Transcription

Electrical,Heating,Ventilation,Plumbing AndAir ConditioningContractorsProposal Form

Lygon House50 London RoadBromleyKent. BR1 3RA020 8315 IMPORTANT INFORMATION & DATA PROTECTION32.CONTACT INFORMATION53.PROPOSER DETAILS64.BUSINESS ACTIVITIES75.GENERAL QUESTIONS86.PREMISES97.INSURANCE PRODUCTS7.1Property and Business Interruption107.2Contract Works and Plant137.3Legal Liability147.4Professional Indemnity177.5Directors & Officers Liability187.6Legal Expenses208.CLAIMS HISTORY219.DECLARATION22Page 2

Lygon House50 London RoadBromleyKent. BR1 3RA020 8315 [email protected] INFORMATION1.1Important InformationPlease answer all of our questions.Completing this form does not oblige us to agree to provide insurance to you, nor you to accept anyquotation(s) we offer.Should we accept your proposal, our acceptance will be based on the information presented to usbeing a fair presentation of you, your property and your business.It is important that you understand that Insurers may treat policies as if they had never existed anddecline all claims if you provide false or misleading information, withhold important information or failto advise of any change to the information you have provided.Please note that 'You' or 'Your' in the context of these questions and this proposal means the person(s)named as Proposer and/or any other director or partner of the named Proposer.Unless you advise us otherwise, policy documents will be issued by email.1.2Data Protection – How we will use your DataThe Basics:Camberford Underwriting, and the underwriters with whom we arrange insurance, collect and userelevant information about you to provide you with insurance cover and to meet our legal obligations.This information includes details such as your name, address and contact details and any otherinformation that we collect about you in connection with the insurance cover from which you benefit.This information may include more sensitive details such as information about your health and anycriminal convictions you may have.In certain circumstances, we may need your consent to process certain categories of information aboutyou (including sensitive details such as information about your health and any criminal convictions youmay have). Where we need your consent, we will ask you for it separately. You do not have to give yourconsent and you may withdraw your consent at any time. However, if you do not give your consent, oryou withdraw your consent, this may affect our ability to provide insurance cover and may prevent usfrom handling your claims.Your information may be shared with, and used by, a number of third parties in the insurance sector forexample insurers, agents or brokers, reinsurers, loss adjusters, sub-contractors, regulators, lawenforcement agencies, fraud and crime prevention and detection agencies and compulsory insurancedatabases. We will only disclose your personal information in connection with the insurance cover thatwe provide and to the extent required or permitted by law.Other people's details you provide to us:Where you provide us or your broker with details about other people, for example employees, you mustprovide this notice to them.Page 3

Lygon House50 London RoadBromleyKent. BR1 3RA020 8315 [email protected] rights:You have rights in relation to the information we hold about you, including the right to access yourinformation held by us. If you wish to exercise your rights, discuss how we use your information orrequest a copy of our full privacy notice, please use the contact details provided below or in our fullprivacy notice available at the website link below.Want more details?For more information about how we use your personal information and your rights please see our fullprivacy notice, which is available online at the following location:www.camberford.com/privacyContact DetailsCamberford UnderwritingData Protection Officer50 Fenchurch StreetLondonEC3M 3JYPage 4

Lygon House50 London RoadBromleyKent. BR1 3RA020 8315 [email protected] INFORMATION2.1Name of insurance broker (if any)making this declaration of facts:2.2Name of person providinginformation within this form:2.3Contact Email:2.4Contact Telephone Number:Page 5

Lygon House50 London RoadBromleyKent. BR1 3RA020 8315 [email protected] DETAILS3.1Proposer(s):Full name of Proposer includingtrading name. Also includeany/all subsidiary companies tobe insured.3.2Individual Name(s):Please list the names and date ofbirths of all Directors and/orPartners of the Proposer(s):3.3Correspondence Address:Full postal (correspondence)address:Name:Date of Birth:Post Code:3.4Years Established:Number of years the proposerhas been established:3.5Years Experience:Number of years experience ofthe proposer within your businessactivities:3.6FCA Classification:Please complete the followinginformation which we must havefor regulatory classification.Does the Proposer’s annual turnover exceed EUR2,000,000?What is the total number of full time employees ofthe Proposer?Page 6YES/NO

