bhib affinities quote form - media and entertainment · email: [email protected]...

Email: [email protected] Telephone: 0330 013 0036

Brokerbility Limited is registered in England and Wales number: 05074716

Registered Office: AGM House, Barton Close, Grove Park, Enderby, Leicester, LE19 1SJ

Authorised and regulated by the Financial Conduct Authority

Media & Entertainment Media & Entertainment Media & Entertainment Media & Entertainment ---- Quotation FormQuotation FormQuotation FormQuotation Form

Product SelectionProduct SelectionProduct SelectionProduct Selection

Last Annual Turnover: £ ________________________

Select if Bespoke or Freelancers Package: Select if Bespoke or Freelancers Package: Select if Bespoke or Freelancers Package: Select if Bespoke or Freelancers Package:

Bespoke

The bespoke policy is designed for businesses with over 4 employees and more than 250,000

turnover.

Freelancers Package

The Freelancers Package is designed for Freelancers or small businesses with up to 3 employees and

no more than £250,000 turnover. Cover is selectable based on pre-defined options. This includes

Technical and Portable Equipment up to £50,000, Employers Liability (£10m), Public Liability (£5m),

Contents (up to £25K) and ICOW cover (up to £25K). Personal Accident and Professional Indemnity

covers can also be selected, and short period cover options are available.

Please fill out the relevant section dependent on which policy you have chosen above

Client Details

The Company

Company Status Limited Company ☐ Unlimited Freelancer ☐

Unincorporated Company ☐ Unincorporated Freelancer ☐

Trading name: ___________________________

Correspondence Address: __________________________





Post code

County:

Business description:

Year Business established:

Contact Details

Salutation

Forename

Surname

Telephone

E-mail

Occupation

Please fill out the relevant section dependent on which policy you

have chosen above

Bespoke Policy

Your Premises

Address:

Town:

County:

Post code:

Is the property a storage unit? Yes No

Is the storage unit secured with a closed shackle padlock within a recognised storage location (e.g.

Big Yellow, Safestore, Set a Side Storage) constructed with external walls of brick, stone or concrete

and roofed with slate, tiles or profile metal and staffed on a 24 hour basis?

Yes No





Property Damage

Do you require Buildings or Tenants Improvements cover?

Occupancy status: Not occupied Yes – Buildings Yes – Tenants Improvements

Please fill in the relevant question set below, dependent on your answer to the question above

Buildings

Buildings Sum Insured: £

(Buildings can only be insured if Contents or Portable & Technical Equipment is insured)

Rent owed to you:£

(Rent Owed can only be insured if Contents or Portable & Technical Equipment is Insured)

Contents Sum Insured: £

Computers and

Ancillary Equipment: £

Tape Stock: £

Do Contents float over other premise Yes No

Money

Select cover required :

Money whilst the premises is open £2,500 £5,000

for business, whilst in a locked safe

or in transit? £7,500 £10,000

Technical & Portable Equipment

Sums insured

Permanently on the premises: £

Does this equipment float over Yes No

other premises occupied by

the insured?

Anywhere in the European Union £

(Excluding equipment used worldwide)





Anywhere in the world £

Is cover required for Loss Yes No

of hire fees above £25,000?

Loss of Hire Fees sum insured £

(if yes)

Temporary Equipment Cover (if applicable)

Please enter only the increase in sum insured or extra cover required, excluding the annual sums

insured already in place.

Permanently on the premises £

Anywhere in the European Union

(Excluding equipment used worldwide) £

Anywhere in the world £

Cover Start Date: / /

Cover End Date: / /

Number of days:

If you require additional premises insurance, please use the space provided at the end of the

Bespoke policy section

Policy Cover

Additional Cover Terrorism

Do you require Terrorism Cover? Yes No

Public Liability Cover

Do you require Public Liability cover? Yes No

Please select limit of indemnity required

£2,000,000 ☐ £3,000,000 ☐ £5,000,000 ☐ £10,000,000 ☐





Do you require Temporary Public Liability cover?

Temporary Limit Required?

Please select limit of Temporary Indemnity required

£2,000,000 ☐ £3,000,000 ☐ £5,000,000 ☐ £10,000,000 ☐

Cover Start Date: / /

Cover End Date: / /

Number of days:

Do you undertake manual work away from the premises? Yes ☐ No ☐

Clerical/Non Manual work away Wage Roll excluding bona fide sub-contractors £ _____________

Clerical/Non Manual payments to bona fide sub-contractors £________________

(Information : For the purposes of this insurance, bona fide sub-contractors are defined as

contractors who work without direction from the client, provide their own tools and materials and

hold their own General liability cover with a limit of indemnity of no less than £2,000,000)

Manual Work Away excluding bona fide sub-contractors £_________________

Manual Work Away - payments to bona fide sub-contractors £ _______________

(Information: For the purposes of this insurance, bona fide sub-contractors are defined as

contractors who work without direction from the client, provide their own tools and materials and

hold their own General liability cover with a limit of indemnity of no less than £2,000,000

Employers Liability Cover

Do you require Employers Liability cover? Yes No

Please provide your ERN / PAYE number if you have any Employees.

