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Annual Contract Works Quote Request

Annual Contract Works Quote Request

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Fortix ID Opportunity
Your Details
Name*
First Last
Business Name
ABN
Phone*
Email*
Website
Address of Main Office*
Street Address City State Post Code
Builders License Number
Years of building experience?*
Has your business been operational for more than 2 years?
- Yes
- No
Are you currently insured?*
- Yes
- Yes, Public Liability only
- No
Existing Insurer
Expiry date of current policy
Are all projects that you are currently working on, insured by your current insurer up until they are complete?*
- Yes – I am currently insured on a ‘Run-Off’ basis so any projects that I have started in my existing policy period are covered through to completion.
- No – I am currently insured on a ‘Turnover’ or ‘Transfer’ basis so only work undertaken up until the expiry date is covered.
- Unsure – I need assistance in confirming this.
About Your Business
Business Turnover for Construction Activities for PAST 12 months*
Business Turnover for Construction Activities for NEXT 12 months*
Number of projects to be undertaken in NEXT 12 months.*
Type of Work Undertaken? (tick all that apply)*
- New Residential Building
- New Commercial/Industrial Building
- Residential Alterations and/or Additions
- Commercial/Industrial Alterations and/or Additions
- Non-Structural Refurbishments/Fitout Alterations
- Standalone Trade Works
- Other
A Builder is defined as the head contractor or principal and you construct the whole building.
New Residential Building
Percentage of New Residential Building work*
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Percentage of work on NEW builds - Single Dwellings
Hidden
Percentage of work on EXISTING buildings - Single Dwellings
New Commercial/Industrial Building
Percentage of New Commercial/Industrial Building work*
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Percentage of work on NEW builds - Other Residential
Hidden
Percentage of work on EXISTING buildings - Other Residential
Residential Alterations and/or Additions
Percentage of Residential Alterations and/or Additions work*
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Percentage of work on NEW builds - Commercial
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Percentage of work on EXISTING buildings - Commercial
Commercial/Industrial Alterations and/or Additions
Percentage of Commercial/Industrial Alterations and/or Additions work*
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Percentage of work on NEW builds - Industrial
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Percentage of work on EXISTING buildings - Industrial
Non-Structural Refurbishments/Fitout Alterations
Percentage of Non-Structural Refurbishments/Fitout Alterations work*
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Percentage of work on NEW builds - Trades
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Percentage of work on EXISTING buildings - Trades
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Overview of TRADES work undertaken
Standalone Trade Works
Percentage of Standalone Trade Works*
Overview of Standalone Trade Works undertaken*
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Overview of CIVIL WORKS ONLY work undertaken
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Percentage of work for NEW builds - Civil Works
Hidden
Percentage of work for EXISTING buildings - Civil Works
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Mechanical and/or Electrical Work Only
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Percentage of work on NEW builds - Mechanical/Electrical
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Percentage of work on EXISTING buildings - Mechanical/Electrical
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Overview of MECHANICAL and/or ELECTRICAL ONLY work undertaken
Other Work
Percentage of other work*
Overview of other work undertaken*
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Percentage of work on NEW builds - Other
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Percentage of work on EXISTING buildings - Other
Project Information
Do any of your projects involve works in or around:*
- An existing excavation deeper than 10 metres
- Or over lakes, rivers, the ocean, or any other body of water?
- Airports that would require an Airside permit?
- Railway trackwork or signalling works?
- Mining, oil, chemical or petrochemical plants
- Gasoline service stations
- Landfills, land which is on the contaminated land register
- Underground works such as tunnels, shafts, mines or galleries
- Road works or bridges
- Pipelines greater than 250 metres or over $10,000,000 in Contract Value
- Excavation of underground services on site, other than to install new services
- Swimming Pools of any types
- NONE OF THE ABOVE
Please provide further details*
Do any of your projects involve the following:*
- Actual excavation work, or work in an existing excavation, deeper than 10 metres
- Demolition above 15 metres in height (other than internal non-structural demolition)
- Demolition work exceeding 25% of your annual turnover
- Construction of any tunnel
- Directional (Horizontal) drilling or boring greater than 1 metre in diameter (other than piling or piers)
- Work in or around an airport or aircraft landing area
- Work in or around tramlines or railways
- Work in oil, gas, chemical or petrochemical plants, including any work on gasoline service stations
- Work in mining processing plants
- Technology which is of a prototype nature
- Swimming Pools of any types
- NONE OF THE ABOVE
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Do any of your projects involve the following:
- Maintenance only works
- Works of an experimental or prototypical nature?
- The application of waste or chemical products to land
- Any Underpinning activities
- Any blasting undertaken
- Demolition work exceeding 25% of your annual turnover?
- Demolition work exceeding 15 metres in height?
- Directional drilling or boring greater than 1 metre in diameter (other than piling/piers)
- Design & Construct where you provide the design
- NONE OF THE ABOVE
Please provide further details*
Geographical Information
Which states do you operate in?*
- NSW
- VIC
- QLD
- SA
- WA
- TAS
- ACT
- NT
- Overseas
Percentage of work done in NSW*
Percentage of work done in VIC*
Percentage of work done in QLD*
Percentage of work done in SA*
Percentage of work done in WA*
Percentage of work done in TAS*
Percentage of work done in ACT*
Percentage of work done in NT*
Percentage of work done Overseas*
NSW Stamp Duty Declaration
Are you a small business Individual / Partnership / Company and/or Trust, which is carrying on a business, and the business has an aggregated turnover of less than $2 million*
- Yes
- No
Aggregated turnover is your Australia wide annual turnover plus the annual turnovers of any business entities that are your affiliates or are connected with you.
Do you work in:*
- CBD
- Metro
- Regional
Tick all that apply
Do you do any work above the 26th Parallel?*
- Yes
- No
The 26th parallel is a line that divides Australia from east to west. It begins at Shark Bay in Western Australia, north of Geraldton, serves as the boundary between South Australia and the Northern Territory and runs into the Pacific north of the Sunshine Coast, just above Gympie.
If yes, please provide further details.*
Material Damage Cover - Upcoming Projects
Estimated total value of projects starting in next 12 months?*

