Construction Annual

Broker Details

Brokerage Name

Broker Name

Broker Email

Broker Address

Broker Phone

Insurance History

As at todays date does the Proposed Insured have Contract Works Insurance currently in force that has been paid for?

Who is your current insurer?

How many years have you had continuous construction insurance?

Is the current insurer offering renewal?

Why is the current insurer not offering renewal?

What is the current premium?

Application Details

Policy Inception Date

Policy Expiry Date

Insured Details

Name of all parties to be insured

ABN

Insured Address

Contact Email

Contact Phone Number

Insured Website

Section 1 - Material Damage

Annual policy type for this proposal?

Estimated Total contract Price (including principal supplied materials) for all contracts commencing during the Policy Period?

Maximum Contract Period (including maintenance period) for any one contract?

Estimated Total Turnover for the last 12 months?

Estimated Total Turnover for the next 12 months?

Maximum Maintenance Period for any one contract?

Maximum Testing Period for any one contract?

Maximum Contract Value for any one contract?

Material Damage Principal Supplied Materials

Escalation

Existing Structure(s)

Demolition and Removal of Debris

Expediting Expenses

Professional Fees

Hoists, Cranes and Mobile Construction Plant

Claims Preparation Costs

Mitigation Expenses

Materials In Storage

Temporary Buildings and Equipment

Plans and Documents

Testing and Commissioning

Public Authorities

Pipeline Leak Search and Locate

Marine Transit

Temp Protection and/or Gov Expenses

Strike, Lock-out, Riot and Civil Commotion

Section 2 - Legal Liability

Do you require Legal Liability cover?

What limit of liability do you require?

Estimated Wages for the next 12 months?

Do you engage contractors / sub contractors?

Do you ensure that contractors and sub-contractors have their own liability insurance?

Do you insist on a minimum limit of liability insurance for contractors and sub-contractors?

If Yes, please specify the minimum limit of liability insurance for contractors and sub-contractors?

Please describe the nature of work undertaken by the contractors and sub-contractors:

Annual total of amounts paid to contractors and subcontractors (excluding payments to labour hire firms) for Labour and Materials

Annual total of amounts paid to contractors and subcontractors (excluding payments to labour hire firms) for Labour Only

Do you use labour hire?

Please describe the nature of work undertaken by the labour hire?

Annual total of amounts paid to labour hire firms for Labour and Materials

Do you manufacture or import Products?

Which Countries Do You Import Form?

What Type of Goods Do You Import or Manufacture?

Will any Products be exported in the next 12 months?

Which Countries Do You Export To

What Type of Goods Do You Export

Do you have property in Physical or Legal Control?

Please provide details of the property in Physical or Legal Control

Site Works (Will the project include any of the following)

Blasting or explosives (other than nail guns)

Yes

No

Works over 5 storeys high

Yes

No

Actual excavation or works in an existing excavation deeper than 10 metres

Yes

No

Underground works such as tunnels, shafts, mines or galleries

Yes

No

Road works or bridges

Yes

No

Work north of the 25th Parallel South

Yes

No

Pipelines greater than 1.0 metres in diameter

Yes

No

Excavation of Underground services on site (other than to install new services)

Yes

No

Directional drilling or boring greater than 1 metre in diameter (other than piling/piers)

Yes

No

Work in or around an airport or aircraft landing area or working railways or tramlines

Yes

No

Work in gas, oil, chemical or petrochemical plants including any work on petrol service stations

Yes

No

Water or Sewerage Treatment Plants

Yes

No

Work in mining processing plants

Yes

No

Technology which is of a prototype nature

Yes

No

Work on landfills, land which is listed on the contaminated land register or the application of waste or chemical products to land

Yes

No

Dams, Coffer Dams, Breakwaters

Yes

No

Works in, over or under water / in watercourse

Yes

No

Demolition only

Yes

No

Power Generator / Distribution Lines

Yes

No

Works located outside mainland Australia or mainland Tasmania

Yes

No

Principals/Partners/Directors Details

How many partners/principals/directors of the business?

Claims History

How many claims have been made in the last 5 years?

Other issues to disclose

Has the Proposed Insured ever had any Insurer decline a proposal, imposed any special terms, cancelled or refused to renew a Contract Works or Liability Insurance Policy?

Details of Declined Insurance

Any Other Issues You Must Disclose under your Duty of Disclosure (For example, any other claims, incidents, circumstances or facts that may be relevant to the Insurer's decision whether to accept the risk and, if so, on what terms)?

Details of Issues

Additional Information

Please provide any additional details or information that may be relevant to your placement request.

Supporting documents

Upload any completed proposals, brochures/marketing material, risk engineering reports, financial statements, expiring insurer endorsements, etc. that may be relevant to your placement request

Maximum file size: 20.97MB

Document Confirmation

I confirm I have attached the following documents:

Geotech Report

Any Project Specific Designs or Specifications

Claims History

Plant and Equipment Schedule, including Model, Year and Value (If applicable)

I agree to the Privacy Policy and Terms of Engagement.

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Broker Details

Insurance History

Application Details

Insured Details

Section 1 - Material Damage

Section 2 - Legal Liability

Principals/Partners/Directors Details

Claims History

Other issues to disclose

Additional Information

Supporting documents

Document Confirmation

Placement Services

Detailed Information Matters

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