SINGLE PROJECT FULL PROPOSAL FORM FOR PROFESSIONAL INDEMNITY NSURANCE by nml23533

VIEWS: 24 PAGES: 29

									                                                     PROPOSAL FORM

                                                                     for

                                                    SPECIFIC PROJECT

                             PROFESSIONAL INDEMNITY INSURANCE



                                                      IMPORTANT NOTICES

                          Please read the following notices before completing this proposal form.



YOUR DUTY OF DISCLOSURE – CONTRACTS OF GENERAL INSURANCE

Before you enter into a contract of general insurance with an Insurer, you have a duty, under the Insurance Contracts Act 1984, to
disclose to the Insurer every matter that you know, or could reasonably be expected to know, is relevant to the Insurer’s decision
whether to accept the risk of the insurance and, if so, on 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.

Your duty however does not require disclosure of any matter: -

           •              that diminishes the risk to be undertaken by the Insurer;
           •              that is of common knowledge;
           •              that your Insurer knows or, in the ordinary course of their business, ought to know;
           •              as to which compliance with your duty is waived by the Insurer.

NON DISCLOSURE

If you fail to comply with your duty of disclosure, the Insurer may be entitled to reduce their liability under the contract in respect of a
claim and/ 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.

UTMOST GOOD FAITH

Every insurance contract is subject to the doctrine of utmost good faith which requires that parties to the contract should act toward
each other with the utmost good faith. Failure to do so on your part may prejudice any claim and/ or the continuation of the insurance
contract.




SPPI Prop Form 1106.doc                                                                                                     Page 1 of 29
CLAIMS MADE POLICY

Any insurance contract (policy) that may be offered on the basis of this proposal form will provide insurance on a “claims made” basis.
This means that the policy will indemnify you for claims made against you and notified to the Insurer during the period of insurance.

The policy will also respond to the written notification of facts that might give rise to a claim pursuant to Section 40(3) of the Insurance
Contracts Act 1984 which states;

“Where the insured gave notice in writing to the insurer of facts that might give rise to a claim against the insured as soon as was
reasonably practicable after the insured became aware of those facts but before the insurance cover provided by the contract expired,
the insurer is not relieved of liability under the contract in respect of the claim, when made, by reason only that it was made after the
expiration of the period of the insurance cover provided by the contract.”

The policy does not provide indemnity in relation to:

           •              events that occurred prior to the retroactive date, if any, specified in the policy;
           •              claims notified or arising out of circumstances notified under any previous policy;
           •              claims made against you prior to the commencement of the period of insurance;
           •              claims made against you after the expiry of the period of insurance;
           •              claims arising out claims or circumstances noted on this proposal form or any previous proposal form;
           •              claims arising out of any facts or circumstances known to you at the commencement of the period of insurance
                          where such facts or circumstances would have put a reasonable person in your position on notice that
                          a claim may be made against you in the future.

The indemnity provided by the policy is subject to all the terms and conditions of the policy.

NOT A RENEWABLE CONTRACT

Any insurance policy offered by the Insurer will terminate at expiry of the specified period of insurance. There is no right to automatic
extension or renewal of the policy. If you wish to effect similar insurance for a subsequent period, it will be necessary for you to
complete a new proposal form prior to the termination of the expiring policy so that the Insurer may consider whether or not to offer a
replacement policy, and if so, on what terms.

CHANGE OF RISK OR CIRCUMSTANCES

The terms and conditions of any insurance policy offered by the Insurer will be based on the information provided to the Insurer.

If any material change occurs to the information provided on or with this proposal form prior to the inception of the policy, it is essential
that the Insurer is advised of the same prior to inception of any policy. Failure to do so on your part may prejudice any subsequent
claim under the policy and/ or the continuation of the insurance contract.

SUBROGATION

You may prejudice your rights with regard to a claim if, without prior approval from the Insurer, you make an agreement with a third
party that will prevent the Insurer from recovering any applicable loss (in whole or in part) from that, or another party.

Your policy will contain provisions that have the effect of excluding or limiting the liability of the Insurer for a claim under the policy if
you have entered into any agreement that excludes, limits or delays your right to recover damages from another party in respect of
such claim.

PRIVACY POLICY

Assetinsure is committed to safeguarding and protecting the privacy of personal information. We are bound by the provisions of the
Privacy Act 1988 which sets out the standards to be met in the collection, use and disclosure of personal information.

If you require further information about our Privacy Policy, please refer to the detailed information on our website –
www.assetinsure.com.au/interest.asp

If you want to access your personal information held by Assetinsure or wish to make a complaint in relation to privacy issues, please
contact us either electronically: info@assetinsure.com.au or complaints@assetinsure.com.au or at the address shown in this
document.




SPPI Prop Form 1106.doc                                                                                                      Page 2 of 29
GENERAL INSURANCE CODE OF PRACTICE

Assetinsure has adopted the General Insurance Code of Practice which stipulates minimum standards of services to our clients. If you
would like further information in regard to the Code of Practice, please refer to the Code of Practice website –
www.codeofpractice.com.au or our own website – www.assetinsure.com.au/interest.asp




                  IMPORTANT INSTRUCTIONS FOR COMPLETING THIS PROPOSAL FORM


     1.    All questions must be answered in full. Failure to do so may result in delays in providing a quotation or
           effecting the insurance.