Lygon House50 London RoadBromleyKent. BR1 3RA020 8315 [email protected]berford.com4.BUSINESS ACTIVITIES4.1Business DescriptionPlease answer appropriately to describe your business:4.2Electrical WorkYES/NOHeating/Ventilation WorkYES/NOAir Conditioning WorkYES/NOPlumbing WorkYES/NOSolar Panel InstallationYES/NOAdditional ActivitiesAny other activities that you undertake that are not listed above must be disclosed in the box below.You will not be covered for activities that are not disclosed.4.3Qualified/AccreditedCan you confirm that you and all employees and contractors working for you arequalified/accredited where and to the extent necessary to comply with local law,regulation and industry best practice?Page 7YES/NO

Lygon House50 London RoadBromleyKent. BR1 3RA020 8315 [email protected] QUESTIONS5.1Please read the following questions and state if they are true in respect of this proposal.Have you, or any director of your company, ever:Had a proposal for insurance declined?YES/NOHad special conditions imposed onto an insurance policy or a policy cancelled?YES/NOHad a claim rejected by an insurer?YES/NOHad any criminal convictions (other than minor motoring offences) that are not yetspent or do you have any prosecution pending?YES/NOBeen the subject of a County Court Judgement (or Scottish equivalent) or been declaredbankrupt or insolvent or placed under administration?YES/NOHad an arson or suspected arson event, whether insured or not, at any property ownedin part or in full by You or which you have occupied at the time of such event?Had any formal objection or refusal of any registration or are there any circumstancesknown which may prejudice the continued holding of registration?5.2YES/NOYES/NOFinancial Status and History of the proposer:Are you currently trading at a loss or do you have debts that you may not be capable ofservicing?YES/NO5.3Is the proposer domiciled and registered in and does the proposer only undertake workwithin the United Kingdom, the Isle of Man and the Channel Islands?YES/NO5.4Does the proposer undertake any work in Northern Ireland?YES/NOPage 8

Lygon House50 London RoadBromleyKent. BR1 3RA020 8315 [email protected] list the full address of any Premises to be insured:(if property is not being insured, please still list the locations from which you trade)Premises 1:Post Code:Premises 2:Post Code:Premises 3:Post Code:Premises 4:Post Code:Page 9

Lygon House50 London RoadBromleyKent. BR1 3RA020 8315 [email protected] AND BUSINESS INTERRUPTION7.1.1Please complete the table to provide details of the cover you require:SUM INSUREDSECTIONBuildings (including fixed glass, landlord’sfixtures/fittings, outside walls, gates andfences)Premises 1Premises 2Premises 3Premises 4 Is the building constructed of noncombustible floors, walls and roof spacethroughout?YES/NOYES/NOYES/NOYES/NOStock and Materials in Trade All Other Contents (including fixtures &fittings, machinery, plant, tenantsimprovements and computers) Day One Uplift. Do you wish to have the SumInsured for Buildings and Contents adjustedby up to 15% in the event that costs ofreinstatement or repair escalate between thedate of loss or damage and the eventualsettlement date? Rent Payable Indemnity Period (Rent Payable)Business Interruption (Gross Profit)Indemnity Period (Gross Profit)12/24/36Months 12/24/36Months12/24/36Months 12/24/36Months12/24/36Months 12/24/36Months12/24/36Months 12/24/36MonthsAdditional Increased Cost of Working Rent Receivable Indemnity Period (Rent Receivable)12/24/36MonthsPage 1012/24/36Months12/24/36Months12/24/36Months

