BondingApplication

Name(Required)

First Last

Email(Required)

Company Name(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Contractor's License No(Required)

Company Telephone(Required)

Name of Contact Person(Required)

Position of Contact(Required)

Contact's Telephone

Contact's Email Address

Additional Contact

Is Your Firm Certified?

Certified With

Owner Information

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Date of Birth(Required)

Position(Required)

Ownership Percentage(Required)

Please enter a number from 1 to 100.

Credit Score(Required)

Please enter a number from 100 to 800.

Spouse Information

Name(Required)

First Last

Date of Birth(Required)

Position(Required)

Credit Score(Required)

Please enter a number from 100 to 800.

Financial Information

What type of accounting software does the company use

Who prepares the company financial statement?

Does the company prepare a balance sheet, income statement and other financial statement?(Required)

Name of the firm that prepares your financial statement & tax return

Address

Street Address Address Line 2 City State ZIP Code

What were your firm’s gross revenue (total sales or contract before expenses) for 2016?(Required)

What were your firm’s gross revenue (total sales or contract before expenses) for 2017?(Required)

What were your firm’s gross revenue (total sales or contract before expenses) for 2018?(Required)

In the past has your company applied for a bond?(Required)

If you have been bonded before name of prior bonding company

Reason for change

In the past has your company completed a contract that required a bond?(Required)

Please list the bond sizes

What are the two largest completed contract by your company? (Provide name of project owners contract amount year project complete and gross profit)

Untitled

Did your company file last year tax return?(Required)

Do you have a credit report?(Required)

Do you have a line of credit?(Required)

Do you own another company?(Required)

Name of that company

Do your company have insurance?(Required)

Do you have a balance sheet?(Required)

Do you have a business plan?(Required)

If you have general liability insurance provide the expiration date

If you have auto insurance provide the expiration date

If you have excess liability insurance provide the expiration date

If you have workers compensation insurance provide the expiration date

Do you have proven experience with an NJ contract?(Required)

What is the contract size?

What NJ agency owns the project?

Is this a subcontract or a prime contract?

Please state the prime contractor's name

Form Authorization

I authorize New Jersey Economic Development Authority ("Authority") and Statewide Hispanic Chamber of Commerce of NJ to obtain such information including, but not limited to, a credit bureau check as it may require, covering the applicant and/or its principals, stockholders and/or investors.

Under the provisions of the Federal Privacy Act, 5 U.S.C. 552a, you are not legally required to provide a Social Security number to the Authority in order to submit your application for this Program. The failure to provide a Social Security number to the Authority may not affect any right, benefit, or privilege to which you are entitled by law. The Authority uses the numbers to distinguish between people with a similar or the same name; voluntarily providing this number to the Authority makes it easier for us to identify individuals more accurately and to keep accurate documentation.

Please check yes to acknowledge that a tax clearance certificate is required to participate in the Small Business Bonding Readiness Assistance Program. Directions to download your tax clearance certificate can be found at this link: https://www.njeda.com/wp-content/uploads/2021/08/Securing-Your-Tax-Clearance-Certificate-Directions-Client.pdf

Acknowlegement(Required)

Yes, I acknowledge that I will provide a tax clearance certificate to the SHCCNJ for participation in the program

Your Name(Required)

Your Title(Required)

Please Verify

Owner Information

Spouse Information

Company Information

Financial Information

Form Authorization