Commercial Combined

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					                                                                                 COMMERCIAL COMBINED

Broker name                   WML Brokers Ltd                              Contact name              Simon Allison
Broker address                5 The Orchard Denmead Waterlooville PO7 6YG
Telephone number              07972 584192                                 Fax number
                              02392 350105
Email address                 simon.allison@wmlbrokers.co.uk               Date submitted            16/09/2012
Renewal date                                                               Deadline date
Holding agent                                                              Last year’s premium       £
Holding insurer                                                            Target premium            £

Proposer’s / Insured’s details
Proposer’s name                                                            Co. Registration no.




Proposer’s address                                                         Website address

Address continued                                                          Town/City

County                                                                     Post code

Business description                                                       Year established

Amusement Arcade Propreitors including Licenced licenced gamong machiens

Bookmakers and Property Owners

All premises age restricted to 21 and over




Covers Required (please indicate with X)

Material Damage                                 Computers                                  Fidelity Guarantee

Business Interruption                           Engineering                                Frozen Food

Employers Liability                             PA/Sickness                                Loss of Licence

Public & Products Liability                     Business Travel                            Professional Indemnity

Contractors All Risk                            Marine Cargo                               Credit

Goods In Transit                                Legal Expenses                             Motor Fleet

Loss Of Money                                   Directors & Officers                       FULL Terrorism




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                                                                                COMMERCIAL COMBINED

Claim Experience in past 5 years
Date                Details (include circumstances and post loss action to prevent reoccurrence)   Amounts paid

                                                                                                   £
                                                                                                   Include any outstanding
                                                                                                   amounts not yet paid

Risk location 1
Address

Address continued                                                        Town/City

County                                                                   Post Code

Occupation / use

Risk location 2
Address

Address continued                                                        Town/City

County                                                                   Post Code

Occupation / use




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                                                                                           COMMERCIAL COMBINED

Risk Profile for location 1 ( ‘cut and paste’ this section as required for ALL additional locations )

Construction
Purpose built & walls of brick, concrete or stone (exposed steelwork to be fully enclosed in fire resistant                    Yes/No
material), concrete floor and roof with less than 10% combustible linings

Building suitable for occupation & concrete or steel framed with metal walls or roof, (walls/roof may include non-    Yes/No
combustible composite panelling as an external cladding) & concrete floors

Standard construction i.e. masonry walls, timber floors/mezzanine floor and roof covered with slate or tile or        Yes/No
multi-storey building with glazed curtain walling

Significant combustible elements, internal wall/roof linings, external timber claddings, timber frame structures or   Yes/No
buildings with combustible composite (sandwich) panels or unsuitable for trade

Combustible composite panels or linings anywhere within the construction of the building. If YES, state               Yes/No
description and type, condition and location (i.e. walls/roof/external/internal)

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Are the buildings:

Detached buildings in single occupation with minimum 10m separation from the nearest neighbour?
                                                                                                                               Yes/No
Either detached buildings or buildings separated by concrete block or brick wall up to the underside of the roof?
                                                                                                                               Yes/No
Other than the above, please provide full details

_______________________________________________________________________________________________________________

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Briefly describe general condition of buildings and maintenance regime




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                                                                                        COMMERCIAL COMBINED

Location and occupancy
Number of Hours occupied per day and per week?                                                                      Hrs per day
                                                                                                                    Days per week
Are any machines / processes operational whilst unattended? If YES, provide full details:                                    No

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If Subsidence, Ground Heave and Landslip cover is required, please state whether:

    the premises have suffered or are showing signs of such damage                                                         Yes/No

    the properties either side of you have suffered or are now showing signs of this damage                                Yes/No

    to your knowledge the vicinity is susceptible to such damage                                                           Yes/No

    the premises are in the immediate vicinity of any river bank, railway embankment or cutting, cliff or quarry,
    mine or other underground working or on made up ground
                                                                                                                           Yes/No
    there are any trees or shrubs over 20ft in height within 30ft of the premises
                                                                                                                           Yes/No
If 'Yes' to any of the above, provide full details:

______________________________________________________________________________________________________________

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Are the premises in an area susceptible to flooding?                                                                       Yes/No

- If “Yes” please provide details of any known improvements made/planned by the Environmental Agency




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                                                                                        COMMERCIAL COMBINED

Electrical
System installed within the last 5 years to relevant regulation standard                                                Yes/No