Lygon House50 London RoadBromleyKent. BR1 3RA020 8315 [email protected] Property Sections (not premises specific)Goods in Transit (Included automatically at 1,000. Only state an alternative amount if you require a limit higher than this.Computer Equipment Breakdown at the Premises. Maximum 50,000 Computer Equipment Breakdown Increased Cost of Working. Maximum 25,000 All Risks to General Business Equipment All Risks to Laptops & Mobile Phones Fidelity Guarantee (Theft by Employees). Maximum 100,000 Money in Safe or Strongroom in the Premises State the highest amount required at any one premises.Money in Transit or Bank Night Safe Book Debts Included automatically at 5,000. Only state an alternative amount if you require a limit higher than this.Stock Deterioration following Refrigeration Breakdown Included automatically at 1,500. Only state an alternative amount if you require a limit higher than this.7.1.3Buildings/Construction (please answer the following questions in respect of this proposal)Are the Premises constructed of brick and/or stone walls with slate, tile, felt, orconcrete roof?YES/NODo any premises have a flat roofed area exceeding 25% of its total?YES/NOAre any premises an individual flat or tenement building?YES/NODo the premises contain any composite panels?YES/NOAre any premises Listed?YES/NOPage 11

Lygon House50 London RoadBromleyKent. BR1 3RA020 8315 [email protected] answer the following questions in respect of this proposal7.1.5Are all premises free from signs of damage which may be attributable to Subsidence,Landslip or Heave?YES/NOAre any Premises being monitored or previously been monitored for Subsidence,Landslip or Heave – or actually incurred damage from Subsidence, Landslip or Heave?YES/NOFloodAre any Premises in a flood plain or area that has previously flooded?7.1.6Premises 1Premises 2Premises 3Premises 4YES/NOYES/NOYES/NOYES/NOStorage of ProductsAre all goods, products and equipment stored in accordance with manufacturer’sguidance?7.1.7YES/NOSecurityPlease complete the table to provide details of the security protections in effect at each Premises:Premises 1Premises 2Premises 3Premises 4CCTVYES/NOYES/NOYES/NOYES/NOGated UnitYES/NOYES/NOYES/NOYES/NO24 Hour/Overnight Manned SecurityYES/NOYES/NOYES/NOYES/NORoller Shutters to all external leadingdoors, shop front and other large glassexternal facing areas.YES/NOYES/NOYES/NOYES/NOIntruder Alarm Type (ie., Audible,Central Station, or BT Redcare)7.1.8Age of Buildings and Number of Storeys (please complete the table to confirm the Age and numberof storeys in respect of each premises to be insured)Premises 1Year BuiltNumber of StoreysPage 12Premises 2Premises 3Premises 4

Lygon House50 London RoadBromleyKent. BR1 3RA020 8315 [email protected] WORKS & PLANT7.2.1Please complete the following table to detail the Contract Works and/or Contractors Plant cover yourequire.Owned Plant Hired in Plant (State the Any One Occurrence/Accident Limit)Hiring Charges (Estimate for the next 12 months). Hired in plant cover is not available unless thisinformation is provided.Continuing Hire Charges (This is automatically included where Hired in Plant is insured. You must include the valuesof Continuing Hire Charges in the Hired in Plant Sum Insured).Employees Tools and Effects (Limited to 500 per Employee)Contract Works (State the maximum value of any one contract). Maximum Contract Period is 12 months.Please contact us if this is insufficient.Turnover (You must state estimated turnover if Contract Works cover required).Page 13

Lygon House50 London RoadBromleyKent. BR1 3RA020 8315 [email protected] LIABILITYEmployers’ Liability Limit (Minimum 10m)YES/NO7.3.2Public/Products Liability Limit ( 1m, 2m, 5m, or 10m)Please state Limit of Indemnity required for Public and Products Liability (if required)7.3.3 Wageroll, Turnover and EmployeesPlease complete the table to detail your estimated wageroll, estimated turnover, and number ofEmployees and Labour Only Sub-Contractors for the next 12 months. Do not include payments to ornumbers of bona fide Sub-Contractors:Type of Work Undertaken by Employees andLabour Only Sub-ContractorsEstimated AnnualWagerollEstimatedAnnual TurnoverClerical (non manual work) Employees Electrical Work in Private Dwellings Electrical Work in Shops and Small CommercialBuildings Electrical Work in Industrial and LargeCommercial Buildings Heating/Ventilation Work in Private Dwellings Heating/Ventilation Work in Shops and SmallCommercial Buildings Heating/Ventilation Work in Industrial andLarge Commercial Buildings Air Conditioning Work in Private Dwellings Air Conditioning Work in Shops and SmallCommercial Buildings Air Conditioning Work in Industrial and LargeCommercial Buildings Plumbing Work in Private Dwellings Plumbing Work in Shops and SmallCommercial Buildings Plumbing Work in Industrial and LargeCommercial Buildings Solar Panel Installation General Building Manual Work at your Premises Only Other:(please specify) Other:(please specify) Page 14Number ofEmployees

