inspire+ Quotation Request

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Contact Name
Contact Email:		Phone Number


This section is about the Insured and their business


Business Name:
Correspondence Address
Address Line 1
Address Line 2
Town
County
Postcode


Company Status
Date Established
Employers Reference Number
Insurance Effective Date
Current Insurer
Target Premium

Do you want to name other companies on the same insurance policy?	No	Yes

Business Description	Please use the space below to include additional information that may affect insurers assessment of your requirements. (include details about the type of work you do, where the work is done, the types of clients' you work for etc). Please consider your obligations from the Declaration below.

Staffing & Turnover

	Headcount (FTE)	Payments (Own Premises)	Payments (Work Away)
Principals & Directors - Manual		�	�
Principals & Directors - Clerical - Admin		�	�
Principals & Directors - Clerical - Professional		�	�

Employees - Manual		�	�
Employees - Clerical - Admin		�	�
Employees - Clerical - Professional		�	�

Labour Only Subcontractors		�	�

Turnover	�

This section is about the work done and how the business is managed

Bona Fide Sub-Contractors

Do you use Bona-Fide Sub-Contractors?	No	Yes

Work Locations, Height, Depth & Heat

Risk Management

Do you want to answer the Risk Management Questions? (This is more appropriate for manual trades and may qualify you for better terms)	No	Yes

This section is about the insurance covers required

Do you need Liability Insurance?	No	Yes
Do you need Contractors All-Risks Insurance?	No	Yes
Do you need Professional Indemnity Insurance?	No	Yes
Do you need Property Insurance?	No	Yes

This final section is about the business history

Directors & Principals

Have you or any principals or directors in the business or any company in which you or such Principal or Director have or had an interest:

Ever been refused insurance or had any special terms or conditions imposed by an insurer?	No	Yes

Ever been convicted or is any prosecution pending for any offence (other than motoring offences that did not result in a custodial sentence)?	No	Yes

Ever been declared bankrupt, the subject of bankruptcy proceedings, insolvency, winding up, receivership, administration or liquidation or disqualified from being a company director?	No	Yes

Ever received a prohibition notice or been prosecuted or awaiting intended prosecution under the Health & Safety At Work Act?	No	Yes

Claims History

How many years continuous insurance do you have for consideration of claims history?
Have you made any claims, or have there been any incidents that could have led to claim, whether insured or not, in the past 10 years?	No	Yes

Material Facts

Please note your obligations with respect to material facts. Material facts are those which may affect the insurers assessment of the risk. This duty of disclosure is imposed on policyholders by the legal principle of Utmost Good Faith and clauses in the policy. It arises at inception, during the policy term, at renewal and whenever previously disclosed facts change. If you are in doubt as to whether a fact is one that you should disclose, you should declare it to Abbott Insurance regardless.

Additional Information: (Accreditations, Risk Management etc)

What are the total annual payments to BFSC?		�
Breakdown of BFSC Payments (total to be 100%)
Scaffolding	%
Hot Roofers	%
Other Manual (including heat)	%
Other Manual (Excluding heat)	%
Non-Manual	%
Do you have a procedure to check that the insurance of BFSCs provides the same level of Public Liability cover			No	Yes

What is the maximum height at which you will work	m
What is the maximum depth at which you will work?	m
Is any of your work undertaken outside the UK	No	Yes

Please provide a split of your turnover by the area in which you work:
United Kingdom		%
Elsewhere in Europe		%
USA and Canada		%
Elsewhere in the World		%
Do you use foreign nationals when working outside the UK?	No	Yes

Does any of your work involve the handling of asbestos or other hazardous substances	No	Yes
Do you hold an asbestos licence	No	Yes
Do you work in any hazardous locations	No	Yes

Please indicate the required sum insured for the following
Own Plant & Equipment	Total Sum insured	�	Single Item Limit	�

Hired In Plant	Annual Charges	�	Single Item Limit	�

Employees Tools	Total Sum Insured	�	Limit Per Employee	�

Contract Works	Maximum Contract Price	�

Second Insured Name		Employers Reference Number
Third Insured Name		Employers Reference Number
Fourth Insured Name		Employers Reference Number

Does any of the work away from your own premises involve the application of heat?	No	Yes

