AMSA 2021 Insurance Program Application

INFORMATION STATEMENT

Everest Risk Group (ERG)
ERG is a Corporate Authorised Representative (No 276869) of Insurance Advisernet Australia Pty Limited. (IAA - Australian Financial Services Number 240549). We suggest reviewing our Financial Services Guide for information relating to our business and how we are remunerated.

Click Here to View our Financial Services Guide

Use of information

The information you provide will be shared with authorised representatives of the Australian Men's Shed Association (AMSA), Everest Risk Group; and, any other party for the purposes of administering the products provided to the Australian Men's Shed Association as part of the AMSA Insurance Program; and, any other program forming part of the AMSA

Everest Risk Group values your privacy. Our Privacy Policy sets out how we collect, disclose and handle personal information under the Privacy Act and the Australian Privacy Principals. By providing us such information you consent to these practices unless you tell us otherwise. Our Privacy policy is available at https://www.insuranceadviser.net/ia-privacy-policy or by contacting us.

Frequently Asked Questions regarding the AMSA Insurance Program
Click here for the Frequently Asked Questions prior to completing this declaration; as, many of the questions you may have could already be answered.

A copy of the base policy wording can be accessed by clicking - The policy schedule will be available following renewal:
Summary of Covers

A summary of covers afforded and changes from expiry (excluding endorsements) can be downloaded here

To print a sample of the 2021 Application & Additional Content

The application cannot be saved halfway through completion. If necessary, we suggest you print a copy of the application in order to familiarise yourself with the 2021 content as a number of additional questions have been added for 2021. To familiarise yourself with this additional content, you may download and print a sample of this application by clicking HERE
Please select to continue... *

We have read and understand the use of information statement

Please select the category your association falls into *

Mens Shed Womens Shed Community Shed Repair Cafe Other
Shed Name (Legal Entity Name) *
Postal Address *

Street Address Line 2 (if applicable)

Suburb
Postal Postcode *
State/Territory *
Primary Contact Person *
Number of Members as at the date of this declaration (a minimum of fifteen applies) *
Random audits could occur, particularly at the time of a claim. Members include all persons recorded in the membership record, regardless of status, attendance or participation in workshop activities.
Does your location participate in the Mutual Obligation program administered by Centrelink? *

Yes No
As you have selected yes to participating in the Mutual Obligation program, please advise the number of participants attending in a 12 month period
Primary Email Address *
Please double check your address prior to submission
Secondary Email Address
Contact Phone Number *
Please use ONLY numbers. No spaces, brackets or otherwise. Example 0400123456
Please Select the Date From Which Cover is to be Effective (Renewals only)

Day Month Year
Please Select the Date From Which Cover is to be Effective (New Policy) *

Day Month Year
Please enter the details of your landlord or other interested party to be noted on your Certificate of Insurance
As a Shed from VIC/WA or TAS, do you require interim coverage as your current insurance with Arthur J Gallagher or other Non AMSA provider expires at 4pm 28 February 2021. It is imperative that by selecting "YES" to this question, you must ensure you check your email and click the "Edit Submission" button to complete your application no later than 10 March 2021. When you are ready to proceed with your submission, select "No" to the following.

Please read and acknowledge the following when completing the declaration questions.

Your Duty of Disclosure - What you must tell us

Under the Insurance Contracts Act 1984 (the Act), you have a Duty of Disclosure. You are required before you enter into, renew, vary, extend or reinstate your Policy, to tell us everything you know and that a reasonable person in the circumstances could be expected to know, is a matter that is relevant to our decision whether to insure you, and anyone else to be insured under the Policy, and if so, on what terms.

You do not have to tell us about any matter
- that diminishes the risk
- that is of common knowledge
- that we know or should know in the ordinary course of our business as an insurer, or
- which we indicate we do not want to know.
If you do not comply with your Duty of Disclosure your insurer may reduce or refuse to pay a claim or cancel your Policy.

If your non-disclosure is fraudulent your insurer may treat this Policy as never having operated.

Under-insurance

Industrial Special Risks property insurance is written on a “Reinstatement/Replacement” basis which means replacing the property destroyed or restoring the damage with new materials without any deduction for depreciation or volunteer labour.

The following is an example illustrating the under-insurance clause.
- Full replacement value $2,000,000
- Declared Value to insurer $1,000,000
According to these declared values, the insured is in effect self-insuring for 50% of the property’s full value. Therefore in the event of claim:
- Actual amount of damage $200,000
- Amount insurer would pay $100,000
Roughly 50% of the total damage would be payable by the insurers due to the under-insurance of the property.

The calculation of “full value” for the purposes and application of the under-insurance clause may change from one policy to another. These variables must be taken into account when calculating the “full value” of your property. Please review these with your Adviser if you have any doubts

Waiver of Liability Agreements
Where another person would be liable to compensate you for any loss or damage otherwise covered by the policy, but you have agreed with that person either before or after the loss or damage occurred that you would not seek to recover any monies from that person, the insurer will not cover you under the policy for any such loss or damage.

