Proposer's Full 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)
Do you require cover for any subsidiary companies? Yes No
If yes, please provide the name(s) of any subsidiary company(s) that you wish to include under your insurance:
Trading Name/Trading As:(if different to the above)
Trading Status:
- - - - - - Please Select - - - - -
Sole Trader
Partnership
Limited Company
Limited Liability Partnership
Unincorporated Association
Occupation/Trade:(Please re-type if different to 'Property Developer')
Business Address:
Business Postcode:
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.
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 of the conviction(s):(e.g. type and reason for conviction(s))
Date of Conviction/Offence:
Details of any fines and/or community service:(Please enter 'None' if you did not receive any fines and/or community service)
Length of custodial sentence(s):(Please enter 'None' if you did not receive a custodial sentence)
Has any insurer ever refused renewal, declined/cancelled cover or imposed any special terms? Yes No
If yes, please provide details:(e.g. details/reason for any insurance refused/ cancelled/special terms imposed, etc.)
Have you, or any other partner or director ever been declared bankrupt or insolvent or been the director of a company which has become insolvent or which has gone into liquidation, receivership or administration? Yes No
If yes, please provide details:(e.g. circumstances of bankruptcy/insolvency/administration etc.)
Date of bankruptcy/insolvency/liquidation/administration:
Amount of bankruptcy/insolvency, etc. (£'s):
Please provide details of date discharged, or please confirm if still current/outstanding:
Have you, or any other partner or director ever had any County Court Judgements (CCJ's), or Sheriff Court Decrees? Yes No
If yes, please provide details:(e.g. type and circumstances of CCJ/Sheriff Decree)
Date of CCJ / Sheriff Decree:
Amount of CCJ / Sheriff Decree (£'s):
Is the CCJ / Sheriff Decree still current/outstanding? Yes No
Have you, or any other partner or director ever been prosecuted under any Health & Safety Legislation or ever been served a prohibition order or improvement order by the Health & Safety Executive? Yes No
If yes, please provide details of the prosecution(s):
Date of prosecution and/or prohibition/improvement order:
Details of any fines and/or action taken by the HSE:(Please enter 'None' if you no further action was taken)
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)
Trade Associations
Are you a member of a relevant trade association for your industry (e.g. CITB, etc.) ?(You may receive additional discounts if you are a member of a trade association) Yes No
If yes, please provide details:
Trade / Work Undertaken
Description of your full trade / work activities undertaken: (Please describe as fully as possible including a percentage split between each activity , where applicable)
What percentage of your work is carried out on, or at the following premises/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 Premises/Locations (state below if applicable) %
Total: 100%
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):
Work Outside UK
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 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
As you have been trading 0 years, please provide details of how you gained your experience:(i.e. position (e.g. director / manager / supervisor / employee), type of business (e.g. construction), and the name of the last company where experience was gained, etc.)
Depth / Height Work
Please state the maximum depth you dig:
0
1
2
3
4
5
5+
metre(s)
If any work is below 3 metres, please provide details:(e.g. type(s) of contract(s)/work undertaken, and percentage of turnover that this work represents)
Do you undertake any piling, underpinning or basement excavation work? Yes No
If yes, please provide details of work undertaken:(i.e. piling, underpinning or basement excavation work)
What percentage of your overall work activities does this work represent (e.g. 10%)? %
Is this work carried out by Bona Fide Sub-Contractors?(BFSC's are sub-contractors who carry out their part of the work without supervision and hold their own liability insurance.) Yes No (own employees)
Please state the maximum height worked:
0
5
10
15
20
25
30
35
40
45
50+
metre(s)
If any work is above 15 metres, please provide details:(e.g. type(s) of contract(s)/work undertaken, and percentage of turnover that this work represents)
Do you or your employees undertake any steel erection/structural steel work? Yes No
If yes, please provide details:(i.e. type of work undertaken)
What percentage of your turnover does the steel erection/structural steel work represent (e.g. 10%)? %
Do you use slings, cradles, bosuns chairs, abseiling equipment or tower cranes?(not including cherry pickers and mobile platforms) Yes No
If yes, please provide details of equipment used and how frequently it is used:(e.g. tower cranes - used 10% of time)
If working at height, do you use any hydraulic lifts/platforms, access plant or any other equipment?(including cherry pickers and mobile platforms) Yes No
If yes, please provide details of equipment used and percentage of time it is used:(e.g. cherry pickers - used 10% of time)
Scaffolding
Do you use a scaffolding sub-contractor? Yes No
Do you ever erect your own scaffolding? Yes No
If yes, type of scaffolding (e.g. tower, tied, etc.) :
How often do you erect your own scaffolding?
