Quotation Request

Kingsbridge Recruitment Scheme

Client Details

Business Profile

Optional Covers

Office Contents Cover

Declaration

Additional Information

*Hidden* General Calculations

*Hidden* Recruiters Calculations

*Hidden* Umbrella Calculations

*Hidden* Endorsements tab

*Hidden* SODAN tab

BUSINESS DETAILS

Business description

Employment Agency Business as defined in the Employment Agencies Act 1973 and subsequent legislation

Business description

Umbrella Company and/or Payroll Services Company

Business Description Continued box

Do any of the business activites fall outside of the above description, such as statement of works, consultancy or other professional services?

YesNo

Does the business provide any additional advice or services for contractors which fall outside the above business description, such as IR35 status, company formation, contract drafting or accounting services in addition to payroll?

YesNo

LIMITS OF COVER

Employers' Liability - Please select the limit required

£10,000,000 £25,000,000

Public/Products Liability - Please select the limit required

£1,000,000 £2,000,000 £5,000,000 £10,000,000

Professional Indemnity - Please select the limit required

£1,000,000 £2,000,000 £5,000,000 £10,000,000

Please provide a retroactive date if known:

This can be found on your current policy schedule, and is required in order to provide retroactive cover for work carried out from this date.

D&O retroactive date

Corporate liability retroactive date

Cyber retroactive date

RISK INFORMATION

Does the business supply permanent workers only?

YesNo

In regards to the supply of temporary workers, does the business accept the client's terms of business?

YesNo

Is the supervision, direction and control of placed temporary workers always the responsibility of the end client?

YesNo

Does the business ever accept contractual liability for the workers negligence?

YesNo

Does the business expect the insurance to extend to the actions of the contractors?

YesNo

Does the business supply manual workers under non-standard terms of business to any of the following industries;

Aviation, nuclear power generating, petrochemical industries, demolition, any work on bridges or towers or steeples or chimney shafts or blast furnaces or viaducts or mines, pile driving, tunnelling, quarrying, use of explosives, excavations below 5 metres or heights above 15 metres?

YesNo

Are all contractors supplied through bona fide recruitment agencies?

YesNo

Maximum number of drivers on the road at any one time, where drivers' negligence is required?

Estimated payroll of the agency's own staff?

Excluding contractors please confirm the estimated payroll of the agency's own staff?

Estimated payroll and number of placed personnel in the following categories:

a) Standard terms of business, b) Non-standard (the clients) terms of business

Payroll is to be allocated to domiciliary care, only if the business is CQC registered and provides genuine domiciliary care services directly into service user’s homes. If the business only supplies labour to CQC registered entities such as care homes, hospices or hospitals, please transfer this entry to the Medical / Care category

	Number of Contractors p/a Average	Number of Contractors p/a Maximum	Estimated Payroll p/a Standard	Estimated Payroll p/a Non Standard	HIDDEN Standard Cover Action	HIDDEN Full Cover Action	HIDDEN Rating Band

Please provide full details:

Estimated payroll of placed personnel in the following categories:

	Agency NOT accepting supervision, direction & control of labour supplied	Agency accepting supervision, direction & control of labour supplied	HIDDEN Standard Cover Action	HIDDEN Full Cover Action

Please provide full details:

Is the business CQC regulated?

YesNo

Does the business provide domiciliary care services directly to end users in their private homes?

YesNo

Is the business CQC regulated?

YesNo

Does the business provide domiciliary care services directly to end users in their private homes?

YesNo

Please provide additional information:

Is your organisation accredited by a respected industry body?

Please provide additional information:

Please confirm the turnover in the below categories

Turnover

Last financial year - UK

Estimate for current financial year - UK

Estimate for next financial year - UK

Last financial year - USA

Estimate for current financial year - USA

Estimate for next financial year - USA

Last financial year - Other (inc. EU)

Estimate for current financial year - Other (inc. EU)

Estimate for next financial year - Other (inc. EU)

Temporary Placements

*Temporary Placements*

*hidden question used as header on the Matrix

Last financial year - UK

Estimate for current financial year - UK

Last financial year - USA

Estimate for current financial year - USA

Last financial year - Other (inc. EU)

Estimate for current financial year - Other (inc. EU)

Permanent Placements

*Permanent Placements*

*hidden question used as header on the Matrix

Last financial year - UK

Estimate for current financial year - UK

Last financial year - USA

Estimate for current financial year - USA

Last financial year - Other (inc. EU)

Estimate for current financial year - Other (inc. EU)

Is cover required for overseas offices or perhaps the business has employees located outside of the UK? Then please speak to a member of our team who will be happy to assist in providing a solution tailored to your needs.

