property damage & bodily injury “hangs over your...

Public Liability Insurance “It protects your assets”

LICENSED PLUMBING CONTRACTORS LIABILITY INSURANCE PROPOSAL

Incorporating Tools of Trade Cover

Level 1, 192 Melbourne StreetNorth Adelaide, SA 5006

Tel. (08) 8267 2875Freecall. 1800 670 411

Fax. (08) 8361 8299PO Box 3002

North Adelaide, SA 5006

PSB INSURANCE BROKERS PTY LTDACN 053 015 311AFSL No. 241402

Members of the NationalInsurance Brokers [email protected]

www.psbgroup.com.au

Property Damage & Bodily Injury“hangs over your head”

Public Liability Insurance “It protects your assets”

COVER OPTIONSTools of Trade Fire, Specified Perils, Collision and/or overturning, theft following upon visible, forcible and violent entry to locked

vehicles or locked permanent building.

Option A Unspecified Tools of Trade (limit $1,000 any one item)

)000,1$ timil(kcotS edarT

Option B Specified Tools of Trade (eg: tools over $1,000)

I/We in effecting Insurance in accordance with the information furnished in this Proposal declare and warrant:(a) the statements in this Proposal are true.(b) I/we have disclosed all matters of which, to my/our knowledge, you should be aware.(c) no Insurance Company has ever cancelled, declined or refused to renew, or imposed special terms or conditions on, any policy held by me/us.(d) that I/we agree to accept the terms, exclusions, conditions and limitations of your policy.

ERUTANGISETAD

ONSEY?sesimerp ruoy morf yawa gnidleW)d(ONSEY?sevisolpxe fo egarots ro esU)a(

(b) Boilers &/or compressors which require Govt. certification? YES NO (e) Non-electrical activities? YES NO

ycilop siht rednu deriuqer revoc sI)f(ONSEY?krow noitcurtsnoC)c( YES NO

If “YES” to any of the above, please specify (if insufficient space, please add addendum page)

for non-electrical activities?

(b) List all claims and uninsured losses, damage or liabilities that have involved your Business during the last 5 years.

ONSEY?tnelaviuqe ro draoB Plumbing Industry eht yb denilpicsid neeb reve uoy evaH)c(

If “YES”, please provide details including date of hearing and finding.

(min $5 million) $5 million $10 million $20 millionytilibaiL cilbuP-deriuqer ytilibaiL fo timiL

ytilibaiL stcudorP-

YES NOYES NO(g) work in heights more than 10m & depths more than 3m?

THANK YOU FOR COMPLETING THIS PROPOSAL

Do your operations include

Tools of Trade cover

Declaration

Date Description Amount Insurer

1

2

3

4

$

$

$

1. 3.

4.2.

/

/

(a) Have you, your Business, or any Director, Proprietor or Partner of your Business ever had

(i) insurances cancelled or had special conditions imposed? YES NO

ONSEY?denilced ecnarusni rof lasoporp a)ii(

ONSEY?ycilop a wener ot esufer rerusni na)iii(

If “YES”, provide full details

Previous Insurances, Claims, Damage, Losses and Liabilities

(h) Working in the following industries: Mining, petrolium/oil, nuclear plants, Aviation including Aircraft, watercraft, landing strips, gas /public utilies?

}

GENPLUM2012

If more than 4 Specified items please attach a list of items to be individually noted.

So that we can save you time and paper and improve our services we offer you the option to receive your insurance documents electronically. If you choose to receive the documents electronically, we will deliver your insurance policies, Product Disclosure Statements and our Financial Services Guide and other disclosure documents by sending an email with PDF attachments or sending an email with a hyperlink or sending a letter with our website or a combination of these options. If you would like us to communicate with you in this way, please tick the following box.

If at any stage you no longer wish to receive documentation from us electronically or you require a hard copy of any documentation, please write to us advising that this method is no longer acceptable to you.

