1 Allianz Global Corporate & Specialty Pacific Allianz Professional Indemnity Insurance Construction Projects Proposal Form
2 General Information The General Information set out below is provided for your (the Insured s) information only. It does not form part of the insurance contract with you, and is not part of the policy. Nothing contained in the General Information imposes contractual obligations on you, or creates contractual rights. These are contained in the policy and any endorsement. Your Duty of Disclosure Before You (the Insured) enter into the Policy with Us (the Insurer), the Insurance Contracts Act 1984 requires You to disclose to Us every matter that you know or could reasonably be expected to know is relevant to Our decision whether and on what terms Your application for insurance is acceptable and to calculate how much premium is required for Your insurance. You have the same duty to disclose those matters to Us before You renew, extend, vary or reinstate the Policy. The duty applies until the Policy is entered into, or where relevant, renewed, extended, varied or reinstated (Relevant Time). If anything changes between the time You provide answers or make disclosure and the Relevant Time, You need to tell Us. What You do not need to tell Us You do not need to tell Us about any matter that: diminishes Our risk; is of common knowledge; We know or should know as an insurer; or We tell You We do not need to know. What happens if the duty of disclosure is not complied with? If the duty of disclosure is not complied with We may cancel the Policy and/or reduce the amount We pay if You make a claim. If fraud is involved, We may treat the Policy as if it never existed, and pay nothing. Claims Made This policy operates on a claims made and notified basis. This means that the policy covers you (the Insured) for claims made against you and notified to us (the Insurer) during the Period of Insurance. The policy does not provide cover in relation to Prior Claims/Circumstances (as set out in the relevant exclusion) nor in relation to acts, errors, omissions or other conduct which first takes place before the Retroactive Date of the policy (if such a date is specified). Where you give notice in writing to us of any facts that might give rise to a Claim against you as soon as reasonably practicable after you become aware of those facts but before the expiry of the period of insurance, you may have rights under Section 40(3) of the Insurance Contracts Act 1984 to be indemnified in respect of any Claim subsequently made against you arising from those facts notwithstanding that the Claim is made after the expiry of the period of insurance. Any such rights arise under the legislation only. The terms of the policy and the effect of the policy is that you are not covered for Claims made against you after the expiry of the period of insurance unless such Claim is made during the Discovery Period or under the Extension for Run-off After Transaction. Who does the duty apply to? The duty of disclosure applies to You and everyone that is an insured under the Policy. If You provide information for another insured, it is as if they provided it to Us.
3 General Insurance Code of Practice We (the Insurer) are a signatory to the General Insurance Code of Practice. The Code aims to raise standards of practice and service in the insurance industry. It: promotes better communication between insurers and customers which will lead to better public understanding of insurance to allow customers to make informed choices, and outlines good standards of practice and service to be met by insurers to enhance their reputation responding efficiently to their customers needs. Dispute Resolution Process We (the Insurer) will do everything possible to provide a quality service to you (the Insured). However, we recognise that occasionally there may be some aspect of our service or a decision we have made that you wish to query or draw to our attention. We have a Complaints and Dispute Resolution Procedure which undertakes to provide an answer to your complaint within fifteen (15) working days. If you would like to make a complaint or access our internal dispute resolution service please contact our nearest office and ask to speak to a dispute resolution specialist. Contact for assistance or confirmation of cover If you need to confirm any policy transaction or clarify any of the information contained in this policy document or if you have any other queries, please contact any of our offices or refer to our website at If this insurance has been issued through an insurance intermediary If your policy has been arranged through our agent, or a broker who is acting under an agency arrangement such as a binder with us, then they are acting as our agent and not as your agent. They will tell you when this is the case. for If Your Policy has been arranged by a broker, other than a broker acting under such an agency arrangement with us, then the broker is acting as your agent. Where this Policy has been arranged through an intermediary a commission may be payable by us to them for arranging the insurance. Privacy Notice At Allianz, we (the Insurer) give priority to protecting the privacy of your (the Insured s) personal information. We do this by handling personal information in a responsible manner and in accordance with the Privacy Act 1988 (Cth). How We Collect Your Personal Information We usually collect your personal information from you or your agents. We may also collect it from our agents and service providers; other insurers and insurance reference bureaus; people who are involved in a claim or assist us in investigating or processing claims, including third parties claiming under your policy, witnesses and medical practitioners; third parties who may be arranging insurance cover for a group that you are a part of; law enforcement, dispute resolution, statutory and regulatory bodies; marketing lists and industry databases; and publicly available sources. Why We Collect Your Personal Information We collect your personal information to enable us to provide our products and services, including to process and settle claims; offer our products and services and those of our related companies, brokers, intermediaries and business partners that may interest you; and conduct market or customer research to determine those products or services that may suit you. You can choose not to receive product or service offerings from us (including product or service offerings from us on behalf of our brokers, intermediaries and/or our business partners) or our related companies by calling the Allianz Direct Marketing Privacy Service Line on , EST 8am to 6pm Monday to Friday, or going to our website s Privacy section at
