NEW HAMPSHIRE INSURANCE COMPANY

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					Contractors Operations and Professional Services
(COPS) Proposal
American Home Assurance Company

Notice: The COPS policy provides that the limit of liability available to pay settlements or cleanup
costs shall be reduced by amounts incurred for legal defense. Further note that amounts incurred for
legal defense shall be applied against the deductible amount.


Instructions
1.   Please complete all of this application. Your application may not be dealt with if this form is
     incomplete and/or required submission information is absent.

2.   If space is insufficient to complete answers, please continue on your firm's letterhead.

3.   Have this form signed and dated by an owner, partner or director/officer of your firm.

4.   See page 8 for list(s) of required submission information.


Applicant’s Details
1.   Named Insured/Name of Company__________________________________________________

     Address of Head Office ___________________________________________________________

     Website ______________________________________________________________________

     Contact and Title _______________________________________________________________

     ABN Number __________________________________________________________________

     Input Tax Credit percentage _______________________________________________________

     Named Insured is a Partnership         Corporation         Joint Venture     Other 

2.   Attach a list of proposed Named Insureds to be covered by this policy (only those entities
     performing the services and/or operations as proposed will be designated as Named Insureds).

3.   Check coverage(s) you are applying for:
     A   Contractor's Operations and Professional Services (COPS)

         Limit of liability______________________________________________________________

         SIR/Deductible _____________________________________________________________

         Proposed Effective Date ______________________________________________________

4.   How long has the Named Insured been in business? ____________________________________

5.   During the past five years has the name of the applicant been changed or has any other
     business been purchased or have any mergers or consolidations taken place?

                                                                  Yes    No, If “yes”, please describe.
     _____________________________________________________________________________


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6.   Total Professional Staff of Applicant

     (1) Principals _________________________________________________________________

     (2) Supervisors / Foreman _______________________________________________________

     (3) Total number of engineers & architects ___________________________________________

     (4) Total number of field personnel _________________________________________________

     (5) Hydrgeologists, Geologists, Chemists ____________________________________________

     (6) All other (describe) __________________________________________________________

7.   Are any Joint Ventures being proposed for coverage under this policy?

                                                                                Yes               No, If “yes”, please describe.
     _____________________________________________________________________________

     _____________________________________________________________________________

     _____________________________________________________________________________

8.   Are your projects bonded?

                                                                                Yes               No, If “yes”, please describe.
     _____________________________________________________________________________

     _____________________________________________________________________________

     _____________________________________________________________________________

9.   Does any one project or contract represent more than 25% of annual fees?

                                                                                Yes               No, If “yes”, please describe.
     _____________________________________________________________________________

     _____________________________________________________________________________

10. Please list the combined prior year's revenue.

     _____________________________________________________________________________

     _____________________________________________________________________________

11. Contract Values


                               Estimate for next 12 months                 Present 12 months                 Previous 12 months

                        From         .........................              .........................          .........................
                          To         .........................              .........................          .........................
All Operations                                  $                                      $                                  $
Construction only no design                     $                                      $                                  $




COPS PROP AUSTRALIA                                              2 of 10
Profile of Operations
12. Please complete the following for projected sales over the next 12 months.
A.   PROFESSIONAL SERVICES
     A1 Environmental Services
                                            (a)                 (b)                   (c)               (d)
                                         % In house     % Sub-contracted out   Projected $ sales   Number of jobs
 Decommissioning and Demolition

 Remedial Investigations

 Feasibility Studies

 Remedial Design Plans and Specs

 Obvs/Inspect of Construction

 Const/Proj Management

 Real Estate Audits

 Soil Testing/Analysis

 Surveying

 Lab Testing/Analysis

 Asbestos/Lead/Mold Abatement Design
 EnvRisk Assessments/Audits/Indoor Air
 Quality Asses
 Regulatory Consulting/Permitting

 Tank Testing/Maintainance

 Tank System Design

 Waste Brokering/Rec/Arrange

 Health & Safety Training

 Other (please explain)

 Total Section A1                            X                   X



     A2 Non-Environmental Services
                                             (a)                (b)                   (c)              (d)
                                         % In house     % Sub-contracted out   Projected $ sales   Number of jobs
 Feasibilty Studies

 Constuct/Proj Management

 Surveying

 Design Other Than....

