Contractors All Risks Quotation Form

Please insert your details here and one of our commercial advisers will contact you with a contractors all risks insurance quotation shortly.

This form is designed to for individuals/companies requiring contractors all risks insurance whilst working at a contract site. The policy can provide annual cover for public & employers liability, contract works, own plant, hired-in plant, employees tools and temporary buildings.

If you have any problems with completing this form, please phone us on 01623 641 386 for assistance.

General Contact Information
Proposers Name(s): (enter sole trader's name or all partner's names if a partnership)
Contact Name: (if different to proposer's name)
Limited Company Name: (if operating as a limited company)
Trading Name: (if different to the above)
Trading Status:	- - - - - - Please Select - - - - - - Sole Proprietor Partnership Limited Company Limited Liability Partnership
Occupation/Trade:
Correspondence Address:
Postcode:
Daytime Telephone Number:
Mobile Telephone Number:
E-Mail Address:
General Information
Have you, or any other partner or director ever been convicted of any criminal offences or had any insurance refused, cancelled or special terms imposed?	Yes     No
If yes, please provide details: (e.g. type of conviction, date(s) of conviction, details of any fines, custodial sentence, or details of any insurance refused/cancelled, etc.)
Have you, or any other partner or director ever been declared bankrupt or insolvent or been subject to any County Court Judgements or IVA's or been the director of a company which has become insolvent or gone into liquidation?	Yes     No
If yes, please provide details: (e.g. date(s) of bankruptcy/insolvency, amount of bankruptcy/insolvency, date discharged, circumstances, etc.)
Have you, or any other partner or director ever been prosecuted or served a prohibition order by the Health & Safety Executive?	Yes     No
If yes, please provide details: (e.g. date of prosecution(s), details of offence(s), etc.)
Trade Associations
Are you a member of a relevant trade association for your industry (e.g. CITB, etc.)?	Yes     No
If yes, please provide details:
Trade / Work Undertaken
Description of your business activities:   (Please describe as fully as possible including a percentage split between each activity, where applicable)
What percentage of the turnover is carried out at the following locations:
(i) Private Dwelling Houses and Flats?	%
(ii) Commercial Buildings (e.g. shops, offices, pubs, etc.)?	%
(iii) Industrial Buildings (e.g. industrial units, factories, etc.)?	%
(iv) Other Locations (specify) ?	%
Total:	100%
Hazardous Locations / Work Outside UK
Is work carried out at any hazardous locations? (e.g. offshore installations, railways, motorways, bridges, tunnels, flyovers, viaducts, power stations and/or nuclear installations, refineries, petrochemical installations, or chemical works, oil or gas refineries or bulk storage facilities, airports, aircraft or airfields, quarries, mines, ships, docks, jetties, piers, dams, reservoirs, coastal defence or flood prevention, towers, steeples, chimney shafts and blast furnaces.)	Yes     No
If yes, please state type of location(s) and the percentage of work spent at the location(s):
Is any work undertaken outside the UK?	Yes     No
If yes, please provide details: (i.e. area(s) worked and percentage of turnover)
Professional Risks
Do you provide any advice, design or specification?	Yes     No
Trading Experience
How many years has the business been trading?	0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 30+ year(s)
Number of years experience (if different)	0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 30+ year(s)
Depth / Height Work
Please state the maximum depth you dig:	- - - 0 1 2 3 5 5+ metre(s)
Do you undertake any piling or underpinning work?	Yes     No
If yes, please provide details:
Please state the maximum height worked:	- - - 0 5 10 15 20 25 30 30+ metre(s)
Do you or your employees undertake any steel erection/structural steel work?	Yes     No
If yes, please provide details: (i.e. type of work and percentage of turnover)
Do you use slings, cradles, bosuns chairs, abseiling equipment or tower cranes? (cherry pickers and mobile platforms are acceptable)	Yes     No
If yes, please provide details of equipment used and how frequently it is used:
Heat Details
Do your activities involve the use of heat? (e.g. blow lamps, blow torches, welding equipment, etc.)	Yes     No
If yes, please state the type used (e.g. blow lamp, etc.) and the percentage of work that involves the use of heat:	Type used: Percentage of work:
Do you operate a 'hot work' permit system for heat applications?	Yes     No
Health & Safety
Do you have a written Health & Safety policy in force which is reviewed regularly and distributed to employees?	Yes     No
Do you carry out a full Health & Safety Risk Assessment at the contract site before commencing work?	Yes     No
Are written Method Statements prepared for each contract?	Yes     No
Is Health & Safety training given to employees and is the training recorded?	Yes     No
Do you supply and enforce use of Personal Protective Equipment (PPE) where required?	Yes     No
Do you or your employees work with asbestos, silica, explosives or any other substances hazardous to health?	Yes     No
If yes, please provide details:
Do you or your employees carry out any demolition work on buildings or structures other than as part of a contract for reconstruction, alteration or repair?	Yes     No
If yes, please provide details of demolition work: (i.e. percentage of work involving demolition, type of demolition work, etc.)
Does any of your work involve the use of fixed woodworking machinery? (hand held power tools are acceptable)	Yes     No
If yes, please provide details: (i.e. No. of employees using the machinery and annual wages of the employees using the machinery)	No. of employees: Estimated wages:£
Contract Works Construction / Security Details
Do your activities involve the construction or renovation of timber framed buildings?	Yes     No
If yes, please confirm the approximate percentage of your turnover that this work represents?	%
Do you erect full site perimeter fencing and/or boarding at the contract site?	Yes     No
Please provide details of any additional security used to secure any materials or plant on site: (e.g. security patrols, plant kept in locked building, etc.)
Claims History
Have you or any other partner or director suffered any loss or had any claims made against you in the last 5 years?	Yes     No
If yes, please provide details:	Date of claim 1: Cost of claim 1:£ How claim occurred? ----- Date of claim 2: Cost of claim 2:£ How claim occurred? ----- Date of claim 3: Cost of claim 3:£ How claim occurred? ----- Unfortunately, we are unable to provide a quotation if you are exceeding 3 claims. -----
Turnover
Estimated turnover for the next 12 months (£'s):
Builders / Property Developers Only
If your trade or business is a builder or property developer, please state the percentage split of your work:
New Construction up to 20m height:	%
New Construction up to 10m height:	%
General Building: (alteration, maintenance, repairs, etc.)	%
Other Building Work (please describe)	%
Total:	100%

