PUBLIC LIA BILITY INSURA NC E STA TEMENT O F FA C T & A PPLIC A TIO N FO RM

Transcription

1 PUBLIC LIA BILITY INSURA NC E STA TEMENT O F FA C T & A PPLIC A TIO N FO RM INTRO DUC TIO N The Na tio na l Fe d e ra tio n of M a ste r Wind o w & G e ne ra l C le a ne rs is a n Intro d uc e r A p p o inte d Re p re se nta tive o f Willis Limite d a nd Willis Lim ite d is a utho rise d a nd re g ula te d b y the Fina nc ia l Se rvic e s A utho rity a nd ha s a rra ng e d a Pub lic Lia b ility insura nc e sc he m e fo r me m b e rs o f the Fe d e ra tio n. The p o lic y is und e rwritte n by Fo rtis Insura nc e Limite d, Re g iste re d A d d re ss: Fo rtis Ho use, To llg a te, Ea stle ig h, SO 53 3YA, Eng la nd. Re g iste re d Numbe r Fo rtis Insura nc e is a utho rise d a nd re g ula te d b y the Fina nc ia l Se rvic e s A utho rity. This Sta te me nt o f Fa c t a nd A p p lic a tio n Fo rm is a re c o rd of the info rm a tio n a d vise d to Fo rtis Insura nc e a nd fa c ts a re a ssume d a b o ut yo ur risk. The se ha ve b e e n ta ke n into a c c o unt whe n c a lc ula ting a nd a sse ssing yo ur risk a nd p re mium up o n whic h yo ur p o lic y is b a se d. It fo rm s p a rt o f yo ur c o ntra c t o f insura nc e. Ple a se c he c k the info rma tio n in this Sta te me nt o f Fa c t a nd A p p lic a tio n Fo rm. Ple a se e nsure tha t it is c o rre c t a nd the numbe rs o f princ ip a ls, p a rtne rs a nd e mplo ye e s is a c c ura te ly sta te d a nd tha t no d e ta ils a re misse d. Fa ilure to d o so c ould inva lid a te the p o lic y fro m inc e p tio n o r re sult in a c la im b e ing re p ud ia te d. Yo u m ust p ro vid e a ll the ma te ria l fa c ts tha t ma y influe nc e a c c e p ta nc e o f yo ur insura nc e, its te rms, c o nd itio ns a nd p re m ium. If yo u a re in d o ub t whe the r a p a rtic ula r fa c t is m a te ria l, yo u sho uld d e c la re it. Yo u sho uld ke e p a re c o rd (inc lud ing c o p ie s o f le tte rs) o f a ll info rma tio n p rovid e d. A c o p y o f a ll info rma tio n g ive n will b e sup p lie d up o n re q ue st. Polic y Sum ma ry This is a summ a ry o f the sta nd a rd c o ve r a va ila ble und e r the Fo rtis Se mplo y Insura nc e Po lic y. This summa ry d o e s no t inc lud e a ll the p o lic y be ne fits, limits a nd e xc lusio ns; full te rms a nd c o nd itio ns c a n b e fo und in the Po lic y Wo rd ing, a c o p y o f whic h is a va ila ble fro m Willis Limite d o n re q ue st. The p o lic y, a nd no t this sum ma ry, is the b a sis o f the c o ntra c t o f insura nc e. Eng lish la w a p p lie s to the c o ntra c t. Fortis C om me rc ia l G ua rd Se mploy Polic y The Se m p lo y Insura nc e Po lic y is a n a nnua l insura nc e c o ntra c t tha t g ive s c o ve r fo r b usine ss insura nc e s in Engla nd, Wa le s, Sc o tla nd, the Isle o f M a n a nd the C ha nne l Isla nd s. 1

