Quotation Request Polished Cleaners Scheme *HIDDEN* Questions Cleaning Insurance Quote Public Liability Insurance Employers Liability Insurance Your Details Work Undertaken Working At Height Optional Covers Claims Declaration Cover Details *HIDDEN* IGNORE *HIDDEN* QuestionsIs this an existing Allied case? YesNo What was last years premium? £ Close Brothers Interest Rate Policy Number Prefix Policy Number Policy Number Suffix What is the insured's ERN? Have Camberfords issued the documents? YesNo Details of any claims No claims Notes for Camberford Law PL Excess Business Description General QuestionsWho works in your business? Just meMe and others How many years experience do you have working in the cleaning industry? Please select Less than 1 year Between 1 and 2 years Between 2 and 3 years Over 3 years What type of business do you operate? Please select Sole Proprietor Limited Company Do you own more than 50% of the shares in the Ltd company? YesNo So there is another Director of the business? YesNo In that case you will legally need to have Employers Liability Insurance. Is that OK? YesNo So you wish to proceed with just Public Liability Insurance? YesNo What type of business do you operate? Please select Sole Proprietor Legal Partnership Limited company Who else carries out work for the business? Employed CleanersSelf Employed CleanersA mixture Who else carries out the work for the business? Business partner(s)Employed CleanersSelf Employed CleanersA mixture So it's just you and your business partner(s) working in the business? YesNo So who else, other than you and your business partner(s) works in the business? Employed cleanersSelf Employed CleanersA mixture Who else carries out the work for the business? Fellow DirectorsEmployed CleanersSelf Employed CleanersA mixture What is your primary business trade? Please select Carpet & Upholstery Cleaning Contract Cleaning Domestic Cleaning Oven Cleaning Window Cleaning Pressure Washing Public Liability InsuranceWhat limit do you require for Public Liability? £1,000,000 £2,000,000 £5,0000,000 £10,000,000 And when do you need cover to start from? 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 2024 Does your annual turnover exceed £75,000? YesNo Will your turnover exceed £140,000 per year? YesNo Employers Liability Insurance Based on the information you have provided we feel you need Employer's Liability Insurance, for which the limit of cover will be £10,000,000So we can provide a quotation please can you provide following: What is your estimated annual turnover? £ What is your estimated annual wageroll for your employed cleaners? £ What are your estimated annual payments to self employed cleaners? £ Do you make any payments to Bona Fide Sub Contractors? YesNo What are your estimated annual payments to Bona Fide Sub Contractors £ Client Details We need to collect your personal details so we can put your insurance quote together. For more information about how we use and store your details, please take a look at our privacy policy. What is your name? -- Mr Mrs Miss Ms Dr Prof. Capt. Lord Lady Major Rev. Master Exec(s) of Mx How many business partners do you have? Please Select One Two Three What is the name of the second partner in the business? -- Mr Mrs Miss Ms Dr Prof. Capt. Lord Lady Major Rev. Master Exec(s) of Mx What is the name of the third partner in the business? -- Mr Mrs Miss Ms Dr Prof. Capt. Lord Lady Major Rev. Master Exec(s) of Mx What is the name of the fourth partner in the business? -- Mr Mrs Miss Ms Dr Prof. Capt. Lord Lady Major Rev. Master Exec(s) of Mx And what is the name of the business to be insured? What is the address of the business? UDPRN UPRN Organisation Line 1 Line 2 Town/City County Postcode Enter address manually or Enter address manually Use address lookup Please could you provide a contact phone number for yourself And a contact email address Email Email enter again What year did your business start trading? Are you happy for this information to be used by Polished Insurance to obtain you a quotation for your business. We will not pass your information on to any other companies for marketing purposes YesNo The Work You Undertake What type of cleaning work do you undertake? Tick all activities you undertake Internal cleaning of domestic properties including holiday homes Do you include bed linen changes, washing and/or ironing services? YesNo Do you clean in any new build properties? YesNo Do you do any End of Tenancy Cleaning? YesNo Do you do any house clearances? YesNo Internal Cleaning of Commercial Premises – shops, offices, hotels, pubs, restaurants and nursing homes Do you clean in shopping centres? YesNo What areas do you clean in shopping centres? Just the shopsJust the communal areasBoth Do you clean in any factories and/or warehouses other than communal facilities, offices, toilets and canteen areas? YesNo Do you do any commercial kitchen cleaning? YesNo Do you clean any ductwork or ventilation systems? YesNo Do you clean in any new build commercial premises? YesNo Do you clean any other types of commercial premises? YesNo What type of premises do you