Steeplejacks 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 Steeplejacks Public and Employers Liability Insurance only. Please note that we are unable to quote for customers based in Ireland.

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 As (if applicable):
Trading Status:	- - - - - - Please Select - - - - - Sole Trader Partnership Limited Company Limited Liability Partnership Unincorporated Association
Business Address:
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
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/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 been declared bankrupt or insolvent or been subject to any County Court Judgements (CCJ's) or IVA's 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, amount of bankruptcy/insolvency, 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/notice 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)
Business Activities
Full description of your work activities: (Please describe as fully as possible including a percentage split between each activity, if you carry out more than one activity)
Are you a member of ATLAS?	Yes     No
If yes, to what level?	- - Please Select - - Standard Steeplejack Advanced Trainee/Apprentice Other
Are you IRATA qualified?	Yes     No
If yes, please confirm level of qualification:	Please Select Level 1 Level 2 Level 3 N/A
Access Equipment
Please provide details of all access equipment used: (e.g. ropes, abseiling, slings, cradles, scaffolding, mobile cranes, tower cranes, etc.)
What percentage of your work involves all of the access equipment stated above?	%
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
Piling / Underpinning
Do you undertake any piling or underpinning work?	Yes     No
If yes, please provide details: (i.e. type of work undertaken)
What percentage of your overall work activities does this work represent (e.g. 10%)?	%
Type of Premises/Locations Worked At (away from your own premises)
Please confirm the percentage of work carried out at the following locations: (must add up to 100%)
Steeples / Towers?	%
Chimneys?	%
Bridges?	%
Viaducts?	%
Commercial buildings (e.g. shops, offices, etc.)?	%
Industrial buildings (e.g. factories, units, etc.)?	%
All other premises/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, nuclear installations, refineries, airports/aircraft, blast furnaces, tunnels, quarries, mines, ships/vessels, docks, harbours, piers, dams, reservoirs, etc.). If in doubt, please disclose.	Yes     No
If yes, please state the type of locations worked at:
Please confirm the percentage of turnover at hazardous locations (e.g. 20%):	0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%
Is any work undertaken outside of the U.K.?	Yes     No
If yes, please provide details: (i.e. area or country of work, percentage of turnover this work represents)
Heat Use
Do your activities involve the use of heat? (e.g. blow lamps, blow torches, welding equipment, heat guns, etc.)	Yes     No
Please state the type(s) of heat used: (e.g. blow lamp, welder, etc.)
Please confirm the percentage of time it is used: (e.g. 5%):	0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50% 55% 60% 65% 70% 75% 80% 85% 90% 95% 100%
Work at Height
Please state the maximum height you would work from ground level:	metres
Please confirm the approx. percentage of time working at the following heights:
Up to 15 metres:	%
15 to 20 metres:	%
20 to 30 metres:	%
30 to 50 metres:	%
50 to 100 metres:	%
Over 100 metres:	%
Total:	100%
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
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.)
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 state your annual payments to Bona-Fide Sub-Contractors (if used): (BFSC's are sub-contractors who supply their own materials/ equipment on site and hold their own insurance, e.g. scaffolders, etc.)
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: (Do not include proprietors, partners or directors)	No.		No.
Total Annual Wages of Employees:
Employers' Reference Number (optional)
Employers' Reference Number (ERN) (if available):		(e.g. 123/AB12345 or 'Exempt')
Turnover
Estimated turnover for the next 12 months: (Please be as accurate as possible, as an over estimation will increase the premium to be quoted)
Additional Covers / Information
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
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:
Tools Cover (Optional)
Do you require cover for tools?		Yes     No
Tools Sum Insured:		(£500 to £7,500 maximum)
Hired-In Plant (Optional)
Do you require cover for Hired-In Plant?		Yes     No
Please confirm the hired-in plant total sum insured 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
Commercial Legal Expenses Cover (Optional)
Is Commercial 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)
Is Directors and Officers 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
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
Cover Start Date / Renewal Date:		(dd/mm/yyyy)
Current Annual Premium:		This may help us to get you a better quote
Name of Current / Previous Insurer:		e.g. Aviva, AXA, Allianz, QBE, RSA, Zurich, etc.

Request Quotation

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

Estimated Quote Time: 1 to 4 working days