Commercial Combined Risk Presentation Pro-Forma
Please confirm the sections to be quoted:
Section 1.
Material damage
Section 2.
Business interruption
Section 3.
Money
Section 4.
Trade all risks
Section 5.
Goods in transit
Section 6.
Computer breakdown
Section 7
Frozen foods
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☐
☐
☐
☐
☐
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Section 8.
Employers liability
Section 9.
Public liability
Section 10.
Products liability
Section 11.
Environmental impairment
Section 12.
Legal expenses
Section 13.
Directors and officers
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Name of business to be insured
Address for correspondence
Description of business / trades
undertaken
Renewal date
Current insurer
Expiring premium
£
YES
NO
Has the insured, a senior figure
in the organisation (Director or
Partner), or spouse, been
declared bankrupt, or entered
into any arrangement with
creditors
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☐
Has the insured, a senior figure
in the organisation (Director or
Partner), been convicted of a
criminal offence
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☐
YES
NO
Has the insured, a senior figure
in the organisation (Director or
Partner), been prosecuted under
any Health and Safety
regulations, the Consumer
Protection Act, or any other
statutory regulations
☐
☐
Has the insured ever been
refused or declined insurance
cover or had an insurance policy
terminated or special terms
imposed?
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Please submit to: Premier Commercial Limited [email protected]
You can telephone us to discuss your risk on 0845 111 0125
Premier Commercial Limited is authorised and regulated by the Financial Conduct Authority and is a Coverholder at Lloyd’s
Section 1. Material damage
Location 1
Location 2
Location 3
Location 4
£
£
£
£
Construction of walls
-
-
-
-
Construction of floors
-
-
-
-
Construction of roof
-
-
-
-
Flat felt roof
-
-
-
-
-
-
-
-
-
-
-
-
Automatic fire alarm
-
-
-
-
Sprinkers
-
-
-
-
Declared value of contents
£
£
£
£
Declared value of computers
£
£
£
£
Value of stock
£
£
£
£
Value of stock in the open
£
£
£
£
Value of stock of non-ferrous
metals
£
£
£
£
Value of stock of wines & spirits
£
£
£
£
Value of stock of tobacco
£
£
£
£
Value of stock of electronics
£
£
£
£
Value of stock of precious metals
and gems or jewels
£
£
£
£
Intruder alarm
-
-
-
-
Occupation of premises
-
-
-
-
Unattended machinery
-
-
-
-
Separation
-
-
-
-
Proximity to other
buildings
-
-
-
-
Postcode
Declared value of buildings
Combustible panels /
linings
Distance to nearest fire
service
Section 2. Business interruption
Basis of sum insured
-
Annual Sum insured
£
Basis of sum insured
-
Annual Sum insured
£
Basis of sum insured
-
Annual Sum insured
£
Basis of sum insured
-
Annual Sum insured
£
Basis of sum insured
-
Annual Sum insured
£
Basis of sum insured
-
Annual Sum insured
£
Optional extensions
Basis of sum insured
Contract Sites
Sum insured
Not required
Basis of sum insured
Specified customers
Sum insured
Not required
Basis of sum insured
Specified suppliers
Sum insured
Not required
Basis of sum insured
Transit
Sum insured
Not required
Period of indemnity
-
Period of indemnity
-
Period of indemnity
-
Period of indemnity
-
Period of indemnity
-
Period of indemnity
-
Section 3. Money
In the Premises when open for
business and attended
In the Premises when closed for
business or unattended in a safe
Not insured
Not insured
Details of safe
Whilst in transit, including in bank
night safe
Not insured
Section 4. Trade all risks
Portable computer equipment
Not insured
Mobile telephones
Not insured
Portable tools of trade
Not insured
Unspecified items
Not insured
Cover is operational in the area
Not insured
Section 5. Goods in transit
On goods carried in owned
vehicles
Not insured
Number of own vehicles
Not applicable
On goods carried by third party
hauliers, by parcel post or by rail
Annual value of carryings /
sendings
Not insured
Not applicable
More specialised cargo and transit cover can be presented by using the appropriate form available Here
