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Professional Indemnity Insurance
Engineers & Allied Industries...

To receive a confirmed quote, please complete the form below. You will receive a confirmed quote on the same business day or the next business day if received after hours.

If you would prefer to talk to a broker first, please call 1300-881-779 business hours and receive an indicative quote over the phone.

 

Client Details...

Insured Name:

Trading Name:

ABN No.(if applicable):

Full Address:

Email Address:

Website (if applicable):

Telephone No:

Start date of business:

 

If you have already spoken to someone in our office, please note their name here so that this form can be processed by them as they will know something about you already.

Brokers Name:

 

Is cover for any subsidiary or associated company?

Yes    No

Does Your business incorporate any prior trading entities? Yes    No

 

Professional Duties...

What is your occupation (eg.Civil Engineer):

Please provide a full description of Your business activities.

   

Qualifications...

Please detail your qualifications &/or experience in this field:

   

Quote Required...

Please nominate the amount of covers you require:

Professional Indemnity  .    

Public Liability

$1,000,000 Not required
$2,000,000 $5,000,000
$5,000,000 $10,000,000
$10,000,000 $20,000,000

   

Engineering Services Provided...

Please provide a percentage breakdown of Your business activities:

Revenue by Type of Service - (must add up to 100%)
Acoustical engineering %
Architecture %
Building surveying %
Chemical engineering %
Civil engineering %
Construction Management %
Drafting %
Electrical engineering
%
Environmental engineering %
Geotechnical / soil engineering %
Heating & ventilation, air conditioning engineering %
Interior designing %
Land surveying %
Marine engineering %
Marine surveying %
Mechanical / Hydraulic engineering %
Mining engineering %
Oil & gas engineering %
Plumbing engineering %
Project Management %
Quantity surveying %
Structural engineering %
Town Planning %
Other %
Please provide details:

   

Area of Industry...

Percentage breakdown of Your work in the following areas:

Revenue by Type of Service - (must add up to 100%)
Acoustics & Noise pollution %
Biophysical studies %
Bridges & tunnels %
Buildings - High rise (over 3 floors) %
Buildings - Low rise (up to 3 floors) %
Contaminated site clean up %
Dams %
Design of pollution control equipment %
Domestic surveying %
Environmental appraisals / audits / impact assessments %
Environmental program design %
Engineering surveys %
Feasibility studies, investigations or reports %
Foundations & underpinning (excluding investigations for foundations) %
Harbours & jetties %
Hazardous chemical substances %
Heating, ventilating, air conditioning, hydraulics & plumbing %
Hydrographic surveys %
Industrial surveys (projects valued less than $2,000,000) %
Industrial surveys (projects valued in excess of $2,000,000) %
Marine surveys
%
Mechanical plant & bulk handling equipment including silos
%
Mines
%
Modular buildings %
Nuclear or atomic projects %
Oil & gas pipelines %
Petrochemicals, refineries, fertilizers, ammonia urea plants %
Photogram metric surveys %
Risk & hazard assessments %
Roadworks surveys %
Schools, hospitals, municipal buildings & recreational centres %
Sewerage or water systems %
Social impact assessment %
Soil testing & foundation investigating %
Structures at fairs, shows & exhibitions %
Supervision of construction %
Town planning %
Underground storage facilities %
Waste disposal, treatment or management %
Other %
Please provide details:

   

Underwriting questions...

No. of people in the business
.
Gross Fees last 12 months
Australia If Nil, put in "0"    
USA/Canada If Nil, put in "0"    
Elsewhere If Nil, put in "0"    
.
Estimated Fees next 12 months
Australia If Nil, put in "0"    
USA/Canada If Nil, put in "0"    
Elsewhere If Nil, put in "0"    

If you conduct or have conducted business in overseas countries, please provide details:

   

Please state the percentage of Your activities (based on income) applicable to each State
ACT NSW NT QLD SA TAS VIC WA O/Seas
% % % % % % % % %

 

Do you envisage any major changes in your activities? Yes    No
If "Yes", please provide full details:

   

Manual Risk Exposure...

If you are after Public Liability cover as well, we need this question to be answered, otherwise proceed to the next question.

Does your business involve any of the following?

1. Manual labour or manual tasks performed by yourself (apart from measuring)
2. The supervision of manual labour or manual tasks performed by other parties or
3. The responsibility of manual labour or manual tasks performed by other parties.
4. The training of others on how to perform manual tasks
Yes    No

If you answered "Yes", what duties do they perform?