Lygon House50 London RoadBromleyKent. BR1 3RA020 8315 [email protected] you undertake generic and site specific risk assessments?7.3.5Hazardous LocationsYES/NODo you undertake work in any of the following locations?7.3.6TowersYES/NOSteeplesYES/NOChimney ShaftsYES/NOBlast Breakwaters or sea walls collieriesYES/NOMinesYES/NOChemical WorksYES/NOOil RefineriesYES/NOPower StationsYES/NOBulk Oil, Petrol, Gas or Chemical Storage Tanks or ChambersYES/NORailwaysYES/NODepth WorkDo you undertake work at depths exceeding 2 metres?7.3.7YES/NOHeight WorkDo you undertake work at height exceeding 20 metres above ground level?Page 15YES/NO

Lygon House50 London RoadBromleyKent. BR1 3RA020 8315 1Rail (Redzones)Do you undertake work in “Red Zone” (live rail) areas of railways?YES/NOHeat WorkDo you undertake heat work OTHER THAN by use of hot air gun (heat gun) and/orsoldering iron?Hiring OutYES/NODo you hire out any plant or equipment?YES/NOBFSCPlease answer the following questions in relation to bona fide Sub-Contractors:Estimated payments you will make to bona fide Sub-Contractors within the next 12months7.3.12 Do you direct, supervise and/or control any bona fide Sub-Contractor work?YES/NODo bona fide Sub-Contractors ever work to a specification from you and/or do yousign off on their work?YES/NOHMRC Employers Reference NumberCompanyERN StatusIf exempt, please explain below:Page 16ERN Number

Lygon House50 London RoadBromleyKent. BR1 3RA020 8315 [email protected] INDEMNITY7.4.1Please answer the following questions in respect of this proposal:7.4.2Do you undertake work for any subsidiary, connected or association company?YES/NOHave you sustained any loss through the fraud or dishonesty of any person employedby or contracted to work for you?YES/NOHas any fraud, dishonesty, bankruptcy or administration order applied to you or anyof your employees?YES/NOHave any claims been made against you or are you aware of any circumstance thatmay lead to a claim being made?YES/NODo you undertake design and/or consultancy work in relation to bridges or tunnels,nuclear or atomic projects, foundations, underpinning, chemical works,petrochemical works, refineries, airports, railways or motorways?YES/NODo all persons conducting design and/or consultancy work, whether employees oroutside consultants, have at least 3 years experience undertaking such work?YES/NOHave you or any employee or consultant working for you ever failed to complete aproject?YES/NOAre any material changes to the business expected during the period of insurance?YES/NOFees & TurnoverPlease complete the table below regarding your anticipated fees and/or turnover:Type of Work Undertaken7.4.3FeesTurnoverDesign/Specification Work Only (ie. You do NOTundertake Construction/Installation work) Design/Specification work AND correspondingConstruction/Installation Work Design/Specification work subcontracted by YOU to aspecialist Construction Installation Work Only (ie You are NOTresponsible for Design/Specification Work) Indemnity LimitPlease state the Limit of Indemnity required for Professional Indemnity InsurancePage 17