Does any of your work include any involvement with any:
Asbestos or materials containing asbestos?	No	Yes
Nuclear installations or with any nuclear materials?	No	Yes
Oil, gas, petrochemical or chemical works or storage facility?	No	Yes
Aircraft (including aircraft parts), hovercraft or powered watercraft over 8 metres in length ?	No	Yes
Railway (excluding trackside work) or airport (ex airside)	No	Yes
Railway (trackside work) & Airport (airside)	No	Yes
Dock, harbour, canal, watercourse or boatyard (other than where you have described your business as boat repairs)	No	Yes

Do you have a "Standard Operating Procedure" for "Small Works"	No	Yes
Do you complete Risk Assessments for all works (other than Small Works)?	No	Yes
Do you complete Method Statements for all works (other than Small Works)?	No	Yes
Do you conduct Staff Training and are records of all training kept?	No	Yes
Has your H&S or Risk Management Systems been externally audited and accredited	No	Yes

Professional Indemnity Limit
How many people are involved in design or advice for a fee?

Do you operate business premises from more than one location?	No	Yes
Are your premises used only as an office?	No	Yes

Is your office shared with other occupants?	No	Yes
Are all other occupants working solely in non-manual activities?	No	Yes


Is your risk address the same as your correspondence address entered above?	No	Yes


Risk Address
Address Line 1
Address Line 2
Town
County
Postcode

Is the property of standard construction (built of brick stone or concrete and roofed with slate tile concrete metal or asbestos)	No	Yes

Main Trade		% of turnover
Secondary Trade

Is your H&S Policy distributed to each employee?	No	Yes

How much of the property is non-standard (as a percentage)?	%

Is your property insulated by combustible composite insulation panels ?	No	Yes
Is your property likely to be unoccupied for more than 30 consecutive days	No	Yes
Is the property free from a history of flooding and not in an area prone to flooding?	No	Yes
Has your property had the electrical systems inspected and certified IEE compliant in the past 5 years	No	Yes
Does your property comply with the minimum standard of security	No	Yes

In what ways does your property not comply with the minimum standard of security?

Is the alarm system maintained by a NACOSS approved company?	No	Yes
Does the alarm system have remote signalling?	No	Yes
Do you have Level 1 police response	No	Yes

Has the property or any adjacent property previously suffered damage from subsidence, heave or landslip or does the building have any visible signs of cracking	No	Yes

Do you require glass cover? (Standard limit of cover is �10,000)	No	Yes

Buildings	Own Buildings	�
	Tenants Improvements	�
	Rent Payable	�
Contents	General Contents	�
	Computers & Electronic Office Equipment	�
	Plant & Equipment Based at Own Premises	�


All Risks	Laptops	�
	Mobile Phones	�
	Camera & Other Photographic Equipment	�
	Tools	�
	Camping Equipment	�
Stock	Stock, Goods in Trust & Materials in Trade (other than High Value Stock)	�
	High Risk Stock & Materials in Trade	�
Transit	Property In Transit	�


Business Interruption	Increased Cost of Working	�
	Annual Gross Profit	�
	Indemnity Period (months)
	Denial of Access	�
	failure of Utilities	�
	Unspecified Suppliers	�
	Transit	�
	Loss of Attraction	�
	Disease Vermin Sanitation	�
	Telecommunications	�

Money	In transit & at Premises during Business Hours	�
	Money in a safe outside Business Hours	�

Professional Indemnity Insurance is underwritten on a claims made basis and as such We will exclude any claim and/or circumstance which may give rise to a claim which is known by You prior to the inception date of the Certificate AFTER FULL ENQUIRY of all relevant persons please answer the following
Have any Professional Indemnity claims been made against You or against any former Principal Director or Partner of You (including whilst in previous employment) whether successful or otherwise?	No	Yes
Have any claims for dishonesty ever been made against You or against any former Principal Director Partner or Employee of Yours?	No	Yes
Are You aware of any circumstance which could reasonably be foreseen to give rise to a claim against You or Your predecessors in business or any of the present or former Principals Directors or Partners?	No	Yes

Ten Years Claims History (If you have more than 5 claims in the past 10 years, please call for further advice.)
Date (dd/mm/yy)	Claim Detail	Section	Amount	Settled?