No Employees / Exempt --------------------------------------





Clerical/Non manual wage roll: £____________

(Information: For the purposes of this insurance, cameramen (including cinematographers, stills

photographers and assistants) who do not work at height, with animals or at any hazardous

locations can be considered non-manual)

All other employees: £ _____________

(Information: For the purposes of this insurance, cameramen (including cinematographers, stills

photographers and assistants) who do not work at height, with animals or at any hazardous

locations can be considered non-manual).

Commercial Legal Protection

Do you require Commercial Legal Protection Cover? Yes☐ No ☐

(If yes note the standard limit of indemnity us £100,000)

Wage roll: £ ____________

Have you made any previous claims in respect of Commercial Legal Protection? Yes ☐ No ☐

If yes, please confirm details of claims?

Personal Accident

Do you require Personal Accident Cover? Yes☐ No ☐

Capital Benefit £10,000

Total Number of People covered





Insured Details

Name

Pre-Existing Medical Conditions Yes ☐ No☐

If yes please state all conditions below:

Date of Birth date Month Year

Age

Add another person + (repeat as above if applicable )

Business Travel

Do you require Business Travel Cover? Yes No

If yes, please fill out the sections below

Destination: Select: UK only ☐☐☐☐ Europe only ☐☐☐☐ Worldwide ☐☐☐☐

Complete appropriate section:

UK trips only

Estimated number of Trips

0 – 4 :

5 – 10 :

11 – 18 :

19 – 31 :

Europe trips only

0 – 4 :

5 – 10 :

11 – 18 :

19 – 31 :





Worldwide trips only

0 – 4 :

5 – 10 :

11 – 18 :

19 – 31 :

Business Travel continued

Any non-business travel, i.e. Yes No

for personal reasons?

Any person traveling over 71? Yes No

Individuals to be insured are all UK Yes No

nationals and domiciled in the UK?

Any trips with multiple destinations? Yes No

Any spouses or children travelling Yes No

with the insured person on

a business trip?

Any travel to or in Afghanistan, Chad, Yes No

Chechnya, Congo (Democratic Republic),

Iraq, Israel, Ivory Coast, Somalia or

Sudan or any other countries where

non-essential travel is advised against

by the Foreign and Commonwealth Office?

Any pre-existing medical conditions for Yes No

which treatment has been required within

the last two years or any trips taken against

medical advice, or taken in order

to receive medical treatment overseas?

Any winter or hazardous sports, e.g. Yes No

diving, mountaineering or climbing

Details of any previous Travel Claims:





Directors & Offices

Do you require cover for Directors and Officers Cover? Yes ☐ No ☐

Limit of Indemnity is £50,000

The Business is a Limited Company Yes☐ No☐

Have you been trading for at least two years, made a profit Yes ☐ No☐

In the last year and declared a positive net worth in the

latest annual company?

Has your accountant qualified their opinion in the latest annual account. Yes ☐ No ☐

Do you have assets or derive turnover outside the United Kingdom Yes ☐ No ☐

Have there been any claims or investigations made against the company,

its directors, officers or employees in the last five years which may have

given rise to a claim under this policy had it been in force. Yes ☐ No ☐

Are you aware of any fact, circumstance, allegation or incident likely

to give rise to a claim Yes ☐ No ☐





Professional Indemnity

Do you require Professional Indemnity Yes No

cover?

Limit of Indemnity? £100,000 £250,000

£500,000 £1,000,000

Select an excess? £0 £500 £1,000

£2,000 £2,500 £5,000

If prior to inception please enter any earlier Retroactive Date required? / /

Are there any contracts where Yes No

the total value exceeded £250,000?

Have you worked under any contracts Yes No

with applicable law outside of the EU?

Are all steps are taken to ensure third Yes No

party rights are not breached?

Are you aware after reasonable enquiry of any matter which may lead to a claim against you,

including but not limited to;

� A shortcoming or problem in your work which cannot reasonably be put right

� A complaint about your work or anything you have supplied which cannot immediately be resolved

� An escalating level of complaint on a particular project

� Any of your customers withholding payment to you after a complaint

Yes No

Notes





Internet and Email

Do you require Internet and Email cover? Yes ☐ No ☐

Limit of Indemnity: Select limit ☐£100,000 ☐£250,000

You do not operate an interactive website? Yes ☐ No☐

(Information: For example, a website which contains a bulletin board, chat forum or newsgroup

facility or where financial transactions can be made).

You are fully compliant with the Data Protection Act Yes ☐ No☐

You have virus protection software operating on their network which is updated daily: Yes ☐No☐

You back up all electronic files on their system at least weekly and stores these off site: Yes ☐No ☐





Freelancers Package

Do you require annual cover? Yes ☐ No ☐

If No please advise us of the cover From date / month/ year

start date and end date: To date / month / year

The Cover

Public Liability Limit: £5,000,000 Automatic

Do you require Technical and £5,000 £10,000 £15,000

Portable Equipment cover? £20,000 £30,000 £40,000

333 £50,000 No

Do you require Employers Yes No

Liability Cover?

