Underwritten by Allianz Australia Insurance Limited
ABN 15 000 122 850 AFSL 234 708
2 Market Street Sydney 2000
Club Marine Business Insurance Proposal
Important Notices. Please read this section before completing this proposal.
Your Duty of Disclosure: Before you enter into this insurance contract How to fill out this Proposal: For questions with multiple choice answers,
with us for the first time, the Insurance Contracts Act 1984 requires you please select from the box next to the correct answer. For other questions,
to provide us with the information we need to enable us to decide please write the information requested in the spaces provided. Make sure
whether and on what terms your Proposal for insurance is acceptable you have read the Policy Document we have given to you. If you require
and to calculate how much premium is required for your insurance. another copy of the Policy Document or any assistance, please contact your
insurance broker or agent.
You will be asked various questions when you apply for this Policy. If there is inadequate space to answer any questions, please use the
When you answer these questions, you must: additional space at the rear of the Proposal or attach a separate sheet of
* give us honest and complete answers; paper. Show the page number and question before the information you wish
* tell us everything you know; and to add, e.g. page 2, Interested Parties' addresses.
* tell us everything that a reasonable person in the circumstances could
be expected to tell us. Definitions:
“we”, “our”, “us” or “Allianz” means Allianz Australia Insurance Limited AFS
You do not need to tell us about any matter: Licence No. 234708 ABN 15 000 122 850 (except in the declaration).
* that diminishes our risk; “you”, “your” means the person proposing for this insurance and any person
* that is of common knowledge; seeking to be named on the Schedule.
* that we know or should know as an insurer; or “Excess” means either the amount of money specified in the Schedule or
* that we tell you we do not need to know. otherwise stated in the Policy for each applicable Section that you must
contribute as the first payment for all claims arising out of one event, or the
Who does the duty apply to? Everyone who is insured under the Policy period specified in the Schedule or otherwise stated in the Policy for which no
must comply with the relevant duty. payment will be made by us. There is a special Excess which applies to loss
or damage caused by an earthquake. The Excess is the lesser of $20,000 or
What happens if you or they do not comply with the relevant duty? If you an amount equal to 1% of the total Sum Insured for all Property Insured at the
or they do not comply with the relevant duty, we may cancel the Policy or Situation under Section 1. The Excess applies to all loss or damage
reduce the amount we pay if you make a claim. If fraud is involved, we occurring within the 72-hour period immediately after the earthquake.
may treat the Policy as if it never existed and pay nothing.
This Proposal uses words that have a special meaning. The definitions of
Duty on renewals, variations and reinstatements: A different duty these words can be found in the Policy Document.
applies for any variation or renewal or reinstatement of the Policy.
Please refer to your Policy Document for this duty. Underinsurance: Section 1 - Material Damage, Section 2 - Business
Interruption, Section 8 - Breakdown, and Section 12 - Boat Dealer Risks of
Privacy Act 1988: The Privacy Act 1988 requires us to tell you that as an this Contract contain underinsurance clauses. It is important in these
insurer we collect your personal and other information in order to: Sections that you insure the full value of property, Average Income/Gross
* decide whether to issue a Policy; Profit and declare the total number of machines. If you do not do so, You will
* determine the terms and conditions of your policy; be underinsured and we will not pay your claim in full.
* compile data; and
* handle claims. Claims Made and Notified Sections: The following Section provides insurance
on a „claims made and notified‟ basis: 1. Section Eleven – Occupational
We disclose personal information to third parties who we believe are Liability
necessary to assist us and them in providing the relevant services and These sections will only respond to Claims first made against you during the
products. For example, in handling claims, we may have to disclose Period of Insurance and notified to us during the Period of Insurance. To the
your personal and other information to third parties such as other extent permitted by law, we will not pay for any Claim that you notify us of
insurers, reinsurers, loss adjusters, external claims data collectors, after the Period of Insurance has expired.
investigators and agents or other parties as required by law. We limit Please note that under sub section 40(3) of the Insurance Contracts Act 1984
the use and disclosure of any personal information provided by us to (Cth), where you give notice to us in writing of facts that might give rise to a
them for the specific purpose for which we supplied it. Claim under Section Fourteen as soon as reasonably practicable after you
become aware of those facts but before the Period of Insurance expires, we
You have the right to seek access to your personal information and to are not relieved of liability under your Policy in respect of the relevant Claim,
correct it at any time. Please contact us on 1300 360 529, EST 9am - when made, by reason only that it was made after the Period of Insurance.
5pm, Monday-Friday and advise us of any changes. If you do not agree We do not cover certain prior or pending Claims. Refer to each Section in the
to the collection of your personal information then, unfortunately, we will Policy for details.
be unable to process your Proposal.
From time to time we may advise or offer you information on other
Allianz products or services that may be relevant and of interest to you.
If you do not wish to receive these offers or information please call the
Allianz Direct Marketing Privacy Service Line – Freecall 1800 000 284,
EST 9am-5pm, Monday-Friday.
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General Information
Quotation, New Business or Renewal (Select) Quote Number
Quotation TBA
Intermediary Name Contact Name Phone Number
Contact Name For Insured Phone Number Fax Number
Is the Insured a existing agent for Club Marine? No
If you are an agent for any other insurer(s), please list insurer(s) name(s)?