     2.    Where a Yes/ No response is indicated please tick or cross the applicable box.

     3.    Some questions contain explanatory notes (in italics) which should be read before providing answers.

     4.    This form must be signed by at least one principal, partner or director of each entity seeking insurance after
           all necessary enquiries have been made of the principals, partners, directors and employees of all such
           entities seeking insurance.

     5.    Where there is insufficient space to answer any question, or additional documentation or information is
           required, please provide same by way of a clearly labelled attachment to this proposal form and specify the
           applicable attachments in the space provided for each question.

     6.    If you require any assistance in completing this proposal form please contact your insurance adviser.

     7.    If a contract of insurance is agreed between you and the Insurer, this proposal form will form the basis of the
           contract.

     8.    Please retain a copy of this proposal form and any attachments for your records.




                                                        Assetinsure Pty Ltd
                                                           ABN 65 066 463 803

                                                             44 Pitt Street
                                                          SYDNEY NSW 2000
                                                               Australia

                                                          T:    +61 2 9251 8055
                                                          F:    +61 2 9251 6387

                                                        www.assetinsure.com.au




SPPI Prop Form 1106.doc                                                                                             Page 3 of 29
Section 1.                Details of Parties to be Insured


1.1        Please state full name and principle address of main Proposer (referred to as the Proposer).




           Please advise what role the Proposer will be undertaking in connection with the Project.
           (Tick where applicable.)


                  Prime or Lead Architectural/Engineering Consultant      ‫ٱ‬

                  Prime Contractor                                        ‫ٱ‬

                  Principal/ Project Owner                                ‫ٱ‬

                  Other (Please describe)                                 ‫ٱ‬



1.2        Please provide the full name and the professional role/ activities to be undertaken by any other parties
           that are to be insured by the proposed Specific Project PI Policy.
           (IMPORTANT - All parties to be insured must be declared. Parties not declared in this question will not
           be covered by the Policy.)

           i)         ………………………………………………………………………………………………….

           Professional activities:      ………………………………………………………………………………

           ii)        ………………………………………………………………………………………………….

           Professional activities:      ………………………………………………………………………………

           iii)       ………………………………………………………………………………………………….

           Professional activities:      ………………………………………………………………………………

           iv)        ………………………………………………………………………………………………….

           Professional activities:      ………………………………………………………………………………

           v)         ………………………………………………………………………………………………….

           Professional activities:      ………………………………………………………………………………




SPPI Prop Form 1106.doc                                                                            Page 4 of 29
1.3        Please provide the Name of Principal / Funding Agency / Developer.




1.4        Are any parties named in Question 1.3 financially associated with any other firm or company involved
           in this Project (whether proposing for this insurance or otherwise)?

                                                                                                            Yes ‫ ٱ‬No ‫ٱ‬

           If ‘Yes’, please provide full details below or by attachment.




1.5        Are any of parties to be insured domiciled outside Australia?

                                                                                                            Yes ‫ ٱ‬No ‫ٱ‬

           If ‘Yes’, please provide full details below or by attachment.




1.6        Have any of the parties to be insured been established for less than 5 years?

                                                                                                            Yes ‫ ٱ‬No ‫ٱ‬

           If ‘Yes’, please provide full details below or by attachment.




1.7        Please provide by attachment brief CV’s for the senior member(s) of staff of the Proposer and each of
           the firms/ companies declared in Question 1.2 of this proposal form with responsibility for;

                 •        the respective firm’s/ company’s overall involvement in the Project; and/ or
                 •        the respective firm’s/ company’s professional activities and duties in connection with the
                          Project.


1.8        Please provide a Contractual Matrix diagram – see Attachment ‘A’.




SPPI Prop Form 1106.doc                                                                                 Page 5 of 29
Section 2.                Project Details


2.1        Please provide the official name (including project number if applicable) and location of the Project.




2.2        Please provide a brief description of the Project (please provide full project details by attachment).




2.3        Please provide a brief description of the ground conditions of the site where the Project is to be
           constructed (please provide full details by attachment).




SPPI Prop Form 1106.doc                                                                              Page 6 of 29
2.4        Please provide the estimated total project values as follows:

           i)         Total overall Project Value:                   ____________________

           ii)        If the parties to be insured are only involved in part of the overall Project please provide the
                      Contract Values applicable for that part:
                                                                      ____________________

           If the Contract is of a Design & Construct nature, the Contract Values declared in 2.4 above, should
           include the value of all work to be executed, all goods and materials to be supplied, and all Gross
           Professional Fees (actual or ‘notional’) associated with the professional activities and duties to be
           performed. Gross Professional Fees should include fees paid through to sub-consultants.


2.5        Please provide an estimate of gross Professional Fees in respect of this Project (or part of the Project
           for which this insurance is intended) for each of the parties to be insured (named in Section 1 of this
           proposal form):

                                  Party to be Insured                              Professional Fees for Project




           If the Contract is of a Design & Construct nature please provide the estimated “notional” professional
           fees that would have otherwise been earned had all the professional activities and duties (including
           project management/co-ordination, construction management and professional supervision/
           inspection of the works) undertaken in connection with the Project been charged out at normal
           commercial rates.

