Fire Protection Engineers Public & Employers 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 Fire Protection Engineers Public Liability and/or 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 applicable):
Trading Status:	- - - - - - Please Select - - - - - Sole Trader Partnership Limited Company Limited Liability Partnership Unincorporated Association
Occupation/Trade:
Business Address:
Business Postcode:
Daytime 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: (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/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 (CCJ's) / 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.)
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)
Trade Associations
Are you a member of a trade association, or do you work to any recognised quality assurance standards? (e.g. Fire Protection Association, UK Fire Association, ISO, etc.)	Yes     No
If yes, please provide details: (i.e. name of association)
Business Activities
Description of your work activities: (Please describe as fully as possible including a percentage split between each activity, if you carry our more than one type of work activity)
Work Locations (Must add up to 100%)
Please provide a percentage split working away at the following premises:
Private Domestic Houses and Flats:	%
Commercial Premises (shops, offices, etc.):	%
Industrial Premises (e.g. industrial units, factories, etc.):	%
All other Premises (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, mainframe computer suites, 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
If yes, please provide details: ( i.e. state type of hazardous location(s) and the percentage of turnover for this work)
Do you or your employees work with any hazardous substances? (e.g. explosives, toxic or corrosive chemicals, siliceous materials, gases, asbestos, radioactive substances or any materials giving rise to dust, fumes or vapours, etc.)	Yes     No
If yes, please provide details: (e.g. type of hazardous substances and percentage of turnover working with hazardous substances)
Do you or your employees use slings, cradles or abseiling equipment? (Not including cherry pickers and platforms as these are acceptable)	Yes     No
If yes, please provide details of equipment used and the percentage of work using this equipment:
Do you use hydraulic lifts, access plant, scaffolding or any other equipment for work at height?	Yes     No
If yes, please provide details: (e.g. type of equipment used and percentage use of equipment)
Work Territory
Is any work undertaken outside of the U.K.?	Yes     No
If yes, please provide details: (i.e. area/country(s) worked at and percentage of turnover for work outside UK)
Professional Services
Do you provide professional services for a fee such as advice/consultancy, design, testing, inspection and certification?	Yes     No
Heat Work
Do your activities involve the use of heat? (e.g. blow lamps, blow torches, welding equipment, grinders, etc.)	Yes     No
If yes, please state all types of heat used:
Percentage of work that involves the use of heat:	0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 85% 85% 90% 95% 100%
Height Worked
Please confirm the maximum height you would work:	0 5 10 12 15 20 25 30 35 40 45 50+ metres
If any work is above 15 metres, please provide details: (e.g. type(s) of contract(s)/work undertaken, and percentage of turnover that this work represents)
Trading Experience
How many years has your business been trading? (A minimum of 3 years previous experience is required if you have 0 years trading)	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)
Number of years previous experience?	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)
Please provide details of any previous experience: (i.e. type of previous relevant work, previous companies worked for, and any relevant qualifications)
Risk Management / Health & Safety
Do you have a written Health & Safety Policy in place?	Yes     No
Do you carry out Risk Assessments for all contracts?	Yes     No
Are adequate procedures in force to fully train and supervise your employees?	Yes     No
Are all employees issued with suitable Personal Protective Equipment (PPE) and sign to confirm receipt?	Yes     No
Claims History
Have you, or any other partner or director had any claims, losses or incidents that may give rise to a claim made against you (including any other company, business or enterprise where the directors, principals, partners or senior officers have been associated or linked) 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 Not Required
		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 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
No. of Employees/Labour Only Sub-Contractors: (Do not include proprietors, partners or directors)	No.		No.
Annual Wages of Employees/Labour Only Sub-Contractors:
Employers' Reference Number (optional)
Employers' Reference Number (ERN) (if available):		(e.g. 123/AB12345 or 'Exempt')
Total Annual Turnover
Estimated Total Annual Turnover for next 12 months:
Split of Turnover
From the above annual turnover, please provide a split of your turnover for the following types of work:
Installation/Maintenance of Fire & Smoke Alarms:
Electrical Contracting, Testing and Inspections: (incl. 3 phase, emergency lighting, etc.)
Installation/Maintenance of Portable Fire Extinguishers:
Installation/Maintenance of Fixed Fire Extinguishers: (incl. Halon & other gas extinguishing systems)
Intumescent/Passive Fire Protection Products (excluding spraying): (e.g. application of intumescent paints (excl. spraying), mastic sealants, batt, etc.)
Intumescent/Passive Fire Protection Products (including spraying): (e.g. application of intumescent paints (incl. spraying), mastic sealants, batt, etc.)
Installation/Maintenance of Sprinklers and Wet Risers:
Installation/Maintenance of Dry Risers:
Pure Retail/Wholesale of Fire Protection Products: (i.e. no installation, etc.)
Fire Risk Assessments, Consultancy or Training: (please describe type of work below if carried out)
Any Other Type of Turnover (please describe other work below):
Optional Cover(s)
Inefficacy Cover
Is inefficacy cover required (recommended)? (for cover in the event of failure of a product to perform intended function)		Yes     No
Loss of Extinguishing Gas Cover (Optional)
Is cover required for loss of extinguishing gas? (£10,000 limit of indemnity to cover loss of gas in systems being worked on)		Yes     No
Financial Loss Cover (Optional)
Is financial loss (incl. products) cover required? (£250,000 limit of indemnity)		Yes     No
Professional Indemnity Cover (Optional)
Is professional indemnity cover required? (Cover for wrongful advice, design, specification, certification, etc.)		Yes     No
If yes, limit of indemnity required:		£100,000 £250,000 £500,000 £1,000,000 £2,000,000 £3,000,000 £5,000,000
Does more than 15% of the turnover relate to pure design, advice, surveying, training or consultation carried out for a fee?		Yes     No
If yes, please provide the percentage of turnover:		%
Is at least 5 years relevant experience held by the persons carrying out, controlling or signing off the works in respect of the professional activities undertaken, or does the person have suitable professional qualifications?		Yes     No
Have there been 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 (e.g. date of claim/incident, cost of claim, circumstances of claim, etc.)
Is manufacturing work undertaken?		Yes     No
Do you currently have a retroactive date for your current policy?		Yes     No
If yes, please provide the retroactive date of your current policy:		(dd/mm/yyyy)
Tools Cover (Optional)
Is tools cover required?		Yes     No
If yes, tools sum insured required: (Max. £5,000 limit)
Contractors Legal Expenses Cover (Optional)
Is contractors legal expenses cover required? (£100,000 cover for legal disputes, employment disputes, tax investigations, etc.)		Yes     No
Legal Expenses Limit of Indemnity:
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)
Do you require directors & officers cover? (Cover for any 'wrongful act' of a director of a limited company)		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:
Limit of indemnity required?		£100,000 £250,000 £500,000 £1,000,000 £2,000,000 £3,000,000 £5,000,000
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, QBE, RSA, Zurich, etc.

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

Estimated Quote Time: 1 to 4 working days