2 The cover may be varied to meet your individual needs and any variations from standard will be detailed in any quotation given and thereafter in the policy schedule. Section 1- Liabilities - (Public Liability) Principal Cover and Benefits of Section 1 Covers legal liability to pay compensation in the event of accidental death, injury or damage to property arising in the course of the business, as detailed below. This contract can cover a maximum of six (6) manual workers including labour only sub contractors. Public Liability Cover Compensation to members of the public in the event of accidental death or injury, damage to property or obstruction, trespass, nuisance, or interference with any right of air, light or water, including claimant s costs, expenses, legal costs and solicitor s fees. Maximum Limit of A choice of 1,000,000, 2,000,000 or 5,000,000 for any one event Principal Cover extensions to Section 1- Liabilities - (Public Liability) Please refer to Section 1 of the Policy Wording for the full details of Cover provided by these extensions. The following are extensions to Cover that are included as standard with areas of Cover taken out under Section 1 so they do not need to be additionally requested to be included:- to Principal; Leased, Hired or Rented Premises; Failure to set or reset alarms limit 250,000; Temporary Occupation of Buildings; Health and Safety at Work Act 1974; Motor Contingent Liability; Court Attendance; Loss of keys limit 25, excess. Principal Exclusions to Section 1- Liabilities - (Public Liability) are as follows, but please refer to Section 1 of the Policy Wording for the full details of all the Exclusions. Injury to any employee Costs incurred by anyone in recalling, removing, repairing, rectifying, replacing, reapplying or guaranteeing any product supplied Liability caused through any products supplied which are used to the knowledge of the Insured in connection with certain hazardous locations or equipment as detailed in Section 1 of the Policy Wording Liability arising in connection with work on some specified hazardous locations which are detailed in Section 1 of the Policy Wording Liability arising in connection with certain equipment which is detailed in Section 1 of the Policy Wording 2

3 Liability assumed under agreement except as detailed in Section 1 of the Policy Wording Liability arising; out of pollution or contamination unless caused by a sudden, identifiable, unintended, and unexpected incident; the maximum liability of the company for pollution or contamination which is deemed to have occurred during any one period of insurance is 1,000,000 in the aggregate through the defective design, plan, formula, or specification of products supplied out of technical, professional or remedial instruction and advice given for a fee or for which a fee would normally be charged The cost of making good, replacement or reinstatement of defective work carried out by the Insured Damage to property belonging to or held in trust by or in the custody or control of the Insured or an employee, including customers property removed for cleaning Claims made in any country outside the European Union Products knowingly supplied directly or indirectly to the USA or Canada Liability for property being worked on where the damage is the direct result of the work undertaken Liquidated damages, fines or penalties exemplary, punitive or multiplied damages Liability arising out of asbestos apart from specified exceptions as detailed in Section 1 of the Policy Wording The first 250 for any property damage claim. Section 2 - Tools - All Risks Principal Cover and benefits of Section 2 Please refer to Section 2 of the Policy Wording for the full details of all the Exclusions. Cover Damage to ladders, buckets, and other cleaning equipment including waterfed poles, reach and wash systems Maximum Amount Payable 500 per person Principle Exclusions to Section 2 Damage which is not identifiable with a specific event Wear tear, rust and other gradual deterioration, condensation, mechanical or electrical breakdown or any process of cleaning repair or restoration Tools left unattended unless contained in a securely locked building or a secured motor vehicle Theft by an employee The first 100 of any claim. Principal General Policy Exclusions Please refer to the General Conditions and Exclusions section of the Policy Wording for full details of all the general Policy Exclusions. Terrorism This policy excludes all losses or loss arising from, caused by, or contributed to by terrorism. 3

