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:(if different to the above)
Trading Status:
- - - - - - Please Select - - - - -
Sole Trader
Partnership
Limited Company
Limited Liability Partnership
Unincorporated Association
Business Address:
Postcode:
Daytime Telephone Number:
Mobile 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 with any criminal offence? Yes No
If yes, please provide details:(e.g. type of conviction(s), date(s) of conviction(s), and details of any fines/custodial sentence.)
Have you, or any other partner or director ever had any previous insurance cancelled, refused, declined or ever had any special terms applied? Yes No
If yes, please provide details:(e.g. type of insurance and reason for declinature or details of any special terms.)
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 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)
Business Activities
Description of your work activities: (Please describe as fully as possible including a percentage split between each activity , where you carry our more than one activity)
Do your activities include the erection of steel framed buildings? Yes No
If yes, please confirm the percentage of your turnover involved in the erection of steel framed buildings: %
Type of premises worked on
Please state the percentage of work carried out at the following premises / locations:
Private dwelling houses and flats? %
Commercial buildings (e.g. shops, offices, etc.) ? %
Industrial buildings (e.g. industrial units, factories, etc.) ? %
All other premises (state below if applicable) ? %
Total: 100%
Hazardous Locations / Work Outside of UK
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 state the type of hazardous locations:
What percentage of your turnover is at hazardous locations?
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
55%
60%
65%
70%
75%
80%
85%
90%
95%
100%
Is any work undertaken outside of the U.K.? Yes No
If yes, please provide details:(i.e. area/country of work and percentage of work outside UK)
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? Yes No
Please confirm the type of heat used:(e.g. flame cutting, grinder, welder, etc.)
Please confirm the percentage of time using heat:(e.g. 5%) %
Details of work at height
Please confirm the maximum height you would work:
0
5
8
10
12
15
20
30
40
50
60
70
80
90
100
100+
metres
Please confirm the approx. percentage of time working 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, bosuns chairs or abseiling equipment? Yes No
If yes, please provide details:(i.e. type of equipment and percentage use of the equipment)
Do you or your employees use hydraulic lifts, platforms, access plant, cherry pickers, scaffolding or other equipment? Yes No
If yes, please provide details:(i.e. type of equipment used)
Do you use any fall prevention equipment? Yes No
Please provide details of any fall prevention equipment used:(e.g. harnesses, etc.)
Depth Work
Please state the maximum depth you dig (if applicable) :
0
1
2
3
5
5+
metre(s)
Do you undertake any piling or underpinning work? Yes No
If yes, please provide details:(i.e. type of work undertaken)
What percentage of your turnover does this work represent? %
Do you undertake any basement work? Yes No
Is this new build basements or new basements under existing structures? New Build Basements New Basements Under Existing Structures
Has all excavation work been undertaken before you get involved? Yes No
Do you carry out any of the excavation work yourselves? Yes No
Are you steel fixing on structural supports? Yes No
Are you pouring the concrete yourselves? 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
Trade Associations
Are you a member of any trade associations? Yes No
If yes, please provide details:
Health & Safety
Do you have a written Health & Safety policy in force which is reviewed regularly and distributed to all 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 all your relevant employees and Labour Only Sub-Contractors have current CSCS cards? 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 turnover this represents)
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 Liability
Public Liability limit of indemnity:
£1 Million
£2 Million
£5 Million
£10 Million
Not Required
Manual Principals Non-Manual/ 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 employ direct workers or labour only sub-contractors)
Is Employers' Liability Cover Required?(£10M limit provided as standard)
Please Select
Yes
No
Manual 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 Manual Employees Working (at height) above Ground Level:
Annual Wages of Manual Employees Working at Ground Level:
Annual Wages of Supervisors Working at Ground Level:
Annual Payments to Labour Only Sub-Contractors (if used) :
Employers' Reference Number (optional)
Employers' Reference Number (ERN) (if available) : (e.g. 123/AB12345 or 'Exempt')
Annual Turnover
Estimated Annual Turnover for the next 12 months (£'s):(Please be as accurate as possible, as an over estimation will increase the premium to be quoted)
Business Legal Expenses Cover (Optional)
Do you require Business Legal Expenses Cover?(£100K cover for legal disputes, employment disputes, tax investigations, etc.) 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 (Optional)
Do you require Directors & Officers Cover?(Cover for any 'wrongful act' of a director or officer of the company) 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, please provide 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 Quotation: This may help us to get you a better quote
Name of Current / Previous Insurer: e.g. Aviva, AXA, Allianz, QBE, RSA, Zurich, etc.