Get a full quote from cleaning Insured

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Please complete with as much detail as you can and email the form to [email protected]

1 Your Details
Full name of Proposer (including any trading names)
Address
Tel No
Fax No
Email *
Website
Date Company established
If trading for less than 12 months, please provide full details of the relevant experience of the directors/principals, including the names of the previous companies worked for
Give details of any trade association or regulatory body you are a member of
2Your Business
Business Description (give fullest possible description of all activities undertaken)
3Your Business Plan
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.
Type of Work
Category A

Clerical or managerial (not involved in any cleaning or other manual work)
Directors Principals, and Partners (£)
Employees (£)
BFSC (£)
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.
Directors Principals, and Partners (£)
Employees (£)
BFSC (£)
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.
Directors Principals, and Partners (£)
Employees (£)
BFSC (£)
Category D

Window cleaning at ground level (excluding use of ladders), including cleaning by “pole system”
Directors Principals, and Partners (£)
Employees (£)
BFSC (£)
Category E

Window cleaning above ground level.
Directors Principals, and Partners (£)
Employees (£)
BFSC (£)
Category F

Cleaning using abseiling, rope access, slings or cradles.
Directors Principals, and Partners (£)
Employees (£)
BFSC (£)
Category G

Pressure washing at a pressure greater than 1,750 PSI but less than 10,000 PSI
Directors Principals, and Partners (£)
Employees (£)
BFSC (£)
Category H – Non Cleaning

General maintenance, painting and decorating, caretakers, gardening, warehousemen, fork lift drivers, delivery drivers and porters.
Directors Principals, and Partners (£)
Employees (£)
BFSC (£)
Any other work, please provide full details
Estimated total turnover for the next 12 months
Total Number of Employees
Do you sell cleaning or other products?

Do you sell cleaning or other products? Yes No
If yes please:
a) State estimated turnover for next 12 months
b) Describe the products sold and their main uses
4Your Insurance Requirements
Please state if you require quotes for more than one limit
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
Tick if required

Tick if required Yes No
Limit of indemnity
£1m
£2m
£5m
Other £m
b) Employers’ Liability - £10,000,000

b) Employers’ Liability - £10,000,000 Yes No
Optional Extensions:

Loss/Consequential Loss of Keys - £25,000

Loss/Consequential Loss of Keys - £25,000 Yes No

Financial Loss - £50,000

Financial Loss - £50,000 Yes No

Customer Goods at own premises - £10,000 per customer

Customer Goods at own premises - £10,000 per customer Yes No

Fidelity Bonding - £5,000

Fidelity Bonding - £5,000 Yes No

Misuse of Telephones - £5,000

Misuse of Telephones - £5,000 Yes No

5Your Health & Safety Procedures

a) Do you have a written Health & Safety Policy as required by the 1974
Health & Safety at Work Act?

a) Do you have a written Health & Safety Policy as required by the 1974
Health & Safety at Work Act? Yes No

Please state the name & position of the person responsible for this

Name

Position

b) Do you have adequate procedures in force to fully train & supervise employees?

b) Do you have adequate procedures in force to fully train & supervise employees? Yes No

c) Is all equipment tested & inspected in accordance with current legislation?

c) Is all equipment tested & inspected in accordance with current legislation? Yes No

d) Are all employees issued with adequate protective clothing, such as gloves and aprons and do
employees sign to confirm receipt?

d) Are all employees issued with adequate protective clothing, such as gloves and aprons and do
employees sign to confirm receipt? Yes No

e) Are risk assessments carried out for all contracts and method statements provided to all employees?

e) Are risk assessments carried out for all contracts and method statements provided to all employees? Yes No

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?

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? Yes No

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)

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) Yes No

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?

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? Yes No

i) Do you carry out COSHH assessments?

i) Do you carry out COSHH assessments? Yes No

If you have answered NO to any of the questions a) to i) or YES to question h) please give a full explanation

6General Questions

Employee Vetting

- Do you conduct an interview with all prospective employees?

- Do you conduct an interview with all prospective employees? Yes No

- Do you obtain proof of the employees address?

- Do you obtain proof of the employees address? Yes No

- Are a minimum of two written references obtained?

