #: D.O.B.: SS #: D.O.B.:
SS #: Spouse: SS #: Spouse:
Name: Name:
Title: % Ownership: Title: % Ownership:
Address: Address:
City/State/Zip: City/State/Zip:
SS #: D.O.B.: SS #: D.O.B.:
SS #: Spouse: SS #: Spouse:

Related Companies
List Affiliates, Subsidiaries, or Related Companies in which this Firm or Stockholders have an interest:
Company: Company:
Type of Business: Type of Business:
% Owned: % Owned:
Company: Company:
Type of Business: Type of Business:
% Owned: % Owned:

Key Personnel
List all Key Personnel - Project Managers, Superintendents, Estimators, etc.
Name: Year Born: Name: Year Born:
Position: Position:
How Long Here: How Long Here:
Name: Year Born: Name: Year Born:
Position: Position:
How Long Here: How Long Here:
Total Number of Employees:
Who holds the License for the Firm?

Prior Experience

List Your Five Largest Jobs Completed in the Last Three Years.
1. Project Description and Location:
Contract Price: $ Gross Price: $ Year Completed:
Owner/G.C./Arch./Eng.: Contact:
Address: City/State/Zip:
Phone: Fax:
2. Project Description and Location:
Contract Price: $ Gross Price: $ Year Completed:
Owner/G.C./Arch./Eng.: Contact:
Address: City/State/Zip:
Phone: Fax:
3. Project Description and Location:
Contract Price: $ Gross Price: $ Year Completed:
Owner/G.C./Arch./Eng.: Contact:
Address: City/State/Zip:
Phone: Fax:
4. Project Description and Location:
Contract Price: $ Gross Price: $ Year Completed:
Owner/G.C./Arch./Eng.: Contact:
Address: City/State/Zip:
Phone: Fax:
5. Project Description and Location:
Contract Price: $ Gross Price: $ Year Completed:
Owner/G.C./Arch./Eng.: Contact:
Address: City/State/Zip:
Phone: Fax:

Subcontractor/Supplier References
Percent of Work Subcontracted: % Policy on Managing Subcontractors:
Lien Releases: Yes No
Joint Check: Yes No
Bond: Yes No

List Five Subcontractor References
Company: Contact:
Address: Phone:
City/State/Zip: Fax:
Company: Contact:
Address: Phone:
City/State/Zip: Fax:
Company: Contact:
Address: Phone:
City/State/Zip: Fax:
Company: Contact:
Address: Phone:
City/State/Zip: Fax:
Company: Contact:
Address: Phone:
City/State/Zip: Fax:

List Five Suppliers
Company: Contact:
Address: Phone:
City/State/Zip: Fax:
Company: Contact:
Address: Phone:
City/State/Zip: Fax:
Company: Contact:
Address: Phone:
City/State/Zip: Fax:
Company: Contact:
Address: Phone:
City/State/Zip: Fax:
Company: Contact:
Address: Phone:
City/State/Zip: Fax:
Do You Normally Pay Suppliers: Discount 30 Days 60 Days Over 60 Days

Largest Job/Current Bond Needs
Largest Job Completed: $ Year:
Largest Work Program: $ Year:
Current Bond Needs: Single: $ Work Program: $

Banking
Bank Name: Contact:
Address: City/State/Zip:
Phone:
How is it Secured? 		Do you have a line of Credit? Yes
No
Amount: $

Continuity/Life Insurance
Is there a buy-sell agreement in effect? Yes No
Insured: Insured:
Beneficiary: Beneficiary:
Amount:
Type: Whole Term		 Amount:
Type: Whole Term

Insurance/Bonding
Current Liability Carrier: Agent:
Current Bond Company: Agent:
Have you ever declared bankruptcy or caused a loss to a surety company? Yes No

If you have declared bankruptcy, please explain.

Accounting
Firm Name: Contact:
Fiscal Year End: Phone:
How Many Years has this Firm Prepared Your Financial Statements?
Type of Statement: Compilation Review Audit
Basis of Preparation of Statements:
Cash Completed Contract
Accrual % of Completion
Basis of Tax Payments:
Cash Completed Contract
Accrual % of Completion

Georgia Law requires that we inform you that any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or application containing any false, incomplete, or misleading information is guilty of a felony in the third.

By pressing the submit button below, I authorize H & H Insurance Services, Inc. to contact the individuals and companies given as references to gather information on the credit, character, capacity, and capital of the company and its employees and owners for bonding purposes.

Your Name: Title: Date:

      

Contractor Bond Profile Owned By H & H Insurance Services, inc.

Copyright 2001- 2008
H & H Insurance
Site Terms of Use and Conditions