Holding Insurance Company Premium Paid Last Yr Current Policy Expiry Date
This policy does not cover the following activities
Marine surveying Sale of motor vehicles Tourist activities, including diving
Marine Engineering/Design Sale of motorcycles
Mining Barges Salvage
Oil rigs Watercraft for hire / hire & drive / rental/reward / charter / loan/courtesy, etc
Ship Building Watercraft / vehicles / trailers built to carry hazardous vehicles & related exposures.
Period of Insurance Effective Date 12/14/2010
Expiry Date 12/14/2011 at 4:00pm
Are you registered for GST? Yes
ITC %
The Insured / Company / Sole Traders Names ABN applicable
1.
2.
3.
4.
Trading Name(s)
1.
2.
3.
Principal activity
How many years have you owned/operated a Marine Business? < 2 years
Underwriting Criteria
Have you alone, in partnership, jointly with any other party or, if a corporation, jointly with any of its directors:
1. suffered any loss(es) (insured or otherwise) totalling more than $5,000 in the last 12 months or totalling more than
$10,000 in the last 3 years or had 2 or more claims in any one policy year? Details No
2. in the last 5 years had any insurer decline any claim or proposal, cancel or refuse to renew a policy, increase
premium or impose special terms, conditions or restrictions on a policy? No
3. in the last 5 years been placed in receivership or liquidation or declared bankrupt? No
4. in the last 10 years been convicted of or had any fines or penalties imposed for any crime involving drugs,
dishonesty, arson, theft, fraud or violence against any person or property? No
If you have answered "Yes" to any of these questions, please attach full details.
Interested Parties Address Nature of their interest
Number of Employees including labour hire and casuals :
Principals/Manager Yard/Ship Personnel
Sales Workshop Personnel
Accounts Personnel Other
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Estimated Gross Turnover of business from:
Activity $ Number Additional Information
Sale of Jetski's all $ - 0
Sale of Watercraft 1m to 15m $ - 0
Sale of Watercraft 16m to 20m $ - 0
Sale of Watercraft; over 20m $ - 0
Jetski's on consignment all $ - 0
Consignment Watercraft 1m to 15m $ - 0
Consignment Watercraft 15m to 20m $ - 0
Consignment Watercraft over 20m $ - 0
Refuelling Operations $ - 0
Marina Berthing fees $ - 0
Charter & Hire Fees $ -
Commissions including Finance $ -
Sub Total $ - 0
Spare parts for (motors, boats, trailers) 0
Chandlery Sales $ - 0
Servicing/repairing watercraft 0
Slipping Fees $ - 0
Dry docks or racks $ - 0
Total value of Sub-contracted Work $ - 0 Example. - MINOR HULL REPAIRS
Sub Total $ - 0 Describe Sub-Contracted Work Activities above
Total Declared Turnover $ - 0
Are any of the watercraft for sale custom built? No
If 'yes', who designs and builds
Do you perform "mast stepping" rigging activities? No
If 'yes' is this function carried out by the business or outsourced to a contractor (include contractor's name).
What percentage of Watercraft are delivered to customers by water? 0%
Describe any other business activity not described above and or any business activity that is not normally considered to be
connected to a Marine Business
Please Note: this policy is not designed to protect non Boat Dealer/Marina activities.
What major franchises are held or brands that you sell? %
1
2
3
Do you have a floorplan, finance or similar arrangement to purchase stock of watercraft? No
Financiers Name
Maximum limit - floorplan $ - Average usage - floorplan $ -
Which boat shows do you display at? (Include Name of show, Location, Dates, etc)
Estimated max replacement value of all Boats Displayed at Boat Shows Per Annum $0
The number of boat shows you attend per annum : - in Australia, - Overseas
Are electrical cables, power point switches, mains box, regularly checked and maintained? Yes
Last date inspected
Please complete "Declared Asset Schedule" tab before proceeding any further.
Section 1 - Material Damage
Summary of this Section
This section covers you for loss or damage to your Buildings, their Contents, employee tools, Watercraft and trailer whilst on land not otherwise
excluded and it also provides a number of additional benefits. This section will not cover watercraft whilst on water.
Is this section required? Yes
Limit of Indemnity (any one Situation / any one Event)
Declared Values (Total all situations) if more than one situation, refer split up in the asset schedule.
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Building(s) $ Not Insured
Piers, wharves, pontoons, dry racks $ Not Insured
Contents including electronic equipment, employee tools. $ Not Insured
Stock consisting of :
General merchandise including Parts and Accessories excluding tobacco, cigarettes, fuel in storage tanks, Trailers,
Watercraft and Customers Goods/Watercraft. $ Not Insured
Petrol, diesel, LPG, oil or any other fuel held in storage tanks owned by you or for which you are legally responsible. $ Not Insured
Stock of Watercraft (incl. trailers) excluding Customers' Goods, consisting of:
Watercraft for sale excluding Watercraft on consignment. $ Not Insured
Watercraft on consignment for sale. $ Not Insured
Customers‟ Goods excluding Watercraft on consignment for sale. $ Not Insured
Specified Items $ Not Insured
Specified Items $ Not Insured
Specified items $ Not Insured
Total All situations, as declared by You at each Situation $ Not Insured
NOTE: Refer to Section Three - Theft and Section Eleven
Sub limits and Additional benefits (any one Situation / any one Event)
Pre-completed values are standard policy limits. Higher values may be selected for additional premium.