- Are a minimum of two written references obtained? Yes No

If you have answered No to any of the above, please provide an explanation why not below:

a) Do you engage Bona-Fide Subcontractors?

a) Do you engage Bona-Fide Subcontractors? Yes No

b) If YES, do you check that they hold Public Liability Insurance with a limit
of indemnity of not less than £1,000,000?

b) If YES, do you check that they hold Public Liability Insurance with a limit
of indemnity of not less than £1,000,000? Yes No

(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)

Do you carry out work:

a) which involves the use of use of welding, flame cutting equipment, blowlamps or hot air strippers (away from your own premises)?

a) which involves the use of use of welding, flame cutting equipment, blowlamps or hot air strippers (away from your own premises)? Yes No

b) on board ships or offshore installations? (If Offshore a Separate Questionnaire is needed)

b) on board ships or offshore installations? (If Offshore a Separate Questionnaire is needed) Yes No

c) at power stations, chemical, gas, nuclear or oil plants or installations?

c) at power stations, chemical, gas, nuclear or oil plants or installations? Yes No

d) within 5 metres of railway tracks?

d) within 5 metres of railway tracks? Yes No

e) outside Great Britain? (please specify which countries below)

e) outside Great Britain? (please specify which countries below) Yes No

f) in Northern Ireland?

f) in Northern Ireland? Yes No

g) boiler and tank cleaning?

g) boiler and tank cleaning? Yes No

h) duct or drain cleaning?

h) duct or drain cleaning? Yes No

i) machinery cleaning?

i) machinery cleaning? Yes No

j) removal of clinical waste or sharps and needles?

j) removal of clinical waste or sharps and needles? Yes No

k) hospital cleaning in theatres / wards / recovery rooms?

k) hospital cleaning in theatres / wards / recovery rooms? Yes No

l) stone cleaning, shot and sandblasting?

l) stone cleaning, shot and sandblasting? Yes No

m) pressure washing at a pressure greater than 10,000 PSI?

m) pressure washing at a pressure greater than 10,000 PSI? Yes No

n) airside? (Separate Questionnaire needed)

n) airside? (Separate Questionnaire needed) Yes No

If you have answered “Yes” to any of the shaded boxes in question 14 please provide full details below

Type of Work (i)

Directors Principals and Partners (£)

Employees (£)

BFSC (£)

Type of Work (i)

Directors Principals and Partners (£)

Employees (£)

BFSC (£)

Type of Work (ii)

Directors Principals and Partners (£)

Employees (£)

BFSC (£)

Type of Work (iii)

Directors Principals and Partners (£)

Employees (£)

BFSC (£)

Type of Work (iv)

Directors Principals and Partners (£)

Employees (£)

BFSC (£)

Loss of Keys Extension

If you have opted for this extension please advise:

- who are the keyholders

How are the keys kept safe:

a) whilst in possession of employees

b) whilst kept at your premises

Please confirm that the keys cannot be identified to the customers premises

Please confirm that the keys cannot be identified to the customers premises yes No

Do you carry out cleaning of carpets, soft furnishings, upholstery & the like?

Do you carry out cleaning of carpets, soft furnishings, upholstery & the like? yes No

If YES, do you issue a written disclaimer of liability in respect of the treatment of such goods?

If YES, do you issue a written disclaimer of liability in respect of the treatment of such goods? Yes No

Do you operate to any recognised Quality Assurance Standard? e.g. ISOEN 9002

Do you operate to any recognised Quality Assurance Standard? e.g. ISOEN 9002 Yes NO

If YES, please state what this standard is

7Your Business History & Claims Experience

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?

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? Yes No

If YES, please provide the following details, including the present position on any claims outstanding against you :

Year

Brief details & type of claim

Amount Paid £

Amount Outstanding £

Year

Brief details & type of claim

Amount Paid £

Amount Outstanding £

Year

Brief details & type of claim

Amount Paid £

Amount Outstanding £

Year

Brief details & type of claim

Amount Paid £

Amount Outstanding £

Has any insurer ever declined to insure you, cancelled or refused to renew your insurance?

Has any insurer ever declined to insure you, cancelled or refused to renew your insurance? Yes No

If YES, please provide full details

Have you or any director or partner ever:

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?

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?
Yes No

Name of Last/Present Insurer (THIS MUST BE PROVIDED)

Policy Number(s) (THIS MUST BE PROVIDED)

Expiry Date of current Policy Expiry Date of current Policy / MM / DD YYYY

Expiring Premium

Get a full quote from cleaning Insured

Get a full quote from cleaning Insured

1 Your Details

2Your Business

3Your Business Plan

For the types of cleaning and other work shown in the table below please add:

Type of Work

Category A

Category B

Category C

Category D

Category E

Category F

Category G

Category H – Non Cleaning

If yes please:

4Your Insurance Requirements

Please state if you require quotes for more than one limit

a) Public Liability Products Liability incorporating:

Limit of indemnity

Optional Extensions:

5Your Health & Safety Procedures

Please state the name & position of the person responsible for this

6General Questions

Employee Vetting

Do you carry out work:

If you have answered “Yes” to any of the shaded boxes in question 14 please provide full details below

Loss of Keys Extension

If you have opted for this extension please advise:

How are the keys kept safe:

7Your Business History & Claims Experience

If YES, please provide the following details, including the present position on any claims outstanding against you :

Have you or any director or partner ever: