Quote Request - Webber Insurance Forms

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One-Off Contract Works Quote Request

1Your Information

2Applicant & Project

3Project Risk Details

4Cover Required

5Declaration

Comments

This field is for validation purposes and should be left unchanged.

Fortix ID Opportunity

Work Request ID

Existing Opportunity

Your Information

Name(Required)

First Last

Business Name

ABN

Enter the 11-digit Australian Business Number for the business being insured.

Best Contact Number(Required)

Email(Required)

Website

Please ensure that your website includes https:// to submit the form correctly.

Main Business Address(Required)

Street Address City State Post Code Country

Do you have any other business locations?(Required)

Yes

If yes, please provide further details(Required)

Applicant & Project

Tell us about your role and the single project you would like insured.

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(Required)

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

Yes

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.

Builders License Number

Years of experience related to this project?(Required)

Are you the(Required)

Developer / Principal

Head Contractor

Sub-Contractor

Owner Builder

Other

Name of Developer / Principal

Name of Head Contractor (if applicable)

If other, please provide further details(Required)

Project Details

Address of the Project(Required)

Street Address City State Post Code Country

Please provide a brief description of the project(Required)

What is the estimated contract value of this project?(Required)

Site Details

Which option best describes the project locality?(Required)

Isolated Site

Typical Suburban Area

Industrial Park

Town Centre

Inner City / CBD

Other

If other, please advise(Required)

What is the best description of the topography at the site?(Required)

Flat

Sloping

Steep

Other

If other, please advise(Required)

What subsoil conditions do you expect to encounter?(Required)

Rock

Clay

Sand

Mixed

Fill

Other

If other, please advise(Required)

How would you describe the site's potential to flood?(Required)

Nil

Low

Medium

High

Other / Unknown

If other, please provide further details(Required)

Does the site contain any easements for(Required)

Water

Gas

Electricity

Other

NONE

If other, please provide further details(Required)

Are there any surrounding properties within 10 metres of the project boundary?(Required)

Yes

Please provide further details(Required)

Will the site be fully fenced or monitored by security at all times after hours?(Required)

Yes

Other

Please provide further details(Required)

Subcontractors & Labour Hire

Complete the follow-up questions only where they apply.

Will you use subcontractors for this project?(Required)

Yes

Do you require subcontractors to hold their own appropriate insurance?(Required)

Yes

Type of work undertaken by Sub-Contractors(Required)

Estimated total amount of payments to the Sub-Contractors for this project?(Required)

Will you utilise Labour Hire staff for this project?(Required)

Yes

Type of work undertaken by Labour Hire staff?(Required)

Estimated total amount of payments to Labour Hire staff for this project?(Required)

Current Project Status

Has any construction already started?(Required)

Yes

When did construction begin?(Required)

Day

Month

Year

What is the value of work already completed?(Required)

What is the value of the work remaining?(Required)

Please describe the work completed to date(Required)

Summarise the major stages completed and the current stage of the project.

Please describe the work that still needs to be completed(Required)

Include the major outstanding stages and any work that has not yet commenced.

What is the estimated project completion date?(Required)

Day

Month

Year

Provide your current best estimate.

Upload current photos showing the project's progress(Required)

Drop files here or

Accepted file types: jpg, jpeg, png, heic, pdf, Max. file size: 32 MB, Max. files: 10.

Upload at least one clear, recent photo. You can upload up to 10 files.

Has the project been previously insured?(Required)

Yes

Has there been any losses or incidents at the site?(Required)

Yes

If yes, please provide further details(Required)

If no, please advise why no insurance has been in place(Required)

If yes, please provide further details(Required)

Are there any outstanding contractual or financial obligations between any parties to this project?(Required)

Yes

If yes, please provide further details(Required)

Project Risk Details

Select all activities or conditions that apply.

Will the project involve any of the following?(Required)

Maintenance only works

Excavation works

Piling

Works of an experimental or prototypical nature?

The application of waste or chemical products to land

Any Underpinning activities

Any blasting undertaken

Demolition work exceeding 15 metres in height?

Directional drilling or boring greater than 1 metre in diameter (other than piling/piers)

Design & Construct where you provide the design

NONE OF THE ABOVE

What is the maximum depth of Excavation?(Required)

How close will the excavation be from a site boundary in metres?(Required)

Will any part of the sidewall of the excavation need to be supported?(Required)

Yes

Unsure

Do you expect to excavate below the water table?(Required)

Yes

Unsure

If piling is neccessary, will they be driven into position?(Required)

Yes

Unsure

Will this project involve works in or around(Required)

An existing excavation deeper than 10 metres

Over lakes, rivers, the ocean, or any other body of water?

Airports that would require an Air-side permit?

Railway track-work or signalling works?

Mining, oil, chemical or petrochemical plants

Gasoline service stations

Landfills or land which is on the contaminated land register

Underground works such as tunnels, shafts, mines or galleries

Road works or bridges

Pipelines greater than 250 metres or over $10,000,000 in Contract Value

Excavation of underground services on site, other than to install new services

Swimming Pools of any types

NONE OF THE ABOVE

Construction & Defects Periods

Select the maximum Construction Period you need in Weeks?(Required)

26 weeks

52 weeks

78 weeks

104 weeks

Other

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

If other, please advise(Required)

Select the maximum Defects Liability Period you need in Weeks?(Required)

13 weeks

26 weeks

52 weeks

78 weeks

Other

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(Required)

Materials & Cover Required

Select the covers you would like us to consider and provide the requested limits or values.

