Builders Public Liability Insurance Quote Form

Please insert your details below and one of our commercial advisers will contact you shortly with a liability insurance quotation.

This form is designed for quotes for Builders Public Liability Insurance and employers liability insurance only.

If you have any problems with completing this form, please phone us on 01623 641 386 for assistance.

Personal/Company Details
Proposer's Full Name(s): (enter sole trader's name or all partner's names if a partnership)
Contact Name: (if different to proposer's name)
Limited Company Name: (if applicable)
Trading Name:
Trading Status:	- - - - - - Please Select - - - - - Sole Trader Partnership Limited Company Limited Liability Partnership Unincorporated Association
Business Address:
Postcode:
Daytime Telephone Number:
Mobile Telephone Number:
*E-Mail Address:
*Please note that your email address will only be used to provide you with your quote and not for any other marketing purposes.
General Information
Have you, or any other partner or director ever been convicted of or charged (but not yet tried) with any criminal offences other than a motoring offence?	Yes     No
If yes, please provide details of the conviction(s): (e.g. type and reason for conviction(s))
Date of Conviction/Offence:
Details of any fines and/or community service: (Please enter 'None' if you did not receive any fines and/or community service)
Length of custodial sentence(s): (Please enter 'None' if you did not receive a custodial sentence)
Has any insurer ever refused renewal, declined/cancelled cover or imposed any special terms?	Yes     No
If yes, please provide details: (e.g. details/reason for any insurance refused/ cancelled/special terms imposed, etc.)
Have you, or any other partner or director ever been declared bankrupt or insolvent or been the director of a company which has become insolvent or which has gone into liquidation, receivership or administration?	Yes     No
If yes, please provide details: (e.g. circumstances of bankruptcy/insolvency/administration etc.)
Date of bankruptcy/insolvency/liquidation/administration:
Amount of bankruptcy/insolvency, etc. (£'s):
Please provide details of date discharged, or please confirm if still current/outstanding:	Please note we are unable to provide a quote if your bankruptcy is not discharged or your CCJ / IVA remains outstanding or unsettled.
Have you, or any other partner or director ever had any County Court Judgements (CCJ's), or Sheriff Court Decrees?	Yes     No
If yes, please provide details: (e.g. type and circumstances of CCJ/Sheriff Decree)
Date of CCJ / Sheriff Decree:
Amount of CCJ / Sheriff Decree (£'s):
Is the CCJ / Sheriff Decree still current/outstanding?	Yes     No
Have you, or any other partner or director ever been prosecuted under any Health & Safety Legislation or ever been served a prohibition order or improvement order by the Health & Safety Executive?	Yes     No
If yes, please provide details of the prosecution(s):
Date of prosecution and/or prohibition/improvement order:
Details of any fines and/or action taken by the HSE: (Please enter 'None' if you no further action was taken)
Have you, or any other partner or director ever been the subject of a recovery action from HM Customs and Excise or the Inland Revenue?	Yes     No
If yes, please provide details: (i.e. name of person or business subject to recovery action, date of recovery action, and reason for the recovery action)
Business Activities
Description of your business activities: (Please describe as fully as possible including a percentage split between each activity, where you carry out more than one activity)
What percentage of the turnover is in respect of the following activities:
(i) General alteration, repair and maintenance?	%
(ii) New build work?	%
Total:	100%
What percentage of the turnover is carried out at the following premises / locations (Must add up to 100%):
(i) Private Dwelling Houses and Flats?	%
(ii) Commercial Buildings (e.g. shops, offices, pubs, etc.)?	%
(iii) Industrial Buildings (e.g. industrial units, factories, etc.)?	%
(iv) Other Premises/Locations (specify below if applicable)	%
Total:	100%
Business Location
Is your home the base for your business or are you operating from separate dedicated business premises?	Home  Business Premises
Is work carried out at any hazardous locations? (Hazardous locations can include, but are not limited to; railways, motorways, bridges, viaducts, nuclear installations, refineries, airports, quarries, mines, ships, docks, piers, towers and offshore installations.)	Yes     No
If yes, please state type of location(s) and the percentage of turnover this work represents:
Is any work undertaken outside of the U.K.?	Yes     No
If yes, please provide details: (i.e. area/country of work, percentage of turnover outside UK)