           If an amount is not entered above Assetinsure will make an estimate of the professional fees. Any
           indications provided by Assetinsure on this basis will be subject to confirmation from the Proposer that
           our estimate is correct. If the estimate is not correct the indicated premiums may be subject to
           change.


2.6        Please provide by attachment a detailed breakdown of the estimated Total Contract Value for the
           entire Project (or part of the Project for which this insurance is intended).




2.7        Please provide by attachment an overall plan and/ or map of the Project.




SPPI Prop Form 1106.doc                                                                                 Page 7 of 29
Section 3.                Construction and Insurance Periods


3.1        Please summarise the expected time schedule for the Project:

           Pre-Construction/ Installation Design
           & Planning                                      _____________ months

           Construction/ Installation                      _____________ months

           Commissioning/ Testing (if applicable)          _____________ months

           Maintenance Period                              _____________ months

           Run-off/Discovery Period                        _____________ months

           Note – as coverage will be on a “claims made” basis the Run-off/Discovery Period forms part of the
           policy period. The length of the requested Run-off/Discovery Period will have an effect on the policy
           premium.


3.2        What is the anticipated date for starting on site?




3.3        Is there a contractual requirement for Professional Indemnity Insurance to continue in force beyond
           completion of the contractual Maintenance Period?

                                                                                                       Yes ‫ ٱ‬No ‫ٱ‬

           If ‘Yes’, what further period is contractually required?         ___________________


3.4        When is this Specific Project PI Insurance expected to incept?




3.5        Please provide a complete Project Bar Chart / Time Schedule for the Project by attachment.




SPPI Prop Form 1106.doc                                                                            Page 8 of 29
Section 4.                Details of Contract Conditions


4.1        Please attach full copies of the main Contract(s) or relevant clauses under which the various
           professional responsibilities (and construction responsibilities in the case of Design and Construct)
           will be performed.




4.2        Please highlight all Contract conditions that may pertain to the professional duties of any and all
           parties to be insured:

           Insurance Clauses                                               see page(s) no.    ________

           Consequential Loss Clauses                                      see page(s) no.    ________

           Other Limitation of Liability/ Waiver Clauses                   see page(s) no.    ________

           Standard of Skill and Care Clauses                              see page(s) no.    ________

           Warranties or Guarantees                                        see page(s) no.    ________



           Irrespective of whether contracts are signed under a Design & Construct project structure, this
           insurance does not provide cover for claims arising out of the day to day supervision of labour and
           construction work which under a traditional form of contract would normally be the responsibility of
           the building or engineering contractor rather than being the professional duty of the professional team.




SPPI Prop Form 1106.doc                                                                              Page 9 of 29
Section 5.                Details of Contract Values

           Please summarise the approximate split of Contract Values for the Project by nature of work involved.

                                                                                                            %
           Feasibility Studies / Reports
           Environmental Studies
           Contaminated Site Remediation
           Land Fill / Land Fill Reclamation
           Power Transmission / Distribution
           Telecommunications
           Heating & Ventilating / Air Conditioning / Refrigeration Services
           Airports (Terminals and all airside work)
           Sports Stadiums / Associated Facilities
           Modular Buildings/ Structures (repetitive design)
           Other Building/ Structural Works – Low Rise (up to 3 levels)
           Other Building/ Structural Works – High Rise (over 3 levels)
           Civil Works
                      - Piling & Foundation work
                      - Roads/ Cycleways
                      - Water / Sewerage / Waste-water / Agricultural Resource Development
                      - Bridges & Over-passes of more than 250m crossing span
                      - Cut-&-Cover Tunnelling, Culverts, Underpasses
                      - Submersed Tunnelling
                      - Bored Tunnelling less that 250m bored length
                      - Bored Tunnelling of more than 250m bored length
                      - Shaft Sinking
                      - Railways
                      - Harbours / Jetties / Other Sea Defences
           Outfall Sewer
           Other Off-shore Pipelines
           On-shore Pipelines (as part of individual installations)
           On-shore Pipelines (other than as part of individual installations)




SPPI Prop Form 1106.doc                                                                           Page 10 of 29
Section 5                 Details of Contract Values (continued)


           Dams / Reservoirs
           Hydro-Electric Installations
           Other Power Generation Works (Thermal / Thermal Co-generation / Waste-to-Energy)
           Nuclear Power Plants
           Cooling Towers / Silos
           Chemical & Petrochemical Plants
           Conveying/ Crushing/ Washing/ Screening / Milling Plants
           Solvent Extraction & Leaching Equipment
           Other Minerals/ Metals Processing plants
           Food/ Beverage Processing Plants
           Other Process Plants
           Other not classified above (please specify, if necessary by attachment):


                                                                                                      100%




SPPI Prop Form 1106.doc                                                                       Page 11 of 29
Section 6.                Professional Activities & Duties to be Insured


           Please indicate which of the following professional activities and duties are required to be performed
           by or on behalf of the parties to be insured in connection with the Project.

