Contractors Combined Insurance – Quote Request

Please complete as much as possible. We’ll use this to obtain tailored contractors combined insurance terms for your business.

Your details

Trading name *

Registered name (if different)

Correspondence address *

Postcode *

Telephone number *

Email address *

Preferred contact method

Best time to contact you

Business details

Approx year business started trading

Legal status *

Full description of activities * e.g. general builders, electricians, plumbers, carpenters, groundworkers, roofing, etc.

Any other activities / trades carried out?

Number of directors / partners

Number of direct employees (manual)

Number of clerical / admin employees

Estimated annual turnover £ *

Turnover – work in the UK (%)

Turnover – work in the EU (%)

Turnover – rest of world (%)

Turnover – manual work (£)

Turnover – non-manual / design / consultancy (£)

Does your work involve any design work for a fee?

Nature of work

Approximate split of work by type (%) These do not need to be exact but should add up roughly to 100%.

New build construction (%)

Refurbishment / alteration (%)

Repair / maintenance only (%)

Domestic / residential work (%)

Commercial / industrial work (%)

Public sector / local authority work (%)

Maximum height worked at (metres)

Maximum depth worked below ground level (metres)

Any work involving demolition, structural alterations or underpinning?

If yes, please provide details

Do you use heat (e.g. blow lamps, hot air guns, welding, cutting, grinding)?

If heat is used, please give details and typical controls

Any work involving asbestos or removal of asbestos containing materials?

If any asbestos-related work, please provide details

Hazardous locations

Do you undertake work in any of the following locations?

Airports / airfields Chemical / petrochemical plants Power stations Offshore installations / vessels Railway property / trackside Tunnels / mines Within ports / docks Abattoirs / food processing

If any of the above apply, please provide details

Labour-only & bona fide subcontractors

Do you use labour-only subcontractors?

Estimated annual payments to labour-only subcontractors £

Do you use bona fide subcontractors (with their own insurance)?

Estimated annual payments to bona fide subcontractors £

Minimum Public Liability limit you require bona fide subcontractors to hold

Do you check and keep copies of subcontractors’ insurance certificates?

Wages / wage roll

Estimated annual wages – directors / principals (manual) £

Estimated annual wages – direct manual employees £

Estimated annual wages – labour-only subcontractors £

Estimated annual wages – clerical / admin staff £

Any other wage categories – details & annual wages

Contract works (if required)

Contract works cover required?

Maximum value of any one contract £

Estimated annual contract value / turnover £

Maximum value of contract works at any one site £

Do you work on existing structures or extensions to existing buildings?

If yes, please describe type of existing properties worked on

Tools, plant & equipment

Own hand tools – total sum insured £

Employees’ tools – total sum insured £

Own plant & machinery – total sum insured £

Hired-in plant – maximum value at any one time £

Estimated annual hired-in plant charges £

Where are tools/plant kept overnight?

Liability cover

Employers Liability required? Usually required by law if you have employees or labour-only subcontractors.

Number of people to be covered under Employers Liability

Public & Products Liability limit required

If other limit required, please specify

Do you work under any formal contract conditions (e.g. JCT)?

If yes, please give details

Personal Accident

Personal Accident cover required?

Number of persons to be covered

Benefit level required

Names / roles of persons to be covered (if specific individuals)

Claims & history

Any claims or incidents (paid or outstanding) in the last 5 years? *

If yes, please provide details Please include dates, type of claim, amount paid / outstanding and circumstances.

Have you or any partner / director ever had insurance cancelled, declined, refused, or had special terms imposed, or any unspent criminal convictions? *

If yes, please provide full details

Current insurance (if applicable)

Current insurer

Policy renewal date

No claims discount (years)

Approximate annual premium £

Anything else we should know?

Additional information Any other details which may help us obtain the most competitive terms for you.

Fields marked with * are required.

By submitting this form you are providing consent for Miller & Partner Ltd to contact you in relation to this quotation and any related insurance products.

Office: Vivian House, Roman Bridge Close, Mumbles, Swansea, SA3 5BG

Call 01792 001350

Email: [email protected]

Miller & Partner is an Authorised Representative of Gauntlet Risk Management Ltd and are authorised and regulated by the Financial Conduct Authority (FCA) under firm reference number 1029698. You may check this on the Financial Services Register by visiting the FCA website, https://www.fca.org.uk/register/ or by contacting the FCA on 0800 111 6768 Privacy Policy

Call: 01792 001350

Contractors Combined Insurance – Quote Request