Professional Indemnity Insurance Proposal Form for Architects

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1 QPI Professional Specialists in Protecting Professions Professional Indemnity Insurance Proposal Form for Architects IMPORTANT INFORMATION Duty of Disclosure When completing any insurance proposal form it is essential that any material facts or information which might influence the judgement of insurers in fixing the premium, or in determining whether they will accept the risk is disclosed. The onus is on you to decide what may be material and there is no duty on Insurers to make enquiries of you. Failure to disclose material facts may allow insurers to avoid the policy and / or repudiate a claim under it. This duty of disclosure applies equally on taking out a new insurance policy and at renewal and throughout the duration of the policy term. Presentation of the Proposal Form It is important that the proposal form is completed as clearly as possible and the declaration signed by a Partner, Director or Principal of the firm. Failure to present the proposal form in a clear format may affect an underwriter s ability to offer terms. If completing the proposal form by hand, we recommend that you use black ink and write clearly in block capitals. All questions must be answered. If not applicable state N/A. If you run out of space please use the additional sheet provided, or alternatively use your firm s letterhead. To support your application, we recommend that where available you supply any brochures, letters of appointment and terms and conditions. Need our Advice? Should you require any advice or assistance with completing this proposal form, QPI Professional will be glad to help. Please contact us on: of 11

2 General Details 1. Name of Practice (please include all names under which you practice) Date Established Main Office Address Main Office Telephone Number Contact Name Contact Address Practice Website Address Postcode: 2. Number of branch offices PLEASE LIST ALL BRANCH OFFICES INCLUDING ADDRESSES ON A SEPARATE SHEET WHERE COVER REQUIRED If more than one office exists, please confirm if there is a senior Partner/Director/Member based at each office? If NO, please provide a C.V. of the person overseeing the office 3. Type of practice and activities undertaken: 4. Are there any subsidiary companies which are to be included under this insurance (whether trading or ceased trading) Subsidiary Year Established Year of Cessation 2 of 11

3 5. Is/are the firm(s) or any principal, partner or director a member of a joint venture or consortium? If YES please provide details on a separate sheet. Staff and Partners 6. Please give details of all Partners, Directors or Members of the Firm (s): Full Name Age Qualifications Date Qualified State how long as Partner/Director/ Member 7. Please advise number of permanent staff (excluding Partners, Directors or Members Qualified Technical Staff Other Non-qualified Technical Administrative 8. Is cover required for any Partner / Director / Member in respect of his / her liability arising from any previous business? If YES, please give details below: For which Partners / Directors / Members Title of previous business Date left business Estimate for current year 3 of 11

4 9. Please state your Gross fees for the last 5 complete financial years and estimate for the next financial year Year Ending UK USA/Canada Elsewhere Total / /20 / /20 / /20 / /20 Last completed year Estimate next year Please state your financial year end: Please provide a split of gross fees for the last complete financial year for the following categories (if practice is newly established please state estimated fees for forthcoming year): United USA / Elsewhere Kingdom Canada Architectural New Build / Refurb Architectural Refurb Non Structural Town Planning Feasibility Studies Landscape Garden / Architecture Quantity Surveying Residential Structural Surveys / Inspection Reports / Valuations Commercial Structural Surveys / Inspection Reports / Valuations Interior Design (structural) Interior Design (non-structural) Project Co-Ordination Project Management Building Surveying Planning Supervisory Work Expert Witness Work Feasibility Adjudication / Arbitration Other Work* (please provide details) Fees paid to independent sub-contractors Total Fees for firm 4 of 11

5 11. Have your activities changed in the past 5 years or do you anticipate any major changes in these activities in the forthcoming 12 months? If YES, please supply details on a separate sheet. 12. If the firm uses independent sub-contractors please answer the following: i. What services does the firm use independent sub-contractors for? ii. How does the firm select and manage independent sub-contractors and does the firm require them to maintain a minimum level of professional indemnity cover? 13. Please provide an estimate for the % of total annual fees for the last complete financial year by the following project categories: Individual Houses % Power Plants / Refineries & Petro Chemical* % Multiple Low Rise Houses % Manufacturing Plants % (5 storeys plus) High Rise Dwellings % Swimming Pools % Modular Dwellings % Mechanical Plant / Bulk Handling Equipment % Office / Retail / Mixed Use % Industrial System Build % Highways % Hospitals and Nursing Homes % Bridges, Tunnels, Dams* % Schools & Universities % Railways/Airports non-safety/track % Hotels and Recreation excluding % or air side* Swimming Pools Sewerage / Water Schemes* % Commercial % Other please specify For all work marked* please provide full details on a separate sheet 5 of 11