OFFICE CONTENTS COVER

Property Details

Add another property. Add row

Please confirm the below statements are true and correct in regards to all premises listed:

•	Constructed with external walls of brick, stone or concrete and roofed with slate, tiles concrete, metal, asbestos or any other non-combustible material.
•	Free from cracks or other signs of damage that may be due to subsidence, landslip or heave and have not previously suffered damage by any of these causes.
•	In an area free from flooding and not near the vicinity of any rivers, stream or tidal waters.
•	In a good state of repair.
•	Self contained with a lockable door.
•	Heated by conventional electric, gas, oil or solid fuel heating system.
•	Fitted with electrical installations which are inspected at least every 5 years by a qualified electrician and any defects remedied.
•	Lifts, boilers, steam and pressure vessels inspected and approved to comply with all of the statutory requirements.

Please click to confirm the above.

DECLARATION

Please confirm the below statements are true and correct:

•	You are not aware of any incidents over the last 5 years that have given rise to a claim, or loss or which would have been covered by the proposers insurance should such policy have been in force, other than those which have been declared to us.
•	After enquiry you are not aware of any pending claims or circumstances that might reasonably be expected to give rise to a claim or loss against, the firm, the firm's predecessors in business or any persons proposed in the insurance, that would fall within the scope of the insurance cover.
•	The proposer, or any principal, director or partner under a current or previous trading title, has never been declared bankrupt or insolvent or been convicted of arson or any other criminal offence (other than motoring offence) or has any prosecution pending.
•	Never had insurance declined, cancelled or an insurer refused to continue or agreed to continue only on special terms.
•	Not had to initiate or defend any Legal Expenses insurance claims or legal proceedings (including hearings before Employment tribunal) in the last 3 years.
•	Not had any Inland Revenue in depth investigation into the company or any of its directors, VAT dispute, PAYE or P11D compliance dispute in the last 3 years.

Please click to confirm the above.

Should you need assistance or have any queries please contact a member of our team on 03301 249590.

ADDITIONAL INFO

Based on the information provided, the details will be submitted to our team for further review ahead of offering a quotation. We ask that you provide the additional information requested below, or alternatively leave blank and one of our team will call you to discuss further.

Please advise of any additional business activities or contractor services which you provide:

Please provide an example contract or agreement, which features the client's terms of business.

Please provide further details in respect of the placement of workers under non-standard terms of business to the following industries:

Please give details of the accountant's professional body of which the director, principal or employee belongs to:

What percentage of your placements are via a recruitment company?

Hidden Recruiters Calculations

Table Rating Premium Total *for calculation purposes

Recruiters EL Limit

Recruiters PL Limit

Recruiters PI Turnover to be used

Recruiters PI Limit

Recruiters Last Financial Year Total UK Turnover (mix temp & perm)

Recruiters Current Financial Year Total UK Turnover (mix temp & perm)

Recruiters Last Financial Year Total US Turnover (mix temp & perm)

Recruiters Last Financial Year Total EU Turnover (mix temp & perm)

100% Permanent Placements?

YesNo

Hidden Umbrella Calculations

PI Table Rating Premium Total *for calculation purposes

PI Minimum Premium *for calculation purposes only

PL Table Rating Premium Total *for calculation purposes

PL Minimum Premium *for calculation purposes

Umbrella EL Limit

Umbrella PL Limit

Umbrella PI Turnover to be used

Umbrella PI Limit

PI Full YN?