                                                                                                   Yes         No
           Administering retention fund                                                              ‫ٱ‬             ‫ٱ‬
           Agreeing clearing, forwarding & custom dues                                               ‫ٱ‬             ‫ٱ‬
           Approval of detailed drawings                                                             ‫ٱ‬             ‫ٱ‬
           Arranging site insurance                                                                  ‫ٱ‬             ‫ٱ‬
           Authorising progress payments                                                             ‫ٱ‬             ‫ٱ‬
           Cash flow forecasts                                                                       ‫ٱ‬             ‫ٱ‬
           Certifying final completion                                                               ‫ٱ‬             ‫ٱ‬
           Certifying final payment                                                                  ‫ٱ‬             ‫ٱ‬
           Co-ordination / expediting                                                                ‫ٱ‬             ‫ٱ‬
           Commissioning/ testing                                                                    ‫ٱ‬             ‫ٱ‬
           Cost estimates                                                                            ‫ٱ‬             ‫ٱ‬
           Design criteria                                                                           ‫ٱ‬             ‫ٱ‬
           Drafting contract conditions                                                              ‫ٱ‬             ‫ٱ‬
           Feasibility studies                                                                       ‫ٱ‬             ‫ٱ‬
           Flow charts/ sheets                                                                       ‫ٱ‬             ‫ٱ‬
           Geotechnical services                                                                     ‫ٱ‬             ‫ٱ‬
           Inspection of installation work                                                           ‫ٱ‬             ‫ٱ‬
           Instructions to tenderers                                                                 ‫ٱ‬             ‫ٱ‬
           Issuing variation orders                                                                  ‫ٱ‬             ‫ٱ‬
           Measurement                                                                               ‫ٱ‬             ‫ٱ‬
           Quality control & assurance                                                               ‫ٱ‬             ‫ٱ‬
           Quantity estimates                                                                        ‫ٱ‬             ‫ٱ‬
           Settling contractual claims                                                               ‫ٱ‬             ‫ٱ‬
           Supervision of commissioning                                                              ‫ٱ‬             ‫ٱ‬
           Tender adjudication                                                                       ‫ٱ‬             ‫ٱ‬
           Working drawings                                                                          ‫ٱ‬             ‫ٱ‬
           Other (please specify, if necessary by attachment):                                       ‫ٱ‬             ‫ٱ‬



SPPI Prop Form 1106.doc                                                                            Page 12 of 29
Section 7.                Details of Gross Fees and Sub-Contracted Fees


           Please provide a split the Total Professional Fees declared in Question 2.5 between the following
           categories of professional activities and duties required to be performed by or on behalf of the all the
           parties to be insured in connection with this Project.

                                                                   Total Gross Fees*, including
                                         Activity                                                 Fees sub-contracted
                                                                   any amount sub-contracted
           7.1        Engineering
                      i)         Civil
                      ii)        Structural
                      iii)       Geotechnical/ Soil
                      iv)        Mechanical
                      v)         Electrical
                      vi)        Heating/ Ventilation/ Air Cond.
                      vii)       Hydraulic
                      viii)      Environmental
                      ix)        Process
                      x)         Acoustic
                      xi)        Marine
                      xii)       Other (please specify)

           7.2        Architectural
                      i)         Architecture
                      ii)        Interior Architecture/Design
                      iii)       Landscape Architecture
                      iv)        Urban/Town Planning

           7.3        Surveying (Land/ Building)

           7.4        Quantity Surveying

           7.5        Project Management

           7.6        Construction Management

           7.7        Project Co-ordination

           7.8        Other – (please specify - by attachment if
                      necessary)



           TOTAL


           * or “Notional Fees” included within the Total Estimated Contract Value in the case of Design &
           Construct.




SPPI Prop Form 1106.doc                                                                               Page 13 of 29
Section 8.                Risk Management


8.1        Does the Proposer and/ or any of the parties named in Question 1.2 of this proposal form hold any
           accreditation or certification for Quality Assurance or other quality control/ risk management
           programme?

                                                                                                            Yes ‫ ٱ‬No ‫ٱ‬

           If ‘Yes’, please identify each such party and the nature of their accreditation or certification (if
           necessary by attachment).




8.2        Does the Proposer and/ or any of the parties named in Question 1.2 of this proposal form have in place
           any formally documented risk management programme specifically dealing with professional liability
           risk not declared in Question 8.1 above?

                                                                                                            Yes ‫ ٱ‬No ‫ٱ‬

           If ‘Yes’, please provide brief details of all such programmes (if necessary by attachment).




8.3        Will there be formal risk management programme in place specifically for this Project?

                                                                                                            Yes ‫ ٱ‬No ‫ٱ‬

           If ‘Yes’, please provide brief details of the programme (if necessary by attachment).




8.4        Will the Proposer and/ or any of the parties named in Question 1.2 of this proposal form be utilising any
           design or project management standard(s) for this Project?

                                                                                                            Yes ‫ ٱ‬No ‫ٱ‬

           If ‘Yes’, please provide brief details of the applicable standard(s) (if necessary by attachment).




SPPI Prop Form 1106.doc                                                                                 Page 14 of 29
Section 9.                Sub-Consultants and Sub-Contractors


9.1        Will the Proposer (or any of the parties named in Question 1.2 of this proposal form) engage the
           services of independent sub-consultants or sub-contractors?