4 Cancellation Procedure There is no option for you to cancel this policy once it has been incepted until the renewal date of the policy unless the business ceases, closes or is sold. Claim Notification Contact the Fortis Claims Department on The line is open 24 hours a day, 365 days a year. The claims handler will ask your name, policy number and full details of the loss circumstances. You will be advised on the procedures and what documentation is required by us to deal with your claim. Alternatively you can fax details on or write to Commercial Claims, Fortis Insurance Ltd, Fortis House, London Road, Gloucester GL1 3NS, England. Full claims procedures are noted in the Policy Wording under the General Conditions and Exclusions. Complaints Procedure If you have a complaint, in the first instance, please speak to Willis Limited on If you remain dissatisfied, or you feel that your complaint remains unresolved, please follow the steps below: Step 1 Contact Fortis Customer Service Adviser, Fortis Insurance Ltd, Fortis House, Tollgate, Eastleigh, SO53 3YA, England. Step 2 If your complaint has not been resolved, the Chief Executive, Fortis Insurance Ltd at the same address. Step 3 If you are not satisfied with the final decision and your business turnover is less than 1,000,000 you can write to the Financial Ombudsman Service at South Quay Plaza 2, 183 Marsh Wall, London, E14 9SR. Please refer to the last page of the Policy Wording for the full details of the Complaints Procedures. Financial Services Compensation Scheme In the event that Fortis Insurance Ltd is unable to meet it s liabilities you may be entitled to compensation from the Financial Services Compensation Scheme; their telephone number is More information can be found at Data Protection Please keep records including copies of all letters, this form and all information supplied to us for the purpose of entering into this contract. Details that you provide may be used by Willis Limited or the Federation or Fortis Insurance or other relevant organisations for the purpose of the administration and renewal of your policy and for claims handling. In addition Willis Limited may use your data for marketing purposes such as market research and contacting you regarding your future insurance or investment needs. If you do not wish your data to be used other than in connection with this insurance please write to Willis Limited, Bridgeman Court, Salop Street, Bolton BL2 1DQ. 4

5 PREMIUM TABLES 1. WINDOW CLEANERS in private dwellings, shops, offices, public houses, schools or hotels These premiums are based upon window cleaning only up to 15 metres in height, are per person and that payment is in full by cheque or monthly by direct debit after a cheque for 25% of the premium has been paid. (Please circle the corresponding premium amount) These premiums are inclusive of Insurance Premium Tax. No. of Persons/ Limit of ,000, ,000, ,000, WINDOW CLEANERS in private dwellings, shops, offices, public houses, schools, hotels and light industrial premises These premiums are based upon window cleaning only up to 15 metres in height, are per person and that payment is in full by cheque or monthly by direct debit after a cheque for 25% of the premium has been paid. Light Industrial premises are defined as manufacture and distribution trade premises up to 10,000 square metres of total floor area. (Please circle the corresponding premium amount) These premiums are inclusive of Insurance Premium Tax. No. of Persons/ Limit of ,000, ,000, ,000, INTERNAL CLEANERS in private dwellings, shops, offices, public houses, schools or hotels These premiums are based upon cleaning up to 4 metres in height internally, are per person and that payment is in full by cheque or monthly by direct debit after a cheque for 25% of the premium has been paid. 5

6 (Please circle the corresponding premium amount) These premiums are inclusive of Insurance Premium Tax No. of Persons/ Limit of ,000, ,000, ,000, INTERNAL CLEANERS in private dwellings, shops, offices, public houses, schools or hotels and light industrial premises These premiums are based upon cleaning up to 4 metres in height internally, are per person and that payment is in full by cheque or monthly by direct debit after a cheque for 25% of the premium has been paid. Light Industrial premises are defined as manufacture and distribution trade premises up to 10,000 square metres of total floor area. This excludes the cleaning or degreasing of process machinery or equipment, silos, tanks, vats, pipe work, ducting, flues or filtration plant or equipment. (Please circle the corresponding premium amount) These premiums are inclusive of Insurance Premium Tax. No. of Persons/ Limit of ,000, ,000, ,000, APPLICATION FORM for PUBLIC LIABILITY INSURANCE Agency number 20840E Please complete all of the answers on this application form and send it to Willis Limited FULL NAME and /or trading name (if different):. ADDRESS: TELEPHONE NUMBER / FAX NUMBER: Post Code. FEDERATION MEMBERSHIP NO: DATE FROM WHICH COVER IS TO APPLY DATE FROM WHICH COVER IS REQUIRED: Section 1 - PUBLIC LIABILITY - LIMIT OF INDEMNITY REQUIRED (Please circle) 1,000,000 or 2,000,000 or 5,000,000 (Please tick which trade you require insurance for and how you wish to pay) TRADE OR BUSINESS Window Cleaners in private dwellings, shops, offices, public houses, schools and hotels only or monthly DD or Window Cleaners in private dwellings, shops, offices, public houses, schools and hotels only or single cheque Window Cleaners in private dwellings, shops, offices, public houses, schools and hotels plus light industrial premises monthly DD or

