Professional Indemnity Insurance Proposal Form For The Design and Consulting Departments of Contractors

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1 Professional Indemnity Insurance Proposal Form For The Design and Consulting Departments of Contractors Important Notice 1. This is a proposal for a contract of insurance, in which Proposer or you/your means the individual, company, partnership, limited liability partnership, organisation or association proposing cover. 2. This proposal must be completed in ink, signed and dated. All questions must be answered to enable a quotation to be given but completion does not bind you or Underwriters to enter into any contract of insurance. If space is insufficient to answer any questions fully, please attach a signed continuation sheet. You should retain a copy of the completed proposal (and of any other supporting information) for future reference. 3. All facts material to the proposed insurance must be disclosed, fully and truthfully to the best of your knowledge and belief. Failure to do so may make the contract of insurance voidable or severely prejudice your rights in the event of a claim. A material fact is one likely to influence Underwriters assessment or acceptance of the proposal; if you are uncertain what may be a material fact, you should consult your broker. 4. You are recommended to request a specimen copy of the proposed policy wording from your insurance broker and to consider carefully the terms, conditions, limitations and exclusions applicable to the cover. 1. General Information 1.1 Name of Practice/Company. 1.2 Address of registered office and/or principal place(s) of business (if different). 1.3 Is cover being sought for any previous or subsidiary practices/companies? If so, please list on a separate signed sheet and provide full details including name, country of registration, address of principal place of business and ownership/relationship with the main practice. 1.4 State the date when the main practice (and any other subsidiary practices/companies requiring cover), began and (where appropriate) ceased business?

2 1.5 Is the Practice financially associated with any other firms? Yes No 1.6 During the past five years, has the name of the Practice been changed or has any other business been purchased or any merger or consolidation taken place? Yes No 2. The Design and Consulting Department Staff Details 2.1 Individual Details. Name of Principals and Senior Members of Staff Qualifications Date Joined Title of Positions Length of time in Position 2.2 Numbers of Staff. Based in the U.K. Overseas Based Principals and Senior Qualified Members as listed Other Technical and Qualified Staff Clerical, Typists, Others TOTALS 2.3 Do you use independent specialist consultants? Yes No 2.4 Do you verify that they carry their own P.I. Insurance Yes No 2.5 Are any persons ever hired from outside agencies on a short-term basis? Yes No Markel Design & Construction Proposal Form Page 2

3 3. Work Undertaken 3.1 Please give an approximate percentage split of the disciplines within your Design and Consulting Department. Architectural % Chemical Engineering % Soil Engineering % Structural Engineering % Nuclear Engineering % Mechanical Engineering % Surveying (i) Land % Electrical Engineering % (ii) Quantity % Planning Supervisor % (iii) Building % Cladding/Roofing % Foundations/Underpinning % Civil Engineering % Heating and Ventilating Engineering % 3.2 Indicate as a percentage of total work the extent of the following activities: (a) HOME BUILDING Design Only Design and Construct Power Plants Refineries and Petro Chemical Installations Manufacturing Plants Industrial Buildings Systems (b) ENGINEERING CONSTRUCTION Design Only Design and Construct Highways Bridges, Tunnels and Dams Railways, Airports, Harbours and Jetties Sewage/Water Schemes (c) INDUSTRIAL Design Only Design and Construct Power Plants Refineries and Petro Chemical Installation Manufacturing Plants Industrial Buildings Systems Markel Design & Construction Proposal Form Page 3

4 (d) AMENITIES Design Only Design and Construct Hospitals and Nursing Homes Schools and Universities Hotels and Recreation Centres 3.3 Do you engage in the manufacture or fabrication of any pre-engineered unit? Yes No 3.4 Add here a statement of the type of work normally carried out, whether consisting of well-established techniques or of the nature of new and original thought developments, processes or designs employed. State whether and what licensing or similar agreements are in force and the degree to which supervision of them is exercised by associates. 3.5 Have you ever failed to complete a project? Yes No (If Yes, please explain reason and type of project etc.) 4. Fees and Contracts 4.1 Please give details of turnover. Past Financial Year Year ending../../.. Current Financial Year Year ending../../.. Home Overseas Home Overseas (a) Turnover where the practice designs and constructs from their own design and provides full technical supervision (b) Fees of those departments where the practice provides: (i) Design and Technical Services where no construction is involved by the practice (ii) Planning Supervisor Services as defined by the Construction (Design and Management) Regulations (a) Turnover where practice constructs from designs accepted on behalf of the practice by independent, qualified and insured consultants. (b) Turnover where Practice constructs from design and technical supervision accepted on behalf of the Practice by independent, qualified and insured consultants. (c) Other turnover not mentioned above. Please provide brief details below. TOTAL TURNOVER FOR WHOLE PRACTICE Markel Design & Construction Proposal Form Page 4