                                                                                                      Yes ‫ٱ‬       No ‫ٱ‬


9.2        If the answer to Question 9.1 is ‘Yes’, is the proposed Specific Project PI policy intended to cover such
           sub-consultants and sub-contractors?

                                                                                                      Yes ‫ٱ‬       No ‫ٱ‬

           If ‘Yes’, will the Proposer or other applicable party waive any rights of recourse against such sub-
           consultants or sub-contractors?

                                                                                                      Yes ‫ٱ‬       No ‫ٱ‬


9.3        If rights of recourse are to be maintained, will the Proposer or other applicable party ensure that:

           i)         such consultants and/or contractors have professional indemnity insurance for not less that
                      the amount of cover requested by this proposal for this insurance?

                                                                                                      Yes ‫ٱ‬       No ‫ٱ‬

           ii)        such consultants and/or contractors are required under their contracts to have professional
                      indemnity insurance for not less than the amount of cover requested by this proposal for this
                      insurance for the same total period?

                                                                                                      Yes ‫ٱ‬       No ‫ٱ‬


           Please note a premium discount may be available if all rights of recourse are to be maintained against
           any sub-consultants or sub-contractors. The level of discount will be dependent upon the level of PI
           carried by such parties and the percentage of the Total Gross/National Fees earned by such parties. If
           a discount is being sought in this respect please provide the following information:-

                                                                                     Percentage of Total
           Name of party against whom rights
                                                    Annual PI Limit and Insurer      Gross/Notional Fees earned
           of recourse are to be maintained
                                                                                     by the named party




SPPI Prop Form 1106.doc                                                                              Page 15 of 29
Section 10.               Tried & Tested Techniques


           Are there any aspects of the Project (or part of the Project) for which this insurance is intended which:

10.1       Comprise or include prototype or innovative designs, materials or construction techniques?

                                                                                                     Yes ‫ٱ‬       No‫ٱ‬


10.2       Are unusual with regard to the performance, quality, durability or tolerances required?

                                                                                                      Yes ‫ٱ‬      No ‫ٱ‬


10.3       The Proposer (or any of the parties named in Question 1.2 of this proposal form) is unfamiliar with and /
           or which do not fall within the scope of work with which the Proposer or any such party is thoroughly
           experienced?

                                                                                                      Yes ‫ٱ‬      No ‫ٱ‬


10.4       The applicable consultants, contractors or sub-contractors are unfamiliar with and / or which do not
           fall within the scope of work with which the applicable consultants, contractors or sub-contractors
           are thoroughly experienced?

                                                                                                      Yes ‫ٱ‬      No ‫ٱ‬


10.5       The Proposer considers should be drawn to the Insurers’ attention?

                                                                                                      Yes ‫ٱ‬      No ‫ٱ‬


           If the answer is ‘Yes’ to any of the above please provide full details (if necessary by
           attachment).




SPPI Prop Form 1106.doc                                                                              Page 16 of 29
Section 11.               Claims and Circumstances


           Please state if the Proposer (or any of the parties named in question 1.2 of this proposal form) is aware
           of:

11.1       Any costs incurred by them in the last 10 years or any claim made against them arising from any actual
           or alleged breach of professional duty or dishonesty?

                                                                                                      Yes ‫ٱ‬      No ‫ٱ‬

           Please note the above Question 11.1 refers to all the professional activities, not just in connection with
           this Project.


11.2       Any circumstance or event which might give rise to a claim for which cover would have been granted
           had this proposed insurance already been in force.

                                                                                                      Yes ‫ٱ‬      No ‫ٱ‬

           Please note the above Question 11.2 refers to professional activities in connection with this Project
           (and any directly related work) only.


11.3       Has the Proposer or any party named in question 1.2 of this proposal form failed to complete a project
           or contract in the last 10 years?

                                                                                                      Yes ‫ٱ‬      No ‫ٱ‬




           If the answer to either of the above is ‘Yes’, please provide full details by attachment.


           NOTE: THE ANSWERS TO THESE QUESTIONS ARE OF THE UTMOST IMPORTANCE AND SHOULD
           ONLY BE COMPLETED AFTER FULL AND SEARCHING ENQUIRY OF ALL THE PARTIES NAMED IN
           QUESTION 1 OF THIS PROPOSAL FORM. MERELY BECAUSE IN THE PROPOSER’S OPINION A
           CIRCUMSTANCE OR EVENT WHICH HAS ARISEN IS UNLIKELY TO RESULT IN A CLAIM DOES NOT
           MEAN THAT ITS OCCURRENCE NEED NOT BE NOTIFIED. DESIGN & CONSTRUCT BUILDING OR
           ENGINEERING CONTRACTORS SHOULD CONSIDER THEIR RESPONSES WITH EXTRA CARE
           ESPECIALLY WITH REGARD TO UNINSURED OR UNCLAIMED COST OR EXPENSE INCURRED PRIOR
           TO HANDOVER OF THE WORKS. IF IN ANY DOUBT, GIVE FULL DETAILS BY ATTACHMENT.




SPPI Prop Form 1106.doc                                                                              Page 17 of 29
Section 12.               Insurance History


12.1       Is the Proposer (and all of the parties named in question 1.2 of this proposal form) currently insured or
           have they previously proposed for or been insured by a professional indemnity policy?

