Lift Engineers Public / Employers Liability Insurance Quote Form

Please insert your details below and one of our commercial advisers will contact you shortly with a lift engineers liability insurance quotation.

This form is designed for quotes for lift engineers public liability / employers' liability insurance with optional contract works cover, tools cover, plant cover, financial loss cover, professional indemnity cover and legal expenses cover.

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

Personal/Company Details
Proposer's Full Name(s): (enter sole trader's name or all partners 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 Trader Partnership Limited Company Limited Liability Partnership Unincorporated Association
Occupation/Trade:
Business Address:
Business Postcode:
Daytime Telephone Number:
*E-Mail Address:
*Please note that your email address will only be used to provide you with your quote and not for any other marketing purposes.
General Information
General Details
Have you, or any other partner or director ever been convicted of or charged (but not yet tried) with any criminal offences other than a motoring offence?	Yes     No
If yes, please provide details: (e.g. type of conviction(s), date(s) of conviction(s), details of any fines and/or length of custodial sentence(s))
Has any insurer ever refused renewal, declined/cancelled cover or imposed any special terms?	Yes     No
If yes, please provide details: (e.g. details of any insurance refused/ cancelled/special terms imposed, etc.)
Have you, or any other partner or director ever had any County Court Judgements (CCJ's) / sheriff decrees / IVA's or ever been declared bankrupt, or involved in a company which has become insolvent or which has gone into liquidation, receivership or administration?	Yes     No
If yes, please provide details: (e.g. date(s) of bankruptcy/insolvency/CCJ/IVA, amount of bankruptcy/insolvency/CCJ/IVA (£'s), date bankruptcy discharged / date CCJ/IVA settled, circumstances of bankruptcy/insolvency/CCJ/IVA, etc.)	Please note we are unable to provide a quote if your bankruptcy is not discharged or your CCJ / IVA remains outstanding or unsettled.
Have you, or any other partner or director ever been prosecuted or served a prohibition or improvement order by the Health & Safety Executive?	Yes     No
If yes, please provide details: (e.g. date of prosecution(s)/prohibition order(s), details of offence(s), circumstances, etc.)
Have you, or any other partner or director ever been the subject of a recovery action from HM Customs and Excise or the Inland Revenue?	Yes     No
If yes, please provide details: (i.e. name of person or business subject to recovery action, date of recovery action, and reason for the recovery action)
Business Activities
Description of your work activities: (Please describe as fully as possible)
Type Of Contracts
Please state the approximate percentage split of your contracts (must add up to 100%):
Percentage of work involving lift installation:	%
Percentage of work involving lift maintenance:	%
Percentage of work involving escalator installation:	%
Percentage of work involving escalator maintenance:	%
'Any Other Work' (please specify below if applicable):	%
Total:	100%
Do you carry out any work on stair lifts?	Yes     No
Lift Dismantling
Does your work involve the dismantling of lifts?	Yes     No
Please provide details of the processes involved and whether this takes place on site or at your own premises:
Type of Premises / Locations Worked At (away from your own premises)
Please confirm percentage of work carried out at the following locations (must add up to 100%):
Private dwelling houses?	%
Blocks of flats?	%
Commercial buildings (e.g. shops, offices, etc.)?	%
Industrial buildings (e.g. factories, units, etc.)?	%
All other premises/locations (state below if applicable)?	%
Total:	%
Hazardous Locations
Is work carried out at any hazardous locations? (These can include, but are not limited to; offshore installations, blast furnaces, dams, railways, motorways, bridges, canals, viaducts, tunnels, nuclear installations, aircraft, airports, quarries, ships, docks, piers, wharves, collieries, mines, chemical works, gas works, oil refineries or power stations, bulk oil or petrol storage facilities and towers.)	Yes     No
If yes, please state type of location(s) and the percentage of turnover at the location(s):
Is any work undertaken outside of the U.K.?	Yes     No
If yes, please provide details: (i.e. area(s) / country(s) worked at, and percentage of turnover this represents)
Hazardous Substances
Does any part of your business involve the use, handling, storage, removal or disposal of asbestos, silica or any other hazardous substances?	Yes     No
If yes, please provide details of the work, your safety procedures, and approx. percentage of turnover relating to this activity:
Do you dispose of all waste materials through a licensed waste disposal contractor or at local authority waste sites?	Yes     No
If no, please provide details of type of waste and method of disposal:
Health & Safety
Does your business have a written Health & Safety policy and are all persons made aware of this safety policy?	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/job?	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 where required?	Yes     No
Professional Services
Do you provide professional services for a fee such as advice/consultancy, design, testing, inspection and certification?	Yes     No
Heat Use
Do your activities involve the use of heat? (e.g. blow lamps, blow torches, welding equipment, heat guns, etc.)	Yes     No
If yes, please state the type of heat used: (e.g. blow lamps, blow torches, welding equipment, heat guns, etc.)
Please confirm the percentage of time it is used:	0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%
Will heat work include the use of welding or flame cutting equipment?	Yes     No
Work at Height
Please state the maximum height/drop you would work:	metres
Trade Associations
Are you a member of the L.E.I.A.?	Yes     No
Trading Experience
How many years has your business been trading?	Please Select 0 Years 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years 16 Years 17 Years 18 Years 19 Years 20 Years 21 Years 22 Years 23 Years 24 Years 25 Years 26 Years 27 Years 28 Years 29 Years 30 Years 30+ Years
Number of years previous experience in this trade: (A minimum of 3 years previous experience is required if you have 0 years trading)	Please Select 0 Years 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years 16 Years 17 Years 18 Years 19 Years 20 Years 21 Years 22 Years 23 Years 24 Years 25 Years 26 Years 27 Years 28 Years 29 Years 30 Years 30+ Years
Claims Experience
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: Cost of claim:£ Details of claim: ---------------------------- Date of claim: Cost of claim:£ Details of claim: ---------------------------- Regrettably, if you have more than 2 claims, we will be unable to provide you with a quotation.

