QBE European Operations STATEMENT OF FACT Policy Number: QBE22879/Y072953QBE0112A Period of Insurance: From: 21/03/14 To: 27/05/14 both days inclusive Greenwich Mean Time and for such further period or periods as may be mutually agreed upon Insured: Mr B Cross t/a Special Effect Twin Town Challenge 2014 The following statements form the basis of this contract of insurance and any incorrect information, non disclosure, non compliance &/or misrepresentation of material fact could invalidate all or part of this insurance. I/we: 1. Confirm that I/we are over 18 years of age (unless a corporate body), are eligible to enter into a contract of insurance & have an interest whether legal, financial, contractual, or otherwise in respect of the insured items/sections to which this contract relates. 2. Confirm that I/we have not been convicted, nor charged with a criminal offence, nor have any prosecutions pending. (Other than prosecutions relating to motor offences) 3. Confirm that I/we have never been declared bankrupt, received any CCJ s, nor had a company which had gone into liquidation. 4. Confirm that I/we have never had insurance refused, cancelled, discontinued, or had special terms imposed by Underwriters. 5. Confirm that all information provided, whether in my/our own hand or not, is true & no material facts have been withheld. (A material fact is one likely to influence acceptance or assessment of your application or continuation of insurance by Underwriters. If you are in any doubt as to whether a fact is material or not you must disclose it immediately) 6. Confirm that during the last 5 years I/we have not made any claim, nor suffered any reported incident which could have given rise to a claim had insurance been in force. 7. Comply with & accept the terms and conditions contained herein & all corresponding policy documentation. 8. Confirm that I/we will inform Bridle Insurance immediately should I/we (at any time) be non-compliant with any of the statements herein Page 1 of 8
QBE European Operations Leisure Combined Schedule Of Insurance Policy Number: QBE22879/Y072953QBE0112A Policy Wording Reference: PLSC080807 Period of Insurance: From: 21/03/14 To: 27/05/14 both days inclusive Greenwich Mean Time and for such further period or periods as may be mutually agreed upon Effective From: Date Issued: Issue Number: Reason For Issue: 21/03/14 21/03/2014 1 New Policy Contract Parties Insurer: Registered Address: QBE Insurance (Europe) Limited (registered in England number 1761561; Home State - United Kingdom. Authorised and regulated by the Financial Services Authority; registration number 202842) Plantation Place, 30 Fenchurch Street, London, EC3M 3BD Tel: + 44 (0) 20 7105 4000 Fax: + 44 (0) 20 7105 4019 Insured: Mr B Cross t/a Special Effect Twin Town Challenge 2014 Address: c/o S T L Communications, Park House, Station Road, Witney, OX28 4LH & anywhere else within the United Kingdom & France that the insured carries on the business Subsidiary Companies: None Declared Business: Organiser Of Driving Event (Including Associated Challenges) For Charitable Purposes Contact Details Coverholder Name: Coverholder Address: CFN Insurance Services Ltd t/a Bridle Insurance (Authorised & Regulated by the Financial Services Authority No. 307818 Deer Park House, Range Road, Witney, OX29 0YN Coverholder Account: Bridle Leisure Y072953QBE0112A Issue Office: Deer Park House, Range Road, Witney, OX29 0YN Page 2 of 8
Claim Notification: Bridle Leisure, Bridle Insurance, Deer Park House, Range Road, Witney, OX29 0YN 0845 0349648 twinder@bridleinsurance.co.uk Complaints: Customer Relations CFN Insurance Services Ltd t/a Bridle Insurance, Deer Park House, Range Road, Witney, OX28 6LS Tel: + 44 (0) 845 034 9648 Fax: + 44 (0) 845 034 9638 Email: twinder@bridleinsurance.co.uk If an eligible complainant and the matter has not been resolved by the Coverholder, to your satisfaction, you may contact: Customer Relations QBE Insurance (Europe) Ltd, Plantation Place, 30 Fenchurch Street, London, EC3M 3BD Tel: +44 (0) 207 105 4000 Fax: 44 (0) 207 105 4032 Email: customerrelations@uk.qbe.com If an eligible complainant and the matter has not been resolved by your Coverholder & Insurer, to your satisfaction, you may contact: The Financial Ombudsman Service, South Quay Plaza 2, 183 Marsh Wall, Docklands, London E14 9SR. Where the insurer is or includes a Lloyd s syndicate policyholders may also be eligible to complain to: Policyholder and Market Assistance, Lloyd s Market Services, One Lime Street, London EC3M 7HA, tel: +44 (0)20 7327 5693, fax: +44 (0)20 7327 5225. A summary of the insurer s complaint handling procedure is available on request and will also be provided to you when acknowledging a complaint. Page 3 of 8
