Contractor Profile Report Form
ADVERTISEMENT
1Contractor Profile Report
Job Information
Case Number: __________________________________
Date: ___________________________
Borrower Name:
__
Co-Borrower Name: ____________________________
Property Address: ___________________________________________________________________________________
Contractor Information
Contractor Name: ________________________________________________________
Address: ___________________________________City: ____________________State: ________Zip: _______________
Principal:___________________________________
Social Security #: _______________________
Point of Contact: __________________________________________
Phone Number: ___________________Cell Number: ____________________ Fax Number: __________________
Email: _____________________________________
Organization
Type of Organization:
Corporation
Partnership
LLC
Joint Venture
Individual
Number of years in which organization has been in business? _________
Other Co. Names? ___________________________________________________________________________________
List jurisdictions legally licensed/qualified to conduct business: _______________________________________________
Tax ID Number: _________________________________License Number: _____________________________________
References
Bank: _________________________ Phone: ________________ Name: ________________ Acct #: ________________
Trade: ________________________ Phone: ________________ Name: ________________ Acct #: ________________
Trade: ________________________ Phone: ________________ Name: ________________ Acct #: ________________
Client: ________________________ Phone: ________________ Date of Work
___________________
(must be in past 12 mos.)
Type of Work: ______________________________________________________________________________________
Client: ________________________ Phone: ________________ Date of Work
___________________
(must be in past 12 mos.)
Type of Work: ______________________________________________________________________________________
Client: ________________________ Phone: ________________ Date of Work
___________________
(must be in past 12 mos.)
Type of Work: ______________________________________________________________________________________
Miscellaneous
Are there any judgments, claims, arbitration proceedings or suits pending or outstanding against you or your
rd
organization or its officers? ________ If yes – describe in an attached document and provide 3
party documentation
Have you or your organization filed any lawsuits or requested arbitration with regard to construction contracts within
rd
the past five (5) years? _________ If yes – describe in an attached document and provide 3
party documentation
Insurance
Liability Insurance Carrier: ____________________________________
(must provide current declarations page w/minimum of 1mm per incident)
Policy #: ________________________________
Expiration Date: _______________________
Workman’s Comp Insurance Carrier: ___________________________________________________
Policy #: ________________________________
Expiration Date: _______________________
Contractor represents and warrants that all information in this Contractor’s Profile is complete and accurate. Contractor
authorizes the borrower, and/or the lender, to contact the references listed above to verify the information represented in this
Contractor Profile.
Signature: ____________________________________________________________________________
Typed/Written Name: __________________________________________________________________
Title: _________________________________________________________
Date: _______________________
In addition to this completed form Contractor must provide copy of State/Local Licenses, Copy of current Liability Insurance, Copy of final repair bid,
and fully executed Lender required documents to include a fully executed W-9.
Fannie Mae
Form 1202 Nov 01
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business