Fillable PROFESSIONAL INDEMNITY INSURANCE CONSULTING ENGINEERS PROPOSAL (RSA Insurance Group)

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PROFESSIONAL INDEMNITY INSURANCE CONSULTING ENGINEERS PROPOSAL (RSA Insurance Group)

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PROFESSIONAL INDEMNITY INSURANCE
CONSULTING ENGINEERS PROPOSAL
This form does not apply to firms which also undertake construction, installation or fabrication. These firms should complete the
Design and Construct Proposal.
A FULL POLICY WORDING IS AVAILABLE ON REQUEST
Please complete and tick boxes as appropriate
In this proposal we use the term ‘Principal’ to mean any sole principal, partner, director or member of a Limited Liability Partnership.
Reference to ‘Proposer’ in this proposal shall include all names included under question 1 who will be the Insured in the insurance policy.
Please ensure that all relevant sections of the Proposal are completed
1 Name under which business/practice is conducted (‘The Proposer’)
2 a Addresses of all offices (including postcode and telephone no.)
b Website address
www.
3 a Description of business activities
b Please give details of any areas of specialism
4 Date commenced
5 Give details of the five largest contracts undertaken in the past three years
Starting and Completion dates Total contract value* Description of contract & service provided
* Civil and Structural Engineers – total contract value
Other Engineers – value of specific work undertaken by the Proposer
6 Give details of the three largest contracts expected to be undertaken in the next twelve months
Starting and Completion dates Total contract value* Description of contract & service provided
* Civil and Structural Engineers – total contract value
Other Engineers – value of specific work undertaken by the Proposer
7 During the past 6 years, has the name of the Proposer been changed or has any amalgamation,
acquisition or take-over taken place or have any Principals departed, retired or died?
Yes No
If ‘Yes’, give details
8 Give details below of
a Principals (including details if sole principal) and
b consultants under a contract of service with the Proposer
Full name Age Qualifications Date qualified
Number of years in this capacity with
the Proposer
a
b
9 Give details below of previous business experience, as appropriate, or attach curricula vitae
Newly established business/practice – complete for all Principals
Existing business/practice – complete for each Principal who has held such position with the Proposer for less than 5 years
Name of Principal
Period engaged in
previous occupation
Name of firm/company
Profession or
business
Position Held
10 State number of other permanent staff
a qualified b all others
i full-time
ii part-time i full-time ii part-time
11 Limit of Indemnity required under this insurance
£250,000
£500,000 £1,000,000 Other
£
(please specify)
12 How much does the Proposer wish to contribute towards each and every claim?
Tick amount required £1,000
£2,500 £5,000 £10,000 Other
£
(please specify)
13 Is cover required for Partners’ Previous Business in respect of any partner named in 8a?
(this extension covers liability incurred as a Partner in a previous practice).
Yes No
If ‘Yes’, state
a for which partners b title of previous business c date partner left business
d limit of Indemnity required,
if less than that stated in 11
14 Is the Proposer represented in any way in the USA or its territories and possessions or Canada?
Yes No
If ‘Yes’, state how (e.g. by subsidiary company, local office, local representative or by any other person or concern holding a
power of attorney on behalf of the Proposer)
15 State gross fees (including those paid to sub-contractors) payable by clients for work undertaken
Last year Previous year
Forthcoming year (estimated)
for new and existing practices
a in the UK (excluding c and e below) £ £ £
b in the USA, its territories and possessions and Canada £ £ £
c in the UK and elsewhere (excluding USA and
Canada) for clients domiciled in the USA its
territories and possessions or Canada, including work
for USA companies, subsidiaries of USA companies or
USA subsidiaries of companies based elsewhere £ £ £
d elsewhere* (excluding USA and Canada) £ £ £
e in the UK for clients domiciled elsewhere*
(excluding USA and Canada) £ £ £
Total of a b c d and e above £ £ £
* State countries and amounts involved
16
Last year Previous year
Forthcoming year (estimated)
for new and existing practices
a state gross fees paid to subcontractors £ £ £
b state largest fee earned from any client £ £ £
17 Indicate which of the following services are performed by the Proposer by showing the percentage of gross fees received during
the past year
Architecture % Marine Engineering %
CDM Regulations role of “Principal Designer” formerly
CDM co-ordinator
% Mechanical Engineering %
Chemical Engineering % Mining Engineering %
Civil Engineering % Soil Engineering %
Electrical Engineering % Structural Engineering %
Electronic Engineering % Other (give details) %
External Wall Fire Review Form EWS1
i. Option A where external wall materials
are unlikely to support combustion