 Waste Water/Sewer Design

 Potable Water System Design

 Other Process/Engineering

 Geotechnical/Foundations/Soils

 HVAC/Electrical/Mechanical Eng

 Civil/Structural Engineering

 Lab Testing

 Construction Materials Testing

 Other (please explain)


COPS PROP AUSTRALIA                                   3 of 10
 Total Section A2



     A3 Other Services
                                               (a)                 (b)                   (c)               (d)
                                            % In house     % Sub-contracted out   Projected $ sales   Number of jobs

 Product Design (products for sale)

 Software Design/Programming

 Financial Management/Consulting

 Other (please explain)

 Total Section A3                               X                   X
 Total Section A2                               X                   X
 Total Section A1                               X                   X
                          TOTAL SECTION A       X                   X



B.   REMEDIAL ACTION CONTRACTING OPERATIONS
     B1 Environmental Contracting
                                                (a)                (b)                   (c)              (d)
                                            % In house     % Sub-contracted out   Projected $ sales   Number of jobs

 Groundwater Sampling

 Soil Sampling

 Haz Material Cleanup/soil excavation

 Groundwater Treatment & Recovery

 Waste Storage

 On-Site Haz Waste Treatment

 Mobile Incineration

 Barrier/Liner Contractors

 Emergency Haz Material Cleanup

 Tank Removal/Installation

 PCB Oil/Equip Retrofill & Removal

 Hydrocar./Chem. Recycling/recovery

 Dredging

 Asbestos/Lead Abatement

 Mold Abatement

 Other (please explain)

 Total Section B1




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      B2 Non-Environmental Contracting
                                                    (a)                (b)                   (c)              (d)
                                                % In house     % Sub-contracted out   Projected $ sales   Number of jobs

 Carpentry, Framing

 Construction Management

 Demolition/Dismantling

 Drilling

 Electrical

 Excavation/Grading

 General Contracting

 HVAC/Mechanical

 Industrial Cleaning (incl. sewer/septic)

 Insulation

 Logging

 Masonry, concrete

 Marine

 Oil Lease

 Painting

 Pipeline

 Plumbing

 Roofing (no residential)

 Steel Erection

 Street and Road

 Other (please explain)

 Total Section B2

 Total Section B1

                          TOTAL SECTION B




 Section                                                       Projected $ sales                Number of jobs

 Professional Services
 Remedial Action Contracting Operations

                                            Grand Total



13. Detail general radius of foreign operations (i.e. Country(ies)) where operations normally occur.
    Indicate percentage relative to total projected values under question 10.

      _____________________________________________________________________________

      _____________________________________________________________________________

      _____________________________________________________________________________
14.   Please detail the percentage of work for overseas work and the percentage of work performed in
      each state, based on percentage of fee income as noted under question 10.
      NSW________% VIC_______% SA________% WA________% TAS________%
      NT________% ACT________% QLD________% Overseas________%


COPS PROP AUSTRALIA                                          5 of 10
15. Does your company select or arrange for the site of disposal for hazardous or non hazardous
    waste on behalf of clients?

                                                                                             Yes     No
16. Does your company own, operate or lease licensed waste treatment, storage or disposal
    facilities?

                                                                                             Yes     No
17. Do you ever rent/lease out equipment?

                                                                Yes         No, If “yes”, please describe.
    _____________________________________________________________________________

    _____________________________________________________________________________

    _____________________________________________________________________________

18. Are updated certificates of insurance from subcontractors kept on file?

                                                                                             Yes     No
19. Are these certificates required to show pollution liability insurance?