Systems more than 5 years old with tests/inspections in line with IEE or equivalent / or inspected by own               Yes/No
qualified personnel

Additional information if any:                                                                                  All certified Yes/No

Heating
System using ducted warm air or water filled radiators fed from a remote boiler and fuel source or no heating           Yes/No

Is oil tank bunded?                                                                                                     Yes/No

Other fixed heating/ describe (oil burner / wood stove)                                                                 Yes/No

Any portable heaters / Describe                                                                                         Yes/No

Fire Protection
Good automatic fire protection coverage heat/smoke detectors and signalling                                             Yes/No

Standard audible fire alarm (no connection)                                                                             Yes/No

What edition does the sprinkler installation conform to:- (must be maintained)

Nearest fire brigade                                                                                                     Miles

Number of fire hydrants within 500 m and diameter of supply pipe

Is smoking prohibited, and where is it permitted?

Are fire extinguisher appliances installed and regularly maintained?                                                    Yes/No

Is there any spraying?                                                                                                  Yes/No

Spray booth details

Is there any storage of stock to height and if so how high in metres?                                                   Yes/No

Does packaging take place?                                                                                              Yes/No

What are the storage arrangements for packaging materials?

Any ISO accreditation or Investors in People?                                                                           Yes/No

Any flammable liquids stored? If yes, state type    and quantity                                                        Yes/No

Describe housekeeping management, (congestion, accumulation, etc)

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Regular waste control and removal in place?                                                                             Yes/No

Is there a disaster recovery plan?                                                                                      Yes/No




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                                                                                    COMMERCIAL COMBINED

Security
Name of alarm installer:-

By which inspectorate is it approved (delete as applicable)

Alarm signal (e.g. Redcare, Digicom)

How many false alarms in the past 12 months

Does the alarm protect the entire premises

Type of protection: e.g. perimeter; glass sensor; volumetric; PIR’s / beams

Is CCTV in operation?

If YES is it: monitored or recorded? Please state tape retention (number of days)

Name of nearest 24-hour manned police station                                                    Miles

Distance

Is there 24 hour manned security on the premises?                                               Yes/No

Area – Predominately residential / commercial

Final exit door:

           Method of locking

           Materials

           Glazing

Do all doors have 5-lever mortice deadlocks complying with BS3621?

If no, provide details _____________________________________________________________________

Accessible windows:

           Method of locking

           Type of glass

           Grilles / Bars / Shutters

Entrapment devices (e.g. computer lockdown plates, etc.):-

Additional Protection




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                                                                                       COMMERCIAL COMBINED

Material Damage
Fire and perils / Theft / AD and all fixed glass including any external signs                        Yes/No

Subsidence                                                                                           Yes/No

Sprinkler leakage                                                                                    Yes/No

Terrorism                                                                                            Yes/No



              Buildings              Tenants
Location                                                    General Contents    Machienery   Stock            Computers
              (Declared Value)       Improvements

1             £                      £                      £                   £            £                £

2             £                      £                      £                   £            £                £

* provide detail for each miscellaneous item: __________________________________________________________________________

______________________________________________________________________________________________________________



Existing excesses / deductibles                                                                      £

Day One inflation provision                                                                          Yes/No

Percentage uplift                                                                                    25%

Extensions and clauses required

Additional Notes

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                                                                                      COMMERCIAL COMBINED

Business Interruption
Cover: as shown under Material Damage section

Financial year end

Turnover                                                                                                      £

Sums insured: gross profit                                                                                    £

Indemnity period                                                                                              12 Months

Additional increase in cost of working                                                                        £0

Loss of rent:                                                                                                 £

Indemnity period :                                                                                            ______________ Months

Book debts                                                                                                    £

Declaration basis                                                                                             Yes/No

Extensions: denial of access and/or exit (due to damage in the vicinity)                                      Yes/No

Customers extension (see note below)                                                                          Yes/No

Suppliers extension (see note below)                                                                          Yes/No

Failure of public utilities                                                                                   Yes/No

Sub-contractors premises                                                                                      Yes/No

Loss of attraction (due to damage in the vicinity)                                                            Yes/No

Contract sites                                                                                                Yes/No

Proportion of profit earned at contract sites                                                                 Yes/No

Advance profits (for business start-up, building extension)                                                   Yes/No

Murder / suicide                                                                                              Yes/No

Transit extension                                                                                             Yes/No

Infectious disease                                                                                            Yes/No