Insured section A - Property NOT INSURED Sum Insured Buildings GBP N/A Stock and materials in trade GBP N/A Machinery plant and all other contents GBP N/A Gaming/amusement &/or entertainment equipment GBP N/A Rent GBP N/A Wines and spirits GBP N/A Stock debris removal GBP N/A Total GBP N/A Goods in transit - 2.3.4 Limit of liability Goods: Gaming/amusement &/or entertainment equipment GBP N/A Own vehicles GBP N/A Carriers GBP N/A Parcel post GBP N/A Rail GBP N/A Number of own vehicles N/A Money - 2.3.7 Non-negotiable money GBP N/A Negotiable money: In buildings outside business hours not contained in locked safes or strong rooms GBP N/A In buildings outside business hours but contained in unspecified locked safes or strongrooms GBP N/A In buildings outside business hours but contained in specified locked safes or strongrooms GBP N/A In buildings during business hours GBP N/A In the private residence of the insured or any authorised partner, director or employee under a contract of employment GBP N/A Whilst in transit GBP N/A Page 4 of 8
Insured section B - Business Interruption NOT INSURED Sum Insured Item 1 Estimated Gross profit GBP N/A Item 2 Estimated Gross revenue GBP N/A Item 3 Increased cost of working GBP N/A Item 4 Additional Increased cost of working GBP N/A Item 5 Rent receivable GBP N/A Item 6 Outstanding debit balances GBP N/A Refund of premium N/A Insured section C - Terrorism NOT INSURED Sum Insured All property specified under Insured sections A and B GBP N/A Insured section D - Loss of Licence NOT INSURED Limit of liability Loss of Licence GBP N/A Insured section E - Employers' Liability Limit of Indemnity Employers Liability INSURED GBP 10,000,000 Any one occurrence Including sub-limits of indemnity for: Manslaughter legal defence costs INSURED GBP 1,000,000 Any one prosecution or proceedings Offshore work NOT INSURED GBP n/a Any one occurrence War and terrorism worldwide except in hostile territories NOT INSURED GBP n/a Any one occurrence War and terrorism in hostile territories NOT INSURED GBP n/a Any one occurrence Jurisdiction: Insured Section E premium subject to adjustment: The United Kingdom No Page 5 of 8
Insured section Limit of Indemnity F - Public Liability INSURED GBP 5,000,000 Any one occurrence G - Products Liability INSURED GBP 5,000,000 Any one occurrence and in the aggregate H - Pollution Liability NOT INSURED GBP N/A Legionella: sub-limit of indemnity NOT INSURED GBP N/A Any one claim and in the aggregate Combined single limit insured sections F, G and H: GBP N/A Jurisdiction (insured sections F, G and H): Territorial limits of cover applicable under this section Insured Section F, G and H premium subject to adjustment: The United Kingdom The United Kingdom & France No All Claims Excesses Insured section Amount of excess* Property GBP 250 Property Subsidence/Land heave/land slip GBP 1000 Business interruption GBP 250 Terrorism GBP 250 Loss of licence GBP 250 Employers' liability GBP 0 Public liability Excess GBP 500 Products liability Excess GBP 500 Pollution liability Excess GBP 500 *or as otherwise stated within the Clauses listed below. Page 6 of 8
Payment Details Annual Policy Premium GBP 700.00 IPT/tax GBP 42.00 Total payable GBP 742.00 ALL PREMIUMS SPECIFIED HEREIN ARE MINIMUM & DEPOSIT & THEREFORE NO RETURN PREMIUM SHALL APPLY IN THE EVENT OF ANY ADJUSTMENT OR CANCELLATION OF THIS INSURANCE The following sets out additional requirements that form part of this contract of insurance. The undernoted clauses amend the insured section and / or clause stated and is each otherwise subject to the terms and conditions of the policy. EVENT ORGANISER CLAUSE WARRANTIES: It is a condition precedent to liability under this clause that: i. all activities including those on a subcontracted basis must be disclosed to insurers for their prior approval ii. the insured shall only use bona fide subcontractors who have Public Liability Insurance, which includes an Indemnity to Principal extension with a limit of indemnity of no less than the insured s limit of indemnity under this policy. The insured shall obtain written proof of the same EXCLUSIONS: This contract of insurance shall exclude: 1. any liability in respect of the Road Traffic Act 2. any liability howsoever caused by, resultant from, or in respect of motor vehicles, including the driving thereof 3. cover in respect of the costs &/or expenses &/or loss or revenue resultant from cancellation &/or abandonment ADDITION DEFINITIONS: 1. Employee: Employee(s) shall be defined as volunteer(s) involved in the event organisation & marshals, but not track (or similar) circuit marshal(s). CONTRIBUTION CONDITION: 1. If at the time of any claim (insured sections F H) there is any other valid & collectable insurance available to the insured, or any other insured party other than insurance that is specifically stated to be in excess of this policy and names the insured for the insurance, then the insurance afforded by this policy will be in excess of and will not contribute with such other insurance. Excess(s) Applicable: Sections A, B, C, D: 250 in respect of all claims Section F,G & H: 500 in respect of all claims Page 7 of 8
SANCTIONS LIMITATION & EXCLUSION ENDORSEMENT The insurer shall not provide cover nor be liable to pay any claim or provide any benefit hereunder to the extent that the provision of such cover, payment of such claim or provision of such benefit would expose the insurer or any member of the insurer s group to any sanction, prohibition, or restriction under United Nations resolutions or the trade or economic sanctions, laws or regulations of any country. Signed on behalf of the Coverholder Mr. Tanoa Rawlinson-Winder Cert CII Head of Leisure & Sport 21/03/2014 Page 8 of 8