Liability Insurance Quotation Questionnaire for the Construction & Associated Industries.

The following information that you provide will be assessed by Lloyd's underwriters &/or authorised personal of Enterprise Underwriting Solutions for them to assess your client’s insurance risk and provide terms and conditions for a liability quotation for you and your client to consider as appropriate for your clients/their needs.

Important
Every proposer or Insured when seeking a new policy of insurance or cover for additional risks or renewal under an existing policy, must disclose any information that might influence the insurers/reinsurers in fixing the premium or determining whether to accept the risk. Failure to do so may entitle insurers to void cover from inception and seek repayment of paid claims. If you are in any doubt as to whether information is material, you should disclose it. Please read the Disclosure and Non Disclosure notes at the bottom of this slip.

1. Insured:
2. How long has the Insured operated this business?
3. Previous Policy Information:

(b) Give particulars of any claim made by the Insured during the past five years,

Date Cost before Excess Excess Details

Please submit additional information below, if needed

Is there previous loss history available on current or past underwriters stationary? Choose an item.

Yes No 

(c) After investigation, are you aware of any circumstances which could give rise to a claim under the proposed
Insurance and which are not mentioned above

Yes No 

(d) Has the insured been declined liability insurance, or had a liability policy cancelled or a liability policy
issued subject to special terms, conditions or restrictions?

Yes No 

4. Description of construction activities

(c) Maximum Periods of Contracts entered into

5. Contract Value (Single) or Limit any one Contract (Annual):

$

6. Limit of Liability

7. Insured Companies Turnover & Wages

(a) What is the estimated annual turnover?

(b)What are the estimated total payments to sub contractors (excluding labour hire payments)

(c) What are the estimated total payments to labour hire companies

(d) What is annual turnover for the expiring year?

(e) What is annual turnover for the previous 4 years?

(f) What is the estimated annual:

Salaries $
Wages $

8. Type of Work Performed

Please indicate the approximate percentage by value of the total work of the Insured according to type: If NONE state NONE.

Dwellings

1. Individually Designed

%

2. Multiple Low Rise

%

3. Multiple High Rise

%

4. Modular (i.e. involving repetitive design)

%

Public Buildings

1. Hospital

%

2. Schools & Universities

%

3. Any Other Municipal Buildings

%

4. Hotels and Recreation Centres

%

5. Offices

%

Industrial

1. Power Plants

%

2. Chemical, Petro Chemical and Nuclear Installations

%

3. Manufacturing Plants

%

4. Industrial Building Systems

%

5. Mechanical Plant, Bulk Handling Silos

%

Civil Engineering

1. Highways

%

2. Bridges, Tunnels and Dams

%

3. Railways, Airports, Harbours and Jetties

%

4. Sewage / Water Schemes

%

Other
Please Specify-
%

TOTAL

100%

9. Please state the 5 largest Contracts which have commenced during the past 5 years :
Starting Date Type of Contract (Building, road, bridge etc.) Total Contract Value Aust $ Mill Approx. Completion Date Were there any Professional Services Provided
by the Insured or on behalf of the Insured
10. Professional Duties of the Insured

Do you provide advice design or specification solely for a fee

Yes No 

Are you responsible under contract or agreement for advice design or specification provided by you?

Yes No 

Are you responsible under contract or agreement for others advice design or specification that has been provided to you?

Yes No 

If yes to any of the above please provide details?

Do you request evidence of Professional Indemnity Insurance from all consultants that provide consultancy services to you?

Yes No 

Are any of the Directors, Principals or employees, AFTER ENQUIRY, aware of any circumstances which may give rise to a claim against the Insured Company or any circumstances which may give rise to a claim against you for professional duties?

Yes No 

If YES, please give details

11. Pollution

Have there been any pollution incidents, complaints, prosecutions, claims or pollution issues?

Yes No 

If Yes, please provide a brief summary

At the time of this Questionnaire does the proposer know of any facts or circumstances which may reasonably be expected to result in a claim or claims being asserted against your company for environmental clean-up or response or for bodily injury or property damage arising from the release of pollutants into the environment?

Yes No 

If Yes, please provide a brief summary

12. Please describe any other activity of the company that is not related to construction
activities/operations.

Turnover applicable-

13. Turnover dissection for Stamp duty calculations

Percentage of 7(a) for current year in each state or territory.

ACT
NSW
NT
QLD
SA
TAS
VIC
WA
Overseas

Confirmation of compliance of duty of disclosure by the insured

Duty of Disclosure

Before you enter into a contract of general insurance with an Insurer, you have a duty, under the Insurance Contracts
Act 1984, to disclose to the Insurer every matter that you know is relevant to the Insurer’s decision whether to
accept the risk of insurance and, if so, on what terms.

You have the same duty to disclose those matters to the Insurer before you renew, extend, vary or reinstate a
contract of general insurance

Your duty, however, does not require disclosure of matter:

  • that diminishes the risk to be undertaken by the Insurer;
  • that is of common knowledge;
  • that your Insurer knows or, in the ordinary course of business, ought to know;
  • as to which compliance with your duty is waived by the Insurer.
Non-Disclosure

If you fail to comply with your duty of disclosure the Insurer may be entitled to reduce his liability under the contract in respect of a claim or may cancel the contract.

If your non-disclosure is fraudulent, the insurer may also have the option of avoiding the contract from its beginning.

Producing Brokers Details
Yes No