What is the maximum height of the scaffolding you erect for your own use?
0
5
10
15
20
25
30
35
40
45
50+
metre(s)
Heat Details
Do your activities involve the use of heat?(e.g. blow lamps, blow torches, welding equipment, grinders, etc.) Yes No
If yes, please state all types of heat used:(e.g. blow lamps, blow torches, welding equipment, grinders, etc.)
Percentage of work that involves the use of heat:
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
55%
60%
65%
70%
75%
85%
85%
90%
95%
100%
Do you operate a 'hot work ' permit system for heat applications? Yes No
Split of Contracts
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 (describe below if applicable) %
Total: 100%
Health & Safety
Do you have an up to date Health & Safety Policy tailored to your activities? Yes No
Do you use an external Health & Safety Consultant? Yes No
If yes, name of Health & Safety Consultant?
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
Asbestos / Hazardous Substances
Do you work with asbestos, silica, explosives or any other substances hazardous to health? Yes No
If yes, type of hazardous substance:(i.e. non-notifiable asbestos, silica, etc.)
What percentage of your overall work activities does this work represent (e.g. 5%)? %
Is this work carried out by Bona Fide Sub-Contractors?(BFSC's are sub-contractors who carry out their part of the work without supervision and hold their own liability insurance.) Yes No (own employees)
Demolition Work
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.)
Fixed Woodworking Machinery / Timber Framed Buildings
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)
Do your activities involve the construction or renovation of timber framed buildings and/or the installation of timber cladding within the next 12 months? Yes No
If yes, please confirm the approximate percentage of your turnover that this work represents? %
What is the maximum number of storeys in any one timber framed structure/block?
1
2
3
4
5
6
6+
storey(s)
What is the largest value of any one timber framed structure/block?
If you work on multiple blocks of flats or private dwelling houses, what is the minimum distance between them? metres
Does the site and work comply with the Joint Code of Practice for construction sites? Yes No
How many years previous experience do you have working on timber framed structures?
0
1
2
3
4
5
6
7
8
9
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25
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27
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30
30+
year(s)
Claims History
In relation to this business or any other previous business in which the proprietor or any partners or directors have traded, in this or any other name, has there been a claim under any of the cover(s) within the last 5 years? Yes No
Claim 1.
Date of Loss:
Cause of Loss:
- - - - - - - - Please Select - - - - - - - -
Accidental Damage
Aircraft and Other Aerial Devices
Assault
Employee Injury
Escape of Beverages
Escape of Oil
Escape of Water
Fire
Fire (Arson)
Flood
Food and/or Drink Poisoning
Fraud or Dishonesty of Staff
Health and Safety Legislation
Impact - Own Vehicle
Impact - Third Party
Legal Costs and Expenses
Lightning
Loss of Licence
Malicious Damage
Other
Personal Injury
Property Damage
Pollution
Professional Indemnity
Replacement of Locks
Robbery or Attempted Robbery
Sprinkler Leakage
Storm
Subsidence, Ground Heave, Landslip
Terrorism
Theft or Attempted Theft
Third Party Injury
Third Party Property Damage
Underground Services Damage
Circumstances of the Loss:
Total Cost of Loss (£'s):(including any amounts paid or outstanding)
Status of Claim: Settled Claim Still Pending
Do you wish to add another claim? Yes No
Claim 2.
