Schedule to the Policy 1 Policy Number: SALSALIA/R79242/0332/15 2 Form Number: SJC2010SAUA 3 Insured Name: Just Sow Ltd t/a The Hive 4 Insured Address: The Hive, 86-90 Paul Street, London,EC2A 4NE 5 Policy Period: From: 8 May 2015 6 Information provided to Underwriters on: To: 7 May 2016 Both dates Inclusive Local Standard Time at the Insured s address as above stated. 5 May 2015 7 Business: Level 3 forest school practitioner providing activities for children, adults and family groups of all ages. General forest school work including shelter building, use of hand tools (including knives), tree climbing to head height, use of swings rope swings and play equipment for children of primary school age, occasional lopping/coppicing, camp fires, overnight camps. Also additional activities, led by suitably qualified practitioners, including wildlife film making, green woodworking and the like.. 8 Limit of Indemnity: Employers Liability: GBP 10,000,000 Any One Claim, including costs and expenses Public Liability: GBP 5,000,000 Any One Claim, costs and expenses in addition Products Liability: GBP 5,000,000 in the aggregate, costs and expenses in addition 9 Excess: Property Damage GBP 250 10 Premium: Employers Liability: GBP 150.00 for the Policy Period Adjustable on Clerical Employees at: % Adjustable on All Other Employees at: 0.5000% Public/Products Liability: GBP 200.00 for the Policy Period Adjustable on UK Turnover at: % Adjustable on EU/ROW Turnover at: % Insurance Premium Tax: GBP 21.00 Deposit & Total Premium: GBP 371.00 11 Endorsements: As attached 6 May 2015 Signed on behalf of certain Underwriters at Lloyd s, London Date 1
Schedule to the Policy ENDORSEMENTS The following endorsement attaches to and forms part of Policy Number SALSALIA/R79242/0332/15 in the name of Just Sow Ltd t/a The Hive :- Excess We shall not indemnify You in respect of the first GBP 250 of all claims (including costs and expenses) arising from Damage to Property. If any amount paid by Us includes the above amount You shall reimburse Us. Premium Payment Warranty It is a condition precedent in respect to liability insurance that the minimum and deposit premium due to SAUA under this insurance is paid to SAUA within 60 days after the effective inception date of the insurance, renewal or adjustment date (as appropriate) of the insurance. Should the premium not be paid within the given period all cover under the insurance will be cancelled and of no further effect and treated as Not Taken Up. Sanction Limitation and Exclusion Clause We shall not provide any benefit under this policy to the extent of providing cover, payment of any Claim or the provision of any benefit where doing so would breach any sanction, prohibition or restriction imposed by law or regulation. Employers Liability Tracing Office Notice Certain information relating to your policy, namely; the policy number(s), employers names and address (including subsidiaries and any relevant change of name), coverage dates, and (if relevant) the employers reference numbers provided by Her Majesty s Revenue and Customs and Companies House Reference Numbers will be provided to the Employers Liability Tracing Office, (the ELTO ) and added to the Employers Liability Database (ELD). It is understood by you that the above named information provided to Insurers will be processed by Insurers, for the purpose of providing the ELD, in compliance with the provisions of the Employers Liability Insurance: Disclosure by Insurers Instrument 2010. The ELTO may provide such information to third parties to assist individuals with claims arising out of their course of employment in the United Kingdom for employers carrying on, or who carried on, business in the United Kingdom, to identify an insurer or insurers that provided employers liability insurance. 2
Schedule to the Policy Bona Fide Sub Contractors Condition We will not indemnify You under this Insurance in respect of any claim arising out of or in connection with work undertaken on Your behalf by bona fide independent contractors (not defined as a Person Employed under this Insurance) unless at the time of engaging such contractors You obtain and retain a copy of the relevant insurance policy schedule or other proof thereof that such contractors have in force: 1 an approved Employers Liability insurance in accordance with any law relating to compulsory insurance of liability to Persons Employed and 2 Public and Products Liability insurance suitable for the nature of the work undertaken on Your behalf and with a Limit of Indemnity not less than that applying to this Policy and containing an indemnity to principals clause. Participant to Participant Exclusion We shall not indemnify You under Sections 1 & 2 of this Insurance against liability arising from Injury caused by the acts or omissions of any participant towards another participant. Bodily Treatment Exclusion We shall not indemnify You under Sections 2 & 3 of this Insurance against liability arising from the provision of any medical or other bodily treatment (other than first aid and ambulance services). Professional Indemnity Exclusion We will not indemnify You in respect of liability arising out of or in connection with the failure of You to fulfil Your professional duties. Efficacy Exclusion We shall not indemnify You under Section 3 of this insurance against any liability arising from the failure (whether full or partial) of any Products to perform the function for which they were intended. Tour Operators Liability Exclusion We shall not indemnify You under Section 2 of this Insurance against liability arising from any package travel arrangement. Use of Rope Swing/ Play Equipment Condition It is a condition precedent to Our liability that prior to the commencement of any use of swings or play equipment the following special precautions will be complied with: 1 the rope and attachment are tested for strength by pulling firmly, 2 the rope is checked for fraying or damage, if found to be frayed or damaged in anyway it is not to be used and replaced immediately, 3 the tree is inspected and is deemed suitable to hold the swing and/or play equipment, 4 the full height from the end of the rope at it s highest likely swing point and/ or play equipment are not to exceed 2 metres from ground level, 5 the potential fall zone shall be suitable terrain including grass or bare earth and leaf litter typical of woodland floors. The zone shall be additionally checked for hazards such as sharp objects. 3