Trading Experience
How many years has your business been trading?	Please Select 0 Years 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years 16 Years 17 Years 18 Years 19 Years 20 Years 21 Years 22 Years 23 Years 24 Years 25 Years 26 Years 27 Years 28 Years 29 Years 30 Years 30+ Years
Number of years experience (if greater):	Please Select 0 Years 1 Year 2 Years 3 Years 4 Years 5 Years 6 Years 7 Years 8 Years 9 Years 10 Years 11 Years 12 Years 13 Years 14 Years 15 Years 16 Years 17 Years 18 Years 19 Years 20 Years 21 Years 22 Years 23 Years 24 Years 25 Years 26 Years 27 Years 28 Years 29 Years 30 Years 30+ Years
Heat Use
Do your activities involve the use of heat? (e.g. blow lamps, angle grinders, welding equipment, heat guns, etc.)	Yes     No
If yes, please state the type of heat used: (e.g. blow lamps, angle grinders, welding equipment, heat guns, etc.)
Please confirm the percentage of time it is used:	0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%
Will heat work include the use of welding or flame cutting equipment?	Yes     No
Height / Depth Work
Please confirm the maximum height you would work:	0 5 8 10 12 15 20 30 40 50 60 70 80 90 100 100+ metres
Please confirm the maximum depth you would dig:	0 1 2 3 4 5 8 10+ metres
Trade Specific Questions
Do you or your employees undertake any steel erection/structural steel work?	Yes     No
If yes, please provide details: (i.e. type of work undertaken)
What percentage of your turnover does the steel erection/structural steel work represent (e.g. 10%)?	%
Do you undertake any piling, underpinning or basement excavation work?	Yes     No
If yes, please provide details of work undertaken: (i.e. piling, underpinning or basement excavation work)
What percentage of your overall work activities does this work represent (e.g. 10%)?	%
Health & Safety
Do you have an up to date Health & Safety Policy tailored to your activities?	Yes     No
Do you carry out a full Health & Safety Risk Assessment at the contract site before commencing work?	Yes     No
Are written Method Statements prepared for each contract?	Yes     No
Is Health & Safety training given to employees and is the training recorded?	Yes     No
Do you supply and enforce use of Personal Protective Equipment where required?	Yes     No
Asbestos / Hazardous Substances
Do you or your employees work with asbestos, silica, explosives or any other substances hazardous to health?	Yes     No
If yes, please provide details: (i.e. type of hazardous substance, percentage of turnover involving this work, etc.)
Demolition Work
Do you or your employees carry out any separate demolition work on buildings or structures other than as part of a contract for reconstruction, alteration or repair?	Yes     No
If yes, please provide details of the demolition work:
Percentage of your turnover involving separate demolition work?	%
Does your work involve hand demolition?	Yes     No
Does your work involve machine demolition?	Yes     No
Does your work involve ball and chain method?	Yes     No
Does your work involve one drop / felling method?	Yes     No
Does your work involve the use of explosives?	Yes     No
What is the maximum height of properties you demolish? (e.g. 15 metres)	metres
Fixed Woodworking Machinery / Timber Framed Buildings
Does any of your work involve the use of fixed woodworking machinery? (hand held power tools are acceptable)	Yes     No
If yes, please provide details: (i.e. No. of employees using the machinery and annual wages of the employees using the machinery)	No. of employees: Estimated wages:£
Will your activities involve the construction or renovation of timber framed buildings and/or the installation of timber cladding within the next 12 months?	Yes     No
If yes, please confirm the approximate percentage of your turnover that this work represents?	%
What is the maximum number of storeys in any one timber framed structure/block?	1 2 3 4 5 6 6+ storey(s)
What is the largest value of any one timber framed structure/block?
If you work on multiple blocks of flats or private dwelling houses, what is the minimum distance between them?	metres
Does the site and work comply with the Joint Code of Practice for construction sites?	Yes     No
How many years previous experience do you have working on timber framed structures?	0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 30+ year(s)
Claims Experience
Have you or any other partner or director suffered any loss or had any claims made against you in the last 5 years?	Yes     No
If yes, please provide details:	Date of claim: Cost of claim:£ Details of claim: ---------------------------- Date of claim: Cost of claim:£ Details of claim: ---------------------------- Regrettably, if you have more than 2 claims, we will be unable to provide you with a quotation.