Details of Cover Required
Public/Product Liability Cover
Is Public/Product Liability required?	Please Select No Yes
Limit of Indemnity required:	Please Select £1 Million £2 Million £5 Million £10 Million Not Required
	Manual Principals	Managerial/Clerical Principals
Number of Proprietors/Partners/Company Directors:
Wages of Proprietors/Partners/Company Directors (£'s):
Annual payments to Bona Fide Sub-Contractors (£'s): (BFSC's are sub-contractors who supply their own materials on site and hold their own insurance)
If you use bona fide sub-contractors, do you have a procedure in place to check they have the same level of liability insurance?	Yes     No
Employers' Liability Cover
Is Employers' Liability required?	Please Select No Yes
	Manual Workers	Non-Manual/Clerical Workers
No. of Employees/Labour Only Sub-Contractors: (Do not include proprietors, partners and directors)
Annual Wages of Own Employees (£'s):
Annual Payments to Labour Only Sub-Contractors (£'s): (LOSC's are sub-contractors who supply labour only and work under your direct supervision)
Employers' Reference Number
Employers' Reference Number (ERN) (if available):
Contract Works
Do you require cover for Contract Works?	Yes     No
Please state the maximum value of any one contract (£'s):
Please state the maximum length of any one contract (e.g. 6 months, etc.):
Own Plant
Do you require cover for Own Plant?	Yes     No
Please confirm the total value of your Own Plant, Tools & Equipment required to be covered whilst working on site (£'s):
Please confirm the maximum value of any one item of your own plant (£'s):
Employees' Tools
Do you require cover for Employees' Tools?	Yes     No
Please confirm how much cover you require for your Employee's Tools (£'s):
Hired-In Plant
Do you require cover for Hired-In Plant?	Yes     No
Please confirm the hired-in plant limit of indemnity for all items of hired-in plant (£'s):
Please confirm the maximum value of any one item of hired-in plant (£'s):
Please confirm annual charges/costs incurred (£'s):
Site Huts / Temporary Buildings
Do you require cover for Site Huts / Temporary Buildings?	Yes     No
Please state how much cover you require for site huts / temporary buildings (£'s):
Business Legal Expenses Cover
Do you require Business Legal Expenses Cover?	Yes     No
Limit of indemnity required? (£'s):
Has the business been involved in any legal disputes, employment disputes or tax investigations in the last 5 years?	Yes     No
Directors & Officers Cover
Do you require Directors & Officers Cover?	Yes     No
Can you confirm that the company is domiciled in the UK; is privately held; has not raised any funds from external parties; has been in operation for more than 12 months; has its financial statements prepared by a qualified accountant, shows a profit and are not subject to any concerns by the auditors; derives at least 50% of all its turnover from clients within the UK and EU; has not acquired any companies which have increased its total assets by 50% or more; and has no mergers or acquisitions planned and has not had any claims made against it or its directors and is not aware of any circumstances that could give rise to such claim?	Yes     No
If no, details:
Limit of indemnity required? (£'s):	£100,000 £250,000 £500,000 £1,000,000 £2,000,000 £5,000,000
Additional Information / Cover
If there is any additional information that you wish to disclose or cover that you wish to include, please provide details:
You are required to make a fair presentation of the risk to insurers which means that you are required to disclose every material circumstance which you know or ought to know relating to the risk to be insured. Materially important information is any information that could influence an insurer's decision to accept your risk including the cost of your insurance. Failure to comply with the duty of fair presentation could mean that your policy is void or that insurers are not liable to pay all or part of your claim(s). By submitting this quotation you are confirming that there are no other material facts to disclose other than those shown above.
Details Of Current / Previous Policies
Current annual premium:	This may help us to get you a better quote
Current / previous insurer:
Renewal date / date cover required:

Request Quotation

Disclosure
Please ensure that all the information you have provided is correct and that you have answered all the questions accurately then press the Request Contractors All Risks Quotation button and we will contact you shortly with a quotation.

Estimated Quote Time: 0 - 2 working days