Certificate of Employers Liability Insurance (a) In accordance with Regulation 5 of the Employers Liability (Compulsory Insurance) (Amendment) Regulations 2008 (the Regulations), one or more copies of this Certificate must be displayed at each place of business at which the Policyholder employs persons covered by this Policy. This requirement will be satisfied if the certificate is made available in electronic form and each relevant employee to whom it relates has reasonable access to it in that form. Policy Number: SALSALIA/R79242/0332/15 1 Name of Policyholder: Just Sow Ltd t/a The Hive 2 Date of Commencement of Insurance: 8 May 2015 3 Date of Expiry of Insurance: 7 May 2016 We hereby certify that subject to paragraph 2: 1 The Insurance to which this Certificate relates satisfies the requirements of the relevant law applicable to Great Britain, Northern Ireland, the Isle of Man, the Island of Guernsey, the Island of Jersey, the Island of Alderney (b) ; and 2 (a) The minimum amount of cover provided by this Policy is no less than GBP 5,000,000 (c) Signed: On behalf of certain Underwriters at Lloyd s, London Notes: (a) (b) (c) Where the employer is a company to which regulation 3(2) of the Regulations applies, the certificate shall state in a prominent place, either that the policy covers the holding company and all its subsidiaries, or that the policy covers the holding company and all its subsidiaries except any specifically excluded by name, or that the policy covers the holding company and only the named subsidiaries. Specify applicable law as provided for in regulation 4(6) of the Regulations. See regulation 3(1) of the Regulations and delete whichever of paragraphs 2(a) or 2(b) does not apply. Where 2(b) is applicable, specify the amount of cover provided by the relevant policy. Paragraph 2(b) does not apply and is deleted.
Statement of Facts Important Notice This Statement of facts is a record of the information and Material Facts advised to the Underwriters. The Proposed Insured by accepting this Statement of Facts confirms the truth of the information contained and that this is accurate and has not been misrepresented or mis-stated. The information contained in this statement of facts forms the basis for the acceptance of the proposal for insurance and the calculation of the premium and will form the basis of the contract of insurance between the Proposed Insured and Underwriters. Failure to disclose any Material Facts, which would be likely to influence the acceptance and assessment of the proposal, may result in the Underwriters refusing to provide indemnity or avoiding the policy in every respect. A Material Fact is one which an Underwriter would regard as likely to influence their assessment and acceptance of this insurance. Should the Proposed Insured have any doubt as to what may constitute a Material Fact they should contact you as their insurance broker. The insurance broker acting for the Proposed Insured should check this Statement on behalf of the Proposed Insured and if any of the information is incorrect you should amend the document and resubmit. Policy Number: Name of Proposed Insured: Correspondence Address Of Proposed Insured: SALSALIA/R79242/0332/15 Just Sow Ltd t/a The Hive The Hive, 86-90 Paul Street, London, EC2A 4NE Trade or Business: Level 3 forest school practitioner providing activities for children, adults and family groups of all ages. General forest school work including shelter building, use of hand tools (including knives), tree climbing to head height, use of swings rope swings and play equipment for children of primary school age, occasional lopping/coppicing, camp fires, overnight camps. Also additional activities, led by suitably qualified practitioners, including wildlife film making, green woodworking and the like.. The Proposed Insured is a: Cover and limits of indemnity: i) Employers Liability: ii) Public Liability: iii) Products Liability: Limited Company GBP 10,000,000 GBP 5,000,000 GBP 5,000,000 Annual Wage rolls as declared: a) Clerical: GBP b) All Other Employees: GBP 25000 Annual Turnover as declared: Payments to Bona-Fide Sub Contractors: GBP GBP 1
No Proprietor, partner or Director of the Proposed Insured has ever: 1 had a proposal declined by an insurer 2 had an insurance renewal refused by an insurer 3 had an insurance cancelled by an insurer 4 had special terms imposed on an insurance 5 had any convictions for any criminal offence involving dishonesty arson theft or wilful damage or any prosecutions pending 6 been declared bankrupt or insolvent or been the subject of bankruptcy proceedings 7 for any of the classes of insurance under this Statement of Facts /policy for which cover is sought suffered any loss or had any claim made against them whether insured or not in the last five years (including current knowledge of any impending circumstances which could give rise to a claim) The work of the trade or business does not involve: The trade or business for which insurance is being sought is done within: Is there any use of heat equipment in connection with the trade or business?: Are any subsidiary companies included within this insurance quotation?: 1 work at heights exceeding 5.00 metres or depths exceeding 0.50 metres 2 the use of chemicals or other substances which could be harmful to health 3 the use of fixed woodworking machinery by employees Great Britain, Northern Ireland, Isle of Man and the Channel Islands Yes, Camp Fires and burning of garden debris. No It is assumed unless advised by the proposer to the contrary that there is no work carried out at or on or in connection with: demolition except demolition solely undertaken with hand held tools and of structures not exceeding 5 metres in height when such work forms an ancillary part of a contract for construction alteration or repair construction alteration maintenance or repair of bridges viaducts towers steeples spires pylons or chimney shafts underpinning pile driving tunnelling quarries collieries mines ships blast furnaces power stations offshore gas or oil installations chemical works or gas refineries or storage facilities or any installation where nuclear processing is undertaken use of explosives airside or on or in the immediate vicinity of aircraft docks harbours railways or watercraft 2