Suite 1, 43 Railway RoadBlackburn Victoria 3130

Tel. (03) 8841 3300Freecall. 1800 670 411

Fax. (03) 9894 1115PO Box 205

Blackburn VIC 3130

PROTECTING YOUR ASSETS

.oN yciloP ot:deriuqer ecnarusnI fo doireP eht etatS

(b) Your Plumbing Licence Number Number of years licenced

(c) Your Business ABN Number (if applicable)

(d) Your Business postal address No. Street

Suburb State Postcode

eliboM ssenisuBsrebmuN tcatnoC)e(

Email etavirP

(f) Number of years the Business has been established

(g) Number of persons (including Directors, Partners, Apprentices, Labourers) working on tools

WagesTurnoverdoirep htnom 21 tsal rof revonruT& segaW ssorG lautcA)h(

WagesTurnoverdoirep htnom 21 txen rof revonruT & segaW ssorG detamitsE

(i) Does work performed by sub contractors total more than 50% of your estimated annual turnover? YES NO

(j) Do you ensure sub-contractors are correctly insured? YES NO

(k) Describe in detail your business activities

(l) Please indicate the type of premises you will be working in Residential Comme

Non- Plumbing

rcial Industrial

ONSEY?snoitallatsni detelpmoc lla tset uoy oD)m(

(a) Provide the names and licence numbers for all licensed Plumbers in your business

Period of Insurance

Information about your business

Licensed Plumbers

Name Licence Number

/ /

% % %

%

( ) ( )

( )( )

Years

Full Time Part Time

$ $

$ $

/ /

(b) Have any of the Directors, Proprietors, or Partners of your Business ever been

(i) charged with any offence regarding fraud or dishonesty? YES NO

ONSEY?tpurknab edam)ii(

ONSEY?ecneffo lanimirc yna fo detcivnoc)iii(

(iv) under investigation for any fraudulent or dishonest acts? YES NO

If “YES” to any of these questions, supply full details

PSB Insurance Brokers P/L ACN 053 015 311 AFS Licence No. 241402

PROTECTINGYOUR ASSETS

(a) Business name Trading As:

Liability ProposalPlumbers

Plumbing Turnover Split Up

Type of Work Insured Sub-Contractors Others No. of Persons working on tools

Domestic Turnover $ $ $

Non Domestic Turnover $ $ $

Type “B” Gas Fitting turnover $ $ $

GENPLUM2012

IMPORTANT MATTERS REFERRED TO IN THE INSURANCE CONTRACTS ACT 1984

YOUR DUTY OF DISCLOSUREBefore you enter into a contract of general insurance with us, 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, is relevant to the Insurer’sdecision 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 ofgeneral insurance.Your duty however, does not require disclosure of matters -• that diminish the risk to be undertaken by us;• that are of common knowledge;• that we know or in the ordinary course of our business ought to know;• as to which compliance with your duty is waived by us.

NON-DISCLOSUREIf you fail to comply with your duty of disclosure, the insurer may be entitled to reduce their liability under the Contract in respectof a claim or may cancel this Contract.If your non-disclosure is fraudulent, the insurer may also have the option of avoiding the Contract from its beginning.

REASONABLE PRECAUTIONS AND FRAUDULENT ACTSYou must take all reasonable precautions for the maintenance and safety of the Insured Property. The insurer will not be liable forany loss, damage, injury or liability arising from a deliberate or fraudulent act committed by you or on your behalf.


(b) Your Electrical Licence Number Number of years licenced





Email etavirP





(i) Does work performed by sub-contractors total more than 50% of your estimated annual turnover? YES NO



(l) Please indicate the type of premises you will be working in Residential Commercial Industrial


(a) Provide the names and licence numbers for all licensed electricians in your business







Period of Insurance


Licensed Electricians

Name Licence Number

/ /

% % %

( ) ( )

( )( )

Years

Full Time Part Time

$ $

$ $

/ /




Electrical ContractorsLiability Proposal

3120 PSB - Electrical Contractors Brochure.indd 2 14/07/11 11:04 AM

GENELEC2012


(b) Your Plumbing Licence Number Number of years licenced





Email etavirP





(i) Does work performed by sub contractors total more than 50% of your estimated annual turnover? YES NO



