Children s Home Proposal

KH2695 A4 Feb09 10/3/09 10:29 AM Page 1 Children s Home Proposal Insurance for Residential Children s Homes Arranged by www.mortonmichel.com

Sterling Insurance Company Limited Children s Home Insurance Proposal Form Please read the Summary and Guide carefully before completing this form. Please answer ALL questions FULLY and do not withhold or misrepresent any facts which are likely to influence the Company s assessment and acceptance of this proposal. You have a duty to disclose all material facts and failure to do so could invalidate the insurance. Copies of all information supplied to us for the purpose of effecting this insurance should be retained. Please use BLOCK CAPITALS or TICK the BOXES as appropriate. If there is insufficient space to complete any answer, please use the supplementary information area at the end of this form or continue on a separate sheet. If you have any difficulty in answering any of these questions, please telephone us at Morton Michel on Local rate 08452 570115 so that we can help. Please complete this form and return it to Morton Michel, Alhambra House, 9 St Michaels Road, Croydon CR9 3DD for a quotation. If we have already provided a quotation, please enclose your cheque for the appropriate amount, made payable to Morton Michel. Your insurance will be provided under a Children s Home policy. Any special terms or conditions will be advised to you in writing. Insurance to commence for 12 months Telephone Number Proposer s name(s) in full See Guidance te 1 Trading title Address of business premises Postal address if different Postcode Postcode Telephone Fax Email address Telephone Fax Email address Website www. Business 1 Number of children for which the home is registered by OFSTED or other registering authority 2 Age range of children From to years 3 Do you (the partner, principle or director) reside on the premises? 4 Number of full and part-time employees See Guidance te 2 Qualified staff office/administration staff Other 5 Annual wage roll Qualified staff office/administration staff Other

6 Estimated Annual Turnover See Guidance te 3 UK Last Financial Year Ended Current Financial Year Ending Coming Financial Year Ending / / / / / / 7 Are children referred to you by any local authority? 8 Do you accept children: a) requiring intimate personal care? b) with a history of alcohol or drug abuse? c) who regularly display aggressive or violent behaviour? d) who have been the subject of physical or sexual abuse? e) who are categorised as emotionally or behaviourally disturbed? If you have answered to any part of Question 8, please provide full details, including procedures followed and safety precautions taken. 9 Do you accept children: a) with a history of solvent abuse? b) who are known arsonists? c) who are known physical and/or sexual abusers? 10 What is the care staff to child ratio a) during the day? b) at night? 11 Do you undertake activities away from the premises involving the children in your care? If, please provide full details 12 Do you provide domiciliary care where staff care for children overnight at premises other than the residential children s home? 13 Does the premises contain a secure unit? 14 Please supply a copy of the following documentation: a) the last regulatory inspection reports; b) the assessment and admissions policy of the home. 15 If the business has been operating for less than 6 months, please supply a copy of your business plan.

Buildings (Please answer these questions even if you do not require Buildings insurance) 1 What is the approximate age of the buildings? How many storeys? 2 Are the buildings (including any outbuildings containing equipment) a) built of brick, stone or concrete and roofed with slates, tiles, concrete or metal? b) in an area unduly exposed to storm or impact damage? See Guidance te 4 3 Have your premises ever been flooded; are they in an area liable to flooding or within 1/4 mile from any river, watercourse or the sea, or have you been informed that your premises are in a potential flood risk area? If you have ticked any shaded box to questions 2 or 3, please provide full details 4 Are the buildings occupied by any other business? If, please provide full details including the occupation of any other tenants and advise how the businesses are separated 5 Are there any adjoining buildings? If, please provide details of the trade(s) carried out therein and how they are separated from your buildings Premises (i.e. that part of the buildings and outbuildings occupied by you for the purpose of the business) 1 Are the premises artificially heated by a conventional central heating system or by fixed appliances, fuelled by electricity or gas from the public supply? If, please give full details 2 Has the electrical installation been checked by a qualified electrician within the last five years and any necessary work completed? 3 Are the premises protected by an automatic sprinkler installation? If, please provide installer s name and address