                                                                                                      Yes ‫ٱ‬      No ‫ٱ‬

           If ‘Yes’:

           With which insurer(s)?




12.2       Has any such proposal ever been declined?

                                                                                                      Yes ‫ٱ‬      No ‫ٱ‬


12.3       In respect of the Proposer or any of the parties named in question 1.2 of this proposal form , has any
           insurer ever:

           i)          Refused to renew any PI policy?                      Yes ‫ٱ‬    No ‫ٱ‬

           ii)         Imposed special restrictions on any PI policy?       Yes ‫ٱ‬    No ‫ٱ‬

           iii)        Cancelled any PI policy?                             Yes ‫ٱ‬    No ‫ٱ‬




           If the answer to any of the above Questions 12.2 and 12.3 is ‘Yes’ please provide full
           details (by attachment if necessary).




SPPI Prop Form 1106.doc                                                                              Page 18 of 29
Section 13.               Other Insurances in Respect of this Project


           Please provide details of other insurances which are likely to be in force in respect of – and during the
           lifetime of – this Project, and which can be expected to provide elements of coverage for professional
           exposures for the parties to be included in this insurance. Please complete this section as fully as
           possible providing attachments where necessary as this information may serve to reduce the Project
           PI premium.

                            INSURANCE                             COVER FOR PROFESSIONAL EXPOSURES

           Construction “All Risks”
           (e.g. Design cover following “physical
           damage”)                                   Does the CAR policy act as a primary pay first policy with a waiver of
                                                      rights of subrogation against other policies?

                                                                                                         Yes ‫ٱ‬     No ‫ٱ‬
           General / Products Liability
           (e.g. No exclusion of professional acts)
                                                      Does the GL/ PL policy act as a primary pay first policy with a waiver
                                                      of rights of subrogation against other policies?

                                                                                                         Yes ‫ٱ‬     No ‫ٱ‬
           Product guarantees
           (e.g. 12 months on equipment supplied)


           Decennial / Latent Defects
           (e.g. 10 years on building works)


           Other Professional Indemnity
           (e.g. Consultants’ annual practice
           policies)
                                                      Please confirm whether the proposed Single Project PI Policy is
                                                      required to be in excess of or secondary to these other Professional
                                                      Indemnity policies
           Liquidated Damages


           Advanced Loss of Profits


           Any other policy (ies)?




SPPI Prop Form 1106.doc                                                                                    Page 19 of 29
Section 14.               Limits and Self-Insured Retention


14.1       Please state the Limit of Indemnity required:


           (Note - This Limit will be in the aggregate for the period of this insurance, and only applies in respect
           of each and every claim to the extent that such aggregate Limit is not exhausted. The Limit of
           Indemnity will include associated costs and expenses incurred in the defence and settlement of any
           claim).




14.2       Please state the Self-Insured Retention that the Proposer is willing to bear in respect of each and
           every claim:



           (Note - Insurers may require a minimum retention higher than that requested. This retention will
           include associated costs and expenses incurred in the defence and settlement of any claim).

           Please note if the Proposer is prepared to carry a retention higher than the minimum retention
           required by Insurers a premium discount may be available.

           Please indicate any alternative Self-Insured Retentions for which premium indications are required:




SPPI Prop Form 1106.doc                                                                               Page 20 of 29
Section 15.               Pollution Exposures


           Is the Proposer prepared to accept a Total Pollution Exclusion under the proposed Project PI policy?

                                                                                                                    Yes ‫ٱ‬   No ‫ٱ‬

           If the answer to the above is ‘No’, please go on to answer this Question 15. (Please note Insurers may restrict
           the coverage in respect of pollution.)

           If the answer is ‘Yes’ please go on to Question 16.


15.1       Is the Proposer (or any party named in question 1.2 of this proposal form) aware of any aspect of the Project that
           may give rise to exposures to pollution or contamination specifically arising out of:

           i)         The type of project?                                      Yes ‫ٱ‬   No ‫ٱ‬
           ii)        The location of the Project?                              Yes ‫ٱ‬   No ‫ٱ‬
           iii)       The history of the Project site?                          Yes ‫ٱ‬   No ‫ٱ‬
           iv)        The design of the Project?                                Yes ‫ٱ‬   No ‫ٱ‬
           v)         The work method to be utilised for the Project?           Yes ‫ٱ‬   No ‫ٱ‬
           vi)        Surrounding property?                                     Yes ‫ٱ‬   No ‫ٱ‬

           If the answer to any of the above is ‘Yes’, please provide full details by attachment and continue to complete
           Section 15.

           If the answer is ‘No’ to all the above please go on to Section 16.


15.2       Does the Proposer (or any party named in question 1.2 of this proposal form) accept responsibility directly or
           vicariously, under the contract or otherwise, for any clean-up, transportation, storage or disposal of any
           pollutant or contaminant, or any other exposure to pollution or contamination for which coverage is required?
                                                                                                               Yes ‫ ٱ‬No ‫ٱ‬

           If ‘Yes’, please identify which parties accept such responsibility, described briefly the responsibility accepted,
           and describe how it is executed. If possible, please refer to the clause in the Contract where such responsibility
           is specified, and attach copies of such clauses.

