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Fire Protection / Security

The completion and signature of this proposal form do not bind the Proposer or Underwriter to complete a Contract of Insurance.

IMPORTANT:YOU MUST COMPLETE ALL QUESTIONS IN FULL. ALL INFORMATION WILL BE TREATED WITH CONFIDENTIALITY.

1 *Full Name of Proposer
(including any trading names)
2 Address
Tel No: Fax No:
Email: www:
4 Date Company established (if less than 12 months please provide full details of relevant experience of directors/principals including the names of previous companies you have worked for)
5 Give details of any trade association or regulatory body you are a member of
6 Business description (give fullest possible description of all activities and products)
(NOTE: COVER WILL ONLY APPLY TO THE BUSINESS DEFINED ABOVE)

7 The Insurance Required
(please state if you require quotes for more than one limit)

Limit of Indemnity - Please tick limit required.
1.4m 2.8m 7m
Yes No
i) Public Liability (policy incorporates products liability/efficacy/wrongful advice/wrongful arrest/contractual liability)
ii) Employers Liability
iii) Fidelity Bonding Extension
iv) Loss of Keys Extension
v) Loss of Halon Extension

Please now complete one or more of the following sections as appropriate, then go to Q 21 (total turnover)
Section A Alarms and Associated Activities
Section B Fire Protection Systems and Products
Section C Security Guarding and Keyholding Services
ie. If involved in intruder alarms and fire extinguishers complete Sections A and B. If involved in CCTV and guarding complete Sections A and C. If only involved in guarding only complete Section C.

SECTION A

8 Alarms and Associated Activities
Estimated Annual Turnover

Manufacture Installation/Servicing
i) Intruder Alarms
ii) Fire Alarms
iii) CCTV
iv) Access Control
v) Locks and Safes
vi) Grilles and Shutters
vii) Central Station Monitoring (applicable only if you run your own station)
viii) Temperature Alarms
ix) Vehicle Alarms
x) General Electrical Contracting (including emergency lighting)
xi) Pure Retail/Wholesale (ie. no installation, etc)
xii) Smoke Emitting Devices (e.g. 'smokecloak or smokescreen')
xiii) Any other Turnover
Please detail exactly what this is
9) Estimated manual wages from the above activities (include payments to labour only subcontractors)
10) Are all systems manufactured & or installed to the appropriate British Standard? YES NO
If not, please provide full details

SECTION B

11 Fire Protection Systems and Products
Estimated Annual Turnover

Manufacture Installation/Servicing
i) Portable Fire Extinguishers
ii) Fixed Extinguishers (including Halon and other gas extinguishing systems)
iii) Fixed Extinguishers on Ships
iv) Fire and Smoke Alarms
v) Breathing Equipment
vi) Sprinklers and Wet Risers
vii) Dry Risers
viii) Safety Signs
ix) Pure Retail/Wholesale (ie no installation, etc)
x) Any Other Turnover
Please detail exactly what this is
12 Estimated Manual Wages (from sprinklers)
(include payments to labour only subcontractors)
Estimate Manual Wages (all other)
(include payments to labours only subcontractors)
13 Are all fire protected systems manufactured/installed to the appropriate British Standard?
If not, please provide full details
YES NO

SECTION C

14 Security Guarding & Keyholding Services
Estimate annual turnover from Security Guarding and Keyholding
Please state approximate split in % terms of guarding contracts between:-
i) Car Compounds V) Store Detectives
ii) Building Sites Vi) Gate Control/Commissionaires
iii) Warehouses & Factories vii) Mobile & Residential Patrols
iv) Offices viii) Keyholding Services
15 Estimated Number of guards Estimated annual guards wageroll
16 Are you involved in carrying cash?
If yes please provide full details
YES NO
17 i) Do you provide guard dog security
YES NO
If yes, state number of dogs
Do you comply with the Guard Dogs Act and any amending legislation
YES NO
18 ii) Do you have a system in place for ensuring guards are on duty on site at the required time.
YES NO
19 a) Do you provide any ancillary non-guarding activities such as industrial/commercial process monitoring?
YES NO
b) Are you involved in crowd control, protestor sites, doormen at licensed premises, bodyguards or similar activities
If yes to a) please provide full details.
YES NO
20 It is a requirement and policy condition that all employees be vetted. Please confirm your vetting procedure.
21 Total Turnover From Sections A,B & C
TOTAL ESTIMATED TURNOVER from sections A, B & C TOTAL ESTIMATED MANUAL WAGES from sections A, B & C
TOTAL ESTIMATED CLERICAL WAGES
No. of EMPLOYEES Manual Clerical
(Please ensure that your total turnover and wages provided add up to the same as provided in Sections A, B & C)
22 General Questions (to be completed by ALL proposers)
What equipment do you use or processes do you carry out away from your premises that involve the application of heat?
23 Have you signed any contracts with central monitoring stations where they restrict their liability?
YES NO
If yes a copy of the contract conditions MUST be attached
24 Do your own contract or your customers contract conditions increase your normal legal liabilities?
YES NO
If yes a copy of the contract conditions MUST be attached
25 Do you undertake work (or supply goods to):-
a) outside Republic of Ireland?
YES NO
b) at a height in excess of 16 metres?
YES NO
c) on Board ships, on off-shore installations, at airports chemical or petrochemical works, nuclear installations, bulk oil or gas storage facilities?
YES NO
d) mainframe computer suites?
YES NO
if you have answered YES to any of these questions, please give details indicating the proportion of your turnover and wages for the work:-
26 a) Do you engage subcontractors:- (other than labour only)
YES NO
d) If yes, do you check subcontractors hold public liability insurance (including products liability if the whole of a service or a completed installation is involved) for an indemnity of at least 1.3m covering the work being subcontracted?
YES NO
27
Please advise the percentage of work relating to private dwellings %
Previous Insurance & Claims Experience
28 Name of Last Insurer
Last Policy Numbers(s) Expiry Date
Has any insurer ever declined to insure your, cancelled or refused to renew your insurance?
YES NO
If yes, please provide full details
a) Have you or any of your directors or partners previously been involved in the management of any business which has ceased to trade, or is about to cease to trade?
YES NO
b) Have you or any of your directors or partners been prosecuted under the Health & safety at Work Act 1974, the Consumer Protection Act 1987, or any other legislation relating to the health and safety of your employees or members of the public, or in respect of any criminal offences?
YES NO
If you answered YES to a) or b), please provide full details including names of the businesses concerned
32 Claims
Please state the experience for claims made against you over the last five years
Employers Liability
YearNoPaid Outstanding

Public/Products/Efficacy/Contractual Liability/Fidelity Bonding/Loss of Keys
YearNoPaid Outstanding
b) Please give additional details of the circumstances and outcome of any settled or outstanding claim in the last five years which exceeds 5,000 or any relating to industrial disease or deafness. If there have been no such claims enter NONE
Email Address *
This email address will be used for correspondence regarding this On-Line form and for no other purpose.
I have read and agree to Brennan Insurances Terms and conditions.
YES NO
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