Accidental damage $ 100,000
Employees‟ tools of trade For each employee per event $ Not Insured
Removal of debris The greater of $20,000 or 20% of Declared Value at the Situation or $ 20,000
Temporary removal of Contents and Stock in trade (other than Watercraft). Max $10,000 $ Not Insured
Temporary removal for Watercraft. Max $50,000 $ Not Insured
Works of art, antiques and curios ( any one item ) $ Not Insured
Extra Cost of Reinstatement $ Not Insured
Hail Damage to Stock of Watercraft in the Open Air. $ Not Insured
Others Parts & accessories in transit $ Not Insured
Others $ Not Insured
Others $ Not Insured
Optional Benefit
Fusion: (limit as per the policy wording) No
Flood No
Diminished Value Allowance No
Excesses
Loss or Damage to Watercraft Per watercraft $ 500
Max. per event $ 2,500
Employees‟ Tools Per event $ 500
Hail damage to Stock of Watercraft in the Open Air $1,000 for each Watercraft and $30,000 in total, for any one Event
Earthquake Lesser of $20,000 or 1% of Total Declared Values at the Situation
Named Cyclone Per event $ 500
All other Events Per event $ 500
Section 2 - Business Interruption
Summary of this Section
This section covers you for the consequential loss that you sustain as a result of an event that would give rise to a claim under Section One and Three
and a number of additional benefits. This policy will not cover watercraft whilst on water.
Is this section required? Yes
Limit of Indemnity (any one Situation / any one Event)
Indemnity Period (Months) (Months) Nil / Not Required
Declared Values (Total all Situations)
Annual Gross Profit
Payroll (if not included Gross Profit) - Weeks $ Not Insured
Loss of rent receivable Weeks $ Not Insured
Uninsured Working Expenses
$ Not Insured
$ Not Insured
$ Not Insured
Total Declared Value $ Not Insured
Optional Benefits
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Additional increase in cost of working $ Not Insured
Accounts receivable $ Not Insured
Claims preparation expenses $ Not Insured
Suppliers' and/or customers' premises (to 20% of the Total Declared Value) $ Not Insured
Section 3 -Crime
Summary of this Section
This section covers you for theft of your property, Loss of Money and breakage of Glass and a number of additional benefits.
Is Defined Event 1 - Theft Cover required? Yes
Limits of Indemnity Limit any one claim
Contents including Stock consisting of :
General merchandise including Parts and Accessories
Petrol, diesel, LPG, oil or any other fuel held in storage tanks owned by you or for which you are
legally responsible.
Watercraft including consignment Watercraft and all associated Trailers new and used.
Sub limits and Additional benefits (any one Situation/any one event)
Employees' tools of trade Any one employee $2,000 & any one event $5,000 unless otherwise noted here: $ Not Insured
Temporary Removal Contents and Stock excluding Watercraft 20% of applicable limit shown above or $ Not Insured
Temporary Removal Watercraft 20% of applicable limit shown above or $ Not Insured
Other, please describe $ Not Insured
Optional benefits
Parts and accessories attached to Customers &/or your Stock where watercraft is not stolen. $ Not Insured
Excesses
Loss or damage to Watercraft, including theft of parts from Watercraft. Per Watercraft $ 500
Maximum per event $ 2,500
All other events Per event $ 500
Is Defined Event 2 - Money Cover required? Yes
Limits of Indemnity
Combined $ Not Insured
Outside Business Hours - not in Approved Safe, Strongroom or automatic teller machine. $ Not Insured
Excesses
All events $ 500
Is Defined Event 3 - Glass Cover required? Yes
Limits of Indemnity
Glass Replacement Value
Illuminated signs Replacement Value
Additional benefits
Frames, Tiles and Stock , Alarm tapes, signage and temporary shuttering $ 5,000
Excesses
All events $ 500
Section 4 - General Property
Summary of this Section
This section covers you against accidental damage to your declared property anywhere in Australia. Cover excludes theft from vehicles not securely
locked or left ungaraged overnight without being fitted with an active, operational & audible alarm.
Note there is no cover for stock of watercraft.
Is this section required? Yes
Limits of Indemnity
Unspecified Items (excluding electronic equipment) (Max Limit $2,000 any one item)
Stock $ Not Insured
Specified Electronic Equipment
Limit any one item
$ Not Insured
$ Not Insured
$ Not Insured
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$ Not Insured
Specified items (excluding electronic equipment) include items valued over $2,000.
Limit any one item
$ Not Insured
$ Not Insured
$ Not Insured
$ Not Insured
Excesses
All events $ 500
Section 5 - Public And Products Liability
Summary of this Section
This section covers amounts you are legally liable to pay as compensation for personal injury and/or property damage as a result of an occurrence in
connection with your Marine Business within the Territorial limits. Note this policy will not cover mechanical or structural repairs, building/rebuilding,
chandlering, ownership of a marina, ownership or operation of a slip, rigging or painting.
