One Underwriting - Mobile Plant and Equipment Proposal Form

Mobile Plant and Equipment Proposal

Mobile Plant Equipment Proposal Download Print Version

Broker or dealer details

Company:

Name:

Phone:

Email:

Insured details

Named insured:

ABN:

ITC entitlement:

Business activities

Situation of primary depot:

Postcode:

Geographical area of operations:

Do you operate overseas?:

Yes
No

If yes, please list countries

Is this a new venture? :

Yes
No

If yes, please provide details of previous experience

Years in business:

Current insurer:

Current broker:

Policy due date:

Annual turnover ($):

Wages ($):

No of employees:

Details of any dangerous or hazardous goods handled

Are any of your machines used or expected to be used:

• On, in or under water or in tidal areas?:

Yes
No

• Used on barges or watercraft?:

Yes
No

• Underground?:

Yes
No

• Use in connection with mining?:

Yes
No

• In demolition? :

Yes
No

• In connection with drilling for oil or natural gas? :

Yes
No

• Railway work?:

Yes
No

• Airport work?:

Yes
No

• In association with any other hazardous occupation? :

Yes
No

If YES to any of the above, provide details

Do you ‘Dry Hire’ any of your Machines to others (without Operator)? :

Yes
No

If Yes to ‘Dry Hire, what is the:

% of total time, please provide a copy of your hire agreement.

If Yes to ‘Dry Hire’ do you offer the ‘Dry Hirer’ a Damage Waiver option in respect to Damage to the hired Machine?:

Yes
No

If Yes to ‘Dry Hire’ do your conditions of hire contain any clause or condition which may effect our rights of recovery against the ‘Dry Hirer’ in the event of Damage to the hired Machine?:

Yes
No

Schedule of Machines and Attachments to be insured

Sum Insured should be the Market Value of the machine and include the value of attachments and accessories or separately list and declare.

Complete the below for each item of Plant & Equipment or add as an attachment:

Item No. 1:

Year:

Description:

Reg No.:

Sum Insured(Incl. value of attachment & accessories($):

Agreed Value:

Yes
No

Owned or Hired:

Owned
Hired

What security and theft prevention measures are in place to protect your equipment?

Coverage details

SECTION 1. Damage to machines

Is cover required for this section?:

Yes
No

Total sum insured ($):

Limit any one loss ($):

Excess :

% of the sum insured or

$ whichever is the greater.

Including additional beneﬁts
Accessories, Tools and Spare Parts - Limit $25,000	Hired Out Machines - Damage Waivers - Limit as per value declared in schedule and hire agreement	Lock and Keys - $2,500 per item with a maximum $10,000 any one period of Insurance
Appreciation in Value	Protection and Removal - Damage - Limit $250,000	Furnace Fan Protection
Damage to Lifted Goods - Limit $250,000	Recovery Costs - No Damage - Limit $100,000	Fire Brigade and/or Emergency Service Charges - $20,000
Deemed Total Loss	Removal of Debris	Windscreen - Nil excess ﬁrst claim
Employees Personal Property - Limit $5,000	Sign writing – Limit $100,000	Hired in Plant - $50,000
Expediting Costs - 25% of indemnity payable for damage or $250,000 (whichever is the lesser)	Undamaged Ancillary and/or Peripheral Equipment	Automatic Additions - Limit $500,000 - 90 day notiﬁcation period
	Non Owned Trailer in Control - $50,000
	Hire Costs Following Theft - $5,000 up to 30 days

Note: If selected, cover will be limited to one excess free windscreen per vehicle per policy year

Optional endorsements to section 1

Hired in machines – blanket cover for unspecified

Is cover required?:

Yes
No

If Yes, please state Maximum Value of Plant to be insured ($):

Cover for machines that you intend to hire in during the period of Insurance

Item No. 1:

Description of Machines:

Est. No. of Machines:

Est. total annual hiring:

Est. market value of all hire in machines at any one time ($):

Est. market value of the most valuable hire in machine ($):

Hiring charges (fees) under contract of time ($):

Length of hire under contract:

Continuing hire charges

Is cover required?:

Yes
No

Limit: Indemnity Period. x weekly:

weeks, however excluding the first 14 continuous days of Interruption after Damage occurs.