                              Name                               Responsibility                       Contract Clause




SPPI Prop Form 1106.doc                                                                             Page 21 of 29
15.3       Is it possible to apportion a project value and / or fee element (actual or notional) to any of the above
           responsibilities?

                                                                                                                       Yes ‫ٱ‬   No ‫ٱ‬

           If ‘Yes’, please specify such project value or fee.



15.4       Is any contractor or consultant (whether to be insured or not) employed to undertake any site investigation to
           ascertain the extent, location, or content of pollution or contamination on the Project site, or the history of the
           Project site with regard to pollution or contamination exposures?

                                                                                                                       Yes ‫ٱ‬   No ‫ٱ‬

           If ‘Yes’, please provide details (if necessary by attachment), including the name of such contractor or consultant
           and copies of any reports or test results.




15.5       To what extent has the critical design criteria relevant to pollution or contamination exposures exceeded the
           minimum accepted standards?



15.6       Has the Proposer (or any party named in question 1.2 of this proposal form) become aware during feasibility
           studies, tender or contract negotiations of any potential breaches of current or anticipated laws and regulations
           covering pollution or contamination in the territory in which the Project is located?

                                                                                                                       Yes ‫ٱ‬   No ‫ٱ‬

           If ‘Yes’, please provide full details by attachment of action taken to comply with such laws and regulations.


15.7       Is the Proposer (or any party named in question 1.2 of this proposal form) aware after full enquiry if any of the
           parties to be insured have been the subject of any claim for any alleged or actual breach of professional duty
           based upon or arising out of pollution or contamination?

                                                                                                                       Yes ‫ٱ‬   No ‫ٱ‬

           If ‘Yes’, please provide details by attachment.




SPPI Prop Form 1106.doc                                                                                Page 22 of 29
Section 16.               Consequential Financial Losses


           Is coverage required for Consequential Financial Losses under the proposed Project PI Policy?

                                                                                                       Yes ‫ٱ‬       No ‫ٱ‬

           If the answer to the above is ‘Yes’ please go on to answer this Section 16. (Please note Insurers may
           restrict the coverage in respect of Consequential Financial Losses.)

           If the answer is ‘No’ please go to Section 17.


16.1       Does the Proposer (or any party named in question 1.2 of this proposal form) accept responsibility for
           Consequential Financial Losses directly or vicariously, under contract or otherwise for which
           coverage is required?

                                                                                                       Yes ‫ٱ‬       No ‫ٱ‬


16.2       Please provide the clauses in the Contract where such responsibility and/or liability are specifically
           referred to.


           If the contract specifically limits liability for Consequential Financial Losses please provide relevant
           clauses.

           Note - if the Contract specifically releases any party from any liability for Consequential Financial
           Losses please provide copies of relevant clauses by attachment.


16.3       What is anticipated loss of revenues per week in the event of a delayed completion date?




16.4       What contingent time margin has been built into the overall construction period to enable delays in the
           works to be made up within the overall planned schedule?




SPPI Prop Form 1106.doc                                                                               Page 23 of 29
16.5       Are there any particular components of the Project that would be deemed to be critical to the overall
           timely completion of the Project i.e. where the delay and/or failure of one part of the Project could
           have a “knock on” effect delaying other parts of the Project?

                                                                                                          Yes ‫ٱ‬      No ‫ٱ‬

           If ‘Yes’, please provide details (if necessary by attachment).




           What would the individual estimated construction periods be for these “schedule critical” components
           of the Project?




16.6       Will an Advanced Loss of Profits (or similar) policy be purchased in respect of this Project?

                                                                                                          Yes ‫ٱ‬      No ‫ٱ‬


           If ‘Yes’, please provide details including limits and deductibles (if necessary by attachment).




16.7       Please answer this question if the Project involves the design and/or construction of any type of
           process plant (if necessary by attachment).

           i)         At what percentage of “full capacity” will the process plant be expected to run on a day to
                      day basis e.g. 80% of full capacity?


           ii)        What is the anticipated loss of revenues per week in the event of non-performance and/or
                      under performance of the process plant?


           iii)       What is the likelihood of failure of one part of the plant affecting the overall output?


           iv)        Are there any back up procedures in place in the event of failure?


           v)         To what extent has the critical design criteria relevant to performance exceeded the
                      minimum accepted standards?




SPPI Prop Form 1106.doc                                                                                  Page 24 of 29
Section 17.               Third Party Property Damage and Bodily Injury


           Is coverage required for Third Party Property Damage and Bodily Injury under the proposed Project PI
           Policy?

                                                                                                       Yes ‫ٱ‬      No ‫ٱ‬

           If the answer to the above is ’Yes’ please go on the answer this Section 17. (Please note Insurers may
           still restrict the coverage in respect of Third Party Property Damage and Bodily Injury).

           If the answer is ‘No’ please go to Section 18.

17.1       Please advise if the Project is to be constructed on a “green field” site?

                                                                                                       Yes ‫ٱ‬      No ‫ٱ‬

           If ‘No’, please advise details of surrounding property (including Principal’s property) as follows:

           i)         The distance of surrounding property from the proposed Project site:




           ii)        The nature of the surrounding property (type of property, usage of property and estimated
                      value of property):




           iii)       A site plan detailing location of proposed Project and surrounding property (by attachment).