Is this section required? Yes
NB: Customers' Goods cover in this policy is legal liability cover. For full accidental damage cover refer material damage sections.
Limit of Indemnity
General liability Any one occurrence $ 10,000,000
Products liability Limit any one occurrence and in the aggregate during any one period of insurance $ 10,000,000
Sub Limits
Resulting damage from faulty workmanship. $ 10,000,000
Customers' Watercraft/Vehicles in physical or legal control. $ 500,000
Customers' Goods in physical or legal control excluding Watercraft &/or Trailers. $ Not Insured
Declared Turnover $ -
Optional benefits
Cost of Rectifying Faulty Workmanship (Cover not available for Ship repairers) $ Not Insured
Do you import products ? No
If "Yes", please describe items imported and where imported from. Include brochures of items, Include turnover figures. Also include information of
how products are suitable for purpose if imported to Australia.
If Yes, please state the % of turnover applicable 0% Country Import
Do you export products ? 0% Country Export
If "Yes", please describe items exported and where exported to. Include brochures of items, Include turnover figures. Also include information of how
products are suitable for purpose for the country exported to.
Have you assumed obligations under any contract or agreement, eg waivers of liability, hold harmless or
indemnification agreements? If "Yes" provide full details. No
Do you provide professional, technical, consultancy, advisory services or the like either for a fee or as an
ancillary service to your business ? No
If you answered "Yes" to the above question you should consider and discuss with your insurance advisor Section 14 - Occupational
Liability.
Describe any business activity performed away from the business location(s).
1. Within Australia
2. Overseas
3. Where application of heat or use of welding is involved.
Do you have a formal Occupational Health & Safety Program that has been or is being implemented ? Yes
Do you hold or conduct Marine Surveys & or issue Seaworthiness Certificates Details No
Do you engage contractors to perform work on your behalf ? No
If Yes please describe what activities undertaken by contractors
Excesses
All claims for faulty work/rectification on Watercraft under 20 metres $ 1,000
Property in physical or legal control excluding faulty work/rectification per Watercraft $ 500
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per event $ 2,500
Bodily injury Nil
All other claims excluding bodily injury $ 1,000
Section 6 - Commercial Motor
Summary of this Section
This section covers you for damage to your Vehicles whilst being driven by you or your employees. It provides cover for Vehicles registered in the
name of the business and used specifically for a purpose within the business. This section will also cover your liability to pay for damage or injury
caused by your Vehicles (other than injury covered by a CTP policy).
Is this section required? Yes
The cover
Part "A" – Loss or Damage to Vehicles Not Insured
Part "B" – Liability to Third Parties $ -
Property Damage and Bodily Injury (CTP Gap Liability) as per policy.
This section can only provide cover for Vehicles registered in the name of your Marine Business, insure other Vehicles separately.
Specified vehicles
Please provide details of Specified Vehicles in the Specified Vehicles schedule page of this proposal.
Is there any other information that may be relevant to our decision to insure you or the terms on which we would
agree to insure you ? (if "Yes" please provide details below) No
Optional benefit applicable to Part "A"
Removal of basic excess for windscreen claims No
Hire costs following an accident No
Excesses
Basic $ 400
Additional Excess: All drivers up to the age of 21 $ 850
Additional Excess: Drivers aged between 21 and 25 $ 500
Inexperienced Drivers Excess , Drivers aged over 25 but have held their licence less than 2 years $ 500
Section 7 - Employee Dishonesty
Summary of this Section
This section covers you for loss of your property resulting from the fraudulent or dishonest act(s) of your employees.
Is this section required? Yes
Limit of Indemnity - in respect to any one Employee or all Employees $ Not Insured
Staff Numbers
Staff with no access to money, cheques, parts or keys Nil / Not Required
Staff with access to payroll, money, cheques, parts or keys Nil / Not Required
Staff employed to arrange finance or insurance for customers Nil / Not Required
Additional benefits
Retroactive Period, limit 12 months prior to inception of this section. Insured
Security Questions
How often are bank statements and books of accounts reconciled? Weekly
How often are stock takes conducted? 6 Monthly
Do you check references before hiring employees? Yes
Method used to pay wages. Cheque
Other Information
Please describe in full any other information that may be relevant to our decision to insure you or the terms on which we would agree to insure you.
Excess $500
Section 8 - Breakdown
Summary of this Section
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This section covers you against breakdown only of your machinery and electronic equipment with a number of additional benefits.
Is this section required? Yes
Blanket Machinery
Blanket Machinery Limit any one loss $ Not Insured
Specified Machinery.
List below the description/capacity/size/power. Limit of Indemnity
$ Not Insured
Specified Electronic Equipment
List below the description details Replacement Value
$ Not Insured
Optional benefits
Deterioration of Stock $ Not Insured
Restoration of data $ Not Insured
Increased cost of working $ Not Insured
Excesses
Blanket cover any one loss $ 500
Specified machinery or electronic equipment any one loss $ 500
Deterioration of stock. The greater of 10% of each loss or $500
Restoration of data. 5% of the loss with a minimum of $500
Increased cost of working per event 2 Days
Section 9 - Tax Audit
Summary of this Section
This section will reimburse you for the costs of retaining professional advisers required to respond to a Tax Audit required by an Australian statutory
authority but excluding personal taxation affairs.
