| Contact
Name : |
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| Company
Name : |
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| Address:
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| County:
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| Postcode: |
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| Tel
No |
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| Fax
No |
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| E-mail
Address |
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| Website
Address |
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| Renewal
Date : |
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| Business
Description : |
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| Combined
Liability |
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A.
Employers Liability:
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B.
Public & Products Liability - Indemnity Limit required:
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Other:
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| Wageroll
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Clerical/Managerial:
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Electrical:
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Mechanical:
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All
Others:
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Turnover : |
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Contracting:
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All
Other:
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| Claims
Experience: |
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Paid |
Outstanding |
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1997/98
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1998/99
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1999/20
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| Contractors'
All Risks |
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| Summary
of Cover |
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A.
Contract Site Limit
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Other:
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B.
Contractors' Own Plant
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Please
state if higher limit required:
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C.
Hired in Plant (any one accident)
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D.
Continuing Hire Charges
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E.
Employees Tools (per employee)
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| Underwriting
Information |
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Contracting
turnover
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Annual
hiring charges
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Average
number of employees
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Average
contract duration
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months
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Claims
Experience:
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Paid |
No. |
Outstanding |
No. |
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1997/98
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1998/99
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1999/20
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| Professional
Indemnity |
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Limit
of Indemnity Required
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Other:
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Policy
Excess
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Please
give details of Turnover in
£000's
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Turnover
where firm Designs & Installs from their own Design
& provides full technical supervision
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Turnover
(fee income) where firm provides Design & Technical
Services where no installation is involved by firm.
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Turnover
where firm provides Installation services only having engaged
others to provide Design & Technical Supervision on
their behalf
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Pure
contracting turnover not mentioned in above
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Please
Give approximate percentage split with regard to your design
and consulting Department
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Electrical
contracting %
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%
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Mechanical
(HVAC) Contracting %
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%
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