CONTRACT WORKS (ALL RISKS) QUOTATION
PROPOSER
Name
T/as
Trade
Sole Trader
Partnership
Limited
Trading Since
Territory
UK Only
UK & ROI
ROI Only
LOCATION
Address
Postcode
CONTACT DETAILS
Tel
Fax
Mob
Email
Web
COVER REQUIRED
Contract Works
Annual Policy
Go to Projections
Single Site
Provide details
Client/Employer
Site Address
SIte Postcode
PROJECTIONS
Single Contract
Single Site Contract Value
Duration
1
2
3
4
5
6
7
8
9
10
11
12
12+
Months
Bank/Mortgage Lenders Interest
Annual Policy
Annual Turnover
Maximum Contract Value
Average Contract Period
1
2
3
4
5
6
7
8
9
10
11
12
12+
Months
WORK ATIVITIES
Your work and % split of each activity :
INSURANCE HISTORY
Required Date
Current Insurer
Policy Number
Premium
Current Broker
PLANT/EQUIPMENT
Value of Own Plant
Own Plant Max Item Value
Value of Site Huts
Hired in Plant (HIP) Fees
HIP Max Item Value
WORK SPECIFICS
Height
0 m
<10m
<15m
<20m
>20m
Depth
0 m
<1m
<2m
<3m
<5m
>5m
Click If applicable to your work..
Use Of Heat
Scaffolding
Roofing
Towers
Bridges
Fly Overs
Quarrying
Tunnelling
Demolition
Railways
Chemicals
Asbestos
Airports
Steeples
On/Near Water
Explosives
Underpinning
Marine
Motorways
Piling
Design
Radiation
If selected give details in OTHER INFORMATION
CLAIMS RECORD
Tick if any claim in last 5 years
Give claim details, types, dates :
OTHER INFORMATION
Telephone 02870325999 for assistance