In the event of a loss, state what percentage of work can be carried on away from premises or independently
or sub-contracted out?                                                                                        _________________ %

Additional Notes

____________________________________________________________________________________________________________

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Excess applicable:                                                                                            £




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                                                                      COMMERCIAL COMBINED

Employers Liability
Health & Safety policy statement in place?                                                Yes/No

Have risk assessments been undertaken?                                                    Yes/No

Is there a specified individual responsible?                                              Yes/No

Is Health & Safety training provided?                                                     Yes/No

Are records maintained of each employees training?                                        Yes/No

Is safety clothing and equipment provided?                                                Yes/No

Is all machinery adequately guarded & maintained?                                         Yes/No

Are all safety notices/instructions prominently displayed?                                Yes/No

Is there an accident book?                                                                Yes/No

Is there any manual handling?                                                             Yes/No

Additional Notes

_____________________________________________________________________________________________________________

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Limit of indemnity required                                                               £ 10,000,000

Total number of employees:-



Category                                                                 Number           Wage Roll

Directors                                                                                 £

Clerical                                                                                  £

Manual                                                                                    £

Others/ detail info                                                                       £




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                                                                                   COMMERCIAL COMBINED

Public/Products Liability
Do you use heat away from the premises (if yes, please describe fully in notes)                     Yes/No

Limits of Indemnity
Public Liability                                                                       £ 5,000,000 any one loss

Products Liability                                                                     £ 5,000,000 aggregate

Turnover split by territory                                         Turnover Split %
UK                               £                                  Retail                                        %

EU                               £                                  Manufacture                                   %

North America                    £                                  Installation                                  %

Rest of World                    £

Payments to bona-fide sub contractors (total annual amount)                            £

Extensions (optional dependent on trade)

Financial Loss                                                                         £

Efficacy                                                                               £

Product Recall / Guarantee                                                             £

Libel & Slander                                                                        £

Excess applicable:                                                                     £




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                                                                            COMMERCIAL COMBINED
Money
Annual cash carryings:     Own carrying                                                £

                                                                                       £

                                           Safe
 Location                Safe Details                 Safe Limit       Cash Machiens       Gaming Machiens       In Transit
                                          Grade

1                                                 £                £                       £                 £

1                                                 £

Additional Notes




P.A. Assault:        Capital sums                                                      £ 10,000

                     Weekly benefit                                                    £ 100

Optional Extensions Money in machines                                                  Limits as above

                                                                                       £

Replacement keys and locks                                                             £

Declaration Basis                                                                      £

Excess Applicable:                                                                     £




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                                                                             COMMERCIAL COMBINED

GOODS IN TRANSIT
Cover                           All Risks
Type of goods
Packaging used (describe)
Territorial Limits              UK: Yes / No                                              UK & Europe: Yes / No
Annual Carryings                Own Vehicles                                              £
                                Hauliers                                                  £
                                Post                                                      £
Number & type of own vehicles
Sums insured / limits           Maximum any one consignment                               £
                                Tools                                                     £
Haulage company used
Optional Extensions:            Overnight risks on vehicles in the open                   Yes/No
                                Samples carried by commercial travellers                  Yes/ No
                                Property on approval whilst at a third party’s premises   Yes/No
                                Property on demonstration at a third party’s premises     Yes/No

                                Exhibitions                                               Yes/No

                                Livestock                                                 Yes/No

                                Goods sent to outworkers                                  Yes/No

                                Expenses involved in debris removal, reloading and re-
                                securing, carrying to original destination                Yes/No
                                                                                          Yes/No
                                Tarpaulins, sheets, trailer curtains, etc.
                                                                                          Yes/No
                                Temporary vehicle substitution
                                                                                          Yes/No
                                Returned goods
                                                                                          Yes/No
                                Automatic reinstatement of sums insured
                                                                                          Yes/No
                                Declaration basis.
Excess Applicable:                                                                        £




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                                                                                COMMERCIAL COMBINED

ENGINEERING
Plant inspection                                                                                  Yes/No
Insurance                                                                                         Specified Machinery/
                                                                                                  All Machinery
Sum insured                                                                                       £
If specified machinery, list plant items below (I = Inspection only; BE = Breakdown & explosion; SUD = Sudden & unforeseen
damage)

      Location             Description of equipment                Geographical limit             Cover      Replacement cost
                                                                                                            £
                                                                                                            £
                                                                                                            £
                                                                                                            £
                                                                                                            £
Excess applicable                                                                                 £




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