ii. Option B where combustible materials
are present in external wall
%
%
Heating & Ventilating Engineering %
b If fees are declared under 17 (CDM Regulations role of “Principal Designer” formerly CDM co-ordinator), give details
how those in the principal designer role are informed of the duties and responsibilities under The Construction (Design and
Management) Regulations 2015 and their training/qualifications to perform the Principal Designer role
18 If the Proposer engages in the following types of work, state the percentage of gross fees received in the last year
Air conditioning for ‘clean’ rooms
%
Amusement rides and lifting equipment
%
Aviation industry
%
Dams, harbours, jetties, offshore installations and marine projects
%
Design of fire protection and security systems
%
Expert witness work
%
Feasibility studies
%
High rise properties (over 10 stories)
%
Housing developments (up to 50 units)
%
Housing developments (over 50 units)
%
Leisure buildings including hotels
%
Nuclear, atomic or petrochemical industry
%
Office developments
%
Railway signalling equipment
%
Schools, hospitals and municipal buildings
%
Sewage and water schemes
%
Shops
%
Small Industrial units
%
Soil testing and site investigation
%
Tunnels, mines and bridges
%
Other (give details on a separate sheet)
%
19 State percentage of gross fees received in the last year applicable to
Public sector or PFI contracts %
Housing Association contracts %
Contract Values over £10m %
20 a Does the Proposer undertake any work where the construction/installation is carried out outside
the United Kingdom?
Yes No
If ‘Yes’, please give the following details:
Country
Starting and Completion
Dates
Total contract value
Description of Contract and
Service provided
b Does the Proposer work other than from its U.K. offices?
Yes No
c Does the Proposer enter into contracts where the jurisdiction is other than U.K. Courts?
Yes No
If the answer to b or c is ‘YES’, full details are required
(i.e. List the jurisdiction and contract information.)
21 a Does the business/practice or any Principal act on behalf of, or undertake work for any firm,
company or organisation in which the business/practice or any Principal has a financial interest?
Yes No
b Does any Principal perform an executive role or hold a position whereby he or she is able to
make a major policy decision on behalf of such firm, company or organisation?
Yes No
If ‘Yes’, in either case, give details (by separate note, if preferred)
c Is such other company, firm or organisation associated with any process of manufacture,
construction or erection or any form of contracting or supply?
Yes No
22 Does the Proposer undertake any contract which involves the business/practice or its subcontractors in
a manufacture, construction, erection or installation
Yes No
If ‘Yes’, state what proportion of the fees declared relates to such contracts
%
b the supply of materials, plant, goods or equipment?
Yes No
If ‘Yes’,
i does the supply relate to UK branded products only?
Yes No
ii what proportion of the fees declared relates to such contracts?
%
A copy of the contract conditions between the Proposer and the manufacturer or source must be attached
23 Does the Proposer use any brochures, written agreements or conditions of contract in connection
with the business/practice?
Yes No
If ‘Yes’, please attach copies
24 Does the Proposer work to a professional code of practice?
Yes No
If ‘Yes’, provide details in the box below
25 Is the Proposer accredited to or in the process of becoming accredited to ISO 9001,
Cyber Essentials or subject to any other form of external assessment?
Yes No
If ‘Yes’, give details below
26 Is the Proposer able to confirm that
a work undertaken by staff is regularly reviewed by a Principal or qualified manager?
Yes No
b no disciplinary action has been taken by any outside professional or regulatory body against
any Principal or member of staff?
Yes No
c steps are taken to ensure compliance with the latest data privacy legislation?
Yes No
d commercially licenced and purchased anti-virus software is in operation across their network and
that patches & updates are applied regularly in accordance with the suppliers’ recommendations?
Yes No
e critical/sensitive data is backed up at least weekly to a secure location (i.e. offsite, cloud)?
Yes No
f there is a Business Continuity Plan or Disaster Recovery Plan and it addresses cyber risks
including back up of data?
Yes No
g written procedures or checklists are used for the professional services provided?
Yes No
h contracts or terms of acceptance are evidenced in writing, specify the work to be undertaken
and the extent of the Proposer’s responsibility?
Yes No
i records are kept of all contracts, letters of engagement, client meetings and telephone calls?
Yes No
j working papers are retained for at least 3 years?
Yes No
k diary systems, registers or other procedures are in operation to ensure that deadlines are met?
Yes No
l a formal review of working procedures is undertaken at least annually?
Yes No
m satisfactory written references are always obtained for new employees?
Yes No
If ‘No’, to any of the above, give details below.