                                                                                             Yes     No
    If “yes”, indicate percentage ____________ %

20. What are the minimum limits of liability you require for your subcontractors?

    (a) General Liability ____________________________________________________________

    (b) Pollution Liability ____________________________________________________________

    (c) Professional Liability _________________________________________________________

21. Do you require subcontractors policies to name you as an additional insured?

                                                                                             Yes     No
    If “yes”, indicate percentage ____________ %

22. Do your contracts with subcontractors contain an indemnification provision?

                                                                                             Yes     No
    If “yes”, attach copies of all insurance requirements and indemnification clauses.

    If “yes”, indicate percentage ____________ %

23. Does your company enter into written contracts where you assume liability?

                                                                                             Yes     No
    If yes, attach copies of all insurance requirements and indemnification clauses.

    If “yes”, indicate percentage ____________ %




COPS PROP AUSTRALIA                                  6 of 10
24. Please list your current liability coverage information.

Coverage                      Carrier             Limits            Expiration       SIR          Retrodate
General Liability
Contractors
Pollution
Liability
Workers Comp
Umbrella
Auto Liability
Errors and
Omissions




25. Do you ever make use of casual labour?

                                                                   Yes      No, If “yes”, please describe.
     _____________________________________________________________________________

27. Please list any raw or process materials used at the jobsite (include all gasoline, kerosene, diesel
    fuel usage).


              Description of material       Quantity stored on job site              Method of storage
                                                                                      (Drum / Tank)




The following two questions must be answered for all coverages.

28. Have any claims been previously made against the applicant or reported under any other
    Pollution or Professional Liability policies?

                                                                                              Yes       No
     If “yes”, state:

     (a) the date when claim was made _________________________________________________

     (b) the date the incident, act or omission giving rise to the claim took place __________________

     (c) name of the claimant _________________________________________________________

     (d) nature of the claim___________________________________________________________

     (e) amount paid or estimated may be paid ___________________________________________

     (f)   final disposition or current status ________________________________________________




COPS PROP AUSTRALIA                                   7 of 10
It is agreed that claims made prior to the inception of the policy period are excluded from this
proposed coverage, unless expressely provided otherwise in the policy or by endorsement.

                                                                                          Initial   Yes
29. Is the applicant aware of any fact, circumstance or situation which could result in a claim being
    made against it or any other person or entity for whom coverage will be sought?

                                                                Yes       No, If “yes”, please describe.
    _____________________________________________________________________________

    _____________________________________________________________________________

    _____________________________________________________________________________


Safety
30. Are personnel trained in the use of personal protective equipment?

                                                                                           Yes     No
31. Does your company conduct on a regular basis the following seminars?

    (a) Occupational Health and Safety                         Yes       No
    (b) Management and Safety Regulations                      Yes       No


Submission Required Information
32. The following information is required for all policies and should be supplied at the time of
submitting application:

        Brochure/statement of qualification

        Safety Procedure/Manual

        Resumes of Key Personnel including all Project Managers

        Project list (to include brief description and contract value)

        Standard terms of Engagement

        Hard copy of loss runs applicable to these coverages including pollution loss information.

        Audited financial statements (last 2 years) and current interim financial (may be unaudited)

33. The following information is required for CPL coverage.

        Spill or Emergency Contingency Plans

        Training Manual

        Standard Operating Procedures, if available




COPS PROP AUSTRALIA                                  8 of 10
PLEASE READ THE FOLLOWING STATEMENT CAREFULLY AND SIGN BELOW WHERE INDICATED. IF A POLICY IS
ISSUED THIS SIGNED STATEMENT WILL BE ATTACHED TO THE POLICY.
THE INSURED HEREBY ACKNOWLEDGES THAT HE/SHE/IT IS AWARE THAT THE LIMIT OF LIABILITY CONTAINED IN
THE CPL POLICY SHALL BE REDUCED, AND MAY BE COMPLETELY EXHAUSTED, BY THE COSTS OF LEGAL
DEFENSE AND, IN SUCH EVENT, THE INSURER SHALL NOT BE LIABLE FOR THE COSTS OF LEGAL DEFENSE OR FOR
THE AMOUNT OF ANY JUDGMENT OR SETTLEMENT OR CLEANUP COSTS TO THE EXTENT THAT SUCH EXCEEDS THE
LIMIT OF LIABILITY OF THIS POLICY.
THE INSURED HEREBY FURTHER ACKNOWLEDGES THAT HE/SHE/IT IS AWARE THAT LEGAL DEFENSE COSTS THAT
ARE INCURRED SHALL BE APPLIED AGAINST THE DEDUCTIBLE AMOUNT.