5 4.2 Please give details of the five largest contracts commenced during the last five years where the Design and Consulting Department has been involved. Date Started Name and Type of Project Services Performed Total Contract Value Estimated Date of Completion 4.3 Please give details of any major new operations being undertaken during the next twelve months. 5. Business Associations and Qualifications 5.1 Is the work of all Associated and/or subsidiary companies design departments/sections checked by Head Office? Yes No (If No, please provide full details) 5.2 (a) Is the Practice or any principal a member of a consortium or joint venture? Yes No (b) Has the Practice or any principal previously been a member of a consortium or joint venture? Yes No If the answer to 5.2 (a) and/or (b) is "Yes", special arrangements must be made with the Insurers. Please provide the relevant dates and the names of the other members and their respective capacities in the consortium or joint venture on a separate letterheaded sheet, together with copies of any contracts or agreements. 5.3 Has the Practice a Quality Assurance System in place? Yes No (If Yes, please provide a copy of your certificate) 5.4 Has the Practice or any partner, principal or director or any other company or organisation related to the Practice ever provided services in connection with the identification of asbestos, chemicals or other hazardous materials? Yes No 5.5 Have those persons in the Design and Consulting Department providing planning supervisor services, as defined in the Construction (Design and Management) Regulations 1994, passed a relevant professional body s training course? Yes No Markel Design & Construction Proposal Form Page 5

6 6. Previous Insurance 6.1 If the Practice is currently insured or has been insured in the past 12 months, please state: (a) Name of insurers (b) Indemnity limit (c) Excess (d) Expiry date of present policy (e) Numbers of years the Practice has been continually insured (f) Retroactive date of current P.I. policy 6.2 Has any Proposal for similar insurance made on behalf of the Practice, any predecessors in business, or present partners, ever been declined or has any such insurance ever been cancelled or renewal refused? Yes No 7. Claims Decalaration 7.1 (a) Please provide full details of all claims involving the Practice or its predecessors in business in the past ten years. (b) Please provide full details of all claims involving any partners, principals, directors, officers or employees of the Practice (whilst at the Practice or in a previous practice) in the past ten years. (c) For 7.1 (a) and (b) above please provide details of the type of allegation, the court or agency involved and any determination, judgment, claims payments (including without prejudice or ex gratia payments) and defence costs for each claim. 7.2 After enquiry, are the Practice, any of its partners, principals, directors or officers aware of any circumstances, allegations or incidents which they have reason to suppose could give rise to a claim against the Practice or any of its partners, principals, directors, officers or employees? Yes No (If Yes, please provide full details on a separate letterheaded sheet.) NOTE:Any claims reported or which should have been reported under 7.1 and/or 7.2 above will be excluded from cover under the policy. Markel Design & Construction Proposal Form Page 6

7 8. Other Material Facts After enquiry, is the Practice, any of its partners, principals, directors or officers aware of any other material facts? Yes No A material fact is one likely to influence assessment of this risk, the premium charged or the terms and conditions imposed by Insurers. If your proposal is a renewal, it should include any change in facts previously advised to Insurers. If you are in any doubt as to whether a fact would be considered material, you should disclose it. All the information requested in this proposal is material. Failure to disclose a material fact could prejudice your rights to recover in the event of a claim or allow Insurers to avoid the policy. Please contact your broker if you require any guidance. 9. Insurance Requirements 9.1 What is the Limit of Indemnity required? 9.2 What is the amount of excess that the Practice would be prepared to carry in respect of each and every claim? (a) 5,000 (b) 10,000 (c) 25,000 or more 10. Data Protection Act 1998 Consent to use of information Insurers will use the information provided herein to manage the insurance policy, including underwriting and claims handling. This may include disclosing it to other insurers, regulatory authorities or to Insurer s agents providing services on their behalf. In order to detect and prevent fraud, Insurers may at any time: (a) share information about the Practice, its partners, principals, directors and/or officers with other organisations and public bodies including the Police; (b) check and/or file the Practice s and/or its partners, principals directors and/or officers details with fraud prevention agencies and databases, and if Insurers suspect fraud, Insurers will record this. Insurers and other organisations may also search theses agencies and databases to: (i) (ii) (iii) Help make decisions about the provision and administration of insurance, credit and related services for the Practice, its partners, principals, directors and officers; Trace debtors or beneficiaries, recover debt, prevent fraud and to manage the Practice s accounts and insurance policies; Check identities to prevent money laundering. (c) undertake credit searches and additional fraud searches. Insurers can supply on request further details of the databases that they access or contribute to. Markel Design & Construction Proposal Form Page 7