Section 6. Computer breakdown
Portable computer equipment
£
Static computer equipment
£
Additional costs incurred for
reinstatement of data
£
Section 7. Frozen foods
Basis of sum insured
Not insured
Sum insured for damage to
foodstuffs in refrigerated plant
£
Specified freezer 1
Not applicable
Specified freezer 2
Not applicable
Specified freezer 3
Not applicable
Section 8. Employers liability
Sum insured
£10,000,000
Wageroll by activities including
labour only sub-contractors:
Clerical / sedentary
£
Driving / delivering
£
Warehousing at premises
£
Woodworking machinery
at premises
Manual away from the
premises excluding heat
Manual away from the
premises excluding heat
£
£
£
High risk activities
Work at heights in excess
of 15 metres
Work with hazardous
materials i.e. asbestos
Erection of steel or
timber
No
No
No
Work at depths below 3
metres
Work producing noise
levels above 85dB(A)
Work with fixed wood
working machinery
Detail
Please advise detail of high risk activities estimating % of applicable wageroll
No
No
No
Section 9. Public liability
Sum insured
£5,000,000
Wageroll by activities including
labour only sub-contractors:
Manual away from the
premises excluding heat
Manual away from the
premises excluding heat
Payments to bona fide
subcontractors
£
£
£
High risk activities
Storage of bulk liquids or
gases at your premises
Work at gas or chemical
works or stores
Work at nuclear plants or
No
power stations
Work at oil refineries or
No
bulk oil storage facilities
Work at docks or on
No
ships
Burning of debris or
agricultural burning
No
No
Work at airports
No
Work at quarries or
mines
No
Detail
Please advise detail of high risk activities estimating % of applicable wageroll
Section 10. Products liability
Sum insured
£5,000,000
Turnover by area of operation:
European Economic Area
£
United States of America
and / or Canada
£
Rest of the World
£
High risk activities
Supply of products to the
automotive industry
Supply of products to the
rail industry
Supply of products to the
defence industry
Supply of products to the
petrochemical industry
No
No
No
No
Supply of products to the
marine industry
Supply of products to the
aviation/aero industry
Supply of products to the
offshore industry
Supply of products to the
agricultural industry
No
No
No
No
Detail
Please advise detail of high risk activities estimating % of applicable turnover and whether products are
safety critical
Section 11. Environmental impairment liability
Sum insured
Has your buildings have not been tested for lead
based paint, asbestos or radon?
Has any 'Fill Material' ever been used at your
premises or do you 'Discharge Fill Materials'?
Are there any dry wells, septic systems, storage
tanks, leach field or oil / water seperators at the
premises?
Has any remediation or monitoring of soil or
groundwater ever taken place at the premises or is
there any plans to do so?
Does the use of the premises require any
environmental permits
Does the activities at the premises generate, handle,
store or dispose of any hazardous waste or
materials?
At the commencement of this insurance you are not
aware of any circumstances that may reasonably be
expected to give rise to a claim under this section?
Not insured
No
No
No
No
No
No
No
Section 12. Legal expenses
Section
Required
Limit of liability
Employment disputes
Yes
£100,000
Employment Compensation
Awards
Yes
£100,000
Health and Safety Appeals
No
£0
Legal Defence
Yes
£50,000
Contract Disputes and Debt
Recovery
No
£0
Property Disputes
Yes
£50,000
Court Attendance
No
£0
Tax Protection
Yes
£50,000
Licence Protection
No
£0
Personal Injury
No
£0
Section 13. Directors and officers liability
Sum insured
£50,000
Have you or any of your directors and officers had a
claim or prosecution intimated against you in this
capacity in the last 5 years nor are you aware of any
claim or prosecution which may arise
No
Is there any plans to change the ownership structure
of the company by merging with, acquiring or taking
over another company
No
Are you in the process of undergoing any
redundancies or planning any redundancies
No
Do you have any assets in North America
No
Policy wording