Details Of Cover Required
Public/Product Liability
Public/Product Liability limit of indemnity:		£1 Million £2 Million £5 Million £10 Million Not Required
		Manual Principals		Non-Manual/ Clerical Principals
Number of Proprietors/Partners/Co. Directors:	No.		No.
Annual Wages of Proprietors/Partners/Co. Directors:
Please confirm your annual payments to Bona-Fide Sub-Contractors (BFSC's) (if used): (BFSC's are sub-contractors supply their own labour and materials on a site and hold their own public and employers' liability 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 (Compulsory by Law if you have employees or use labour only sub-contractors)
Is Employers' Liability Cover Required? (£10M standard limit of indemnity)		Please Select Yes No
		Manual Employees		Non-Manual/ Clerical Employees
Number of Employees/Labour Only Sub Contractors: (Do not include proprietors, partners or directors)	No.		No.
Annual Wages of Employees/Labour Only Sub Contractors: (Please note that Labour Only Sub-Contractors supply labour only and not materials)
Employers' Reference Number (optional)
Employers' Reference Number (ERN) (if available):		(e.g. 123/AB12345 or 'Exempt')
Turnover
Estimated Annual Turnover for the next 12 months:
Additional Optional Covers
Contract Works
Do you require cover for Contract Works?		Yes     No
Please state the maximum value of any one contract:
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, & Equipment required to be covered whilst working on site:
Please confirm the maximum value of any one item of your own plant (£'s):
Tools
Do you require cover for Portable Tools?		Yes     No
Please confirm how much cover you require for your Tools:
Hired-In Plant
Do you require cover for Hired-In Plant?		Yes     No
Please confirm the hired-in plant total limit of indemnity for all items of hired-in plant:
Please confirm the maximum value of any one item of hired-in plant:
Please confirm annual charges/costs incurred: (e.g. £10,000 per annum)		per annum
Professional Indemnity
Is Professional Indemnity cover required?		Yes     No
Please confirm the limit of indemnity required:		Please Select £100,000 £250,000 £500,000 £1,000,000 £2,000,000 £5,000,000
Please confirm the fees you received for design and/or consultancy work in the last 12 months:
Please confirm the estimated fees for design and/or consultancy work in the next 12 months:
Have you had any claims or incidents that could have given rise to a professional indemnity claim in the last 5 years?		Yes     No
If yes, please provide details: (i.e. date of incident, circumstances, etc.)
Can you confirm that all persons carrying out design and/or consultancy work have at least 3 years experience undertaking such work?		Yes     No
Financial Loss Cover
Is Financial Loss cover required?		Yes     No
If yes, please state limit of indemnity required:		Please Select £25,000 £50,000 £100,000
Legal Expenses Cover
Is Commercial Legal Expenses cover required? (£100,000 standard limit of indemnity)		Yes     No
Has the business and/or its directors been involved in any legal dispute, tax investigation or any other court or tribunal action in the last 5 years?		Yes     No
Please provide details of the dispute including dates:
Directors & Officers Cover
Is Directors and Officers cover required?		Yes     No
Please confirm the limit of indemnity required:		Please Select £100,000 £250,000 £500,000 £1,000,000 £2,000,000 £5,000,000
Additional Information
Details of any additional information you wish to disclose or any other cover required:
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
Renewal Date / Cover Start Date:		(dd/mm/yyyy)
Current Renewal Premium / Best Quote:		This may help us to get you a better quote
Name of Current / Previous Insurer:		e.g. Aviva, AXA, Allianz, QBE, RSA, Zurich, etc.

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Disclosure
Please ensure that all the information you have provided is correct, then press the Submit Lift Engineers Quote button and we will contact you shortly with a quotation.

Estimated Quote Time: 1 to 4 working days