*automatically populated via rating file

YesNo

Hidden Endorsements tab

NS5 - USA/CANADA JURISDICTION – AMENDMENT TO TERRITORIAL LIMITS AND COURTS JURISDICTION IN RELATION TO SECTION 7 OF THE POLICY

Limit of Indemnity

NS5 - USA/CANADA JURISDICTION – AMENDMENT TO TERRITORIAL LIMITS AND COURTS JURISDICTION IN RELATION TO SECTION 7 OF THE POLICY

Excess

ZS5 - SUBROGATION WAIVER – PUBLIC AND PRODUCTS LIABILITY

Name

ZS6 - INDEMNITY TO OTHER PARTY EXTENSION

Name

ZS13 - AMENDMENT TO EXTENSION 18 DRIVERS NEGLIGENCE

Name a)

ZS13 - AMENDMENT TO EXTENSION 18 DRIVERS NEGLIGENCE

Name b)

ZS13 - AMENDMENT TO EXTENSION 18 DRIVERS NEGLIGENCE

Excess

Business Interruption

Increased Cost of WorkingLoss of Gross Revenue

Hidden SODAN tab

First paragraph

*to be manually filled in and printed to the SODAN*

Demands and needs section

*to be manually filled and printed to the SODAN*

Monthly Instalments

*to be manually populated to be printed to the SODAN*

Monthly Instalments TOTAL

*to be manually populated to be printed on the SODAN*

Monthly Instalments Interest

*to be manually populated to be printed on the SODAN*

Monthly Instalments APR Rate

*to be manually populated to be printed on the SODAN*

Allocated Underwriters name

*to be manually overtype with the Allocated UW name if necessary and printed to the SODAN*

Email Address

*to be manually populated to be printed to the SODAN*

Set KCI Partner Discount	@	%	£0.00
Set Commercial Load/Discount	£		£0.00

Set ExposureDiscount	@	%	£0.00
Set Commercial Load/Discount	£		£0.00
Set KCI Partner Discount	@	%	£0.00

Set Commercial Load/Discount	@	%	£0.00
Set KCI Partner Discount	@	%	£0.00

Set Commercial Load/Discount	£		£0.00
Set KCI Partner Discount	@	%	£0.00

Set Exposure Discount	@	%	£0.00
Set Commercial Load/Discount	£		£0.00
Set KCI Partner Discount	@	%	£0.00
Set PL Minimum Premium	£		£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

Quotation Request

Kingsbridge Recruitment Scheme

TELL US ABOUT YOU

PICK THE POLICY START DATE

TELL US ABOUT THE BUSINESS

BUILD THE POLICY

Sections of Cover Required

BUSINESS DETAILS

Business description

Business description

LIMITS OF COVER

Employers' Liability - Please select the limit required

Public/Products Liability - Please select the limit required

Professional Indemnity - Please select the limit required

RISK INFORMATION

Please confirm the turnover in the below categories

Turnover

Temporary Placements

Permanent Placements

Is cover required for overseas offices or perhaps the business has employees located outside of the UK? Then please speak to a member of our team who will be happy to assist in providing a solution tailored to your needs.

OPTIONAL COVERS

Management Liability

Management Liability (Directors' and Officers' Liability and Corporate Liability) - Please select the any one claim limit required

Employment Practice Liability - Please select the aggregate limit required

OFFICE CONTENTS COVER

Property Details

Please specify the sum insured required under the following headings

*HIDDEN* Calculations

DECLARATION

Should you need assistance or have any queries please contact a member of our team on 03301 249590.

ADDITIONAL INFO

Based on the information provided, the details will be submitted to our team for further review ahead of offering a quotation. We ask that you provide the additional information requested below, or alternatively leave blank and one of our team will call you to discuss further.

Cover Details

*Hidden* General Calculations

Drivers Negligence

Legal Expenses

Material Damage & BI Totals

Terrorism Cover

Management Liability

*Hidden* Recruiters Calculations

*Hidden* Umbrella Calculations

*Hidden* Endorsements tab

*Hidden* SODAN tab

HIDDEN Calculations

Hidden General Calculations

Hidden Recruiters Calculations

Hidden Umbrella Calculations

Hidden Endorsements tab

Hidden SODAN tab