Details Of Cover Required
Public/Product Liability
Public/Product Liability limit of indemnity:		£1 Million £2 Million £5 Million £10 Million
		Manual Principals		Non-Manual / Clerical Principals
Number of Proprietors/Partners/Co. Directors:	No.		No.
Annual Wages of Proprietors/Partners/Co. Directors:
Please confirm your annual payments to Bona-Fide Sub-Contractors: (BFSC's are sub-contractors who supply their own labour and materials on site and hold their own liability insurance)
Employers' Liability (Compulsory by Law if you have employees or use labour only sub-contractors)
Is Employers' Liability Cover Required? (£10M standard limit of indemnity)		Please Select Yes No
		Manual Workers		Non-Manual / Clerical Workers
Number of Employees/Labour Only Sub-Contractors: (Do not include proprietors, partners or directors)	No.		No.
Annual Wages of Own Employees:
Annual Payments to Labour Only Sub-Contractors: (LOSC's are sub-contractors who supply labour only and work under your supervision)
Employers' Reference Number (optional)
Employers' Reference Number (ERN) (if available):		(e.g. 123/AB12345 or 'Exempt')
Turnover
Estimated turnover for the next 12 months (£'s): (Please be as accurate as possible, as an over estimation may increase the premium to be quoted)
Additional Covers
Contract Works (optional)
Do you require cover for Contract Works? (i.e. the permanent / temporary works and materials on site)		Yes     No
Please state the maximum value of any one contract: (This amount will normally be less than and no more than your annual turnover.)
Please state the maximum length of any one contract: (e.g. typically up to a maximum of 6 or 12 months)		1 month 2 months 3 months 4 months 5 months 6 months 7 months 8 months 9 months 10 months 11 months 12 months 15 months 18 months 24 months Over 24 months
Site Security Details
Do you erect full site perimeter fencing and/or boarding at the contract site?		Yes     No
Please provide details of any additional security used to secure any materials or plant on site: (e.g. security patrols, plant/tools kept in locked building, CCTV, etc.)
Own Plant (optional)
Do you require cover for Own Plant?		Yes     No
Please confirm the total value of your Own Plant, & Equipment required to be covered whilst working on site:
Please confirm the maximum value of any one item of your own plant (£'s):
Tools Cover (optional)
Do you require cover for Portable Tools?		Yes     No
Please confirm how much cover you require for your Tools:
Hired-In Plant (optional)
Do you require cover for Hired-In Plant?		Yes     No
Please confirm the hired-in plant total limit of indemnity for all items of hired-in plant:
Please confirm the maximum value of any one item of hired-in plant:
Please confirm annual charges/costs incurred: (e.g. £10,000 per annum)		per annum
Professional Indemnity (optional)
Is Professional Indemnity cover required?		Yes     No
Please confirm the limit of indemnity required:		Please Select £100,000 £250,000 £500,000 £1,000,000 £2,000,000 £5,000,000
Please confirm the fees you received for design and/or consultancy work in the last 12 months:
Have you had any claims or incidents that could have given rise to a professional indemnity claim in the last 5 years?		Yes     No
If yes, please provide details: (i.e. date of incident, circumstances of claim, amount of claim, etc.)
Can you confirm that all persons carrying out design and/or consultancy work have at least 3 years experience undertaking such work?		Yes     No
Contractor's Legal Expenses Cover (optional)
Is Contractor's Legal Expenses cover required? (£100,000 standard limit of indemnity)		Yes     No
Has the business and/or its directors been involved in any legal dispute, tax investigation or any other court or tribunal action in the last 5 years?		Yes     No
Please provide details of the dispute including dates:
Directors & Officers Cover (optional)
Is Directors and Officers cover required?		Yes     No
Can you confirm that the company is domiciled in the UK; is privately held; has not raised any funds from external parties; has been in operation for more than 12 months; has its financial statements prepared by a qualified accountant, shows a profit and are not subject to any concerns by the auditors; derives at least 50% of all its turnover from clients within the UK and EU; has not acquired any companies which have increased its total assets by 50% or more; and has no mergers or acquisitions planned and has not had any claims made against it or its directors and is not aware of any circumstances that could give rise to such claim?		Yes     No
If no, details:
Please confirm the limit of indemnity required:		Please Select £100,000 £250,000 £500,000 £1,000,000 £2,000,000 £5,000,000
Additional Information
Details of any additional information that you wish to disclose or any other cover required:
You are required to make a fair presentation of the risk to insurers which means that you are required to disclose every material circumstance which you know or ought to know relating to the risk to be insured. Materially important information is any information that could influence an insurer's decision to accept your risk including the cost of your insurance. Failure to comply with the duty of fair presentation could mean that your policy is void or that insurers are not liable to pay all or part of your claim(s). By submitting this quotation you are confirming that there are no other material facts to disclose other than those shown above.
Details Of Current / Previous Policies
Liability Renewal Date / Cover Start Date:		(dd/mm/yyyy)
Current Annual Premium / Best Quotation:		This may help us to get you a better quote
Name of Current / Previous Insurer:		e.g. Aviva, AXA, Allianz, QBE, RSA, Zurich, etc.

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Disclosure
Please ensure that all the information you have provided is correct, then press the 'Request Builders Liability Quotation' button and we will contact you shortly with a quotation.

Estimated Quote Time: 1 to 72 hours