*This is the total value of all projects that you are expecting to commence within the policy period.
Maximum contract value for any one project?*

*This is the maximum value of any one individual project that you are expecting to start within the policy period.
Do you currently have any projects on hand that are incomplete?*
- Yes
- No
If yes, please provide further details*
What is the maximum number of months for any one project?*
- 6 months
- 12 months
- 18 months
- 24 months
- Other
This is the maximum time any one project will take to complete.
If other, please advise limit*
What is the maximum number of months required for a Defects Liability Period?*
- 3 months
- 6 months
- 12 months
- 18 months
- Other
A defects liability period is a set period of time after a construction project has been completed during which a contractor has the right to return to the site to remedy defects.
If other, please advise limit*
Cover Requirements
Other cover required. Do you require a quote for:*
- Public Liability (Section 2)
- Pre-existing Structures
- Employee Tools
- Other Property (i.e. Display Homes or Structures other than buildings on site)
- Current Projects (i.e. Projects you have on the go but are not yet completed)
- Your Mobile Machinery, Plant & Equipment
- Hired in Mobile Machinery, Plant & Equipment
Please tick all that apply.
Public Liability
Level of Public Liability cover required?*
- $10,000,000
- $20,000,000
- $50,000,000
- Other
Please advise limit required*
Do you require Public Liability coverage for other business activities?*
- Yes
- No
Other business activities may be work where liability cover is required but there is no construction or material damage cover required
Please provide further details on other activities*
Annual Turnover of other activities*
Pre-existing Structures
Pre-existing Structures - Please provide further details including Description, Address, Postcode and Insurance Value.*
Employee Tools
Limit Required of Employee Tools*

“Employee tools” means construction tools and effects owned by Employees, but does not include laptop computers, mobile telephones, tablets or cameras.
Other Property
Other Property - Please provide further details including Description, Address, Postcode and Insurance Value.*
Current Projects
Please provide further details of any current projects currently underway including Description, Address, Postcode and Insurance Value.*
Mobile Plant, Machinery & Equipment
Limit Required for Mobile Plant, Machinery & Equipment*