Limit: I.P. x weekly hire charges ($):

Total business interruption ($):

Finance Payment Protection

Is cover required?:

Yes
No

• Limit 12 months repayment costs ($):

• Excess 14 days

List vehicles this extension applies to from Schedule of Machines and Attachments to be insured.

SECTION 2. Increased costs of working

Is cover required?:

Yes
No

Limit any one loss $:

(First loss cover)

Indemnity period (no. of weeks):

However excluding the first 14 continuous days of interruption after damage occurs.

Could any of the machines (or parts of any machines) be difficult to replace if damaged during the proposed period of insurance?:

Yes
No

If yes, please provide details

SECTION 3. Loss of income

Is cover required?:

Yes
No

Summary of interest insured

Shortfall in weekly income occurring during the Indemnity period, less any savings in the costs of working of the Machines that cease or are reduced as a result of the Damage up to the Sum Insured applicable to Section 3.

Sum insured $ :

Indemnity period (no. of weeks):

However excluding the first 14 continuous days of interruption after damage occurs.

SECTION 4. Machinery breakdown

Is cover required?:

Yes
No

Summary of interest insured

The cost of repairing or replacing Insured machines following breakdown damage.

Sum insured

Item No. 1:

Item No. in Schedule of machines:

Sum Insured($):

Excess ($):

Have any major components of these Machines been replaced, reconditioned or otherwise undergone major work in the last 3 years?:

Yes
No

If yes, please provide details

Item No. 1:

Details of work:

Date of work:

SECTION 5. Registered Machine Liability

Is cover required?:

Yes
No

Summary of Interest Insured

Legal Liability of the Insured to third parties for Property Damage and/or Injury occurring during the period of insurance to items listed in the Schedule of Machines that are registered for road use in connection with the Business.

Note: Policy excludes liability for loss arising from machines used as working tool, therefore all clients should have a General Liability cover as per Section 6 below.

Sum insured

Sum insured:

$20,000,000

Excess*:

$1,000 each claim
$2,500 each claim
$5,000 each claim

* all excesses are inclusive of legal costs & expenses

Including additional benefit

Liability relating to Dangerous or Hazardous Goods: Sub limit $500,000

SECTION 6. Broadform Liability

Is cover required?:

Yes
No

Summary of Interest Insured

Legal Liability of the Insured to third parties Property Damage and/or Injury and/or Advertising Injury happening during the Period of Insurance caused by an Occurrence in connection with the Business (including liability for unregistered Machines).

Sum Insured :

$5,000,000
$10,000,000
$20,000,000

Excess*:

$1,000 each claim
$2,500 each claim
$5,000 each claim

* all excesses are inclusive of legal costs & expenses

Additional Beneﬁts

• Vibration, Removal or Weakening of Support: Sub-limit $500,000 • Property in your Care, Custody or Control (CCC): Sub-limit $250,000

Please provide details of third party property in your CCC below

Please provide and categorise the precise nature of each activity performed as part of your Business and indicate the approximate percentage of your turnover (total must equal 100%)

Item No. 1:

Business Activity:

Percentage:

Use of sub-contractors?:

Yes
No

If yes, approx annual payments($):

If yes, please advise if they have their own current insurance policies in place

• Public & Products Liability :

Yes
No

• Workers Compensation Insurance:

Yes
No

• Other:

Yes
No

If yes, please advise what type of policy

Use of Labour Hire Personnel?:

Yes
No

If YES, approx annual payments($):

If YES, please advise type of work performed by labour hire personnel

If YES, are checks carried out to ensure the Labour Hire company carries Public & Products Liability?:

Yes
No

Do you conduct any welding or hot work away from your premises?:

Yes
No

If YES, please provide details

Do you manufacture, import, export, wholesale or distribute a product of any kind?:

Yes
No

If YES, please provide details

Optional Endorsement

Do you require hook liability? If YES, please advise sub limit required below:

Yes
No

Hook liability sub-limit ($):

Claim History

Any Claims History – All Sections (for the last 5 years)*:

Yes
No

Have you had any claims in the past 5 years? (If yes, please provide details below or add as an attachment):

Yes
No

Item No. 1:

Date of claim:

Class of insurance:

Brief description:

Excess applicable($):

Gross amount of loss($):

Insurance History

Have you, your partners or directors, companies or businesses ever:

• insurance refused or application for insurance declined?:

Yes
No

• special conditions imposed on your insurance?:

Yes
No

• insurance cancelled? :

Yes
No

• renewal of insurance not invited?:

Yes
No

• an insurance claim rejected? :

Yes
No

• been charged with any offence(s) relating to fraud or dishonesty? :

Yes
No

• been declared bankrupt or placed into receivership, administration or liquidation? :

Yes
No

• been convicted of a criminal offence? :

Yes
No

• had insurance refused or application for insurance declined? :

Yes
No

If you have answered yes to any of the above, please provide details

Duty of Disclosure

Before you enter into a contract of insurance, you have a duty under the Insurance Contracts Act 1984 (Cth) (ICA) to disclose anything that you know, or could reasonably be expected to know, or in the case of consumer contracts (as defined in Part IV of the ICA) (Consumer Contracts) to take reasonable care not to make a misrepresentation, that may affect our decision to insure you and on what terms. You have that duty after proposal, and up until the time we agree to insure you. You have the same duty before you renew, extend, vary or reinstate a contract of insurance.

You do not need to tell us anything that:

reduces the risk that is insured;
is common knowledge;
we know or should know as an insurer; or
we waive compliance with your duty of disclosure.
If you are uncertain about whether or not a particular matter should be disclosed to us, please contact your Aon Client Manager.

Non-disclosure

If you do not tell us anything you are required to or, in the case of Consumer Contracts, fail to take reasonable care not to make a misrepresentation, we may cancel your contract or reduce the amount that it is required to pay you if you make a claim, or both. If your failure to disclose is fraudulent, we may refuse to pay a claim and treat the contract as if it never existed.

Privacy

One Underwriting Pty Ltd is committed to protecting your personal information in accordance with the Australian Privacy Principles under the Privacy Act 1988 (Cth). We collect, use and disclose personal information to offer, promote, provide, manage and administer our various insurance services we are involved in as set out in the One Underwriting Privacy Notice. In order to do this, we may also share your information with other persons or entities who assist us in providing or promoting our services as set out in the One Underwriting Privacy Notice. Further information about our privacy practices can be located in the One Underwriting Privacy Policy, a copy of which can also be sent to you on request by your One Underwriting representative. You may also gain access to your personal information, or modify your privacy preferences, by contacting your One Underwriting representative or our Privacy Officer through the means set out in the One Underwriting Privacy Notice.

If you are disclosing personal or sensitive information about any other person to One Underwriting, you confirm that you have obtained the consent of that person to disclose to One Underwriting their personal or sensitive information and you have made them aware that One Underwriting will or may disclose their information to third parties that are reasonably necessary to assist in the provision of the relevant services or products. If you have not obtained consent from this other person to disclose their personal or sensitive information to One Underwriting, you will inform us before providing the relevant information to us.

By submitting this proposal form, you acknowledge that you have read the One Underwriting Privacy Notice and agree that we can handle any personal information you have provided to us in the manner set out above.

I agree for One Underwriting Pty Ltd or Aon to send me information about its goods, services and promotions via email or phone

Declaration

I/We declare that the answers above are true and correct and I/We have discharged my/our duty of disclosure.

I/We confirm that the Insured has not been charged with any fraud or dishonesty or other criminal offence, made bankrupt or placed in receivership,administration or liquidation.