Date of Loss:
Cause of Loss:
- - - - - - - - Please Select - - - - - - - -
Accidental Damage
Aircraft and Other Aerial Devices
Assault
Employee Injury
Escape of Beverages
Escape of Oil
Escape of Water
Fire
Fire (Arson)
Flood
Food and/or Drink Poisoning
Fraud or Dishonesty of Staff
Health and Safety Legislation
Impact - Own Vehicle
Impact - Third Party
Legal Costs and Expenses
Lightning
Loss of Licence
Malicious Damage
Other
Personal Injury
Property Damage
Pollution
Professional Indemnity
Replacement of Locks
Robbery or Attempted Robbery
Sprinkler Leakage
Storm
Subsidence, Ground Heave, Landslip
Terrorism
Theft or Attempted Theft
Third Party Injury
Third Party Property Damage
Underground Services Damage
Circumstances of the Loss:
Total Cost of Loss (£'s):(including any amounts paid or outstanding)
Status of Claim: Settled Claim Still Pending
Do you wish to add another claim? Yes No
Regrettably we will be unable to provide a quotation if you have had more than 2 claims.
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 state your annual payments to Bona-Fide (supply & fix) Sub-Contractors (if used) : (BFSC's are sub-contractors who supply their own materials and hold their own insurance. Typical examples of BFSC's can be plumbers, electricians, etc.)
If you use Bona Fide Sub-Contractors, do you check that they have the same level of liability insurance? Yes No
Employers' Liability (Compulsory by Law if you employ direct employees or use labour only sub-contractors)
Is Employers' Liability Cover Required?
Please Select
Yes
No
Manual Workers Non-Manual/ Clerical Workers
Number of Employees/Labour Only Sub-Contractors: (Do not include proprietors, partners or directors) No. No.
Annual Wages of Drivers and/or Yardsmen:
Annual Wages of Site Supervisors:
Annual Wages of all other Direct Employees (PAYE):
Annual Payments to Labour Only Sub-Contractors:(LOSC's are sub-contractors who supply labour only and work under your direct supervision)
Employers' Reference Number (optional)
Employers' Reference Number (ERN) (if available) : (e.g. 123/AB12345 or 'Exempt')
Turnover
Estimated contracting turnover for the next 12 months (£'s):(Please be as accurate as possible, as an over estimation will increase the premium to be quoted)
Contract Works
Do you require cover for Contract Works?(i.e. the permanent / temporary works and materials on site) Yes No
Please state the maximum value of any one contract:(This amount will normally be less than and no more than your annual turnover.)
Please state the maximum length of any one contract:(e.g. typically up to a maximum of 6 or 12 months)
1 month
2 months
3 months
4 months
5 months
6 months
7 months
8 months
9 months
10 months
11 months
12 months
15 months
18 months
24 months
Over 24 months
Site Security Details
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.)
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:
Please confirm the maximum value of any one item of your own plant:
Employees' Tools
Do you require cover for Employees' Tools? Yes No
Please confirm how much cover you require for your Employee's Tools:
Hired-In Plant
Do you require cover for Hired-In Plant? Yes No
Please confirm the hired-in planttotal sum insured 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
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:
Business Legal Expenses Cover
Do you require Business Legal Expenses Cover? Yes No
Limit of indemnity required?
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?
£100,000
£250,000
£500,000
£1,000,000
£2,000,000
£3,000,000
£5,000,000
Additional Information
Any additional information you wish to disclose or any extra 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.
Cover Start Date / Renewal Date: (dd/mm/yyyy)
Current Annual Premium / Best Quote: This may help us to get you a better quote
Name of Current / Previous Insurer: e.g. Aviva, AXA, Allianz, RSA, Zurich, etc.