PUBLIC & PRODUCTS LIABILITY FORM

PUBLIC & PRODUCTS LIABILITY

CLAIMS HISTORY & DISCLOSURES

Contact Name (required)

Last Name (required)

Phone (required)

Email (required)

Business Name (required)

Business Address (required)

Preferred start date (required)

ACTIVITIES & LIMITS

Business occupation (required)

Public & Products Liability (required)

Estimated turnover in the next 12 months (required)

Estimated payments to sub-contractors in the next 12 months

Estimated payments to labour hire in the next 12 months

Number of employees

Unregistered plant tools & equipment (required)

UNDERWRITING QUESTIONS

Maximum height worked to (required)

Maximum excavation depth (required)

Do you anticipate your projects will involve any of the following. (required)

Civil works and/or earth works not associated with a total building contract (incl. road or sub-divisions) exceeding $50,000?

Work involving piling, shoring greater than 1m in height or underpinning?

Demolition works (other than work incidental to the main contract) and involving stand-alone structures on the contract site, not exceeding 10 metres in height?

Work involving house raising, restumping or relocating?

Road works or bridges?

Works on, in, over or under water?

Works at hazardous locations such as airports, railways, oil & gas rigs, oil & chemical refineries, mines, quarries, power stations, tunnelling, pipe-jacking and directional drilling.

Business activities as a labour hire company?

Work with asbestos?

Please provide additional information for anything you have selected above:

CLAIMS HISTORY & DISCLOSURES

Has the Insured had any Public Liability claims in the past five years? (required)

If yes, please provide details of:

Have any insurers ever declined your proposal/application?

Yes

Have any insurers refused or cancelled cover or imposed special conditions in respect of the proposed insurance?

Yes

Have you or any person applying for this insurance ever been declared bankrupt, insolvent, had liquidators appointed, been a defendant in a civil court case, or convicted of any criminal offence?

Yes

If you have answered yes to any of the above, please provide full details:

DUTY OF DISCLOSURE/ DUTY NOT TO MAKE A MISREPRESENTATION
Before you enter into an insurance contract, you have a duty to tell the insurer anything that you know, or could reasonably be expected to know, that may affect the insurer’s decision to insure you and on what terms. You have this duty until the insurer agrees to insure you. You have the same duty before you renew, extend, vary, or reinstate an insurance contract.

IF YOU DO NOT TELL THE INSURER SOMETHING
If you do not tell the insurer anything you are required to, they may cancel your contract, or reduce the amount they will pay you if you make a claim, or both. If your failure to tell the insurer is fraudulent, they may refuse to pay a claim and treat the contract as if it never existed.

UNDER INSURANCE

DUTY OF DISCLOSURE/ DUTY NOT TO MAKE A MISREPRESENTATION
Before you enter into an insurance contract, you have a duty to tell the insurer anything that you know, or could reasonably be expected to know, that may affect the insurer’s decision to insure you and on what terms. You have this duty until the insurer agrees to insure you. You have the same duty before you renew, extend, vary, or reinstate an insurance contract.

UNDER INSURANCE
Your contract of insurance may contain an average or under insurance provision. This means that if you under insure, you will have to bear part of any loss yourself.

INSURING THE INTEREST OF OTHER PARTIES
If you require another party to be covered by your policy, you must request this in advance. Most policy conditions will not provide indemnity to other parties (e.g. mortgagees, lessors, principals etc.) unless their interest is noted on the policy.

Public & Products Liability Only

Public and Products Liability

A commercial insurance brokerage with a client centric approach and proven experience in the industry.

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