17.2       Does the proposed Project comprise of any elements or techniques that are known to potentially
           explosive and/or highly inflammable (or in any other way potentially hazardous to surrounding
           property)?

                                                                                                       Yes ‫ٱ‬      No ‫ٱ‬

           If ’Yes’, please provide full details including likely maximum radius of surrounding area that would be
           effected by such explosive, inflammable or otherwise hazardous nature of the Project




SPPI Prop Form 1106.doc                                                                               Page 25 of 29
17.3       Does the proposed Project consist of any elements or techniques that could potentially be hazardous
           to persons?

                                                                                                      Yes ‫ٱ‬      No ‫ٱ‬

           If ‘Yes’, please provide full details.



Section 18.               Further Information


           Please provide by separate attachment any further information that may assist in the understanding of
           the Project, contractual liabilities or any Professional Duties being performed.

           Note – the effectiveness and reliability of any insurance effected on the basis of this proposal form will
           be determined by the scope and quality of information provided to the Insurers.




SPPI Prop Form 1106.doc                                                                              Page 26 of 29
Section 19.               Declaration


This proposal form must be signed by at least one principal, partner or director of the Proposer and every party declared in
Question 1.2 of this proposal form (preferably the Managing Principal, Partner or Director).

The completion and/ or signing of this proposal form does not oblige any party to enter into a contract of insurance.

•    I/we have made due inquiry of the Proposer, or other applicable party declared in Question 1.2 of this proposal form,
     and their principals, partners, directors, managers and appropriate staff members in respect of all questions in this
     proposal form and have the authority to sign this proposal form on their behalf in effecting this insurance.

•    I/we acknowledge that I/we have read and understand the Important Notices in this proposal form.

•    I/we declare that all statements and responses are true and accurate, and no fact or matter has been misstated,
     misrepresented or omitted.

•    I/we agree that this proposal form and all additional information provided by me/us shall be incorporated into and shall
     form part of any contract of insurance.

•    I/we acknowledge that until a contract of insurance is entered into, I/we must notify any material change to the facts
     and/ or matters disclosed in this proposal form.

•    I/ we consent to:

           o     the use of personal information about me/ us in accordance with the Assetinsure Privacy Policy; and
           o     the disclosure of personal information in accordance with the Assetinsure Privacy Policy.

•    If I/we have disclosed personal information about any other person, I/we confirm that I/ we are authorised to:

           o     disclose to Assetinsure such personal information and consent to its use in accordance with the
                 Assetinsure Privacy Policy; and
           o     the disclosure of such personal information in accordance with the Assetinsure Privacy Policy.



Name of Proposer:                ________________________________________________________

Signature:                       ________________________              Date: _______________________


Name of Proposer:                ________________________________________________________

Signature:                       ________________________              Date: _______________________


Name of Proposer:                ________________________________________________________

Signature:                       ________________________              Date: _______________________

(If insufficient space please use Additional Signatory Proposal Form Addendum.)




SPPI Prop Form 1106.doc                                                                                     Page 27 of 29
Section 20.               Attachments




           Please note here any attachments that form part of this proposal:
                                                                                    Attached?
           Question 1.4             Financial associations                          ‫ٱ‬
           Question 1.5             Proposers domiciled outside Australia           ‫ٱ‬
           Question 1.6             Established for less than 5 years               ‫ٱ‬
           Question 1.7             CV’s for senior staff                           ‫ٱ‬
           Question 1.8             Attachment ‘A’ – Contractual Matrix             ‫ٱ‬
           Question 2.2             Full details of Project                         ‫ٱ‬
           Question 2.3             Full details of ground conditions               ‫ٱ‬
           Question 2.6             Breakdown of Estimated Total Contract Value     ‫ٱ‬
           Question 2.7             Overall plan or map of Project                  ‫ٱ‬
           Question 3.5             Bar Chart/ Time Schedule                        ‫ٱ‬
           Question 4.1             Contracts and relevant clauses                  ‫ٱ‬
           Section 5.               Nature of Work – other                          ‫ٱ‬
           Section 6.               Detailed Professional Duties – other            ‫ٱ‬
           Question 7.6             Categories of Professional Activities – other   ‫ٱ‬
           Section 8                QA/ Risk management details                     ‫ٱ‬
           Section 10.              Specific Hazards Information                    ‫ٱ‬
           Section 11.              Claims Information                              ‫ٱ‬
           Section 12.              Insurance History                               ‫ٱ‬
           Section 13.              Details of Other Insurances                     ‫ٱ‬
           Section 15.              Pollution                                       ‫ٱ‬
           Section 16.              Consequential Financial Losses                  ‫ٱ‬
           Section 17.              Third Party Exposures                           ‫ٱ‬
           Section 18.              Further Information                             ‫ٱ‬




SPPI Prop Form 1106.doc                                                                   Page 28 of 29
                          SINGLE PROJECT PROFESSIONAL INDEMNITY INSURANCE

                                          ATTACHMENT ‘A’


Contractual Matrix Diagram




SPPI Prop Form 1106.doc                                                     Page 29 of 29

								
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