JCT 21.2.1 (Non Negligence) INSURANCE QUOTATION
PROPOSER
Name
T/as
Trade
Sole Trader
Partnership
Limited
Trading Since
Territory
UK Only
UK & ROI
ROI Only
LOCATION
Address :
P/Code :
CONTACT DETAILS
Tel
Fax
Mob
Email
Web
THE CONTRACT
Work Type
Address
P/Code
Are You Main Contractor
CONTRACT DETAILS
Contract Value
Start Date
Contract Period
1
2
3
4
5
6
7
8
9
10
11
12
Months
Maintenance Period
1
2
3
4
5
6
7
8
9
10
11
12
Months
Tick If Any Claims In Last Five Years
If claims give types, dates & values in "Other Information"
CONTRACT EMPLOYER
Name
Address
P/Code
Tel
CONSULTING ENGINEER
Name
Address
P/Code
Tel
CONTRACT SPECIFICS
ANY DEMOLITION?
Tick If Yes
Will A Specialist Sub Cont'r Be Used
Sub Cont'r Name
ANY PILING?
Tick If Yes
Piling Depth
0
1
2
3
4
5>
Metres
Will A Specialist Sub Contractor Be Used
Sub Cont'r Name
Proximity To Third Party Property
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>
Metres
Underpinning Depth
0
1
2
3
4
5>
Metres
Excavation Depth
0
1
2
3
4
5>
Metres
INSURANCE'S
Confirm You Have These Insurances
Employers Liability Insurance
Public Liability Insurance
Contract Works Insurance
Current Insurer/s
Current Broker
Next Renewal Date
CONDITIONS
These Conditions Apply: (1) That all work will be carried out under the direction or method statement of a suitably qualified consultant engineer. (2) That suitable site investigations will be undertaken prior to the start of any works. (3) That before works begin the qualified consultant engineer approves a schedule of conditions of all adjoining or surrounding third party property is prepared. (Report, Photos & Video). (4) That all work will comply with the relevant local planning and building regulations (5) That any specialist sub contractor engaged provides, before works commence, written confirmation that they hold Employers Liability & Public Liability insurances.
These are important conditions which wiIl apply!.
OTHER INFORMATION
Telephone 02870325999 for assistance