Schedule to the Policy 1 Policy Number: SAL 61176 2 Form Number: SJC2010SAUA 3 Insured Name: Global Brigades UK Ltd 4 Insured Address: 290 Woolwich Church Street, London, SE18 5ND 5 Policy Period: From: 16 January 2014 6 Information provided to Underwriters on: To: 15 January 2015 Both dates Inclusive Local Standard Time at the Insured s address as above stated. 8 January 2014 7 Business: Charity who carry our recruitment for overseas placements and also undertake fundraising within the UK. This policy is covering the UK liabilities only. 8 Limit of Indemnity: Employers Liability: GBP 10,000,000 Any One Claim, including costs and expenses Public Liability: GBP 2,000,000 Any One Claim, costs and expenses in addition Products Liability: GBP 2,000,000 in the aggregate, costs and expenses in addition 9 Excess: Property Damage GBP 500 10 Premium: Employers Liability: GBP 150.00 for the Policy Period Adjustable on Clerical Employees at: % Adjustable on All Other Employees at: 0.3500% Public/Products Liability: GBP 1000.00 for the Policy Period Adjustable on UK Turnover at: 0.2000% Adjustable on EU/ROW Turnover at: % Insurance Premium Tax: GBP 69.00 Deposit & Total Premium: GBP 1219.00 11 Endorsements: As attached 16 January 2014 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 SAL61176 in the name of Global Brigades UK Ltd :- Excess We shall not indemnify You in respect of the first GBP 500 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. 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. Inflatable & Amusement Exclusion We shall not indemnify You under Sections 2 & 3 of this Insurance against liability arising from the following inflatables amusements or activities: 1 Mechanically or electrically powered rides of any nature (other than static coin operated rides) 2 Children s playground or soft play equipment including inflatables of any nature 3 Any equipment or amusement which involves the kicking or punching of any objects 4 Any equipment or amusement for use outside Your premises 2
Schedule to the Policy 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). Pyrotechnics Exclusion We shall not indemnify You under Section 2 of this Insurance against liability arising from the use of pyrotechnics or dry ice machines. Spectator Stands/ Stage Exclusion We shall not indemnify You under Sections 1, 2 & 3 of this Insurance against liability arising from any erection and or dismantling of any spectator stand stage or seating of temporary or portable design or construction. 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. Libel/Slander Exclusion We shall not indemnify You under Sections 2 & 3 of this Insurance against liability arising from: 1 Libel slander defamation or malicious falsehood 2 Slander of title of goods or other injurious falsehood 3 Wrongful misrepresentation. 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: SAL 61176 1 Name of Policyholder: Global Brigades UK Ltd 2 Date of Commencement of Insurance: 16 January 2014 3 Date of Expiry of Insurance: 15 January 2015 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: Trade or Business: The Proposed Insured is a: Cover and limits of indemnity: i) Employers Liability: ii) Public Liability: iii) Products Liability: SAL61176 Global Brigades UK Ltd 290 Woolwich Church Street, London, SE18 5ND Charity who carry our recruitment for overseas placements and also undertake fundraising within the UK. This policy is covering the UK liabilities only. Sole Proprietor GBP 10,000,000 GBP 2,000,000 GBP 2,000,000 Annual Wage rolls as declared: a) Clerical: GBP b) All Other Employees: GBP 9,000 Annual Turnover as declared: GBP 500,000 Payments to Bona-Fide Sub Contractors: GBP 1
No Proprietor, partner or Director of the Proposed Insured has ever: 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 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) 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, Isle of Man and the Channel Islands No, 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