About ProBuiltCo Roofing & Construction | Triangle General Contractor

Company Info

Tax id

Email Address

Company name

Phone Number

D/B/A Name, if any

Fax Number

Has the Company operated under any other name(s) in the past five years?

Company Address

Street Address

City

State

zip

Do you have Additional Mail Address?

Yes No

Has the Company changed address(es) in the past five years?

Yes No

Does the Company have offices, plants or warehouses at other addresses?

Yes No

Business Organization and History

Type of Company

Date the Company was formed

State in which formed or incorporated

Registered Agent (Lawyer/incorporator)

Other (Specify)

Does the Company share office space, staff, or equipment (including telephone exchanges) with any other business or organization?

Yes No

Instructions: In the following Section, fill in the required information on all present and past Key People for the past five years. “Key People” include: Principals, directors, officers. Shareholder of 5% or more of the Company issued stock. Any manager or individual who participates in overall policy-making or financial decisions for the Company. Any person in a position to control and direct the firm’s overall operations. Signatories to bank accounts and any debt instruments, whether or not otherwise considered Key People. “Shareholders” are owners of stock or other securities that can be converted to stock that, if exercised, would constitute 5% of the Company issued stock. Other securities include stock options, secured or unsecured bonds, warrants and rights.

Identify all Key People

Name And Home Address

Date of Birth

Title

SS#

From

% of Ownership

How Shares Were Acquired

Add More?

Yes No

Number of employees (not including key people)

At present or during the past five years have any of the Key People of the Company served as a Key Person (see definition on page 3) or owned 5% or more of any other firm (including firms that are inactive or have been dissolved?

Yes No

Financial Information

Has the Company, or its affiliates, or any of its Key People, been a party to a bankruptcy or reorganization proceeding?

Yes No

Experience/Performance

Does the Company have a bonding capacity?

Yes No

In writing bonds for the Company, does the surety company rely on the indemnity of any other firm(s) or individual(s)?

Yes No

What is the Company’s bonding capacity ($): (Single Job)

What is the Company’s bonding capacity ($): (Aggregate)

Has the Company or any of its officers, owners or managers had any business related licenses, certificates or certifications revoked in the past 5 years?

Yes No

Compliance Information

In the past five years has the Company or any of its affiliate firms been the subject of any of the following actions by any government agency (Government agencies include city, state, federal public agencies, quasi-public agencies, authorities and corporations, public development corporations and local development corporations):

Been suspended, debarred, disqualified, had its prequalification revoked or otherwise been declared ineligible to bid or to perform work?

Yes No

Been barred from bidding or denied a contract as a result of refusal of Key People to testify before a grand jury or administrative board?

Yes No

Been denied a contract despite being the low bidder for any other reason?

Yes No

Been defaulted on any contract?

Yes No

Had a contract terminated for “cause”?

Yes No

Been given a final unsatisfactory performance determination or deemed a poor performer (by letter or formal proceedings)?

Yes No

Been prevented, or barred from bidding for any other reason?

Yes No

Been denied a contract for failure to obtain surety or otherwise provide required security?

Yes No

Had liquidated damages assessed against it, upon completion of a contract or failure to complete a contract?

Yes No

Compliance Information (Part II)

In the past ten years has the Company or any of its current or past Key People or affiliate firms:

Been under investigation, involving any alleged violation of criminal law relating to business activities?

Yes No

An INVESTIGATION includes an appearance before a grand jury by representatives of a business entity, any oral or written inquiry or review of the entity’s documents by a public agency, temporary commission or other investigative body including, but not limited to, subpoenas and/or search warrants, or questioning of employees concerning the general operation or a specific project of activities of such business entity.

Had records in its or his/her control, custody or ownership subpoenaed by any law enforcement agency?

Yes No

Been questioned by any officer or agent of a law enforcement agency regarding any practices or conduct relating to the providing of construction related services?

Yes No

Been advised of being the target or subject of an investigation involving any violation of criminal law?

Yes No

Been notified or being the subject of court ordered electronic surveillance?

Yes No

Been arrested or indicted or otherwise named as an unindicted co-conspirator in any indictment or other accusatory instrument?

Yes No

Been convicted, after trial or by plea, of any felony under state or federal law?

Yes No

Been convicted of any misdemeanor involving business-related crimes?

Yes No

Entered a plea of nolo contendere to a charge of embezzlement, theft, forgery, bribery, falsification or destruction of records, receiving stolen property or a violation of the antitrust law?

Yes No

Entered into a consent decree?

Yes No

Been granted immunity from prosecution for any business-related conduct constituting a crime under state or federal law?

Yes No

Taken the Fifth Amendment in testimony regarding a business related crime?

Yes No

Been required to engage the services of an integrity monitor in connection with the award of, or in order to complete, any public or private contract?

Yes No

Do any current or past Key People listed in this application have any felony or misdemeanor charges pending against them that were filed either before, during or after their employment with the Company?

Yes No

919-642-3792

[email protected]

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