4 a) Are the premises protected by an intruder alarm which is in working order and subject to a maintenance contract? If, please provide installer s name and address and attach a copy of the specification to this proposal b) Are all external doors to your premises protected in accordance with the Guide to Security in the Summary and Guide? c) Are all opening windows to your premises protected in accordance with the Guide to Security in the Summary and Guide? If, please provide full details of other security fittings 5 Please provide details of the cooking apparatus used at the premises Health, Safety and Protection of Children 1 Is responsibility for Health, Safety and Protection of Children designated to a senior manager/leader? 2 Are all doors at your premises fitted with finger guards or finger shields? 3 Do you have a written Fire Risk Assessment? See Guidance te 5 4 Do you have a written General Health and Safety Risk Assessment? See Guidance te 6 5 Do you have a written Anti-Bullying Policy? 6 Do you have a written Protection Policy to guard against abuse by any person? If, a) when was the Policy last reviewed and updated? b) is the Policy reviewed and updated at least annually? c) are all of your staff and volunteers aware of the Policy and do they have access to it? d) do all staff and volunteers receive appropriate formal training on protection of children? e) are such training sessions held at least annually? 7 Do you comply with all legislation and guidelines applicable to your activities relating to the protection of the children? If you have answered to ANY of the above, please provide full details

General Questions 1 How long have you been in business at this address? Years Elsewhere? Years 2 Please provide full details of your experience relevant to operating a residential children s home See Guidance te 7 3 Please provide full details of your experience in the care and supervision of children See Guidance te 7 4 Please provide full details of the qualifications and experience in the care and supervision of children, in respect of all relevant staff See Guidance te 8 Name Age Qualifications Date(s) Qualified Experience 5 a) Do you obtain satisfactory and confirmed references in writing of prospective employees integrity before employing them? b) Have you obtained the necessary Criminal Records Bureau Disclosures for all new and existing members of staff/voluntary helpers? See Guidance te 9 c) If you are awaiting Criminal Records Bureau Disclosures on members of staff/voluntary helpers, are all staff/voluntary helpers that have not been checked using the Criminal Records Bureau fully supervised at all times by a suitable person with Criminal Records Bureau clearance? If to a), b) or c), please provide full explanation 6 Have you had continuous insurance since your business has been established? If, please provide name and address of current and previous insurer(s) and policy number(s) covering a period of five years. If, please provide reasons.

7 Has any insurer ever a) declined your proposal? b) refused to renew or cancelled your policy? c) imposed special terms or conditions for any of the risks proposed? If to any of the above, please provide full details 8 Have you, the proposer or any principal, director or partner under a current or any previous trading title a) been declared bankrupt or insolvent or been subject to a County Court Judgement or are any proceedings pending? b) been convicted of arson or other criminal offence (other than motoring offences) or is any prosecution pending? c) been prosecuted under the Factories Acts 1961, the Health and Safety at Work etc Act 1974, the Consumer Protection Act 1987 or the Food Safety Act 1990? d) been served with a Prohibition tice under the Health and Safety at Work etc Act 1974 or the Food Safety Act 1990? If to any of the above, please provide full details 9 Have you suffered any losses caused by any of the risks to be insured in the last five years? If, please provide details Years Cause Details Cost 20 20 20 20 20 Failure to disclose previous claims could result in the invalidation of your policy. 10 Have there been any claims made or are you aware of any incidents which might give rise to a claim for abuse? If, please provide full details