clean? Carpet and Upholstery Cleaning (including soft furnishings) Do you clean hard floors (wood, stone, tiles etc) YesNo Do you do any restoration of hard floors? YesNo Window Cleaning including soffits, fascias, frames, conservatory roofs and signage Do you clean any new build properties? YesNo Domestic Oven Cleaning Gutter Cleaning Solar Panel Cleaning Does any of your work involve accessing a roof to clean solar panels? YesNo Do you clean at any solar panel farms or parks? YesNo Pressure Washing Will you use pressure in excess of 3,600 psi (248 bar)? YesNo Will you do any render cleaning? YesNo Roof Cleaning Does any of your work involve anyone being physically on the roof? YesNo Other activities not listed Please provide details of the type of work you undertake Do you undertake any work at heights above 15m from the ground? YesNo Where do you carry out your work? Please select Inside buildings Outside buildings Both inside and outside What % of your work is done inside buildings? What % of your work is done outside buildings? Do you do any work at a height over 1m above floor level? YesNo What is the maximum height you work at above floor level? Please select Up to 5 metres Up to 15 metres Up to 25 metres Over 25 metres What is the maximum height (in metres) that you work at? Please give a split of the work you undertake above 1m from the floorWhat % of your overall work is carried out between 1 and 5 metres from the floor? What methods do you use for cleaning between 1 and 5 metres from the floor? Please select Ladders Cherry Pickers Access Platforms/Towers Rope Access What % of your overall work is carried out between 5 and 15 metres from the floor? What methods do you use for cleaning between 5 and 15 metres from the floor? Please select Ladders to 9m Cherry Pickers Access Platforms/Towers Rope Access What % of your overall work is carried out between 15 and 25m from the floor? What methods do you use for cleaning between 15 and 25m from the floor? Please select Cherry Pickers Access Platforms/Towers Rope Access What % of your overall work is carried out at a height over 25m from the floor? What methods do you use for cleaning at a height over 25m from the floor? Please select Cherry Pickers Rope Access Cradles Optional CoversDo you require cover for your own plant, tools and equipment? YesNo Please choose the level of cover you need for all the plant, tools and equipment you own Please select £1,000 £6,000 £10,000 £15,000 £20,000 £25,000 £35,000 £50,000 Do you need to insure any plant or equipment you hire? YesNo What level of cover do you require? Please select £50,000 £100,000 What are your annual hiring charges? up to £5,000 £5,000 to £10,000 Over £10,000 ClaimsHave you or any of your directors or partners, or any company of which any of you have been a director, or any partnership of which any of you been a partner, sustained any loss or damage or had a claim made against you during the last 5 years? When answering, please include any incidents which might give rise to a future claim YesNo How many such claims; incidents of loss or damage; and incidents that might give rise to a future claim have there been in the last 5 years? 1 2 3 4+ What is the total amount (including paid or outstanding amounts and whether insured or not) of all such claims and incidents? Less than £2,000 £2,000 to £5,000 £5,000 + Declaration Please read through the following statements It is understood that: Your work does not involve any discharge of fumes, effluent or anything of a noxious nature. Your business including any bona fide sub-contractors working for your business do not undertake any hot work away from your premises. Hot work is use of any flame equipment or anything else that creates heat (other than a domestic iron) or sparks. Your business including any bona fide sub-contractors working for your business do not undertake or intend to undertake any work on harbours or docks that boats or ships can access. Your business including any bona fide sub-contractors working for your business do not undertake or intend to undertake any work on wharves, piers, sea defences, dams or coffer dams. Your business including any bona fide sub-contractors working for your business do not undertake or intend to undertake any work in confined spaces. Your business including any bona fide sub-contractors working for your business do not undertake or intend to undertake any work in aircrafts or on the airside of any airports or airfields. You have provided your employees (if you have any) with health and safety training specific to their work activities and keeps record of such. Your business including any bona fide sub-contractors working for your business do not undertake or intend to undertake any work on offshore installations, chemical or petro- chemical works, oil or gas refineries, fuel storage installations, power stations, nuclear plants, mines or collieries. Your business including any bona fide sub-contractors working for your business do not undertake or intend to undertake any work in blast furnaces, commercial/industrial ovens, chimneys, well