Tree Surgery Insurance, Arboricultural Insurance, Tree Surgeon Liability Insurance, Commercial Vehicle Insurance, Fleet Insurance - Trust Insurance

Arborist Liability Insurance

The completion of this form in no way binds the Proposer to purchase insurance, nor does it bind Underwriters to give insurance.

Any information given will only be passed to Underwriters for the purpose of quotation and will be treated as confidential.

Name

Please enter the names of all Proprietors / Partners / Directors or Company name if applicable

Please enter trading name of business (Client Name if no business name available)

Address

Postcode:

Email Address

Telephone Number:

Fax Number:

Mobile Number:

Are you VAT registered?

Yes No

If so VAT number:

How many partners are involved in manual work?

What date did you commence trading?

Are you a limited company and if so what is your company reg. Number?

Renewal Date of existing insurance?

Please state full activities in which your firm is involved?

What qualifications do you and your staff have to work in arboriculture and when where they obtained? We must have all details of certificates or we will not offer a quotation.

What Machinery do you use in the course of your business?

Do you work outside the Uk?

Yes No

If so which countries fo you work in?

Current/Previous Insurance Company?

Current Broker?

Renewal Premium?

Are you a member of any arboricultural or related association?

When is your commercial vehicle insurance due for renewal?

PUBLIC AND PRODUCTS LIABILITY

What limits of indemnity do you require?

What is your estimated annual Turnover?

Please split your income per category

Landscaping:

Tree Surgery at ground level:

Tree Surgery using Ropes/Harness

Hedge Cutting

Forestry Felling - Manual

Forestry Felling - Mechanised

Fencing, Planting & Spraying

Sales of

Others please describe

Do you undertake any work for the railways?

Yes No

If yes please fill out the section below, if no please skip to power clearance

Railway Questionnaire

Do you work in Green Zones?

Yes No

Do you work in Red Zones?

Yes No

If so please provide an estimate of annual wage roll for each activity undertaken

Activity	Wage Roll Green Zone	Wage Roll Red Zone
Tree Surgery	£	£
Landscaping	£	£
Planting	£	£
Electrical Work	£	£
Fencing	£	£
Other	£	£

Please supply us with details of your turnover when working on the following:-

Working on track alignment and near platforms?

Undertake work relating to signalling?

Work on surrounding landscape and not involving the above

What is the total value of the contract?

How long have you had this contract?

What previous experience do you and your team have on railway contracts?

How many individuals have the relevant qualifications to work on the railway?

What is the average number of employees working on site at one time?

What is the ratio of supervisors/Managers to workers?

What percentage of your turnover is made up of this contract?

Do you use sub-contractors or are you contracted to another company?

Yes No

Do you check your sub contractors have the correct liability insurance and qualifications?

Yes No

Do you undertake any work involving London underground ltd or Docklands light railway?

Yes No

If so please provide details

Is any power clearance undertaken?

Yes No

If yes please fill out the section below, if no skip

Power clearance questionnaire

How long has your company been involved in clearing power lines?

Do all employees hold relevant certificates to work on power lines?

Yes No

Who surveys the work area before work commences?

What experience does that person have in surveying?

What experience and qualifications do your employees have to work near power lines?

How are work directions logged and adhered to between surveyor and supervisors?

How long before work is commenced to you contact landowner?

Do you ask for this permission to be put in writing?

Yes No

If restrictions are requested by the landowner how do you conform to these?

Who inspects the work to ensure it has been completed to the correct standard?

When work is satisfactory, do you keep a record system, which can be called upon in the event of an allegation?

What first aid precautions do you enforce when work is based in a rural area?

Do you have your equipment checked in accordance with LOLER legislation

Yes No

If you use any lifting equipment (i.e. harness) it must be inspected annually by a qualified inspector to comply by the health & safety requirements. Please noet we will not insure you unless this is complied with. If yes please provide details of who inspected your equipment and when your last inspection was?

Have you or any third party made a claim under this section of insurance or attempted to claim? If so please provide details

EMPLOYERS LIABILITY INSURANCE

Sum insured is limited to £10,000,000

Is employers liability required?

Yes No

Please split wage roll into the following categories:

Category	Direct Employees	Labour only sub-contractors & casual labour	Partner / Principals Wages
Clerical	£	£	£
Tree Surgery - Groundwork	£	£	£
Tree surgery - From Harness	£	£	£
Hedge Cutting	£	£	£
Fencing & Planting	£	£	£
Forestry felling - Manual	£	£	£
Forestry felling - Drivers	£	£	£
Directors/Partners dividends	£	£	£
Others	£	£	£

How many full time employees do you employ?

How many part time employees do you employ?

Please confirm what qualifications the grounds men and climbers have?

Do you make any payments to Bona Fide sub contractors and how muc if so?

Do you have an accident book?

Yes No

Have there been any entries in your accident report book the last 5 years?

Yes No

Has there been any incidents in the past five years that have or could have caused a claim under this insurance?

Date	Incident	Costs

HEALTH AND SAFETY RISK ASSESSMENT QUESTIONNAIRE

Do you have a taiored health and safety policy written for your business activities?

Yes No

Who in your organisation is responsible for health and safety matters and what training have they received?

Are all employees regularly assessed for health and safety and training provided in areas required to improve?

Yes No

Do you keep records of all training and assessments?

Yes No

Are all new employees assessed and given an induction package?

Yes No

Do you ask all new employees to sign to say they have received your induction package and training?

Yes No

Do you use any outside source for your health and safety training? If so who?

Do you issue risk assessments for each site you and your employees work at?

Yes No

Do you supply all employees and sub contractors with personal protection equipment complying with current UK health and safety?

Yes No

Do you get all employees and sub contractors to sign a document stating they have received and will wear personal protective equipment?

Yes No

How do you ensure that all employees wear protective equipment?

When did you last receive a health & safety inspection visit and were they any requirements as a result?

Do you comply with PUWER legislation?

Yes No

Do you have at least one person appointed and trained to take charge of the first aid arrangements?

Yes No

Is all your machinery properly guarded and complies with the latest legislation?

Yes No

GENERAL QUESTIONS

Have you or any partner/director in connection with your business:-

Had any proposal or insurance declined, cancelled, refused, or made subject to increased rates or special terms

Yes No

Been convicted of arson or any offence involving dishonesty of any kind (i.e. fraud, theft, etc.)

Yes No

Been prosecuted under any safety legislation during the last 5 years?

Yes No

Been declared bankrupt or insolvent?

Yes No

If YES to any of the above please give details:

Important
You are reminded that you must provide all material information likely to influence the acceptance and assessment of this insurance. If you have any doubts as to whether a fact is material it should be disclosed below. Failure to disclose all material facts may invalidate your policy or may result in your policy not operating fully.

I/we DECLARE that my/our ways works machinery and plant are properly fenced and guarded and otherwise in good order and condition, and my/our premises are in a good state of order.

I/we hereby declare that the above statements and particulars which I/we have read over and checked are true and that no information has been withheld which might increase the risk or influence acceptance by the underwriters and that should the above particulars alter in any way I/we will advise the underwriters immediately. I/we have not suppressed, mis-represented or mis-stated any material fact and have fairly estimated our wages and salaries expenditure and turnover and agree that this proposal shall hold promissory and form the basis of the contract between me/us and the underwriters.

Tree Surgery Insurance, Arboricultural Insurance, Tree Surgeon Liability Insurance - Trust Insurance

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