Lygon House50 London RoadBromleyKent. BR1 3RA020 8315 [email protected] & OFFICERS LIABILITYDo you require Directors & Officers Liability Insurance?YES/NOIf YES, please complete questions 7.5.1 to 7.5.6. If NO, please continue to question 7.67.5.1LimitPlease state the Limit of Indemnity required for Directors & Officers insurance:7.5.27.5.3D&O General Questions - Please answer the following questions in respect of this proposal:Has the company been established for more than 12 months?YES/NODo the Company’s activities involve the provision of financial products or services?YES/NODoes the Company’s latest annual report and accounts show a positive net income(after tax)?YES/NODoes the Company’s latest annual report and accounts show a positive shareholderfunds/net worth?YES/NODoes the Company have any assets or subsidiaries in the USA or Canada?YES/NOAre the Company’s shares publicly traded on any stock exchange?YES/NOHave any claims been made against any past or present Director or Officer of theCompany or its Subsidiaries?YES/NOAre you aware of any circumstances which may give rise to a claim?YES/NOTurnoverPlease state your Company’s total consolidated turnover as shown in your latest annual report andaccounts:7.5.4Company Registration NumberPlease state your Company Registration Number:Page 18

Lygon House50 London RoadBromleyKent. BR1 3RA020 8315 [email protected] and Employment Practices Liability LimitPlease indicate the Limit required for Entity and Employment Practices Liability. If NONE, pleasecontinue to question 7.6:7.5.6NONEYES/NO 250,000YES/NO 500,000YES/NOEntity and Employment Practices Liability General Questionsquestions in respect of this proposal:-Please answer the followingDo you have written employment and grievance procedures that have beenissued to all employees?YES/NODo you have MORE than 100 employees?YES/NOAre you anticipating any redundancies in the next 12 months?YES/NOAre any final stage disciplinary procedures or other formal processes underwaythat could give rise to a claim?YES/NOHave there been any claims, or circumstances that might lead to a claim,involving any of you?YES/NOPage 19

Lygon House50 London RoadBromleyKent. BR1 3RA020 8315 [email protected] EXPENSESDo you require Legal Expenses Insurance?YES/NOIf YES, please complete questions 7.6.1 to 7.6.4. If NO, please continue to question 8.7.6.1WagerollWhat is your estimated total Wageroll for the forthcoming period of insurance (next 12 months)7.6.2Disputes, Prosecution, ActivitiesHave you, your business or employees been involved in any legal disputes, action orprosecution (excluding driving offences) during the last 5 years whether insured ornot?7.6.3RedundanciesTo the best of your knowledge and belief, are any redundancies envisaged in yourbusiness within the next 12 months?7.6.4YES/NOYES/NOMergers/TakeoverIn the last 3 years, have you been taken over, merged with or taken over any othercompany, or to the best of your knowledge and belief is it likely that your firm willtake over another firm within the next 12 months?Page 20YES/NO

Lygon House50 London RoadBromleyKent. BR1 3RA020 8315 [email protected].com8.CLAIMS HISTORY8.1Claims HistoryHave you or any of your Directors or Partners, or any company of which any of youhave been a director, or any partnership of which any of you have been a partner,sustained any loss or damage or had a claim made against you during the last 5years?YES/NOIF YES please complete table below:DATE OFLOSSTYPE OF LOSSCLAIM AMOUNTDESCRIPTION OFINCIDENTPage 21STATUSPaidO/S OPEN/CLOSED OPEN/CLOSED OPEN/CLOSED OPEN/CLOSED OPEN/CLOSED OPEN/CLOSED OPEN/CLOSED OPEN/CLOSED OPEN/CLOSED

Lygon House50 London RoadBromleyKent. BR1 3RA020 8315 ional InformationIn the box below, please state any additional information necessary to provide; insofar that itincreases a risk or might otherwise be relied on by us to make a fair and reasonable assessment ofyour proposal.9.2DeclarationDo you confirm that the statements made and questions answered on behalf of theproposer are to the best of your knowledge and belief true and complete?Signed:Date:Page 22YES/NO

Proposal Form . Lygon House 50 London Road Bromley Kent. BR1 3RA 020 8315 5000 [email protected] Page 2 CONTENTS SECTION PAGE 1. IMPORTANT INFORMATION & DATA PROTECTION 3 2. CONTACT INFORMATION 5 3. PROPOSER DETAILS 6 4. BUS