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1 Your Details
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2Your Business
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3Your Business Plan
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For the types of cleaning and other work shown in the table below please add:
a) The estimated wages (including overtime and any bonuses) for principals, directors partners and employees(this includes labour only sub- contractors) for the next 12 months.
b) The estimated payments to bona-fide sub contractors (BFSC) for the next 12 months.
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Type of Work
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Category A
Clerical or managerial (not involved in any cleaning or other manual work)
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Category B
Cleaning private dwellings, offices, doctors, dentists, cafes, takeaways, restaurants, pubs, clubs and retail premises (excluding supermarkets and shopping centres). Including carpet and upholstery cleaning.
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Category C
Cleaning supermarkets, shopping centres, hotels, kitchens (excluding ducting), schools, universities, hospitals, care homes, builders cleans, factories or other industrial premises. Pressure washing at pressure not greater than 1750 PSI and graffiti removal.
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Category D
Window cleaning at ground level (excluding use of ladders), including cleaning by “pole system”
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Category E
Window cleaning above ground level.
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Category F
Cleaning using abseiling, rope access, slings or cradles.
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Category G
Pressure washing at a pressure greater than 1,750 PSI but less than 10,000 PSI
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Category H – Non Cleaning
General maintenance, painting and decorating, caretakers, gardening, warehousemen, fork lift drivers, delivery drivers and porters.
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Do you sell cleaning or other products?
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If yes please:
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4Your Insurance Requirements
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Please state if you require quotes for more than one limit
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a) Public Liability Products Liability incorporating:
i) Failure to perform (inefficacy)
ii) Deliberate acts
iii) Treatment risks
iv) Failure to secure premises
v) Incorrect destruction of goods
vi) Damage to property being worked upon
vii) Damage to third party plant whilst being operated
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Tick if required
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Limit of indemnity
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b) Employers’ Liability - £10,000,000
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Optional Extensions:
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Loss/Consequential Loss of Keys - £25,000
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Financial Loss - £50,000
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Customer Goods at own premises - £10,000 per customer
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Fidelity Bonding - £5,000
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Misuse of Telephones - £5,000
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5Your Health & Safety Procedures
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a) Do you have a written Health & Safety Policy as required by the 1974
Health & Safety at Work Act?
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Please state the name & position of the person responsible for this
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b) Do you have adequate procedures in force to fully train & supervise employees?
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c) Is all equipment tested & inspected in accordance with current legislation?
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d) Are all employees issued with adequate protective clothing, such as gloves and aprons and do
employees sign to confirm receipt?
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e) Are risk assessments carried out for all contracts and method statements provided to all employees?
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f) In respect of work at height are all employees fully trained and issued with
safety equipment and is such training and equipment issued fully documented & recorded?
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g) If there is any use of ladders OR any work over 10 metres a supplementary Height Work Questionnaire is required. Please tick to confirm that you have completed this. (if you do not have this please contact us)
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h) Do you use, handle, store or transport any hazardous substances such as explosives,
toxic or corrosive chemicals, siliceous materials, gases, asbestos, isocyanates, radioactive
substances or any materials giving rise to dust, fumes or vapours?
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i) Do you carry out COSHH assessments?
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6General Questions
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Employee Vetting
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- Do you conduct an interview with all prospective employees?
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- Do you obtain proof of the employees address?
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- Are a minimum of two written references obtained?
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a) Do you engage Bona-Fide Subcontractors?
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b) If YES, do you check that they hold Public Liability Insurance with a limit
of indemnity of not less than £1,000,000?
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(Definition: A bona-fide subcontractor is one who supplies their own equipment and operating staff & who should have their own Public/Products Liability Insurance with a limit of at least £1,000,000)
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Do you carry out work:
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a) which involves the use of use of welding, flame cutting equipment, blowlamps or hot air strippers (away from your own premises)?
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b) on board ships or offshore installations? (If Offshore a Separate Questionnaire is needed)
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c) at power stations, chemical, gas, nuclear or oil plants or installations?
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d) within 5 metres of railway tracks?
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e) outside Great Britain? (please specify which countries below)
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f) in Northern Ireland?
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g) boiler and tank cleaning?
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h) duct or drain cleaning?
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i) machinery cleaning?
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j) removal of clinical waste or sharps and needles?
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k) hospital cleaning in theatres / wards / recovery rooms?
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l) stone cleaning, shot and sandblasting?
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m) pressure washing at a pressure greater than 10,000 PSI?
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n) airside? (Separate Questionnaire needed)
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If you have answered “Yes” to any of the shaded boxes in question 14 please provide full details below
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Loss of Keys Extension
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If you have opted for this extension please advise:
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How are the keys kept safe:
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Please confirm that the keys cannot be identified to the customers premises
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Do you carry out cleaning of carpets, soft furnishings, upholstery & the like?
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If YES, do you issue a written disclaimer of liability in respect of the treatment of such goods?
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Do you operate to any recognised Quality Assurance Standard? e.g. ISOEN 9002
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7Your Business History & Claims Experience
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Have you or any director or partner ever had any claim made against you in the last 5 years,
(whether insured or not) in respect of the insurances for which you are now proposing?
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If YES, please provide the following details, including the present position on any claims outstanding against you :
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Has any insurer ever declined to insure you, cancelled or refused to renew your insurance?
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Have you or any director or partner ever:
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been prosecuted under the Health & Safety at Work Act 1974, the Consumer Protection Act 1987 or any other legislation relating to the health & safety of your employees?
been convicted of or charged (but not yet tried) with a criminal offence other than a motoring offence?
been concerned with any business which has been wound up, liquidated, dissolved or ceased to trade?
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