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,
Please submit additional information below, if needed
Is there previous loss history available on current or past underwriters stationary? Choose an item.
YesNo
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:
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
%
4. Modular (i.e. involving repetitive design)
%
Public Buildings
2. Schools & Universities
%
3. Any Other Municipal Buildings
%
4. Hotels and Recreation Centres
%
Industrial
2. Chemical, Petro Chemical and Nuclear Installations
%
3. Manufacturing Plants
%
4. Industrial Building Systems
%
5. Mechanical Plant, Bulk Handling Silos
%
Civil Engineering
2. Bridges, Tunnels and Dams
%
3. Railways, Airports, Harbours and Jetties
%
4. Sewage / Water Schemes
%
Other
9. Please state the 5 largest Contracts which have commenced during the past 5 years :
10. Professional Duties of the Insured
Do you provide advice design or specification solely for a fee
YesNo
Are you responsible under contract or agreement for advice design or specification provided by you?
YesNo
Are you responsible under contract or agreement for others advice design or specification that has been provided to you?
YesNo
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?
YesNo
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?
YesNo
If YES, please give details
11. Pollution
Have there been any pollution incidents, complaints, prosecutions, claims or pollution issues?
YesNo
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?
YesNo
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.
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