5 Details of Proposer 1. Please provide the full legal name of the Policyholder(s) to be insured Project role(s) a) b) c) d) e) f) Please use a separate sheet of paper if there is insufficient room above. Please note that all references to the Policyholder in the singular or you or your in the remainder of this document include all Policyholders that are listed above. Details of the Project 2. Please state the name and location of the Project to be insured: 3. Please provide the legal name of the Principal of the Project to be insured: 4. Please provide a brief description of the Policyholder s largest five (5) contracts or projects during the last 5 years that are relevant to your credentials and experience in undertaking this Project: Name and details of contract or project Contract period Contract Value a) $ b) $ c) $ d) $ e) $ 1
6 5. Please advise: a) The total estimated gross Project value: $ b) The estimated gross (actual or notional) Project professional fees attributable to the Policyholder(s): c) The estimated gross (actual or notional) Project professional fees and all other income attributable to the Policyholder(s): $ $ 6. Please confirm the percentage of income or gross (actual or notional) Project professional fees that fall into the following categories: Category a) Fees and income attributable to design and construction where you do the design yourself. $ b) Fees and income where you are responsible for design and construction and you outsource or sub-contract the design component. $ c) Fees received from design only reports and engineering or feasibility studies. d) Fees where you are engaged in a professional capacity to carry out project management, construction management or the supervision of construction. $ e) Income where you are responsible for construction, erection, installation and manufacture and have no responsibility for design or professional supervision. $ $ Amount f) Fees or income not included in the above (please provide details below) g) Total (must reconcile to question 5c) above). $ $ Please include additional detail for question f) above. Use a separate sheet of paper if there is insufficient room. 2
7 7. a) Please further allocate the Professional Services detailed in the above question into the following professional disciplines: Business Discipline % Turnover/fees Civil Engineering % Structural Engineering % Mechanical Engineering % Electrical Engineering % Chemical Engineering % Process/ Control System Engineering % Environmental Engineering % Geotechnical Engineering % Acoustic Engineering % Heating/ Ventilation/ Air Conditioning Engineering % Mining Engineering % Hydraulic Engineering % Marine Engineering % Project/ Construction Management % Surveying % Architecture % Interior Design % Landscaping % Town Planning % Other (please provide details) % Total 100% Please use a separate sheet of paper if there is insufficient room above 3
8 7. b) Please categorise the structures being built as part of the Project: Contract Type % Gross Project Value Residential Buildings % Commercial Buildings % Industrial Buildings % Institutional Buildings % Modular Buildings % Fairground Structures % Mines % Oil and Gas Pipelines % Petrochemical plants/ refineries % Nuclear Facilities % Foundations/ Underpinning % Bridges/ Tunnels % Dams % Roads % Harbours/ Jetties % Railways % Airports % Sewerage plants % Waste disposal treatment % Pollution Control Systems Design % Pre-purchase inspections % Land surveying % Building surveying % Marine surveying % Quantity surveying % Other (please provide details) % Total 100% Please use a separate sheet of paper if there is insufficient room above 4
9 8. a) Are any of the professional duties related to the Project likely to be performed by entities located outside of Australia or New Zealand? Y N If Yes, please give details of what service(s) will be provided from where (use a separate sheet of paper if insufficient room below). b) Will the Policyholder have any subsidiary, assets or employees located within the USA or Canada? Y N If Yes, please give details (use a separate sheet of paper if insufficient room below). 5
10 Risk Management Questions 9. Will the Policyholder operate any quality assurance systems, or utilise risk management programs, or belong to a limitation of liability scheme in relation to the Project? Y N If Yes, please give details (use a separate sheet of paper if insufficient room below). 10. Does the Project involve any innovative designs, materials or construction processes? Y N If Yes, please give details (use a separate sheet of your letter headed paper if insufficient room below). 11. a) Will you use independent specialist consultants or sub-contractors to perform professional services on the Policyholder s behalf? Y N b) If Yes to the above question, do you always insist that such specialist consultants or sub-contractors hold and maintain professional indemnity insurance? Y N If No, to part (b) please provide details of why not (use a separate sheet of paper if insufficient room below). 12. Does the Policyholder have an equity stake in this Project? Y N If Yes, please provide details (using a separate sheet of paper). 13. Has the Policyholder agreed to limit other parties liability (including clients, subcontractors or joint venture partners)? Y N If Yes, please provide details using a separate sheet of paper. 14. Has the Policyholder agreed to contract out of proportionate liability legislation in relation to the Project? Y N If Yes, please give details (use a separate sheet of your letter headed paper if insufficient room below). 6
11 Claims Information 15. After enquiry of the Partners/Principals/Directors and employees of all Policyholders, has there been or is there now pending a claim against any Policyholder, their Subsidiaries, their predecessors in business or their current or former Partners/ Principals/Directors or employees for a Civil Liability in the performance of the Policyholder s Professional Services in relation to this Project or a Project of similar nature and scope of works? Y N If Yes, please give details (use a separate sheet of paper if insufficient room below). 16. After enquiry of the Partners/Principals/Directors and employees of all Policyholders or any of their Subsidiaries is anyone aware of any circumstance or incident which may give rise to a claim against any of the Policyholders, or their Subsidiaries or their Partners/Principals/Directors or employees in relation to this Project or a Project of similar nature and scope of works? Y N If Yes, please give details (use a separate sheet of paper if insufficient room below). 17. After enquiry of the Partners/Principals/Directors and employees of all Policyholders or any of their Subsidiaries aware of any prosecution or investigation (actual or pending) of any Policyholder, any Subsidiary, or any Partner / Principal/Director or employees under any International, Commonwealth, State or Local statute, legislation, regulation or By Law? Y N If Yes, please give details (use a separate sheet of paper if insufficient room below). 18. After enquiry of the Partners/Principals/Directors and employees, has the Policyholder, any Subsidiary or any Partner/Principal/Director or employee ever been subject to any disciplinary action, been fined or penalised, or been the subject of an inquiry investigating or alleging professional misconduct? Y N If Yes, please give details (use a separate sheet of paper if insufficient room below). 7
12 Insurance Requirements 19. What limit(s) of liability does the Policyholder require quotations for? $5 million $10 million $20 million $50 million $100 million 20. What self-insured retention is the Policyholder prepared to carry? $250,000 $500,000 $1,000,000 $2,000,000 Other: 21. What period of insurance is required for: a) The design and construction period? Years / Months b) The discovery phase (during which the Principal may identify and report any defects for rectification? Optional Extension for Deeds of Novation 22. Does the Policyholder require cover for a deed of novation that has been entered into as part of the Project? Y N If Yes, please provide details, including details of the contract, including what due diligence you have performed (use a separate sheet of paper). 8
13 Attachments 23. Please attach the following documents as part of your insurance Submission: Documents attached? a) Detailed Project scope of works (including relevant diagrams) Y N b) Detailed breakdown of estimated Project value (including actual or notional professional fees), including all fees paid to sub-consultants that are not insured under this policy but for which the Policyholder(s) are responsible Y N c) Time schedule or gantt chart for the Project, including the expected feasibility and design phase; the expected construction phase and the estimated completion date Y N d) A copy of the Project contract between the Principal and the Policyholders Y N e) A diagram of the legal relationship between the Principal and Policyholder(s); between each of the Policyholder(s); and between the Policyholder(s) and their parent entities (if relevant), including details regarding the legal domicile of each entity Y N f) Details of other insurance (including the policy number, insurance company, limit of liability and excess) for: (i) Construction All Risks (covering material damage) (ii) Construction liability (covering loss arising from bodily injury/property damage) (iii) Other professional indemnity insurance (for example annual policies of insurance held by consultants to the Project, or annual policies held by the parent entities of the Policyholder(s) (iv) Any policy covering construction defects or warranties in relation to the Project (v) Any other insurance relevant to the Project Y N g) Marketing or tender presentations outlining the Policyholder s capabilities in relation to the Project Y N 9
14 Declaration Please Note: Signing the Declaration does not bind the proposer or the Insurer to complete this insurance. I declare that I have made all necessary inquiries into the accuracy of the responses given in this proposal and confirm that the statements and particulars given in this proposal are true and complete and that no material facts have been omitted, misstated or suppressed. I agree that should any of the information given by me alter between the date of this proposal and the inception date of the insurance to which this proposal relates, I will give immediate notice thereof to the insurer. I acknowledge receipt of the notices included in the cover sheet of this proposal and that I have read and understood the content of them. I confirm that I am authorised by the proposing Policyholder(s) (and their partners/principals/directors if applicable) to complete this proposal form and to accept the quotation terms for this insurance on behalf of all Policyholder and their Subsidiaries (and their partners/principals/directors if applicable). Name: Title: Signature: Date: If more convenient we will accept separate Declaration pages, to allow separate completion of the Declaration by each Policyholder. 10
15 Allianz Australia Limited 2 Market Street Sydney NSW Australia Phone: Fax: Disclaimer & Copyright Copyright 2014 Allianz Australia Ltd. All rights reserved. The material contained in this publication is designed to provide general information only. Whilst every effort has been made to ensure that the information provided is accurate, this information is provided without any representation or warranty of any kind about its accuracy and Allianz Australia Limited cannot be held responsible for any mistakes or omissions.