COVER The basic Children s Home policy provides Property Damage, Public Liability (5M Limit), Products Liability (5M Limit), Employers Liability (10M Limit) and Legal Expenses (100K Limit). Please refer to the Summary and Guide for details of the cover provided. Property to be Insured The sums to be insured by each item must represent the full value of the property to be insured. Please do not bracket items together. 1 Stock of food and drink 2 Computing equipment, fax machines, televisions, audio, video and photographic equipment used in connection with the business 3 Other business contents such as play equipment, office furniture, filing cabinets, domestic furniture etc, plus fixed glass, blinds and signs that you own or for which you are responsible 4 Personal effects and clothing of directors, partners, employees, and visitors (limit 250 per person) 5 If you own the building and wish to insure it - The buildings including foundations and outbuildings, Landlord s fixtures and fittings together with boundary walls, fences and gates, plus allowance for architects and surveyors fees, public authorities and debris removal costs. If you rent the building - 6 Tenant s improvements, alterations and decorations 7 Any other property - please provide full details National Framework Contract for the placement of children in Children s Homes The National Framework Contract for the placement of children in Children s Homes recommends that insurance be arranged for Professional Indemnity (with a minimum limit of indemnity of 2M) and for children s belongings (minimum sum insured of 500 per child). We offer these sections as Optional Covers. (Please refer to the Summary and Guide for details of the cover provided.) Professional Indemnity Limit 2M (Higher Limits may be available on request). Do you require this Optional Cover? If, please answer the following questions 1 Are you connected or associated (financially or otherwise) with any other business organisation? If, do you undertake any work for such organisation(s) for which cover is required? If, please state nature of the work undertaken and the income received for such work.

2 During the past 5 years have you: a) changed your business name/trading name? b) purchased any other business? c) merged or consolidated with any other business? 3 Do you engage outside consultants, independent contractors or sub contractors? If a) is cover required for the work undertaken by the outside consultants? b) do you ensure that any outside consultants engaged carry their own Professional Indemnity insurance? c) what percentage of fees over the last three years have been paid to outside consultants? % Please provide full details including nature of the work, projects undertaken and names of consultants. 4 After full enquiry have you sustained any loss through the fraud or dishonesty of any person? 5 After full enquiry are you aware of any fraud, dishonesty, bankruptcy or administration order applicable to any past or present principal, partner, director or employee? 6 After full enquiry has any claim been made against the business or any principal, partner, director or employee whilst in this or any other business? 7 After full enquiry are you aware of any circumstance or incident which has or could result in any claim being made against the Proposer s business, or any principal, partner, director or employee of this or any other business? If you answered to questions 4, 5, 6 or 7, please provide details below OPTIONAL COVER Children s Belongings Do you require this Optional Cover? Other Optional Covers The following Optional Covers may also be added to your policy. Please refer to the Summary and Guide for details of the cover provided. Please indicate which other Optional Covers you require. Business Interruption Annual Gross Revenue Standard Indemnity Period is 12 months. If you require a longer period, please tick period required: 18 Months 24 Months Money Refrigerated Stock If, Sum Insured required

Supplementary information - indicate for which questions you are supplying extra information Please read the declaration carefully and check the answers you have given before signing the proposal form. Declaration Please read the declaration carefully and check the answers you have given before signing the proposal form. I/We (or, in the case of a partnership or a limited company, any one of the partners or directors) apply to Sterling Insurance Company Limited for Children s Home insurance and a) declare that to the best of my/our knowledge and belief the answers given are true and complete in every respect and all material particulars which may affect the assessment of the risk have been disclosed. If any written answer has been made by another person, such person shall for that purpose be deemed to be my/our agent and not the agent of the Sterling Insurance Company Limited. To the extent that has been necessary, I/we have consulted relevant members of the organisation to verify answers stated in this form b) understand that Sterling reserves the right to contact previous insurers to verify the information contained in this form c) agree that this proposal and declaration shall be the basis of the contract between me/us and Sterling Insurance Company Limited and shall be deemed incorporated into such contract Data Protection Act I/We understand and agree that the personal information I/we provide (including sensitive personal details) may be used for insurance purposes by Sterling Insurance Company Limited, its connected companies, reinsurers, agents and subcontractors; and also shared with other insurance companies as required for the purposes of my/our insurance. Where we have provided information about my/our spouse(s), partner(s) or another person/other persons (including their sensitive personal details) I/we confirm that I/we have their permission to provide this information for insurance purposes. I/We understand that I am/we are entitled to a copy of my/our personal information on payment of a fee. From time to time, Morton Michel may wish to send you details of services and products, if you do not wish to receive such mailings, please tick this box Signed Position Date (Both signatures required if proposal is in joint names) You have a duty to disclose all material facts and failure to do so could invalidate the insurance. Cover does not commence until the proposal has been accepted by the Company unless otherwise agreed by Morton Michel.