Declaration
The applicant represents that the above statements and facts are true and that no material facts have
been suppressed or misstated.

Completion of this form does not bind coverage. Applicant's acceptance of Insurer's quotation and
Insurer's written agreement to be bound is required to bind coverage and to issue policy. It is agreed
that this form shall be the basis of the contract should a policy be issued, and will be attached to the
policy.

All written statements and materials furnished to the Insurer in conjunction with this application are
hereby incorporated by reference into this application and made apart hereof.

If an order is received, the application is attached to the policy so it is necessary that all questions be
answered in detail.




                                    Signed ....................................................


                                    Title .........................................................
                                    (to be signed by Chairman/Chief Executive or equivalent)



                                    Company ..................................................


                                    Date ........................................................

Important Notices
The COPS policy has a claims-made basis for professional indemnity coverage. The Contractors Pollution
Liability policy can be provided on a claims-made basis or on an occurrence basis. Please note the following
claims-made notice if you choose the Contractors Pollution Liability Claims Made policy.

Claims-Made Insurance
This policy is issued by American Home Assurance Company on a claims-made and notified basis. This means
that this policy only covers Claims (as defined) first made against you (the Insured) during the Policy Period (as
defined) and notified to the insurer in writing during the Policy Period. This policy does not provide cover for any
Claims made against you (the Insured) during the Policy Period if at any time prior to the commencement of the
Policy Period you (the Insured) became aware of facts which might give rise to those Claims being made
against you (the Insured), or if the Pollution Conditions which gave rise to the Claim against you existed before
the Retroactive Date specified in the Schedule.

Section 40(3) of the Insurance Contracts Act 1984 provides that where you (the Insured) gave notic e in writing to
the insurer of facts that might give rise to a Claim against you (the Insured) as soon as was reasonably
practicable after you (the Insured) became aware of those facts but during the Policy Period, the insurer cannot
refuse to pay a Claim which arises out of those facts, when made, because it was made after the Policy Period
COPS PROP AUSTRALIA                                            9 of 10
had expired. Please note that the Insured may do nothing after a Claim to waive or prejudice its rights to which
the insurer expects to be subrogated.

Insured’s Duty of Disclosure
Section 21 of the Insurance Contracts Act 1984 (Cth) provides that before you enter into a contract of General
Insurance with an insurer, you have a duty to disclose to the insurer every matter that is known to you and which
you know, or a reasonable person in the circumstances could be expected to know, is relevant to the insurer’s
decision whether to accept the risk of the insurance and, if so, upon what terms. You have the same duty to
disclose those matters to the insurer before you renew, extend, vary or reinstate a contract of general insurance.

However, your duty of disclosure does not require you to disclose matters:

   that diminish the risk to be undertaken by the insurer;
   that are of common knowledge;
   that your insurer knows or, in the ordinary course of its business, ought to know;
   as to which compliance with your duty is waived by the insurer.

This duty of disclosure continues after the proposal form has been completed up until the Policy Period
commences.

Consequences of Non-Disclosure
If you fail to comply with your duty of disclosure, the insurer may be entitled to reduce its liability under the
contract in respect of a Claim or may cancel the contract. If your non-disclosure is fraudulent, the insurer may
also have the option of avoiding the contract from its beginning.

Duty of Utmost Good Faith
The duty of utmost good faith applies to this contract. This means that there is implied into this contract a
provision requiring each party to it to act towards the other party, in respect of any matter arising under or in
relation to it, with the utmost good faith.

American Home Assurance Company
ABN: 67 007 483 267




COPS PROP AUSTRALIA                                     10 of 10

				
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