SELF BUILD INSURANCE (PACKAGE) QUOTATION
PROPOSER
Name
Occupation
Address
Postcode :
CONTACT DETAILS
Tel
Fax
Mob
Email
Web
THE CONTRACT
Type
Select Contract Type
New Build - Detached House
New Build - Semi Detached House
New Build - Terraced House
New Build - Bungalow
Renovation - Detached House
Renovation - Semi Detached House
Renovation - Terraced House
Renovation - Bungalow
Contract Address
Postcode
EXPERIENCE
Please outline the experience or qualifications you have to undertake a self build project of this nature:
SELF BUILD COVER
Tick the cover you require
1 Employers Liability
(10 Million Indemnity
)
2 Public Liability
( 2 Million Indemnity
)
3 Contract Works
(Contract Materials)
4 Plant & Equipment
(
)
CONTRACT VALUES
Total Contract Value
(Renovation)
Existing Structure Value
Works Start Date
Contract Duration
Months
Max Labourers At Any One Time
0
1
2
3
4
5
6
7
8
9
10>
Payments To Bona Fide Sub's
*
(*) E.g Firms with own insurance (Plumbers, Electrical etc)
WORK SPECIFICS
Max Height
0 m
<5m
<10m
<15m
<20m
>20m
Max Depth
0 m
<1m
<2m
<3m
<5m
>5m
The following are basic conditions...
A designated health & safety officer will be appointed :
The contract address is not within 250m of water :
The buildings are of brick, stone or concrete :
The roofing is slate, tiled, metal or concrete :
No asbestos products are used :
The roofing is not flat :
You will occupy the residence upon completion :
Scaffolding will be erected by a qualified person :
Works do not involve major demolition :
Buildings will be locked/secured when unattended :
Site huts/containers will be locked when unattended :
Plant & equipment will be secured :
Materials will be stored securely pending installation :
Site hazards signage will be displayed :
No works have started before inception of cover :
A method statement of works has been agreed :
If you are unable to tick to confirm give details below...
INSURANCE HISTORY
Tick if any previous injury or property claims
If claims give details, date & values...
FINANCIAL INTEREST
Interest of Bank/Building Society... (As applicable)
OTHER INFORMATION
Telephone 02870325999 for assistance