 

Contractors...

Do you employ contractors, sub-contractors? Yes    No

Do You require cover for sub-contractors?
Yes    No

If "NO", do You insist they carry their own insurance?
Yes    No

   

Contracts...

Do You always enter into written contracts with your clients covering the services that You have agreed to provide?
Yes    No

WARNING: Signing of Contracts There are potential insurance ramifications of signing contracts without appropriate legal advice. Many contracts have "`hold harmless" clauses included in them and put the insured in a situation where they may not be covered under their liability policies. This policy has an exclusion relating to Contractual Liability. Basically, the exclusion states that the Insurer will only provide indemnity for any contractual liability where the signing of the contract does not increase the insured's liability beyond what would have applied had the contract not been signed.

NOTE: All contracts should be checked by your lawyer before signing.

   

Insured's History...

Have any claims been made in the last ten (10) years against this Business or any of its predecessors or any prior business of any of its former Partners, Principals or Directors, or have circumstances been notified to insurers that might give rise to a claim?
Yes    No

Is any applicant aware of any claim or circumstances that might give rise to a claim against the Business or any prior business of any of their present or former Partners, Principals or Directors, which matter is not referred to above?
Yes    No

Has any applicant ever been subject to disciplinary proceedings for professional misconduct?
Yes    No

Has any applicant ever had a Liability Insurer decline to continue the applicant's insurance or cancel their insurance?
Yes    No

Have you (or any person receiving cover under this policy) ever:
  • Been involved in a company that has been declared bankrupt or insolvent?
  • Been liable for any civil offence or pecuniary penalty?
  • Been charged or convicted for any criminal offence?
  • Been charged or convicted for fraud, theft or dishonesty?

Yes    No


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Declaration...

By submitting this Declaration, the Applicant declares that:
  • they are authorised by each of the other Applicants to make this Declaration,
  • the contents of the Declaration are true and complete,
  • they are under a continuing obligation to immediately inform the insurer of any change in the particulars or statements contained in this Declaration or in the accompanying documents up until the contract is entered into,
  • they authorise the insurer to give or obtain from other insurers or insurance reference bureaus or credit reporting agencies, any information about this insurance or any other insurance held by the Applicant/s.

Name of person making this declaration:


   


   

 

Duty of Disclosure (What you must tell us)
Under the Insurance Contracts Act 1984 (the Act), you have a Duty of Disclosure. You are required before you enter into, renew, vary, extend or reinstate your Policy, to tell us everything you know and that a reasonable person in the circumstances could be expected to know, is a matter that is relevant to our decision whether to insure you, and anyone else to be insured under the Policy, and if so, on what terms.
You do not have to tell us about any matter:
  • that diminishes the risk
  • that is of common knowledge
  • that we know or should know in the ordinary course of our business as an insurer, or
  • which we indicate we do not want to know.
  • If you do not tell us
If you do not comply with your Duty of Disclosure we may reduce or refuse to pay a claim or cancel your Policy. If your non-disclosure is fraudulent we may treat this Policy as never having worked.
Claims Made Policy
The Professional Indemnity section of this Policy operates on a 'Claims made and notified' basis. This means that the Policy covers you for Claims made against you and notified to us during the Period of Insurance.
This Policy does not provide cover in relation to:
  • acts, errors or omissions actually or allegedly committed prior to the retroactive date of the Policy (if a date is specified);
  • claims made after the expiry of the period of insurance even though the event giving rise to the Claim may have occurred during the period of insurance;
  • claims notified or arising out of facts or circumstances notified (or which ought reasonably to have been notified) under any previous Policy;
  • claims made, threatened or intimated against you prior to the commencement of the period of insurance;
  • facts or circumstances of which you first became aware prior to the period of insurance, and which you knew or ought reasonably to have known had the potential to give rise to a Claim under this Policy;
  • Claims arising out of circumstances noted on the proposal form for the current period of insurance or on any previous proposal form.
Where you give notice in writing to the insurer or any facts that might give rise to a claim against you as soon as reasonably practicable after you become aware of those facts but before the expire of the period of cover, you may have rights under Section 40(3) of the Insurance Contracts Act 1984 to be indemnified in respect of any claim subsequently made against you arising from those facts notwithstanding that the claim is made after the expiry of the period of cover. Any such rights arise under the legislation only. The terms of the Policy and the effect of the Policy is that you are not covered for claims made against you after the expiry of the period of cover.