Is this section required? Yes
Limit of Indemnity $ Not Insured
Underwriting Information
Is an annual external audit conducted? No
Are regular internal audits conducted? No
Has an audit by a Commissioner of Taxation been conducted? No
Has a notification of a forthcoming or likely Tax Audit been received or have you any reason to believe that you are likely to be
subject to a Tax Audit ? No
Have you had any fines or penalties in the last 5 years following a Tax Audit ? No
Please provide details if you have answered "Yes" to any of the questions above or describe in full any other information that may be
relevant to our decision to insure you or the terms on which we would agree to insure you.
Excesses
Basic excess Greater of 10% of the Professional Fees or $ 500
Section 10 - Inland Transit
Summary of this Section
This section covers you for loss or damage to Watercraft and parts whilst in a conveying vehicle, vessel, aircraft or train within Australia only, plus a
number of additional benefits. Note that limitations apply to the Theft cover see "Product Disclosure Statement".
Is this section required? Yes
Type of cover required. Fire, Collision and Overturning and Theft Part B
Part A = Fire, Collision and Overturning. Part B = Fire, Collision and Overturning and Theft. Part C = All Risks not excluded.
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Limits of Indemnity - Any One Conveyance
Watercraft $ Not Insured
Parts and Accessories $ Not Insured
Other merchandise and goods. Please describe.
$ Not Insured
Optional benefit
Diminished Value Allowance Not Insured
Institute Cargo Clauses Not Insured
Underwriting Information
Estimated annual value of goods being transported
Watercraft $ Not Insured
Parts and Accessories (Incoming) $ Not Insured
Parts and Accessories (Outgoing) $ Not Insured
Goods and other merchandise (Incoming) $ Not Insured
Goods and other merchandise (Outgoing) $ Not Insured
Other merchandise and goods $ Not Insured
Total $ Not Insured
Other Information
Please describe in full any other information that may be relevant to our decision to insure you or the terms on which we would agree to insure you.
Excesses
Watercraft Per Watercraft $ 500
Per event $ 2,500
Parts and Accessories Per event $ 500
Goods and other merchandise Per event $ 500
Other Per event $ 500
Section 11 - Occupational Liability
This section covers you for claims you are legally liable to pay as compensation due to a breach of your professional duty in the conduct of your
business plus a number of additional benefits. Cover is provided a 'claims made and notified' basis.
Is this section required? Yes
Important Notice : Claims Made Section
This section operates on a "Claims Made and Notified" basis. Full details are contained in the Policy document.
General Questions
1. Have any claims, either successful or otherwise, ever been made against you or your subsidiaries or related companies or their
predecessors in business or any present or past director or principal? (If Yes, please attach full details). No
2.
Are you, or any of your directors, principals or senior managers, after enquiry, aware of any fact or circumstance which may give rise
to a claim, against you or your subsidiaries or related companies or your or their predecessors in business or against any current or
former director or principal whether you consider yourselves liable or not? (if Yes, please attach full details).
No
3.
Has any application for insurance in respect of you or your subsidiaries or related companies or your or their predecessors in
business ever been declined, cancelled, renewal refused or had special terms imposed? (if "Yes", please attach full details).
No
4. Is it the opinion of the Directors that there are reasonable grounds to believe that the business will be able to pay its debts as and
when they become due and payable?(If No, please attach full details). No
5.
Are your financial statements and or Income Tax Returns prepared by or checked by an external accountant, tax agent or auditor?
No
6. Is it the opinion of your external accountant, tax agent or auditor that your accounts comply with relevant accounting standards and
represent a "true and fair" view? No
7. Were your financial accounts prepared on the basis of a "going concern" assumption? No
8. If your accounts were audited, were they qualified in any way? No
9. Are you aware of any significant changes likely to occur to your business operations? No
Insuring Clause A - Directors and Officers Not Insured
Summary of Insuring Clause A
This section covers you and your directors and officers for claims they are legally liable to pay as compensation for any wrongful acts committed or
alleged to have been committed by them in conduct of your Marine Business.
Limit of Indemnity $ Not Insured
Total Current Assets You must attach $ Nil / Not Required
Total Current Liabilities the financial $ Nil / Not Required
Liquidity Ratio statements to 0% $ Nil / Not Required
this proposal.
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Total Assets $ Nil / Not Required
Total Liabilities $ Nil / Not Required
Shareholders Equity 0% $ Nil / Not Required
Gross Profit (last 12 months) 0% $ Nil / Not Required
Net Profit (last 12 months) 0% $ Nil / Not Required
Date of report from which the financial information above was extracted.
Other Information
Please describe in full any other information that may be relevant to our decision to insure you or the terms on which we would agree to insure you.
Excesses $ 1,000
Insuring Clause B - Errors and Omissions Insured
Summary of Insuring Clause B
This section covers you for claims you are legally liable to pay as compensation due to a breach of your professional duty in the conduct of your
Marine Business.
