Contract Works Insurance - Annual

We need you to complete this quick form so that we can get the best quote for you.

If you would prefer to talk to a broker first, please call 1300-881-779 between 8.15am and 5.15pm EST. business days.

 

If you have spoken to a broker in our office, note their name here so that this quote can be processed by them as they will know something about you already.

Brokers Name:

Insured Name

Trading Name

ABN No.(if applicable)

Postal Address

Email Address

Phone No.

Contract Details

Maximum Project Duration (months)

Maximum Defects Liability Period

What type of Projects are being undertaken
(eg. Construction, alteration of residential buildings / unitsor Construction of Commercial buildings, roads, bridges, marinas etc.)

Basis of Insurance for Projects

This policy is issued on a run-off basis

Estimated value of projects to be started in the next 12 months?
$

Estimated number of Projects to be started in the next 12 months?
$

Existing Structures

Will any alterations or refurbishments to Existing Structures be undertaken?
Yes    No

Do you require insurance cover for those Existing Structures?
Yes    No

Will Existing Structures be occupied / tenanted during any Projects?
Yes    No

Demolition Work

What percentage of the Annual Turnover is derived from demolition work?
%

Projections

In the next 12 months, will any Projects differ in size, scope or complexity from those undertaken by you in the past 3 years?
Yes    No

Maximum number of storeys

Maximum number of basement levels

Will the Project Involve any of the following

Is there any demolition involved?
Yes    No

Construction of straw bale homes
Yes    No

Blasting or explosives (other than nail guns)
Yes    No

Buildings or structures of historical significance
Yes    No

Underground works,tunnels,shafts,mines or galleries
Yes    No

Any work in,on,over or under a permanent body of water
Yes    No

Directional drilling or boring greater than 50cm in diameter (not pilings/piers)
Yes    No

Swimming pools
Yes    No

Schools, hospitals, universities,shopping centres, hotels or railway stations
Yes    No

Technology which is of a prototype nature
Yes    No

Will there be any retaining walls greater than 15m in length or 1.5m in height
Yes    No

Will any work be done in flood prone or high annual rainfall zones
Yes    No

Maximum excavation depth (metres)

 

Sum Insured (Material Damage)

   Maximum contract price (Project value) of any one Project
$

   Maximum amount of Principal Supplied Materials for any one Project
$

   Existing Structures (maximum value for any one Project)
$

Contractors Plant, Tools & Reusable Equipment (extra premium payable)

   Hand Tools
$

   Scaffolding / Formwork/ Sheds
$

   Plant (Contractors)
$

 

Sum Insured (Public Liability)

Please nominate the amount of cover you require:


Type the above number:



Declaration

By submitting this Declaration, the Applicant acknowledges:
- they are authorised by all the Applicants to make this Declaration,
- the contents of this form are true and complete,
- they are under a continuing obligation to immediately inform the insurer of any change in the particulars or statements contained in this form up until the contract is entered into,

Name of person making this declaration:


 

 

Duty of Disclosure What you must tell us
Under the Insurance Contracts Act 1984 (the Act), you have a Duty of Disclosure. You are required before you enter into, renew, vary, extend or reinstate your Policy, to tell us everything you know and that a reasonable person in the circumstances could be expected to know, is a matter that is relevant to our decision whether to insure you, and anyone else to be insured under the Policy, and if so, on what terms.
  • You do not have to tell us about any matter
  • that diminishes the risk
  • that is of common knowledge
  • that we know or should know in the ordinary course of our business as an insurer, or
  • which we indicate we do not want to know.
  • If you do not tell us
If you do not comply with your Duty of Disclosure we may reduce or refuse to pay a claim or cancel your Policy. If your non-disclosure is fraudulent we may treat this Policy as never having worked.