GUIDANCE NOTES FOR THE COMPLETION OF THE CHILDREN S HOME INSURANCE PROPOSAL FORM Guidance te 1 Proposer s name(s) and trading title (if applicable) should be in one of the following formats:- (a) (b) (c) (d) Sole trader: - Property and business owned by one person e.g. A Smith, may be used with a trading title, e.g. A Smith t/a ABC Children s Home. Partnership: - Property and business owned by more than one person, e.g. A Smith & J Brown, often with a trading title, e.g. A Smith & J Brown t/a ABC Children s Home. Limited Company: - Property and business owned by a registered Limited Company, e.g. ABC Children s Home Limited, occasionally with a trading title, e.g. ABC Children s Home Limited t/a ABC. Limited Liability Partnership (LLP): - Property and business owned by a Partnership that has been registered as having a limited liability e.g. ABC Children s Home LLP, occasionally with a trading title, e.g. ABC Children s Home LLP t/a ABC. Guidance te 2 A qualified staff member is one that has relevant professional qualifications in their field such as a qualified nurse, doctor, carer or other. Guidance te 3 For the purposes of this insurance, Annual Turnover equates to your Annual Gross Revenue, i.e. all of your income from the residential children s home (in whatever form) before the deduction of expenses, taxes, wages or National Insurance payments. Guidance te 4 Storm: - Premises located on a sea front or at the top of a hill, for example, may be more susceptible to storm damage. Impact: - Premises located at the foot of a busy hill or on a sharp bend, for example, may have an increased risk of impact damage by traffic. Guidance te 5 By law, there is a duty upon owners of buildings - or anyone who has responsibility for buildings - to ensure fire safety at the premises. You will have to complete a risk assessment and record the significant findings of such an assessment. Full details and further information - including a simple guide to fire prevention - can be found at: http://www.communities.gov.uk Guidance te 6 General health and safety risk assessments should be carried out by all companies regardless of the business activity. It is therefore recommended that written assessments of risk are carried out and continually updated. These documents should be retained by the policyholder. A free copy of the leaflet Five Steps to Risk Assessment is available from the Health and Safety Executive website: http://www.hse.gov.uk Guidance te 7 If you will be a hands on Partner or Director rather than in an administrative role, please provide details of any experience or qualifications that you have obtained in the care and supervision of children. Please see Guidance te 6 for details of qualifications and experience. Guidance te 8 Experience may have been obtained in working in a similar environment, in a nursery, in a playgroup, in a school, as a nanny or as a childminder either in a voluntary or paid capacity. A relevant qualification could be e.g., a course in childminding, an NNIEB or NVQ etc. Guidance te 9 All supervisory and monitoring staff should be checked using the Criminal Records Bureau who can be contacted on www.crb.gov.uk. There are also umbrella groups available who will carry out checks on your behalf and details again can be obtained from the CRB website. There are different levels of checks and due to the nature of your business an Enhanced check is required. Any adverse responses received as a result of the check must be referred to Morton Michel immediately.

www.mortonmichel.com Arranged by Tel: 0845 2570900 Fax: 0845 2570547/0548 www.mortonmichel.com Morton Michel Alhambra House 9 St Michaels Road Croydon CR9 3DD www.mortonmichel.com KH2695 02.09