(l) Please indicate the type of premises you will be working in Residential Comme

Non- Plumbing

rcial Industrial


(a) Provide the names and licence numbers for all licensed Plumbers in your business

Period of Insurance


Licensed Plumbers

Name Licence Number

/ /

% % %

%

( ) ( )

( )( )

Years

Full Time Part Time

$ $

$ $

/ /










Liability ProposalPlumbers

Plumbing Turnover Split Up

Type of Work Insured Sub-Contractors Others No. of Persons working on tools

Domestic Turnover $ $ $

Non Domestic Turnover $ $ $

Type “B” Gas Fitting turnover $ $ $

GENPLUM2012

COVER OPTIONSTools of Trade Fire, Specified Perils, Collision and/or overturning, theft following upon visible, forcible and violent entry to locked

vehicles or locked permanent building.

Option A Unspecified Tools of Trade (limit $1,000 any one item)

)000,1$ timil(kcotS edarT

Option B Specified Tools of Trade (eg: tools over $1,000)

I/We in effecting Insurance in accordance with the information furnished in this Proposal declare and warrant:(a) the statements in this Proposal are true.(b) I/we have disclosed all matters of which, to my/our knowledge, you should be aware.(c) no Insurance Company has ever cancelled, declined or refused to renew, or imposed special terms or conditions on, any policy held by me/us.(d) that I/we agree to accept the terms, exclusions, conditions and limitations of your policy.

ERUTANGISETAD

ONSEY?sesimerp ruoy morf yawa gnidleW)d(ONSEY?sevisolpxe fo egarots ro esU)a(

(b) Boilers &/or compressors which require Govt. certification? YES NO (e) Non-electrical activities? YES NO

ycilop siht rednu deriuqer revoc sI)f(ONSEY?krow noitcurtsnoC)c( YES NO

If “YES” to any of the above, please specify (if insufficient space, please add addendum page)

for non-electrical activities?

(b) List all claims and uninsured losses, damage or liabilities that have involved your Business during the last 5 years.

ONSEY?tnelaviuqe ro draoB Plumbing Industry eht yb denilpicsid neeb reve uoy evaH)c(

If “YES”, please provide details including date of hearing and finding.

(min $5 million) $5 million $10 million $20 millionytilibaiL cilbuP-deriuqer ytilibaiL fo timiL

ytilibaiL stcudorP-

YES NOYES NO(g) work in heights more than 10m & depths more than 3m?

THANK YOU FOR COMPLETING THIS PROPOSAL

Do your operations include

Tools of Trade cover

Declaration

Date Description Amount Insurer

1

2

3

4

$

$

$

1. 3.

4.2.

/

/

(a) Have you, your Business, or any Director, Proprietor or Partner of your Business ever had

(i) insurances cancelled or had special conditions imposed? YES NO

ONSEY?denilced ecnarusni rof lasoporp a)ii(

ONSEY?ycilop a wener ot esufer rerusni na)iii(

If “YES”, provide full details

Previous Insurances, Claims, Damage, Losses and Liabilities

(h) Working in the following industries: Mining, petrolium/oil, nuclear plants, Aviation including Aircraft, watercraft, landing strips, gas /public utilies?

}

GENPLUM2012

If more than 4 Specified items please attach a list of items to be individually noted.

So that we can save you time and paper and improve our services we offer you the option to receive your insurance documents electronically. If you choose to receive the documents electronically, we will deliver your insurance policies, Product Disclosure Statements and our Financial Services Guide and other disclosure documents by sending an email with PDF attachments or sending an email with a hyperlink or sending a letter with our website or a combination of these options. If you would like us to communicate with you in this way, please tick the following box.

If at any stage you no longer wish to receive documentation from us electronically or you require a hard copy of any documentation, please write to us advising that this method is no longer acceptable to you.

property damage & bodily injury “hangs over your...

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