Contract Works Renewal Declaration

Hidden

Work Request ID

Your Details

Name*

Business Name

ABN

Phone*

Email*

Website

Builders License Number

Has your address changed in the past 12 months?*

Yes, it has
No, it hasnt

Address of Main Office*

About Your Business for the LAST 12 months

Total value of all projects started in the PAST 12 months?*

What was the total value of the largest project you started in the PAST 12 months?*

Type of Work Undertaken in the PAST 12 months? (tick all that apply)*

Builder – Residential (New Build)
Builder – Residential (Work on Existing Buildings)
Builder – Commercial (New Build)
Builder – Commercial (Work on Existing Buildings)
Builder – Industrial (New Build)
Builder – Industrial (Work on Existing Buildings)
Civil Works Only
Mechanical/Electrical Only
Other

A Builder is defined as the head contractor or principal and you construct the whole building.

If other, please advise more information*

Upcoming Projects in the NEXT 12 months

Estimated total value of projects starting in NEXT 12 months?*

Maximum contract value estimated for any one project in the NEXT 12 months?*

Type of work estimated to be undertaken in the next 12 months? (tick all that apply)*

Builder - Residential - Single Build
Builder - Residential - Other
Builder - Commercial
Builder - Industrial
Trades (including Sub-Contractors)
Civil Works Only
Mechanical / Electrical Only
Other

A Builder is defined as the head contractor or principal and you construct the whole building.

Builder - Single Dwellings

Percentage of work on NEW builds - Single Dwellings*

Percentage of work on EXISTING buildings - Single Dwellings*

Builder - Other Residential

Percentage of work on NEW builds - Other Residential*

Percentage of work on EXISTING buildings - Other Residential*

Builder - Commercial

Percentage of work on NEW builds - Commercial*

Percentage of work on EXISTING buildings - Commercial*

Builder - Industrial

Percentage of work on NEW builds - Industrial*

Percentage of work on EXISTING buildings - Industrial*

Trades (inc Sub-Contractors)

Percentage of work on NEW builds - Trades*

Percentage of work on EXISTING buildings - Trades*

Overview of TRADES work undertaken*

Civil Works Only

Percentage of work for NEW builds - Civil Works*

Percentage of work for EXISTING buildings - Civil Works*

Overview of CIVIL WORKS ONLY work undertaken*

Mechanical and/or Electrical Work Only

Percentage of work on NEW builds - Mechanical / Electrical*

Percentage of work on EXISTING buildings - Mechanical / Electrical*

Overview of MECHANICAL and/or ELECTRICAL ONLY work undertaken*

Other Work

Percentage of work on NEW builds - Other*

Percentage of work on EXISTING buildings - Other*

Overview of OTHER work undertaken*

Project Information

Do any of your projects involve works in or around:*

Please provide further details*

Do any of your projects involve the following:*

Please provide further details*

Geographical Information

Which states do you operate in?*

Percentage of work done in NSW*

Percentage of work done in VIC*

Percentage of work done in QLD*

Percentage of work done in SA*

Percentage of work done in WA*

Percentage of work done in TAS*

Percentage of work done in ACT*

Percentage of work done in NT*

Percentage of work done Overseas*

NSW Stamp Duty Declaration

Are you a small business Individual / Partnership / Company and/or Trust, which is carrying on a business, and the business has an aggregated turnover of less than $2 million*

Yes
No

Aggregated turnover is your Australia wide annual turnover plus the annual turnovers of any business entities that are your affiliates or are connected with you.

Click here to read more about this exemption

Do you work in:*

CBD
Metro
Regional

Tick all that apply

Do you do any work above the 26th Parallel?*

Yes
No

The 26th parallel is a line that divides Australia from east to west. It begins at Shark Bay in Western Australia, north of Geraldton, serves as the boundary between South Australia and the Northern Territory and runs into the Pacific north of the Sunshine Coast, just above Gympie.

If yes, please provide further details.*

Changes to Existing Cover

Select the maximum Construction Period you need in Months?*

This is the maximum time any one project will take to complete.

If other, please advise limit*

Select the maximum Defects Liability Period you need in Months?*

A defects liability period is a set period of time after a construction project has been completed during which a contractor has the right to return to the site to remedy defects.

If other, please advise limit*

Coverage Limits

Do you require any changes to your existing coverage?*

Yes
No

What additional covers do you require this coming year?*

Same as last year
Public Liability (Section 2)
Pre-existing Structures
Employee Tools
Other Property (i.e. Display Homes or Structures other than buildings on site)
Current Projects (i.e. Projects you have on the go but are not yet completed)
Your Mobile Machinery, Plant & Equipment
Hired in Mobile Machinery, Plant & Equipment
None of the above

Please tick all that apply.