27 Has the Proposer any existing Professional Indemnity insurance in force?
Yes No
If ‘Yes’, state
a name of insurer
b renewal date
28 Has any insurer in respect of the risks to which this proposal relates ever
a declined a proposal, refused renewal or terminated an insurance?
Yes No
b required an increased premium or imposed special conditions?
Yes No
If ‘Yes’, in either case, give details
29 a Has any claim been made against the Proposer or any predecessors in business or any Principal,
consultant or employee for neglect, error or omission in relation to professional duties?
Yes No
b Has the Proposer or any predecessors in business or any Principal, consultant or employee
incurred any other loss or expense which might be within the terms of cover?
Yes No
If ‘Yes’, in either case, give details below or attach a separate note if preferred
Date of claim or loss Brief details of each claim or loss
Cost (if any) of claim paid
or loss incurred
Estimated
outstanding cost
c What action has been taken to prevent a recurrence of the situation which gave rise to each claim or loss?
30 Is any Principal, after enquiry, aware of any circumstances which might
a give rise to a claim against the Proposer or any predecessors in business or any
of the present or former Principals?
Yes No
b result in the Proposer or any predecessors in business or any of the present or former
Principals incurring any losses or expenses which might be within the terms of this cover?
Yes No
c otherwise affect the Company’s consideration of this insurance?
Yes No
If ‘Yes’, give details including maximum potential cost (by separate note if preferred)
31 Has any Principal been involved in any other business in the last 5 years which has been declared
bankrupt, insolvent or gone into liquidation?
Yes No
If ‘Yes’, please give details of the business including name, address, trade and dates
Do you wish to pay your premium by monthly instalments?
Yes No
ADDITIONAL INFORMATION
Use this space to provide further information in support of answers given to questions in this Proposal.
Please state question number clearly.
IMPORTANT NOTICES
Please read the following carefully before you sign and date the Declaration and Undertaking
IMPORTANT NOTICE CONCERNING YOUR DUTY TO MAKE A FAIR PRESENTATION OF THE RISK
Before the insurance policy takes effect the Insured have a duty to make a fair presentation of the risks to be insured under
the insurance policy.
A fair presentation of the risk is one:
• which:
– discloses to the Insurer every material circumstance which you know of or ought to know of; or
– gives the Insurer sufficient information to put the Insurer on notice that it will need to make further enquiries for the
purpose of revealing those material circumstances,
• which makes that disclosure referred to above in a manner which is reasonably clear and accessible to the Insurer; and
• in which every material representation as to a matter of fact is substantially correct, and every material representation as to
a matter of expectation or belief is made in good faith.
A material circumstance is one that would influence the Insurer’s decision as to whether or not to agree to insure you and,
if so, the terms of that insurance. If you are in any doubt as to whether a circumstance is material you should disclose it to the Insurer.
A copy of the proposal should be retained by you for your own records.
FINANCIAL OR TRADE SANCTIONS
Royal & Sun Alliance Insurance plc is unable to provide insurance in circumstances where to do so would be in breach of any
financial or trade sanctions imposed by the United Nations or any government, governmental or judicial body or regulatory agency.
PRIVACY POLICY
RSA is committed to ensuring that your privacy is protected.
For a full explanation of how we use the information we collect about you, how you can contact us if you wish to
exercise your rights and the procedure that we have in place to safeguard your privacy please visit:
www.rsagroup.com/support/legal-information/broker-privacy-policy
DECLARATION AND UNDERTAKING
I/We declare that every statement and particular contained within this proposal form:
• which is a statement of fact, is substantially correct, and
• which is matter of expectation or belief, is made in good faith.
If any such facts, expectations and/or beliefs materially change before the insurance policy takes effect I/we undertake to provide
details of all such changes to the Insurer in order to comply with my/our obligation to provide a fair presentation of the risk to be
insured under the insurance policy.
For the purposes of making this proposal for insurance, I/we agree that the Intermediary (which I/we have appointed to advise in
relation to this policy) is acting on my/our behalf and not as an agent of the Insurer.
Signature (Principal)
Date
On behalf of*
*insert name of firm
This insurance will not commence until the Insurer has indicated acceptance of the Proposal. The Insurer reserves the right to
decline any Proposal.
Royal & Sun Alliance Insurance plc (No. 93792).
Registered in England and Wales at St Mark’s Court,
Chart Way, Horsham, West Sussex RH12 1XL.
Authorised by the Prudential Regulation Authority and regulated by the
Financial Conduct Authority and the Prudential Regulation Authority.
UKC01429E PI Consulting Engineers May 2020
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PROFESSIONAL INDEMNITY INSURANCE CONSULTING ENGINEERS PROPOSAL (RSA Insurance Group)

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Completed 10 June 2021

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