shafts, viaducts, bridges, mines, motorways, steeples, silos. Your business including any bona fide sub-contractors working for your business do not undertake or intend to undertake any work on railways or railway installations. Any labour only sub-contractors engaged by you are subject to the same induction and ongoing training (with records of such kept by you) as employees. Your business including any bona fide sub-contractors do not undertake work involving the handling of asbestos, explosive or flammable substances, gases, radioactive chemicals or toxic chemicals Your business including any bona fide sub-contractors do not undertake work involving domiciliary care services, groundworks, restoration of art, antiques or collectables, heritage or listed buildings or shot blasting Your business including any bona fide sub-contractors working for your business do not undertake or intend to undertake any work on boats or ships. You have completed workplace risk assessments and method statements for all significant hazards (examples of significant hazards are substances hazardous to health, high noise levels, power driven machinery, manual handling and work at height) You check that bona fide sub-contractors have Employers’ and Public liability insurance that is valid throughout the period of their contract and you have procedures for reviewing their work methods Can you agree to the statements above? YesNo Please provide details of what you are unable to agree with The following material facts are true; 1. No owner, director, business partner or family member involved in the business; has ever had a proposal or renewal for insurance declined or cancelled, a policy voided, withdrawn or suspended, or special terms imposed by any insurer has ever been convicted of, or charged (but not yet tried) with any criminal offence other than motoring offences or offences that are spent under the Rehabilitation of Offenders Act 1974 has ever been the subject of a winding-up order or company/individual Voluntary arrangement with creditors; or been placed into administration, administration receivership or liquidation is currently insured with Zurich Insurance Company Ltd for the covers being requested. 2. That all other material facts, in addition to 1. above, have been disclosed to us in a clear and accessible manner and have not been misrepresented to us. If you do not comply with the above and any such non- disclosure or misrepresentation by you is: a) proven by us to be deliberate or reckless we may i) avoid the policy which means that we will treat it as if it had never existed and refuse all claims, in which case we will not return the premium paid by you; and ii) recover from you any amount we have already paid for any claims including costs or expenses we have incurred. b) not deliberate or reckless, the policy may be affected in one or more of the following ways depending on what we would have done if we had known about the facts which you failed to disclose or misrepresented: i) if we would not have provided you with any cover we will have the option to: 1) avoid the policy which means that we will treat it as if it had never existed and repay any premium paid; and 2) recover from you any amount we have already paid for any claims including costs or expenses we have incurred ii) if we would have applied different terms to the cover we will have the option to treat the policy as if those different terms apply. We may recover any payments made by us on claims which have already been paid to the extent that such claims would not have been payable had such additional terms been applied iii) if we would have charged you a higher premium for providing the cover we will charge you the additional premium which you must pay in full. Can you agree to the above statements? YesNo Please provide details of what you are unable to agree with Cover Details Set Public Liability Minimum Premium @ % £0.00 Set Northern Ireland Load @ % £0.00 Set Experience Load @ % £0.00 Set Discretionary Load/Discount @ % £0.00 Set Employers Liability Minimum Premium @ % £0.00 Set NI Load @ % £0.00 Set Experience Load @ % £0.00 Set Discretionary Load/Discount @ % £0.00 Total Premium (Net) £0.00 + IPT @ % £0.00 + Policy Fee £ £0.00 Total Premium £0.00 Total Commission £0.00 (Due From Broker) £0.00 *HIDDEN* IGNOREPostcodeNoSpace Postcode Area Postcode Letters Public Liability Public Liability Limit £ Turnover excluding BFSC Payments £ Turnover Percentage Internal & Ground Work Percentage of work up to 15m Percentage of work up to 100m Turnover Internal & Ground £ Turnover up to 15m £ Turnover up to 100m £ Turnover for BFSC £ Northern Ireland Load £ Payments to BFSC greater than 10% of Turnover? YesNo Employers Liability Employers Liability Limit £ Internal Wage Roll up to 15m Percentage Internal Wage Roll up to 100m Percentage Internal Wage Roll £ Ground Wage Roll up to 15m Percentage Ground Wage Roll up to 100m Percentage Ground Wage Roll £ Up to 15m Wage Roll £ Up to 100m Wage Roll £ Northern Ireland Load £ Own & Hired in Plant Own Plant, Tools and Equipment Sum Insured £ Hired in Plant charges up to £