6 14. Please confirm if cover is required for Pollution and Asbestos If YES, please contact the QPI team to request an Asbestos and Pollution questionnaire 15. Please provide details of the three largest projects where construction has commenced during the past six years: Start Date End Date Description of Project (including name of client, location, project type, work stages and services provided) Total Project Value Firm(s) fee if a fixed price contract Firm(s) fee as a % of contract value 16. Please give details of the 3 largest contracts where construction is expected to commence in the next 12 months: Start Date End Date Description of Project (including name of client, location, project type, work stages and services provided) Total Project Value Firm(s) fee if a fixed price contract Firm(s) fee as a % of contract value 17. Are there any changes in the above percentages or any major operations envisaged during the forthcoming year? If YES, please give details on a separate sheet. 6 of 11

7 Risk Management 18. Does the firm(s) have regular principal meetings? If YES, do these involve reports on all current projects? 19a. Does the firm(s) always use standard written contract conditions outlining scope of service If NO: i) What percentage of contracts are in non-standard form?...% ii) What is the procedure for the sign-off of non-standard contracts? Please outline below:...% 19b. Do the standard written contract conditions exclude liability for pollution or contamination? 19c. Does the firm(s) ensure that that all collateral warranties entered into are of a standard format (e.g. standard format or JCT Standard Form of Agreement)? If NO, please confirm that the contractual provisions contain: i) No fitness for purpose or guarantee? ii) Contractual period is restricted to 12 years or less? iii) Standard of care restricted to reasonable skill and care? 19d. Does the customer always sign the contract? 19e. Does the firm(s) have standard procedures for regular review of on-going contracts? 19f. Does the firm provide advice or services which fall outside the scope of the contract? If YES, does the firm(s) always amend the scope of service to reflect any change in project requirements? 20. Does the firm have written risk management procedures which are regularly reviewed and circulated to all staff? If NO, please provide full details of procedures on separate sheet 21. Does the firm(s) operate any Quality Assurance Systems? If YES, please specify: 7 of 11

8 22. Does the firm(s) offer and promote continuous training? 23. Does the firm(s) have systems in place for ensuring that critical dates/time limits are met If YES, please advise details: Claims Information 24. After enquiry, have any professional indemnity claims ever been made against the Firm(s) and/or predecessors of the Firm(s) and/or your current and/or retired Partners, Directors or Principal, either individually or otherwise for any negligence, errors, omission, breach of professional duty or the like, whether successful or not? If YES, please supply details: Date of Claim (dd/mm/yy) Claimant Details of Claim, including amounts paid by insurer in respect of damages and legal costs 25. After enquiry, are any of the Partners, Directors or Prinicples aware of any pending claims and/or circumstances existing that may give rise to a professional indemnity claim against the Firm(s) and/or predecessors of the Firm(s) and/or your current and/or retired Partners/Directors/Principals? If YES, please supply details: Date of circumstance Claimant Details 8 of 11

9 26. Is any Partner, Director or Principal, after enquiry aware of any disciplinary actions taken towards the firm and / or Partner / Director / Principal? 27. Has the Firm(s) sustained any loss through fraud or dishonesty of any person? Is the Firm(s) aware of any allegation or occurrence of fraud or dishonesty at any time committed by any past or present Partners, Director or employee? If YES, please provide details on a separate sheet Previous Coverage 28. Has the firm previously been insured for professional indemnity insurance? (If you are a current client of QPI Professional do not complete) If YES, please supply details: Renewal Date Limit of Indemnity Premium Excess Insurer Name 29. Has an insurer ever declined a proposal, declined to pay a claim, refused renewal, cancelled the policy or imposed special conditions in respect of professional indemnity insurance? If YES please provide details: 9 of 11

10 Cover Requirements Please specify the limit (s) of indemnity for which quotations are required: GBP GBP GBP GBP GBP Please specify the excess you would be prepared to carry GBP GBP GBP GBP GBP Additional Information Please use this space to provide further information in support of answers given to questions in this proposal. Please state question numbers clearly. 10 of 11

11 Declaration I /We declare that the statements and particulars in this proposal are true and that no material facts have been misstated or supressed after enquiry. I / We agree that this proposal, together with any other information supplied shall form the basis of any contract of insurance effected thereon. I / We undertake to inform the insurers of any material alteration to those facts occurring before the completion of the contract of insurance. Signed: Title: Firm(s): Date: QPI Legal Unit 17 Mobbs Miller House Ardington Road Northampton NN1 5NE Tel: Fax: of 11

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