Limit of Indemnity $ Not Insured
Underwriting Information
1. Do you have operations or perform work outside of Australia? (if Yes, please attach full details). No
2. Do you perform work for clients outside of Australia? (if Yes, please attach full details). No
3. Do you have or perform any financing activity other than being an agent for a financial institution in the arranging of finance
concurrently with or as incidental part of the sale of a Watercraft? (if Yes, please attach full details). No
4. Have any claims, either successful or otherwise, ever been made against you or your subsidiaries or related companies or their
predecessors in business or any present or past director or principal? (If Yes, please attach full details). No
5. Are you, or any of your directors, principals or senior manager, after enquiry, aware of any fact or circumstance which may give rise
to a claim, against you or your subsidiaries or related companies or your or their predecessors in business or against any current or
former director or principal whether you consider yourselves liable or not? (if Yes, please attach full details).
No
6. Has any application for insurance in respect of you or your subsidiaries or related companies or your or their predecessors in
business ever been declined, cancelled, renewal refused or had special terms imposed? (if Yes, please attach full details).
No
7. Do you provide tuition / classes on how to handle Watercraft for a fee? No
8. Do any insured persons hold outside directorships at the request, or with the consent, of the corporation or its subsidiaries for which
cover is required? If 'yes' is selected, please provide details below: No
Name of Director Name of outside entity Reasons for holding directorship Details of current D&O insurance
for outside company
(Insurer, Limit of Indemnity, Excess)
For each organisation declared above, please provide details of any shareholder with more than 15% shareholding.
Excesses
Claims under Additional Benefit Trade Practices Act, Fair Trading Act/s $ 1,000
Claims under Additional Benefit Libel and Slander $ 1,000
Claims under Additional Benefit arising from activities as a Finance or Insurance Agent $ 1,000
All other Claims $ 1,000
Insuring Clause C - Employment Practices Not Insured
Summary of Insuring Clause C
This section covers you and your employees for claims they are legally liable to pay as compensation for any claim for certain employment practices
and costs and expenses you incur defending the claim.
Limit of Indemnity $ Not Insured
Underwriting Information
Do you have a written policy on sexual harassment and anti discrimination ? No
Do you have documented procedures for the termination of employees ? No
Do you seek external legal advice on employment issues ? No
Do you have an employee manual? (Please attach to proposal if more than 100 employees) No
Number of employees -
As at Dec 2009 0
As at Dec 2010 0
As at Dec 2011 0
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Average over last 3 years
Number of employees ceased employment last year 0
Number of employer-initiated staff terminations in the last 3 years 0
Number of employees currently earning in excess of $80,000 p.a. 0
Number of employment Practices cases brought against you in the last 3 years 0
Optional Benefit
Insolvent Trading Not Insured
Note: If cover is required, financial statements must be provided.
Excesses $ 1,000
Section 12 - Boat Dealer Risks
Summary of this Section
This covers you for loss or damage to your boats and boats that you display and demonstrate for the purpose of sale. It also covers you for your legal
liability to pay compensation to third parties for damage or injury caused by your boat(s) that you are displaying or demonstrating. This will not
cover watercraft used for hire, charter, hire & drive, rental ,courtesy, loan or reward or "in survey".
Is this section required? Yes
PART A - Loss or Damage to the Insured Boat
Total value of all watercraft for sale (Carried forward from General Information section) $ -
Total value of all watercraft on dislplay at Boat Shows annually $0
Limit any one Watercraft excluding on consignment Up To $0
Limit any one Watercraft on consignment Up To $0
Number of Insured Boats on water at any one time ? 0 Limit any one Boat $0
Total Value All Boats $0
Number of Personal Watercraft on water at any one time ? 0 Limit any one P/ Watercraft $0
Total Value All P/Watercraft $0
Additional benefits Part A ( as per the policy wording )
Trailer
Slipping incidental to repair
Reasonable Salvage Charges
PART B - Legal Liability to Third Parties
Limit of indemnity Boats $ Not Insured
Personal Watercraft Not Insured
Optional Benefit Part B
Water Skiing Not Insured
Optional Benefits applicable to Part A and Part B
Personal Use of Boats &/or Personal watercraft Not Insured
Social Yacht Racing Not Insured
Yacht Racing Not Insured
Time Trails Not Insured
Specified Watercraft
Year Make Model Value Use
1. -
2. -
3. -
Watercraft Displayed at Boat Shows
Number of Boat Shows Per Year - Total Value $0
Boat shows noted as regularly attended by insured
As per details provided in the General Information section.
Excesses
Personal Watercraft $ 1,000
Boats other than Personal Watercraft $ 500
Maximum any one loss $2,500
Theft of accessories/Malicious damage $ 500
Section 13 - Marina Liability
Summary of this Section
This covers you for amounts you are legally liable to pay as compensation for certain personal injury and/or property damage which occurs in
connection with your Marina Business. This section also has optional benefits for slipway operation and repairers liability. You may purchase these
optional benefits for an additional premium.
Is this section required? Yes
Number of berths less than : 5m 10m 15m 20m 25m Over 25m
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Fixed 0
Swing moorings
Rack & stack
Dinghy racks
Buoys
Average value per boat $ - $ - $ - $ - $ - $ -
Total insured value of boats held as at date of application $ Not Insured
Number or percentage of berths for private customers 0
Number or percentage of berths for business 0
Limit of Liability any one occurrence $ Not Insured
Is the marina affiliated with a resort, club, etc? No
Are there plans for structural alterations to the marina in the next 5 years? No
Are demolition works contemplated or being planned for the next 5 years? No
If 'yes', have plans or concepts been submitted to council? No
Does a Dock master or caretaker live on premises? No
Security
Please provide details of security in the Asset Schedule page of this proposal.