General Advice Warning

The information provided is to be regarded as general advice. Whilst we may have collected risk information, your personal objectives, needs or financial situations were not taken into account when preparing this information. We recommend you consider the suitability of this general advice, in respect of your objectives, financial situation and needs before acting on it. You should obtain and consider the relevant product disclosure statement before making any decision to purchase this financial product

Your Privacy

We value your privacy. Our Privacy Policy sets out how we collect, disclose and handle personal information under the Privacy Act and the Australian Privacy Principals. By providing us such information you consent to these practices unless you tell us otherwise. Our Privacy policy is available at https://www.insuranceadviser.net/ia-privacy-policy or by contacting us.

Who do we contact with questions related to 'the insurance'

Everest Risk Group Pty Ltd
Sean McDermott (Authorised Representative # 447131)
Phone: 02 8880 0653
Email: amsa@everestrg.com.au

When sending ERG an email, please place the name of your Shed in the ‘Subject’ line.

When contacting ERG, you should be aware of our Privacy Policy. The Privacy Policy sets out how we collect, disclose and handle personal information under the Privacy Act and the Australian Privacy Principals.
Please Acknowledge your acceptance *

We have read and accept all of the above

Activities of a Shed
The activities the insurers note as being standard, for a Shed, are below.

Community Non for Profit Organisation with activities such as:
1. Fundraising BBQ’s for the shed & community
2. Holding and/or organisation of Fete’s, Markets & the Like including car parking direction (not a valet service) where there will be less than 2,500 participants, no fireworks or pyrotechnics and each exhibitor would be responsible for their own insurance coverage.
3. Project work within a shed space, including all workshop type activities and subsequent installation where statutory certification is not required
4. Project work in the community excluding trade services where statutory certification is required.
5. Mentoring and tutorage of students and those from Youth Justice Programmes from the age of 12
6. Instruction of others within the shed on correct use of workshop tools and equipment
7. Production and sale of woodwork and other products in order to support fundraising objectives of the shed
8. Exercise programmes for mind, body & spirit including workout space where weight blocks do not exceed 5kg
9. Repairs to machinery &/or equipment including lawnmowers or small calibre motorised equipment where statutory certification is not required
10. Book Clubs
11. Excursions, including by bicycle or foot, on designated tracks, pathways and other outside locations
12. Tours & Tour accompaniment within Australia
13. Provision of guest speakers on relevant topics
14. Model aircraft flying and tutorage
15. Working with local retailers to construct equipment as per manufacturers specifications
16. Tutorage and assistance of those with special needs
17. Cookery classes where the instructor has relevant food handling certification
18. Testing & Tagging of Shed owned equipment where the work is done by those holding appropriate certification - This does not extend to equipment being readied for sale.
19. Working with participants provided from external agencies
We ask you review the above activities; and, if necessary advise of others you may perform: - Please note, the additional activities do not form part of the policy unless you are advised otherwise.

*Note: Cover for activities not noted in (1) - (19) above are not covered until confirmation is provided by the insurer/Everest Risk Group

It is not the intention of the policy to cover high hazard activities (example - welding off site)
Please acknowledge your acceptance *

We have reviewed the activities above

DO YOU HAVE ASSETS TO INSURE?

If your Shed has physical assets to insure, you MUST select "Yes" to the next question.

The Standard AMSA Insurance Package includes a Total Declared Value of $100,000 for Fire & Other Perils as well as $15,000 of Burglary for one location.

If you have property to insure (assets/contents/fixtures/fittings/building and other Shed property, including property you assume responsibility to insure, please select "Yes" to the next question.

The Industrial Special Risks policy does not define a Building or a Content. It refers to all tangible assets which are your responsibility to insure. Tangible Assets can include building, contents, fixtures, fittings etc.
Does your Shed require the Industrial Special Risks insurance which forms part of the AMSA Insurance Program? Industrial Special Risks covers Tangible Assets at the insured location *
Consider whether your Shed has assets/contents/fixtures/fittings/building and other Shed property requiring coverage (including property, buildings and contents you assume the responsibility to insure)
Please confirm you understand by selecting "No" in the previous question, your Shed has elected not to insure any Tangible Assets, as part of the AMSA Insurance Package's Industrial Special Risks policy. If your Shed requires Contents or Building insurance, please change your answer above to "Yes" - IMPORTANT NOTE: As you have advised you do not have tangible assets, as in assets/contents/fixtures/fittings/building and other Shed Property to insure, it is imperative you contact our office and advise should this change throughout the year

Do you have an operational Shed or facility with which your members are able to conduct manual work activities? *

Yes No

SARS-CoV-2 (CoV-19)
Did your Shed cease operations during 2020 due to CoV-19? *
Please advise the approximate date your facility reopened or plans to reopen

Day Month Year
Date

SARS-CoV-2 (CoV-19)

Liability

Liability Continued