“Mobile Machinery and Equipment” means hoardings, temporary buildings, scaffolding, falsework and re-usable formwork, Vehicles, hoists, cranes, earth moving equipment, air compressors, welding equipment and other similar plant whether self propelled or non self-propelled, used or to be used in the process of executing the Contract Works.
Do You require coverage for hoists or cranes?*
- Yes
- No
If yes, please provide brief description including Make, Model, Year & Value*
Hired-in Mobile Plant, Machinery & Equipment
Estimate the annual amount you spend on hire charges
What is the replacement value of the largest item you could expect to hire?*
Contractors Pollution Liability
Do you require cover for Contractors Pollution Liability?*
- Yes, we do
- No, we don't
- I am unsure, can I get more information
Contractors Pollution Liability Insurance (CPL) protects you from pollution and asbestos clean-up costs. It also extends to related defence costs, and liability for injury and property damage.
Do you and your staff / contractors know how to deal with the discovery of asbestos or if there is a pollution event?*
- Yes, we have procedures in place
- No, there are no procedures in place
- This question is not relevant to my business
In the past 5 years, have you had any significant / reportable releases or spills of hazardous waste or any other pollutants (as defined by environmental statutes or regulations)?*
- Yes
- No
In the past 5 years, has there been, or is there now pending, a claim against you for clean-up, bodily/personal injury or property damage, resulting from the release into the environment of hazardous substances (including asbestos), hazardous waste, or other pollutants?*
- Yes
- No
Disclosure Questions
The term YOU in the questions below relates to your Firm, Company or you as a Sole Practitioner including present or former Partners, Directors, Principals, Consultants, or Employees.
Are YOU being operated under any type of third party agreement?*
- Yes
- No
If yes, please provide further details*
Have YOU had an insurer decline any claim, cancel any insurance policy or impose special terms to any insurance policy?*
- Yes
- No
If yes, please provide further details*
Have YOU experienced any loss, damage, circumstance, liability or claim against you (whether insured or not) that could be covered by any of the policies now proposed?*
- Yes
- No
If yes, please provide further details*
Have YOU been charged with, pleaded guilty to or been convicted of any criminal offence or had any criminal offence proved?*
- Yes
- No
If yes, please provide further details*
Have YOU been declared bankrupt, insolvent, had a liquidator appointed and/or been placed in external administration?*
- Yes
- No
If yes, please provide further details*
Have YOU been a defendant in any civil court case?*
- Yes
- No
If yes, please provide further details*
Have YOU been associated in any way with any: Outlaw Motorcycle Gang (“OMG”) or any member of an OMG; organised crime gang (“OCG”) or any member of an OCG, or other illegal association?*
- Yes
- No
If yes, please provide further details*
Other Insurances
Do you require a quote or further information about any of the following insurances?
- Business Insurance
- Commercial Motor Insurance
- Builders Warranty (SA or Vic only)
- Life/Income Protection
- Workers Compensation
- Cyber Insurance
- Commercial Motor
- Other
If other, please advise details
Additional Information
Is there any other information that you need to provide to the insurer?*
- YES there is
- NO there is not
Do you have any further information to provide?*
How did you hear about Webber Insurance?*
- Web Search
- Referred by Someone
- A Building Designer Association
- Social Media
- Previous / Existing Client
- Other
If other, please advise*
We appreciate referrals. Please let us know who provided you with our details*
Important Information

Please take a moment to read these important documents prior to submitting your form.
- Click to view our Privacy Policy
- Click to view our Financial Services Guide
- Click to view Duty of Disclosure Requirements
- Click to view Terms of Engagement
Declaration
- I/WE declare that we have read the important notices attached above and I/WE understand those notices.
- I/WE undertake to inform insurers of any material alteration to these facts whether occurring before or after completion of the Contract of Insurance.
- I/WE hereby acknowledge that the insurance cover may be provided in whole or in part by overseas insurers.
Please tick all to confirm that you have read the following documents:*
- Privacy Policy
- Financial Services Guide
- Duty of Disclosure
- Terms of Engagement
Signature

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328A Magill Road, Kensington Park SA 5068

Webber Insurance Services Pty Ltd | ABN: 88 648 036 929 | CAR No: 413233

Authorised Representative of Webber Insurance Group Pty Ltd | AFSL: 488465 | ABN: 70 612 339 894 All rights reserved

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