Facilities Declared Values
Shower $ Not Insured
Storage specifically for dingys $ Not Insured
Toilets $ Not Insured
Club house $ Not Insured
Other Tenancies, please list :
Parking facilities owned or operated : Number of parking spaces 0
Is a fee charged for parking No
Does insured engage contractors to perform work at the Marina ? No
Is the business involved in fuelling operations? No
Self fuel or Attendant? Attendant
Location of fuel In ground In water Above ground Above water
tanks/capacity : (litres) TBA
No. of pumps 0 Are we covering owners liability for tanks? No
Do you own the tanks used to store fuel? No
If 'no': a) Who owns the tanks?: b)Are the tanks insured? No
If there are any plans to remove/close/upgrade tanks in next 3 years please provide details.
If any of the storage tanks have ever had a leak/spill or release in the past please provide details.
If you have had action taken by any authority as a result of environmental damage caused by or through the tanks please provide details.
If you have been fined by any agency or authority for breaches of an environmental nature please provide details.
Are all tanks in compliance with current EPA regulations? No
When were tanks installed, if more than one tank advise individual dates.
Have tanks been lined? No
Tank leak protection used:
Auto Tank guage
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Dipstick monitoring
Visual
Other, describe
Date piping installed Piping construction
Length of piping from tanks to fuelling area: metres
When was piping last checked for leaks?
Dispenser method
Types of fuel offered:
Describe safeguards in place against spillage or leaks:
Optional Benefits
Slipway Operation No
Repairer's Liability No
Rectification of Faulty Workmanship Consequent Upon Damage No
Rectification of Faulty Workmanship $ Not Insured
Boat Builders Liability No
Excesses
Basic $ 1,000
Losses arising out of storage of fuel or fuelling operations $ 2,500
Slipway Operation $ 2,500
Repairer's Liability $ 2,500
Rectification of Faulty Workmanship Consequent Upon Damage $ 2,500
Section 14 - Watercraft Repairer's Liability
Summary of this Section
This covers you for amounts you are legally liable to pay as compensation for damages resulting from loss or damage to watercraft, conents or
machinery and equipment of watercraft in your possession, removal of wreck, loss or damage to third party property which occurs in connection with
your Watercraft Repair Business. This section also has optional benefits for detention of any watercraft, death or personal injury of third parties,
rectification of faulty work and when you or your employees work on board a watercraft at sea. You may purchase these optional benefits for an
additional premium.
Is this section required? Yes
Limit of Indemnity required: $0
Number of years in the watercraft repair business? 5 Years
Number of employees: Full Time 0 Part Time 0
Please advise your annual watercraft repairing revenue for this year, and the estimated revenue for next year.
Income - Repair: This year $0 Estimated next year $0
Please provide full details of your repair facilities i.e. graving docks, floating dry docks, syncrolifts, repair sheds etc. Please provide plans, brochures etc.
Please detail the type of repairs that you perform, split as a percentage of watercraft repair revenue:
Hull (non Hot Work) 0% Engine 0%
Burning /Welding /Hot Work 0% Electrical 0%
Painting 0% Boiler 0%
Please advise the types of watercraft on which you work, split as a percentage of revenue:
Passenger Vessels 0% Other 0%
Yachts 0% Please provide details below
Motor Cruisers 0%
Do you perform watercraft conversion /reconstruction work? No
If “Yes”, what percentage of annual ship repairing revenues does this represent: 0%
Do you perform any work on watercraft that is not repair, reconstruction or conversion work? No
If “Yes”, please describe the nature of such work and advise what percentage of annual watercraft repairing revenues this 0%
represents.
Details:-
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Please advise how much work you sub-contract out, as a percentage of revenue. 0%
What type of work do you sub-contract out?
Do you have a sub-contractor vetting programme or Approved Contractor Scheme? No
What percentage of your annual watercraft repairing revenues are from work sub-contracted in? 0%
Within how many kilometers from the yard are the following operations performed?
(a) watercraft movements in connection with repair operations: 0 Klms
(b) Watercraft test /trials: 0 Klms
Please advise the extent of any contractual liability arising from vessel movements, test or trials.
Are gas-freeing operations performed at your yard(s)? No
If “Yes”, is gas-freeing certification issued by your own employees or by outsiders?
If your own employees perform gas-freeing work, please provide details of their names, experience and professional qualifications:
If outsiders perform gas-freeing work, do you have any contractual liabilities relating to this?
How close is the nearest Public Fire Department Station? 0 Klms
Please provide full details of your own private fire fighting resources:
What is the maximum number of vessels in your yard at any one time?
Please provide details of any repairs carried out away from the yard.
What percentage of annual ship repairing revenues does this represent? 0%
Please provide details separately of any work performed other than watercraft repair, such as fabrication, general engineering,
assembly etc, including annual revenue.
Is yard fenced? No
Please describe security measures, including watchmen.