8 Data Protection Act 1998 Consent to use of information Underwrites will use the information provided herein to manage the insurance policy, including underwriting and claims handling. This may include disclosing it to other insurers, regulatory authorities or to Underwriter s agents providing services on their behalf. In order to detect and prevent fraud Underwriters may at any time: a. Share information about the Proposer and/or its partners, principals, directors, officers and/or employees with other organisations and public bodies including the Police; b. Check and/or file the Proposer s and/or its partner s, principals, directors and/or officers details with fraud prevention agencies and databases and if Underwriters suspect fraud, Underwrites will record this. Underwriters and other organisations may also search these agencies and databases to: i. Help make decisions about the provision and administration of insurance, credit and related services for the Proposer, its partners, principals, directors and officers; ii. iii. Trace debtors or beneficiaries, recover debt, prevent fraud and to manage the Proposer s accounts and insurance policies; Check identities to prevent money laundering; c. Undertake credit searches and additional fraud searches. Underwriters can supply on request further details of the databases that they access or contribute to. Declaration I hereby confirm that I am duly authorised and do give consent to the use of information as set out in Section 10 above. I hereby also declare that I am authorised to complete this proposal on behalf of the Practice and that the statements and particulars in this proposal are true and complete and no material facts have been mis-stated or suppressed. I undertake to inform Insurers of any material alteration or addition to these statements or particulars which occurs before the commencement of the period of insurance. It is hereby acknowledged and agreed that the terms, conditions, limitations and exclusions of the policy may be subject to alteration at any time prior to the commencement of the period of insurance should, any such material alterations or additions arise. Signing of this proposal does not bind Insurers to offer, nor the applicant to accept, insurance, but it is acknowledged and agreed that this proposal (together with all documents accompanying it and any other information supplied by the Practice or the partners, principals, directors and officers to Insurers in connection with the policy) shall be the basis and form part of any such contract. Signed Name Capacity Date This proposal should be completed and signed by a partner, principal or director of the Practice on behalf of all parties seeking insurance. Markel Design & Construction Proposal Form Page 8

9 NOTICE TO THE PROPOSER The Insurers The Insurers will be either Markel International Insurance Company Limited or Markel Syndicate 3000 at Lloyd s, together with any other subscribing insurer(s). Prior to any placement being concluded, the Proposer will be advised which insurer(s) is/are to write this contract of insurance. The Law of the Insurance Contract The parties to this proposed insurance are free to choose the law applicable to the insurance contract. Unless specifically agreed otherwise with Insurers, the proposed contract will be governed by English law. Procedure for queries or complaints Below are two complaints notices. If you are insured with Markel Syndicate 3000 at Lloyd s, please follow the procedure set out in (1) below. If you are insured with Markel International Insurance Company Ltd, please follow the procedure set out in (2). 1. Markel Syndicate 3000 at Lloyd s If at any time you have any questions or concerns regarding this Policy or the handling of a claim, you should in the first instance refer to your insurance broker or intermediary, if applicable. If your problem cannot be resolved in this way, please write to the Claims Manager, Professional Liability Division, Markel International Limited, The Markel Building, 49 Leadenhall Street, London, EC3A 2EA. We will then advise you of Markel s internal complaints handling procedure. If you are still unable to resolve the situation and wish to make a complaint, you can do so at any time by referring the matter to the Complaints Department at Lloyd s. Their address is Complaints Department, Lloyd s, One Lime Street, London, EC3M 7HA; Tel: ; Fax: ; Complaints that cannot be resolved by our internal complaints handling procedure or by the Complaints Department at Lloyd s may be referred to the Financial Ombudsman Service. Further details will be provided at the appropriate stage of the complaints process. These complaints procedures do not affect your right to have recourse to legal action or to any other remedy available to you. 2. Markel International Insurance Company Ltd. If at any time you have any questions or concerns regarding this Policy or the handling of a claim, you should in the first instance refer to your insurance broker or intermediary, if applicable. If your problem cannot be resolved in this way, please write to the Claims Manager, Professional Liability Division, Markel International Limited, The Markel Building, 49 Leadenhall Street, London, EC3A 2EA. We will then advise you of Markel s internal complaints handling procedure. Complaints that cannot be resolved by our internal complaints handling procedure may be referred to the Financial Ombudsman Service. Further details will be provided at the appropriate stage of the complaints process. These complaints procedures do not affect your right to have recourse to legal action or to any other remedy available to you. Markel Design & Construction Proposal Form Page 9

10 About Us Markel International Limited is the London based subsidiary for the international operations of Markel Corporation and is one of the UK s leading specialist insurance companies. The company has developed its expertise through understanding and catering for niche markets. In each of these markets Markel aims to provide quality products and excellent customer service thereby establishing the Markel brand as a market leader. The company operates in the UK through two commercial entities: Markel International Insurance Company Limited, its London based insurance company and Markel Syndicate 3000, its 100 per cent owned Lloyd s syndicate. In both of these business environments Markel International offers a wide range of products, with its considerable underwriting expertise organised around the following product lines: Marine & Energy, Non-Marine Property, Specialty, Professional Liability and Retail. For more details about our products, please visit our website at The Markel Building, 49 Leadenhall Street, London EC3A 2EA Tel: Markel +44 Design (0)20 & 7953 Construction 6000 Fax: Proposal +44 Form (0) Page 10

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