Tel: 01623 641 386     
Public Liability Insurance Quotes
 
Midlands Insurance Services Logo


Main Menu



Air Conditioning Engineers Public & Employers Liability Insurance Quote Form

For UK Customers Only

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 Air Conditioning Engineers Public Liability 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 operating as a limited company)
Trading Name / Trading As:
(if different to the above)
Trading Status:
Occupation/Trade:
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

General Details
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:
(e.g. type of conviction(s),
date(s) of conviction(s),
details of any fines and/or length of custodial sentence(s))
Has any insurer ever refused renewal, declined
or cancelled cover or imposed any special terms?
Yes     No
If yes, please provide details:
(e.g. details of any insurance refused/
cancelled/special terms imposed, etc.)
Have you, or any other partner or director ever had any county court judgements / sheriff decrees / IVA's or been declared bankrupt, or involved in a company which has become insolvent or which has gone into liquidation, receivership or administration?Yes     No
If yes, please provide details:
(e.g. date(s) of bankruptcy/insolvency/CCJ/IVA,
amount of bankruptcy/insolvency/CCJ/IVA,
date bankruptcy discharged or CCJ/IVA settled,
circumstances, etc.)

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 been prosecuted or served a prohibition order by the Health & Safety Executive?Yes     No
If yes, please provide details:
(e.g. date of prosecution(s), details of offence(s), etc.)
Business Activities
Description of your work activities: help
(Please describe as fully as possible including
a percentage split between each activity, where
you carry out more than one activity)
Is any gas fitting or gas installation
work undertaken as part of your activities?
Yes     No
Base Location
Is your home the base for your business or are you
operating from separate dedicated business premises?
Home  Business Premises
Type of Premises / Locations Worked At
What percentage of the turnover is carried out at the following locations (must add up to 100%):
(i) Private Dwelling Houses and Flats?%
(ii) Commercial Premises (e.g. shops, offices, etc.)?%
(iii) Commercial Kitchens and Restaurants?%
(iv) Industrial Buildings (e.g. industrial units, factories, etc.)?%
(v) Abattoirs, Cold Stores, Large-Scale
Supermarkets & Warehouses / Storage Facilities?
%
(vi) Other Locations (state below if applicable)
%
Total: 100%
Is work carried out at any hazardous locations?
(These can include, but are not limited to; offshore installations, railways, motorways, bridges, viaducts, power stations, nuclear installations, oil, gas or petrochemical refineries, aircraft/airports/airside, quarries, mines, watercraft/ships, docks, harbours, piers, towers, steeples, hospitals and other medical facilities.)
Yes     No help
If yes, please state type of location(s) and the
percentage of work spent at the location(s):
Is any work undertaken outside of the U.K.?Yes     No
If yes, please provide details:
(i.e. area and percentage of time outside UK)
Hazardous Substances
Do you or your employees work with asbestos,
silica, explosives or any other hazardous substances?
Yes     No
If yes, please provide details:
Professional Services
Do you provide professional services
for a fee such as advice/consultancy,
design, testing, inspection and certification?
Yes     No
Heat Use
Do your activities involve the use of heat?
(e.g. blow lamps, blow torches, welding equipment, heat guns, etc.)
Yes     No help
If yes, please state the type of heat used:
(e.g. blow lamps, blow torches, welding equipment, heat guns, etc.)
Please confirm the percentage of time it is used:
Will heat work include the
use of welding or flame cutting equipment?
Yes     No
Work at Height
Please confirm the maximum height you would work: metres help
Do you or your employees use
slings, cradles or abseiling equipment?
(cherry pickers and platforms are acceptable)
Yes     No
If yes, please provide details of equipment used
and how frequently it is used:
Trading Experience
How many years has your business been trading? year(s)
Number of years previous experience in this trade:
(A minimum of 3 years previous experience is required if you have 0 years trading)
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:

Details Of Cover Required

Public/Product Liability
Public/Product Liability limit of indemnity:  help
  Manual
Principals
 Non-Manual/
Clerical Principals
Number of Proprietors/Partners/Co. Directors:No. helpNo. help
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
materials on site and hold their own insurance)
  help
Employers' Liability (Compulsory by Law if you have direct workers or use labour only sub-contractors)
Is Employers' Liability Cover Required?
(£10M standard limit of indemnity)
help
  Manual
Workers
 Non-Manual/
Clerical Workers
No. of Employees/Labour Only Sub-Contractors: help
(Do not include proprietors, partners or directors)
No. helpNo. help
Annual Wages of Employees/Labour Only Sub-Contractors:  
Employers' Reference Number (optional)
Employers' Reference Number (ERN) (if available):  help
(e.g. 123/AB12345 or 'Exempt')
Turnover
Estimated Annual Turnover for next 12 months:  help

Optional Cover(s)

Financial Loss Cover
Is Financial Loss Cover required?Yes     No  help?
If yes, please state limit of indemnity required: 
Professional Indemnity Cover
Is Professional Indemnity Cover required?Yes     No  help?
If yes, please state limit of indemnity required: 
Does more than 25% of your turnover relate to design,
advice, surveying, or consultancy carried out for a fee?
Yes     No
Is any work undertaken outside of the European Economic Area?Yes     No
Have you had any claims or incidents
that could give rise to a claim in the last 5 years?
Yes     No
If yes, please provide details:
(e.g. dates of claims, amount paid,
circumstances leading to the claims, etc.)
Tools Cover
Is Tools Cover required?Yes     No  help?
Tools Sum Insured required:
£500 to £5K maximum
Business Legal Expenses Cover
Do you require Business Legal Expenses Cover?Yes     No  Help?
Limit of indemnity required? 
Has the business been involved in any legal disputes,
employment disputes or tax investigations in the last 5 years?
Yes     No
If yes, please provide details:
Directors & Officers Cover
Do you require Directors & Officers Cover?Yes     No  Help?
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:
Limit of indemnity required?:
Additional Information
Details of any additional information 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

Cover Start Date / Renewal Date: 
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, RSA, Zurich, etc.

Request Quotation

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


Estimated Quote Time: 1 to 4 working days