Please provide details separately of:
a) Hot Work Safety Procedures
b) Yard Safety Management Programme
Please provide copies of:
a) your standard contract terms, including applicable limitations of liability.
b) any contract that extends your contractual liability beyond the terms of your standard contract.
Please provide details of any hold harmless or indemnity that you have given to another party under any agreement.
Optional Benefits
Detention No
Personal Injury No
Rectification of Faulty Workmanship Consequent Upon Damage No
Rectification of Faulty Workmanship Limit $ Not Insured
Travelling Workmen No
Excesses
Basic $2,500
Declaration
This declaration applies to all the insurances being applying for.
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I/We declare and agree:
1. that I/we have received or have been offered a copy of the Marine Business Insurance Policy Document;
2. that I/we have read the information concerning the Duty of Disclosure and other Important Notices;
3. that I/we have been truthful and accurate in completing this form and declaration and have not withheld any information likely to affect the acceptance
of this insurance;
4. that I/we have either completed this form personally or, if it has been completed by somebody else, I/we have checked that the questions have been
fully and accurately answered;
5. to make the Premises available for inspection by us if so requested;
6. that upon acceptance, this insurance shall be subject to the Marine Business Insurance Policy;
7. that where personal information has been provided on someone else's behalf, that person consented to this provision;
8. that I/we have read and understood the Privacy Act 1988 information and consent to the collection, storage, use and disclosure of personal and
sensitive information of all persons covered in this document.
9. that if anything happens during the Period of Insurance that alters any of the information provided, I/we will promptly inform the insurer.
10. that I/we realise that if I/we have not complied with the Duty of Disclosure and Duty of Good Faith any claims may not be met.
11.
that we will only agree to offer insurance as described herein. If your quotation request or broker's invoice contains terms and conditions that differ
from those described herein, these will not be binding on us and will not form the basis of the contract between you, the insured and us.
12. that completion and submission of this proposal in electronic form by your agent or broker is acknowledged as being "signed".
Signature Name Position Date
Lodgement
When completed, please email the completed declaration to "marinebusiness@allianz.com.au"
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Club Marine Business Insurance
Proposal
ASSET SCHEDULE: Description of Properties Insured
Sit
Street Address Suburb Postcode State Occupation at each situation Age of Bldg Bldg Construction Construction - Floors
No.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
ASSET SCHEDULE: Security and Fire Protection
Fences
External After hours
Annually Alarm Type (must around Removable
Construction - Fixed Construction - Floating Fire Protection for security security
Sprinklers serviced fire protect entire premises perimeter Bollards or barriers
Marina Berths Marina Berths hoses Windows lighting guards or
extinguishers or show "No alarm") and gates on (all Exits)
after hours patrols
all exits
update selections update selections
ASSET SCHEDULE: Declared Values
Stock of petrol, diesel, Stock of Stock of Customers‟
Contents General merchandise including
Piers, LPG, oil or any other Watercraft for sale Watercraft Goods Total
Buildings including Parts and Accessories excluding
wharves, fuel held in storage (incl. trailers) (incl. trailers) excluding Section 1:
(Including electronic tobacco, cigarettes, fuel in storage
pontoons, dry tanks owned by you or excluding on Watercraft on Material
signage) equipment, tanks, Trailers, Watercraft and for which you are legally Watercraft on
racks consignment consignment Damage
employee tools. Customers Goods/Watercraft. responsible. consignment. for sale. for sale.
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
$ $ $ $ $ $ $ $ $
B = Brick/Massive
0 = Combustible
E = EPS ( Panel Foam )
R = Fire Resisting
M = Mixed
N = Non-combustible
0 - Not Sprinklered
1 - Sprinklered
Yes
No
Proposal
Specified Vehicle Cover : information for Section 8 - Commercial Motor
Vehicle Details
Estimated Check to
No Claim ensure that
Market
If there is a regular Bonus = all data is
Year of Engine size Rego Garaging Value/ Sum
Vehicle No. Make Model Body VIN Number driver, what is the Date of Birth Number of entered if a
Manufacture (Cylinders) Number Postcode Insured/
driver's name. years claim Driver's
Agreed
free Name is
Value
1 present.
No Record
2 No Record
3 No Record
4 No Record
5 No Record
6 No Record
7 No Record
8 No Record
9 No Record
10 No Record
Vehicle details - Accessories. This policy will cover all standard accessories on the vehicles valued under $1,500.
Please list any non-standard accessories or modifications(e.g non factory: turbo, suspension, paint, body kits) to the Specified Vehicles above.
Vehicle No. Accessories Detail
1
2
3
4
5
6
7
8
9
10
Additional Information
Describe all activities associated with the issuance of Marine Surveying below and details of qualifications:
1
2
3
4
5
6
7
8
9
10
Describe all activities associated with the issuance of Seaworthiness Certificates below and details of qualifications:
1
2
3
4
5
6
7
8
9
10
Claims Information
Details - Over $5,000 D.O.L Status Paid O/S
1 $0 $0
2 $0 $0
3 $0 $0
4 $0 $0
5 $0 $0
6
7
8
9
10
Details - Under $5,000 D.O.L Status Paid O/S
1
2
3
4
5
6
7
8
9
10