HomeMy WebLinkAboutCONTRACTOR PROFILE REPORTL-
Contractor Profile Report
Job information
FM
Loan Number: Date:
Borrower Name: Co -Borrower Name:
Property Address:
Contractor Information
Contractor Name: P&C C
Address: P.O. Box 4343
Point of Contact: Paul
Phone Number: 772-216-E
Email: pcco
Type of Organization:
II Number:
com
Corporation U Partne
Social Security #:
Joint Venture 01
CenterState
�'v'7ff1r�ii7CZIW n � s <
FL
Number: 772-461-0095
Number of years in which organization has been in business? 7
Other Co. Names?
List jurisdictions legally licensed/qualified toconduct business: State of Florida
Tax ID Number: 45-4548302 License Number: CGC 056649
References
I: 34948
Bank: TD Bank Phone: 772-466-2066 Name: Mary Ann Baker Acct #: 4267237571
Trade: Cemex Phone: 772mZJ Q-.5661 Name: fob Irish Acct #: _3168582
Trade: Port Consolidated Inc. Phone: 954-522-1182 Name: Nkdia Castillo Acct #: 488900
Client: Paul Jacauin & Sons. Inc.Phone: 772-465-2475 Date ofWork (mustbelnpastUmos.) All Year Long
Type of Work: Concrete, Mason, Framing, Pre=eWinegred3St Building
Client: APP Jet CenterSI CA Phone:_Z72-418-6686_ Date ofWork (must beInpastl2mos.)_
All _Year I nng
Type of Work: Metal Buildings Repair
Client: Gielow Pickles, Inc. Phone: 810-9909083 Date of Work (mastbelnpastl2mos.)201,8 Feb March Argil
Type of Work: Concrete
Miscellaneous
Are there any judgments, claims, arbitration proceedings or suits pending or outstanding against you or your
organization or its officers? NO If yes — describe in an attached document and provide 3rd patty documentation
Have you or your organization filed any lawsuits or .requested arbitration with regard to construction contracts within
the past five (5) years? NO If yes — describe in an attached document and provide 3rd party documentation
insurance
Liability Insurance Carrier: Westfield Ins4lrance(must providecurrentdeclarations page vr/mtnlmumoflmmper Incident)
Policy #: TRA1999576 Expiration Date: 06/30/2018
Workman's Comp Insurance Carrier: FCCI
Policy #: 001 WC18A70343 Expiration Date: 03/22/2019
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.
Typed/Written Name he[yl A JacCuin
rtle: Manager
Date:
In addition to this completed form Contractor must provide copy of StatefLocal Licenses, Copy of current Liability Insurance, Copy of final repair bid,
and fully executed Lender required documents to include a fully executed *9.
Fannie Mae
Form 1202 Nov 01