Contractors All Risks Insurance - Quotation Request

Proposer's name

Contact name

E-mail address

Company or trading name

Business address

Postcode

Telephone No

Fax No (optional)

Description of trade or business

Are you an existing Rowett Insurance client?

Yes No

Details of work undertaken

please describe in the box below

Estimated payments for the next 12 months
to Principals, employees (which include labour masters, labour only sub-contractors or persons supplied by them, self employed persons or persons hired or borrowed) and sub-contractors who provide both labour and materials. Please split your turnover between the type of work shown below.

Type of work

Building work

a) New construction

i) erection of private dwellings, shops, offices, pubs, hotels of up to 4 storeys plus attic

Principals & Partners (£)

Employees (£)

Sub contractors (£)

Turnover (£)

ii) erection of single storey buidings of up to 8 metres in height

Principals & Partners (£)

Employees (£)

Sub contractors (£)

Turnover (£)

b) Jobbing work

Alteration maintenance and repair of properties described in a) above

Principals & Partners (£)

Employees (£)

Sub contractors (£)

Turnover (£)

All other building work (please describe this work below)

Principals & Partners (£)

Employees (£)

Sub contractors (£)

Turnover (£)

All other work (please describe this work below)

Principals & Partners (£)

Employees (£)

Sub contractors (£)

Turnover (£)

please describe all 'other work' mentioned above, here

What is the maximum value of any one contract?

Are the following additional items required on the policy (please check the appropriate boxes as required and insert the applicable amount)

Description

Required?

Total replacement value

Own plant, tools, equipment and temporary buildings

Employees tools and personal effects

Plant and equipment hired in (the figure entered here should be the estimated charges for the next 12 months)

General Questions

1. Will any work be done on aircraft or aircraft operational areas, water-borne craft, off shore or in nuclear installations, petrochemical works or power stations?

Yes No

2. Do you use oxy-acetylene or similar welding or cutting equipment, angle grinders, blow lamps, blow torches, flame guns, hot air guns or other heat producing equipment?

Yes No

3. Do you undertake or provide design plans or technical advice, supervision or inspection?

Yes No

4. Will you undertake any manual work outside the UK?

Yes No

5. Do you handle, use, store or transport asbestos, gases, explosives, radioactive substances or any hazardous chemicals?

Yes No

6. Are your premises in a good state of repair?

Yes No

7. Is your machinery and plant (including mechanically propelled plant) properly fenced, guarded and in good order and where appropriate inspected in accordance with statutory requirements?

Yes No

8. Has any prosecution, prohibition notice or improvement order been placed on the Company under the health and safety regulations during the past 5 years?

Yes No

9. Are all partners, principals and directors in good health and free from physical defect or deformity?

Yes No

10. Do you carry out work in, over, under or adjacent to rivers, lakes or tidal waters?

Yes No

11. Have you or any of your partners or directors either personally or in connection with any business in which you/they have been involved

a) previously held insurance for any of the covers to which this proposal relates at these premises or elsewhere?

Yes No

b) held any insurance (in respect of the covers to which this proposal relates) which have subsequently been declined, terminated, refused renewal or subject to special terms?

Yes No

c) been convicted or charged (but not yet tried) with a criminal offence other than a motoring offence?

Yes No

d) been declared bankrupt or are the subject of any current bankruptcy proceedings or any voluntary or mandatory insolvency or winding up procedures?

Yes No

d) had within the last 5 years any losses whether insured or not or had claims made against you (in this or any existing or previous business)?

Yes No

if you have answered 'yes' to any of the above (1 - 11d) please give details below referring to the question number

Claims History

Has there been any incidents in the last five years which have, or could have given rise to any claims in respect of the cover proposed

Yes No

if yes, please give full details in the box below including dates, details of claims, any monies paid and outstanding
 

Renewal Date of present insurance (if applicable)

Insurance required from

Preferred Payment Method

choose >>> Credit Card Debit Card Cheque Direct Debit