Proposal form for Housing Warranty Insurance Policy

Transcription

1 Proposal form for Housing Warranty Insurance Policy Glossary of terms Approved Inspector: A Construction Industry Council approved company or person carrying out building control (instead of the local authority) Contract Value: The cost to carry out the works including professional fees Reinstatement Value: The Contract Value plus professional fees, demolition and debris removal costs Single structure: Any free-standing structure which does not share foundations with nor rely for support on any adjacent structure Sum Insured: The Reinstatement Value of the premises on completion including any retained structure value General information Company name: Company registration number: Contact name: Position within company (if applicable): address: Are you completing this form on behalf of someone else? If yes, please provide your details: Premises to be insured Number of residential units: Number of single structures: Type: Detached Semi Terraced Flats/apartments Development type (tick any that apply): New build Conversion/refurbishment Describe the project if anything other than wholly new build: Page 1 of 5

2 Does this development include any element of non-residential use? If yes, please give details including proportion of Reinstatement Value and retained structure value: If new build what is the Reinstatement Value? If conversion or refurbishment o What is the Contract Value? o What is the Rebuild Cost of Retained Elements/Structure e.g. retained façade, foundations etc? o What is the age of the existing property? o What are the Premises currently used for? Insurance requirements Sum Insured: We will provide you with a quotation based on our 10 year Guarantee Build policy unless you tick any of the options below: 2 year Guarantee Build Policy (Small works only) 6 year Guarantee Build Policy (minor renovation and extension work) Who is carrying out the building control function? Name of local authority or company name of Approved Inspector: Contact name: On what basis was the Building Control application submitted? Full Plans Building tice If it was submitted on a Building tice you must be able to supply a full set of the building plans (including specifications and calculations) as submitted to Building Control. Page 2 of 5

3 Duration of works Has construction started on site? Start on site date: If yes, please describe what works have been completed to date: (If works to date have been carried out by a third party please state the date that they started on site) Please indicate the current stage of construction e.g. site clearance/demolition, substructure, superstructure, fit out or other: Anticipated completion date (if works are complete the actual date of completion): If the development is phased please give details below and continue on a separate sheet if required: Phase 1 Phase 2 Start date Expected date of Units included within of construction practical completion this phase Premises information N.B. If the Reinstatement Value of any single structure exceeds or is constructed from Green Oak, Ground/Site Investigation reports, method statements, Gantt (Program) charts and plans and elevations will be required before a formal quotation can be issued. Site preparation e.g. If any vibro-compaction or other ground improvement works are/were necessary prior to construction commencing, please provide details below: Page 3 of 5 Foundations Piled Raft Strip/Pad Foundations Structural frame type Are premises to be (have been) built using traditional block/brick or timber frame? If no, please advise what it is to be (has been) built with: Prestressed or precast concrete Steel or cast in-situ concrete Timber Premises Height of premises (in metres): Green oak Number of floors: (If flats or apartments please advise number of units on each floor: ) Number of floors below ground and the % of Reinstatement Value: % Number of floors above ground and the % of Reinstatement Value: % Type of cladding Brick Concrete Curtain walls Glass Metal Prefabricated Stone Roof details Flat 5 or less Pitched > 5 and < 15 Pitched 15 or more: Corrugated/profiled sheets Metal Slates Tiles m

4 Contract details Contract parties Name of architect: Name of contractor: Name of engineer: Name of funder/lender financing this contract/project: Do you consent to SelfBuild or the Insurer releasing information to them? Is there a Housing Association/Registered Social Landlord associated with this project? If yes, who is it? What type of customer are you? For insurance purposes you are either a Consumer Customer or a Commercial Customer. You are a Consumer Customer if you are an individual who is acting for purposes which are outside your trade, business or profession. Otherwise, you are a Commercial Customer. Which one are you? (please tick one) Consumer Customer Commercial Customer Data protection In order to provide you with insurance, we need to obtain information from you regarding your circumstances. We will treat this information in confidence and ensure it is kept secure. We will only use and disclose information we have about you in the normal course of administering your insurance, or as required to comply with legal or regulatory requirements. Occasionally the Insurer may use your details to tell you about other products or services that they feel may be of interest to you and may contact you by telephone or electronically with details of any offers. If you would prefer not to be contacted in this way please tick this box: We are registered under the Data Protection Act 1998 as Data Controllers. Page 4 of 5

5 Declaration During the last three years have you sustained any losses or had any claims that would be covered by this type of Insurance? Has any director/partner/principal: - ever been convicted or is there any prosecution pending for any offence involving dishonesty of any kind? - ever been prosecuted or received notification of intended prosecution under the Health and Safety at Work Act 1974 or Consumer Protection Act 1987? I/We undersigned certify that all details in this proposal form are complete and true and to my/our knowledge no material information relating to the risk has been voluntarily withheld or omitted. I/We understand that the signing of this proposal form does not bind us to effect any policy of insurance but agree that if any quotation is accepted this proposal form and the statements made within shall form the basis of the contract between me/us and the insurers. Signed: Full name: Position in company (Commercial Customers only): Dated: Please tell us: Number of units you constructed within the last financial year: Estimated number of units you will construct within the next 12 months: Is your business currently registered with another warranty provider? If yes: Which one? What is your current rating with them? How long have you been registered with them? Please return your completed form to: SelfBuild Insurance, Ockford Mill, Ockford Road, Godalming, GU7 1RH. Fax: enquiries@selfbuild.uk.com A quotation will be prepared and returned to you as soon as possible. If you require this quotation to be delivered to any address other than stated as the proposer s address above please advise below: Page 5 of 5