Insured Name(Required)Class Insurance(Required)Policy Number(Required)Insurer(Required)Due Date DD slash MM slash YYYY Current Business activities noted as(Required)Do you undertake any other type of work?(Required) Yes No Do you hold a builders licence?(Required) Yes No Do you require cover for Material Damage?(Required)Material Damage provides cover for your project from perils such as Fire, Storm, Malicious Damage, Theft of Building Materials etc Yes No Do you undertake any Pool Fencing?(Required) Yes No If yes, please advise the percentage of your turnover.What is your estimated turnover for the next 12 months?Number of employees including yourself.Are you still operating as a sole trader?(Required) Yes No If No, please advise the name of your new entity(Required)If No, date it was formed(Required) DD slash MM slash YYYY Do you use subcontractors?(Required) Yes No If Yes what is your estimated payments to subcontractors?Do ALL subcontractors have their own Public Liability Insurance and if applicable Workers Compensation Insurance?(Required) Yes No Do you obtain certificates of currency from your subcontractors?(Required) Yes No Do you perform "hot work" away from own premises that involves the use of cutting, welding, grinding or soldering equipment?(Required) Yes No If Yes, describe the activities performedUntitledWhat is the percentage of turnover from "hot work" away from own premises?What is the maximum depth of underground/excavation work in meters?Do you perform external height work at height?(Required) Yes No If Yes, what is the maximum heightIs any work performed by you or on behalf you at or on any of the following:(Required) the part of an airport used by aircraft for loading and unloading and takeoffs and landings offshore platforms and rigs, watercraft underground mine shafts or tunnels demolition of buildings or other structures exceeding 5 meters in height subaqueous / underwater work railway signaling or working within the rail corridor construction and/or structural maintenance of dams/reservoirs or weirs petrochemical plants or refineries power stations Yes No If yes, please provide detailsHave you, the insured, any partner or director or any other person responsible for managing the business, or any other business in which the insured or partners/directors have been trading, have(Required) Been convicted (or charged but not tried) with any criminal offence, or Been declared bankrupt or insolvent or gone into liquidation or receivership, or Had any liability insurance cancelled or non-renewed, or Been prosecuted under any health and safety legislation or similar laws in the past 5 years Yes No If yes, please provide detailsWe note your limit of liability is currently $10 million. In the event of major claim or incident, this may not be sufficient to cover the full legal costs and settlement. Would you like to increase your cover to $20 million?(Required) Yes No Are you aware of any claims or incidences that may give rise to a claim that has not been reported to our office(Required) Yes No Contractual Liability - How can we assist you? Most businesses are often asked to sign contracts - but how much do you know about contractual liability and the impact it can have on your insurance policies and even your assets? Not understanding the issues of contractual liability and signing a contract in this area can have considerable consequences for your own business and your insurance policies. To reduce the risk that this issue can pose to your business and personal assets, talk to us. This applies to tenancy agreements through to large commercial contracts (for example supply contracts). Don’t sign ANY CONTRACTS without checking with us first to determine if your insurance program will cover the additional liabilities that you are likely to assume by signing - or if you are able to obtain additional cover in the market for these liabilities. As your insurance broker, we are able to advise on the insurance coverage that you have. We can also arrange for a specialist third party to complete any necessary legal reviews AT NO COST TO YOU.. You should be aware that in some cases it is not commercially possible to obtain insurance cover for some of the more onerous clauses that can often be included in contracts. Be aware BEFORE you sign. NSW Stamp Duty Exemption for Small Business The NSW Government has exempted small businesses from paying NSW stamp duty on certain types of insurance effected or renewed from 1 January 2018. To receive this exemption please complete the attached declaration and return to our office at least 21 days before your renewal date. Uninsured/ Recommended Risks - Please contact us if you would like a quotation or further informationConstruction Insurance (annual or single project)(Required)Our construction insurance is available for single projects or annual contract works, and includes cover for Damage to insured contract works, Removal of debris, Principal supplied materials, material on site/ transit as well as Public Liablity. We strongly recommend this comprehensive policy for all our builders. Yes No Business Package - Buildings, Contents, Stock & Machinery(Required)Cover is available to protect your factories fit out, contents, stock and machinery from items such as fire, storm, malicious damage, theft, loss of income due to insured event and machinery breakdown including expediting costs for specialist parts. Yes No Mobile Plant and Equipment(Required)Cover can be arranged for physical damage or theft of mobile plant and equipment along with legal liability arising out of registered, conditional registration or un-registered plant. Cover can be extended for hire in plant, dry hire and additional costs incurred due to the loss/ damage of such equipment. Yes No Tools of Trade (General Property Cover)(Required)A Tradesman’s most valuable asset is his tools of trade. If your tools were stolen would you be able to afford to replace them? Cover can be arranged for cost of repairs, cost of replacement or the agreed sum insured following accidental damage or theft whilst on site or at your premises. Yes No Privacy & Cyber Protection Insurance(Required)Do you pay suppliers and contractors? You could be open to cyber fraud/theft. This is where you accidentally transfer funds to a hacker who has impersonated your contractor/ supplier. Any company who pays or issues invoices and holds confidential information should consider this policy to assist with the replacement of funds and recovery of data. Click Here for a Fact Sheet Cyber Protection Information Yes No Legal Expenses(Required)When engaging in business, circumstances can arise where you may need to pay defence costs for statutory and non-statutory business matters that are not covered under traditional public liability or management liability policies. Such as contractual disputes with customer or suppliers and lease or tenancy agreement disputes. Cover can be arranged for these items including a free telephone legal advice that can give you peace of mind in the event of any nasty disputes. Yes No Professional Indemnity(Required)Traditionally public liability insurance excludes claims for a breach of duty or professional advice. Cover can be arranged to protect yourself from claims or allegations made against you by third parties during the policy period arising out of a breach, error or omission in the provision of professional services performed by you directly and/or your consultants and subcontractors for which you are vicariously liable. Yes No Sickness & Accident Cover - Sole Trader(Required)Sickness & Accident Insurance replaces your lost income in the event of sickness or injury. For the self employed person it is an absolute must, where you have no workers compensation cover and can provide cover 24 hours a day, 7 days a week usually anywhere in the world. With mortgages to meet and a family to keep this is the only way to replace your income during incapacity. Business Overhead expenses may also be covered under this policy. Yes No Sickness & Accident Cover - PTY LTD(Required)Sickness & Accident Insurance replaces your lost income in the event of sickness or an injury occurring outside of work. Even if you have workers compensation cover you can still have an accident outside of working hours and of course sickness can occur at any time. With mortgages to meet and a family to keep this is the only way to replace your income during incapacity. Yes No EmailThis field is for validation purposes and should be left unchanged. Δ
