Insured 4 Construction - Contractors Fact Find

Contractors Fact Find
General
Full Company Name*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Name*
Contact Number*

Country CodePhone Number
Business Description*
Any non-motor claims in the last 5 years?*

YesNo

Current Policy
Renewal Date*

DayMonthYear
Date
Current Insurer*
Current Broker*
Target/Renewal Premium*
£GBP

Liabilities

in £GBP
Public Liability Limit*

£1 Million£2 Million£5 Million£10 MillionOther
Employers Liability Limit*

£10 MillionOther
Financial Projections

in £GBP
Estimated Turnover*
£GBP
Wages - Clerical (inc Non Manual Directors)*
£GBP
Wages - Manual Directors*
£GBP
Wages - Manual PAYE*
£GBP
Payments to Labour Sub Contractors (LOSC)*
£GBP
Payments to Bona Fide Sub Contractors (Those who supply their own materials_*
£GBP
Number of Clerical Staff (inc Directors)*
£GBP
Number of Manual Staff (inc Directors & LOSC)*
£GBP

Risk Information
Maximum Working Height*
Meters
Maximum Working Depth*
Meters
Split of Work
Residential (PDH etc)*
%
Commercial (Shops & Offices etc)*
%
Industrial (Factories etc)*
%
Other (Please Specify Below)*
%
Details of Other Work (if necessary)
Asbestos & Heat
Do you work directly with asbestos?*

LicensedNon-LicensedBoth
Do you use Heat?*

YesNo

Contractors All Risks

if Required
Estimated Annual Turnover
£GBP
Maximum Period of any one Contract
Average Period of any one Contract
Maximum Value of any one Contract
£GBP
Average Value of any one Contract
£GBP
Employees Tool & Personal Effects
£GBP
Owned Plant
Total Value of Owned Plant
£GBP
Maximum Value of One Item of Owned Plant
£GBP
Hired Plant
Total Value of Hired Plant
£GBP
Maximum Value of One Item of Hired Plant
£GBP
Estimated Annual Hiring Charges
£GBP

Professional Indemnity
Do you Require Professional Indemnity (PI)*

YesNo
If yes, then what is the Limit of Indemnity?
If yes, what is the Policy Renewal Date?

DayMonthYear
Date

Motor Fleet
Do you Require Professional Indemnity (PI)*

YesNo
If yes, then how many Vehicles?
If yes, what is the Policy Renewal Date?

DayMonthYear
Date

Office Buildings & Content
Do you Require Cover for Office Buildings/Contents*

YesNo
If yes, what is the Policy Renewal Date?

DayMonthYear
Date

Notes & Other Policies Required
Notes
Assumptions We Will Make
We will make a number of assumptions based on your business carrying out best practice.

Disclosure of material facts is the responsibility of the client under the Insurance Act 2015.

If you are unsure what constitutes a material fact then please contact a member of staff.
General
This insurance contract is based upon neither the company director(s) or partners having:
- Been convicted, charged or cautioned for any criminal offence other than (road traffic) motoring offences.
- Been declared bankrupt and/or have been subject of a winding up order, insolvency, liquidation or administration.
- Been a director or partner of a company which has gone into insolvency, liquidation, receivership or administration.
- Ever been prosecuted from failure to comply with Health & Safety or Welfare or Environmental Protection legislation.
- Ever received a HSE prosecution or notice.
- That no business in which you have been involved with has ever had insurance declined, cancelled or refused.
Documentation
- That an up to date Health and Safety policy is in force and made available to your staff and visitors.
- That you always review the circumstances of accidents at work to minimise the likelihood of a recurrence.
- That you retain Health and Safety Risk Assessment Records, Training Records, Method Statements and RIDDOR Forms.
- That you retain contract and sub-contract documentation.
- That you provide and retain a register for the issue of Personal Protective Equipment.
- That all Risk Assessments issued been complied with.
- That you retain proof of insurance for all other bona fide subcontractors used.
- That you keep copies of all liability insurances that you have taken out in the past.
Should be Empty:

Contractors Fact Find

General

Current Policy

Liabilities

Financial Projections

Risk Information

Split of Work

Asbestos & Heat

Contractors All Risks

Owned Plant

Hired Plant

Professional Indemnity

Motor Fleet

Office Buildings & Content

Notes & Other Policies Required

Assumptions We Will Make

General

Documentation