7 Window Cleaners in private dwellings, shops, offices, public houses, schools and hotels plus light industrial premises single cheque Internal Cleaners in private dwellings, shops, offices, public houses, schools and hotels only or monthly DD or Internal Cleaners in private dwellings, shops, offices, public houses, schools and hotels only or single cheque Internal Cleaners in private dwellings, shops, offices, public houses, schools and hotels plus light industrial premises monthly DD or Internal Cleaners in private dwellings, shops, offices, public houses, schools and hotels plus light industrial premises single cheque applicable Please tick each box that is relevant to what you do, the premium will be the highest NUMBERS OF PERSONS Please can you show the maximum number of people in manual work for the business at any one time. Principals, Partners and Directors Partners (please provide full names of all partners) Employees, including labour only subcontractors, hired people and people working under Government Sponsored Work Schemes.. Total Bona Fide Subcontractors need not be shown. You must however check that they do hold their own public liability insurance policy. Your liability for their acts is insured. Section 2 - TOOLS are automatically covered for 500. DECLARATIONS: I do not work at or on: Towers/steeples/chimney shafts/blast furnaces Dams/canals/viaducts/bridges or tunnels Aircraft/airports/railways/ships/docks/piers/wharfs Breakwaters/sea walls/collieries/mines/chemical works Gas works/oil refineries/power stations/nuclear installations Offshore installations or bulk oil, petrol, gas or chemical storage tanks or chambers Computers or computer suites or rooms used exclusively for computer operations Or any offices located within such installations. Manufacturing or distributing trades industrial premises exceeding square metres of total floor area The cleaning or degreasing of process machinery or equipment, silos, tanks, vats, pipe work, ducting, flues or filtration plant or equipment I do not Erect or dismantle scaffolding Use cradles, hoists, tower cranes or harnesses or undertake internal work above 4 metres or external work above 15 metres Use silica, asbestos or substances containing asbestos, acids, gasses, explosives, radioactive or similar dangerous liquids or substances 7

8 (Cover may be provided subject to a premium loading. Please provide full details of work undertaken and the amount of your turnover, as a percentage, related to work above 15 metres) Please note that if any work over 15 metres is carried out by the Waterfed Pole / Reach & Wash system whilst you are standing on the ground, this is covered and no loading will apply. Neither me, nor any member of my family directly connected with the business, nor any partner or director of officer in the business has: Been convicted or charged (but not yet tried) with a criminal offence (other than a motoring offence). Received an official warning for a criminal offence (other than a motoring offence). Ever been declared bankrupt and/or been a director of a Company which has gone into liquidation, administration or receivership. Ever knowingly failed to conform to legislation pertaining to Health & Safety at Work activities. Had any accidents losses or claims prior to inception of this policy whether insured or not. No Insurer has ever: Declined a proposal for insurance Not invited a renewal Cancelled or refused to renew a policy Imposed special conditions or required increased premiums Please provide details of any claims history below in order that this may be referred to Willis Limited as Insurers may accept such claims subject to premium loading.. SIGNED DATE NAME. FINAL CHECK LIST 1. Complete and sign the Application form for Public Liability insurance pages 6/7 2. From the Premium Tables - page 5 - work out your annual premium -. If paying in full write out a cheque to Fortis Insurance. 3. If paying monthly divide the annual premium by 4 = to get the deposit premium and write out a cheque to Fortis Insurance for this amount and complete the Commercial Credit Plan Application Form and Credit Agreement plus the Direct Debit Bank or Building Society Instruction PLEASE SEND ALL OF THESE DOCUMENTS TO WILLIS LIMITED, Bridgeman Court, Salop Street, Bolton BL2 1DQ PLEASE MAKE SURE YOUR CHEQUE IS MADE PAYABLE TO FORTIS INSURANCE AND NOT WILLIS ONCE INSURERS HAVE CONFIRMED COVER, WILLIS WILL CONFIRM THE START DATE OF YOUR INSURANCE BY THE ISSUE OF THE POLICY DOCUMENT. 8