Public Liability

Level of Public Liability cover required?*

Please advise limit required*

Do you require Public Liability coverage for other business activities?*

Yes
No

Other business activities may be work where liability cover is required but there is no construction or material damage cover required

Please provide further details on other activities*

Annual Turnover of other activities*

Pre-Existing Structures

Pre-existing Structures - Please provide further details including Description, Address, Postcode and Insurance Value.*

Employee Tools

Limit Required of Employee Tools*

“Employee tools” means construction tools and effects owned or in the care, custody and control of Employees of the Named Insured up to a maximum new replacement value of $5,000 per item but do not include laptop computers, mobile telephones, two-way radios or other voice transmitters or receivers, or personal organisers or cameras.

Other Property

Other Property - Please provide further details including Description, Address, Postcode and Insurance Value.*

Current Projects

Current Projects - Please provide further details including Description, Address, Postcode and Insurance Value.*

Mobile Plant, Machinery & Equipment

Limit Required for Mobile Plant, Machinery & Equipment*

“Mobile Machinery and Equipment” means hoardings, temporary buildings, scaffolding, falsework and re-usable formwork, Vehicles, hoists, cranes, earth moving equipment, air compressors, welding equipment and other similar plant whether self propelled or non self-propelled, used or to be used in the process of executing the Contract Works.

Do You require coverage for hoists or cranes?*

Yes
No

If yes, please provide brief description including Make, Model, Year & Value*

Hired-in Mobile Plant, Machinery & Equipment

Estimate the annual amount you spend on hire charges

What is the replacement value of the largest item you could expect to hire?*

Contractors Pollution Liability

Do you require cover for Contractors Pollution Liability?*

Yes, we do
No, we don't
I am unsure, can I get more information

Do you and your staff / contractors know how to deal with the discovery of asbestos or if there is a pollution event?*

Yes, we have procedures in place
No, there are no procedures in place
This question is not relevant to my business

In the past 5 years, have you had any significant / reportable releases or spills of hazardous waste or any other pollutants (as defined by environmental statutes or regulations)?*

Yes
No

In the past 5 years, has there been, or is there now pending, a claim against you for clean-up, bodily/personal injury or property damage, resulting from the release into the environment of hazardous substances (including asbestos), hazardous waste, or other pollutants?*

Yes
No

Disclosure Questions

The term YOU in the questions below relates to your Firm, Company or you as a Sole Practitioner including present or former Partners, Directors, Principals, Consultants, or Employees.

Have YOU been made aware of any injuries to anyone on or off site (not including your employees)*

YES, I am
NO, I am not

Has there been any loss of, or damage to, the Project work, materials or property belonging to others that you have not already advised?*

YES, I am
NO, I am not

If yes, please provide further details*

Have YOU been made aware of any circumstances involving asbestos or pollution of any kind which might give rise to a claim against you by a third party?*

YES, I am
NO, I am not

Have YOU ever been charged or convicted of any criminal offence, been declared bankrupt or insolvent, had a liquidator or receiver appointed or been a defendant in any civil court case?*

YES, I am
NO, I am not
I have already declared this to the insurer

If yes, please provide further details*

Other Insurances

Do you require a quote or further information about any of the following insurances?

Business Insurance
Commercial Motor Insurance
Builders Warranty
Life/Income Protection
Workers Compensation
Cyber Insurance
Business Travel Insurance
Other

If other, please advise details

Additional Information

Is there any other information or business changes that you need to provide to the insurer?*

YES there is
NO there is not

Please provide further details*

Important Information

Please take a moment to read these important documents prior to submitting your form.

Declaration

I/WE declare that we have read the important notices attached above and I/WE understand those notices.
I/WE undertake to inform insurers of any material alteration to these facts whether occurring before or after completion of the Contract of Insurance.
I/WE hereby acknowledge that the insurance cover may be provided in whole or in part by overseas insurers.

Please tick all to confirm that you have read the following documents:*

Privacy Policy
Financial Services Guide
Duty of Disclosure
Terms of Engagement

Signature

This electronic signature will be treated the same as if signed personally.

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Contract Works Renewal Declaration

Your Details

About Your Business for the LAST 12 months

Upcoming Projects in the NEXT 12 months

Builder - Single Dwellings

Builder - Other Residential

Builder - Commercial

Builder - Industrial

Trades (inc Sub-Contractors)

Civil Works Only

Mechanical and/or Electrical Work Only

Other Work

Project Information

Geographical Information

NSW Stamp Duty Declaration

Changes to Existing Cover

Coverage Limits

Public Liability

Pre-Existing Structures

Employee Tools

Other Property

Current Projects

Mobile Plant, Machinery & Equipment

Hired-in Mobile Plant, Machinery & Equipment

Contractors Pollution Liability

Disclosure Questions

Other Insurances

Additional Information

Important Information

Declaration

Signature