Will any materials be supplied by the Principal?(Required)

Yes

Unsure

Are any materials stored offsite that need to be insured?(Required)

Yes

Unsure

If yes, what value do they need to be insured for?(Required)

Other cover required. Do you require a quote for:(Required)

Public Liability (Section 2)

Pre-existing Structures

Employee Tools

Your Mobile Machinery, Plant & Equipment

Hired in Mobile Machinery, Plant & Equipment

No Other Cover is Required

Please tick all that apply.

Level of Public Liability cover required?(Required)

$10,000,000

$20,000,000

$50,000,000

Other

Please advise limit required(Required)

Existing Structures & Equipment

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

Will existing structures be occupied during the project?(Required)

Yes

Unsure

Please provide further details(Required)

Limit Required of Employee Tools(Required)

“Employee tools” means construction tools and effects owned by Employees, but does not include laptop computers, mobile telephones, tablets or cameras.

Limit Required for Mobile Plant, Machinery & Equipment(Required)

“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?(Required)

Yes

If yes, please provide brief description including Make, Model, Year & Value(Required)

Estimate the amount you spend on hire charges for this project(Required)

What is the replacement value of the largest item you could expect to hire?(Required)

Claims & Insurance History

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.

Are YOU being operated under any type of third party agreement?(Required)

Yes

If yes, please provide further details(Required)

Have YOU had an insurer decline any claim, cancel any insurance policy or impose special terms to any insurance policy?(Required)

Yes

If yes, please provide further details(Required)

Have YOU experienced any loss, damage, circumstance, liability or claim against you (whether insured or not) that could be covered by any of the policies now proposed?(Required)

Yes

If yes, please provide further details(Required)

Please include: Date of Loss, Description of Incident, Value of Loss (or Estimate of Loss if final costs not yet known)

Have YOU been charged with, pleaded guilty to or been convicted of any criminal offence or had any criminal offence proved?(Required)

Yes

If yes, please provide further details(Required)

Have YOU been declared bankrupt, insolvent, had a liquidator appointed and/or been placed in external administration?(Required)

Yes

If yes, please provide further details(Required)

Have YOU been a defendant in any civil court case?(Required)

Yes

If yes, please provide further details(Required)

Have YOU ever allowed another builder to use your builder’s licence, or used someone else’s licence for one of your own projects, either in the past or as part of any future plans?(Required)

Yes

If yes, please provide further details(Required)

Have YOU been associated in any way with any: Outlaw Motorcycle Gang (“OMG”) or any member of an OMG; organised crime gang (“OCG”) or any member of an OCG, or other illegal association?(Required)

Yes

If yes, please provide further details(Required)

Additional Information

Is there any other information that you need to provide to the insurer?(Required)

YES there is

NO there is not

If yes, please provide further details?(Required)

How did you hear about Webber Insurance?(Required)

Web Search

Referred by Someone

An Association

SBA

TradieWives

Social Media

I am a Previous Client

Existing Client

Other

If other, please advise(Required)

We appreciate referrals. Please let us know who provided you with our details(Required)

Important Information

Please take a moment to read this important information prior to submitting your form.

Duty of Disclosure

1. Your Duty of Disclosure

Before you enter into a contract of general insurance with an insurer, you have a duty, under the Insurance Contracts Act 1984, to disclose to the insurer every matter that you know, or could reasonably be expected to know, that is relevant to the insurer’s decision whether to accept the risk of the insurance, and if so on what terms. You have the same duty to disclose those matters to the insurer before you renew, extend, vary, or reinstate a contract of general insurance.

Your duty does not require disclosure of any matter:

that diminishes the risk to be undertaken by the insurer,
that is of common knowledge,
that your insurer knows or, in the ordinary course of its business, ought to know, or
as to which compliance with your duty is waived by the insurer.

2. Non-Disclosure

If you fail to comply with your duty of disclosure, the insurer may be entitled to reduce its liability under
the contract in respect of a claim, or may cancel the contract.

If your non-disclosure is fraudulent, the insurer may also have the option of voiding the contract from
its beginning.

3. Claims Made Insurance

This policy may have an Errors and Omissions section. If selected, cover is placed on a claims made basis.
This means that claims first advised to you, or made against you, and reported to your insurer during the
period of insurance are recoverable irrespective of when the incident causing the claim occurred, subject
to any applicable retroactive date.

Under Section 40(3) of the Insurance Contracts Act 1984, if you give written notice to the insurer of facts
that might give rise to a claim against you as soon as is reasonably practicable after you become aware of
those facts, but before the policy expires, then the insurer is not relieved of liability for the claim, when made,
only because it was made after the expiration of the period of insurance.

4. Retroactive Liability

The policy may be limited by a retroactive date stated in the schedule. The policy does not provide cover for any claim arising from any actual or alleged act, error, omission, or conduct that occurs before the commencement of the policy, unless retroactive liability cover is extended by underwriters.

5. Liability Assumed Under Agreement

Liability insurance provided by this policy does not cover liability that you have agreed to accept, unless you would have been liable in the absence of such agreement.

6. Utmost Good Faith

In accordance with Section 13 of the Insurance Contracts Act 1984 (Cth), the policy of insurance is based on utmost good faith, requiring underwriters and the proposer or insured to act toward each other with the utmost good faith in respect of any matter relating to the insurance contract.

Your duty of disclosure also applies when you seek to renew, extend, alter, or reinstate a policy.

If you are unsure whether information needs to be disclosed, please contact our office.

I agree to the Duty of Disclosure

I undertake to inform insurers of any material alteration to these facts, whether occurring before or after completion of the contract of insurance.

Please scroll to the end to tick the boxes.

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I declare that I have read the important notices above and understand these notices.

I acknowledge that the insurance cover may be provided in whole or in part by overseas insurers.

Signature

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

Signature

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