Employers Liability Limit: £10,000,000 Automatic

Are there more than 3 employees? Yes No

Please provide your ERN/ PAYE number is you have employees ________________

Personal Accident Benefit: £10,000 Automatic

Do you require Property Contents £2,500 £5,000 £10,000

& Increased Cost of Working cover? £15,000 £25,000 No

This relates to Contents (excluding Technical & Portable Equipment) at your premises and used in

connection with the business. An equivalent limit will also be provided for the economical costs

incurred in minimizing the reduction in income to your business.





Property Questions

Are your business premises constructed Yes No

with walls of brick, stone or concrete

and roofed with slates, tiles or profile metal?

Are the buildings free from cracks or other Yes No

signs of damage that may be due to

subsidence, landslip or heave and

have not previously suffered damage

by any of these and are not in a known subsidence area?

Are your business premises occupied Yes No

solely for the purposes of the business or

with an element of residential accommodation

or are self-contained within a studio or media complex?

Are the premises left unoccupied for more Yes No

than 30 consecutive days?

Is the electrical installation at the premises Yes No

inspected at least every five years by a

qualified electrician and all defects

are remedied accordingly?

Has your business premises been affected Yes No

by flooding or is it within 500 meters

of any water source?

Please provide additional information if any of the above answers are no

Do you require Professional Indemnity Cover? £100,000 £250,000

0 £500,000 £1,000,000

0 No

If prior to inception please enter any [ / / ]

earlier Retroactive Date required?





Professional Indemnity Questions

Do you or have you ever worked under Yes No

any contract with a total value to you

greater than £250,000 in any twelve month period?

Do you or have you ever worked under any Yes No

contract with applicable law outside the

European Union?

Do you take all reasonable steps to ensure Yes No

that any photograph, film clip, music or other

content used or licensed by you does not

breach any third party rights?

Are you aware after reasonable enquiry of any matter which may lead to a claim against you,

including but not limited to;

� A shortcoming or problem in your work which cannot reasonably be put right

� A complaint about your work or anything you have supplied which cannot immediately be resolved

� An escalating level of complaint on a particular project

� Any of your customers withholding payment to you after a complaint

Yes No

Please provide additional information if any of the above answers are no





End of Freelancers Policy section, please fill out the following sections as they apply to both

policies

Previous Insurance Details

Previous Insurer and/or Broker Yes No

Are you the holding broker Yes ☐ No ☐

Do you wish to pay by installments? Yes No

Are you a Member of BECTU? Yes No

Members of the Broadcasting, Entertainment, Cinematograph and Theatre Union (BECTU) receive a

20% discount.

Client Activities

The following client’s activity section and claims sections apply to both the Bespoke Policy and the

Freelancers package

You are domiciled in the United Kingdom True False

and all premises are based in

the United Kingdom

You do not work outside of the UK for True False

more than 90 consecutive days

You do not undertake any work in a territory True False

where the Foreign Office advise against

all non-essential travel?

You do not undertake any work in or on True False

blast furnaces, chimney or well shafts,

viaducts, bridges, mines, refineries,

off-shore installations, power stations,

dams, tunnels, airports or aerodromes,

docks, wharves, piers, harbors, railways,

motorways, aircraft towers, steeples or

ships unless docked

You do not undertake any work involving True False

the use or application of heat away from





their own premises other than the use

of soldering irons

You do not undertake any work in or on True False

water or underground

You do not undertake any work with animals True False

You do not undertake any work more than 10 True False

meters above ground or floor level

You do not undertake any activities involving True False

speeds of over 20 mph

Your activities do not involve participating True False

in Horse riding or other equine activities

You do not participate in winter sports True False

You do not participate in climbing, caving, True False

potholing or any underground activity or any

activity that requires the use of cables, ropes,

wires or guides

.

General Questions

If you have answered False to any of the below questions, please provide full details in the below

declarations detail box. :

You have not been declared bankrupt or become insolvent or made any voluntary arrangement with

creditors or been subject to enforcement of a judgement debit either in a personal capacity or as a

business

True ☐ False ☐

You are not aware of any potential claim or loss from the dishonesty or malice of any employee or

self -employed freelancer

True ☐ False ☐

You have not had an insurance or proposal cancelled, withdrawn, declined or made subject to

special terms

True ☐ False ☐

You have not been convicted of or charged with any offence, other than a motoring offence or

conviction spent under the Rehabilitation of Offenders Act 1974





True ☐ False ☐

You are not aware after enquiry of any potential injury or disease to an employee, which may give

rise to a claim

True ☐ False ☐

Declaration Details if any answered as False:

Claims

Have you had any claims, whether successful or not relating to property damage to be covered under

this policy in the last 5 years?

Yes ☐ No ☐

Has any claim or loss, whether successful or not, ever occurred or been made against you or your

predecessors in business or any past or present partner, principal or director?

Yes ☐ No ☐

Please detail below if answered Yes

Date of Loss:

Loss code : (Select from drop down list)

Loss description:

Outstanding Amount: £

Claim Amount Paid: £





Total Amount £

+ add another claim

End of quotation document

Thank you for taking the time to fill in this form

bhib affinities quote form - media and entertainment · email: [email protected]...

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