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)
Trading Name/Trading As:(if different to the above)
Trading Status:
- - - - - - Please Select - - - - -
Sole Trader
Partnership
Limited Company
Limited Liability Partnership (LLP)
Unincorporated Association
Business Address:
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.
Proposer's 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 been declared bankrupt or insolvent or been subject to any County Court Judgements (CCJ's) or IVA's 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, amount of bankruptcy/insolvency, date bankruptcy discharged or CCJ/IVA settled, circumstances, 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 order/notice by the Health & Safety Executive? Yes No
If yes, please provide details:(e.g. date of prosecution(s), details of offence(s), 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)
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
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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
Trade Associations
Are you a member of any trade associations?(e.g. CITB, etc.) Yes No
If yes, please provide details:
Business Activities
Description of your work activities: (Please describe as fully as possible including a percentage split between each activity , where applicable, e.g. 80% steel erection, 20% steel fabrication, etc.)
Do your activities include the erection of steel framed buildings? Yes No
Does any of your work involve any wall/roof cladding? Yes No
If yes, please confirm percentage cladding work:(e.g. 10%)
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
Do you only use fire retardant cladding? Yes No
Do you use any ACM/ACP cladding materials? Yes No
For what proportion of your work are you the principal (main) contractor rather than a sub-contractor?
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
Please confirm the percentage of your 'work away' from your base:('base' being your home or business premises)
100% work away from base, 0% work at base
90% work away from base, 10% work at base
80% work away from base, 20% work at base
70% work away from base, 30% work at base
60% work away from base, 40% work at base
50% work away from base, 50% work at base
40% work away from base, 60% work at base
30% work away from base, 70% work at base
20% work away from base, 80% work at base
10% work away from base, 90% work at base
0% work away from base, 100% work at base
Locations Worked At
Is work carried out at any hazardous locations?(These can include, but are not limited to; offshore installations, railways, motorways, bridges, viaducts, power stations, nuclear installations, oil, gas or petrochemical refineries, aircraft/airports/airside, quarries, mines, watercraft/ships, docks, harbours, piers, towers, steeples, hospitals and other medical facilities.) Yes No
If yes, please provide details:(i.e. the type of hazardous location(s) details of the work carried out and the percentage of turnover this work represents
Is any work undertaken outside of the U.K.? Yes No
If yes, please provide details:(i.e. area / country worked at and percentage of turnover outside UK)
Professional Services/Risks
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 away from your business premises?(i.e. on site) Yes No
Please confirm the type(s) of heat used:(e.g. flame cutting, grinder, welder, etc.)
Please confirm the percentage of time using heat away from your business premises?
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
Details of work at height
Please confirm the maximum height you would work:(e.g. 15 metres) metres
Please confirm the approx. percentage split of height work at the following heights:
At ground level: %
Up to 10 metres: %
Up to 15 metres: %
Up to 20 metres: %
Over 20 metres: %
Total: 100%
Do you or your employees use slings, cradles, ropes, bosuns chairs, abseiling equipment or the like other than for equipment designed for the raising, lowering or transportation of inanimate materials? Yes No
If yes, please provide details:(i.e. type of equipment used and percentage use of this equipment)
Do you use hydraulic lifts, access plant, scaffolding or any other equipment for work at height? Yes No
If yes, please provide details:(e.g. type of equipment used and percentage use of this equipment)
Do you use any fall prevention equipment? Yes No
Please provide details of any fall prevention equipment used:
Details of work at depth
Please confirm the maximum depth you would dig:
0
1
2
3
4
5
8
10+
metres
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
Hazardous Materials
Do you work with asbestos, silica, explosives or any other substances hazardous to health? Yes No
If yes, please provide details:(i.e. type of hazardous substance(s) and percentage of your turnover this work respresents)
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:
Public/Product Liability
Public/Product Liability limit of indemnity:
£1 Million
£2 Million
£5 Million
£10 Million
Not Required
Manual Working Principals Non-Manual/Clerical Managerial 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 (if used) :(BFSC's are sub-contractors who supply their own materials on site and hold their own insurance)
Employers' Liability (Compulsory by Law if you have direct workers or use labour only sub-contractors)
Is Employers' Liability Cover Required?(£10M standard limit of indemnity)
Please Select
Yes
No
Manual Working Employees Non-Manual/ Clerical Employees
No. of Employees/Labour Only Sub-Contractors:(Do not include proprietors, partners or directors) No. No.
Annual Wages of Clerical Employees:
Annual Wages of Employees (working at height):
Annual Wages of Supervisors/Ground Level Workers:
Annual Payments to Labour Only Sub-Contractors:
Do all of your workers (direct employees and labour only sub-contractors) hold current CSCS cards (if applicable) ? Yes No
If no, how many of your workers (direct and labour only sub-contractors) hold current CSCS cards?
Employers' Reference Number (optional)
Employers' Reference Number (ERN) (if available) : (e.g. '123/AB12345' or 'Exempt')
Turnover
Estimated 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
Will 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? %
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 total hired-in-plant limit of indemnity for all items of hired-in plant:(e.g. £250,000, £500,000, etc.)
Please confirm the maximum value of any one item of hired-in-plant:
Please confirm annual charges/costs incurred:(e.g. £25,000 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
If yes, please provide details:
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
£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.
Renewal Date / Date Cover Required: (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.