Insurance Renewal Questionnaire - Coombs Contractors Ltd

Policy Renewal Date (Anticipated): [Insert Current Policy Expiry Date, e.g., 08/09/2025]

Broker: PSP INS & FIN SOL (LT INS) (Agency: 1100117)

Instructions: Please review the pre-filled information below. If all details are correct and accurately reflect your business for the upcoming 12-month period, please click "Accept". If any information needs updating or further clarification, please click "Edit" and provide the correct details in the relevant section or in the "Additional Information" space at the end. Prompt and accurate information will help us secure the best possible renewal terms for you.

SECTION 1: Insured Details & Business Activities

1. Full Legal Name of Insured:

Coombs Contractors Ltd

2. Correspondence Address:

Unit 15, St. Margarets Park, Pengam Road, Aberbargoed, Bargoed, Mid Glamorgan, United Kingdom, CF81 9FW

Other Operational Addresses (Yards, Depots etc.):

3. Business Description:

Current understanding: Landscaping (soft and hard, including patios, driveways, decking), Gardening, Fence Erecting, Groundworks (including foundations, drainage, site clearance), and Plant Hire (with and without operator, covering owned and hired-in plant). Predominantly working on domestic and commercial sites.

If editing, please specify any changes or additions, e.g., types of groundworks, maximum depth of excavations, specific plant hire activities.

4. Director(s) & Officer(s) Details:

Director 1 Name: Director 1 Position:

Director 2 Name: Director 2 Position:

Any changes to Directors or Officers in the last 12 months?

5. Website Address:

https://www.coombscontractors.co.uk/

SECTION 2: Financial Information

1. Estimated Annual Turnover for the next 12 months:

Previous Figure (AXA ML Policy AC DIR 4516414): £900,000

Crucial: Please provide accurate current/projected figure.

2. Annual Wage Roll (Next 12 months): Direct Employees (PAYE): Labour-Only Subcontractors (LOSC): Bona-Fide Subcontractors (BFSC - who hold their own insurance):

3. Payments to Hired-In Plant Companies (Annual Cost):

SECTION 3: Operational Details

1. Employee Numbers (Next 12 months): Full-Time: Part-Time: Labour-Only Subcontractors regularly used:

2. Work Away / Location of Work: Percentage of work at Domestic Premises: Percentage of work at Commercial Premises: Percentage of work at Own Premises: Do you work at any hazardous locations (e.g., railways, airports, chemical plants, nuclear facilities, dockyards)?

3. Groundworks Activities: Maximum depth of excavation (meters): Do you undertake work involving underpinning or piling? Do all operatives involved in excavations hold current certification for use of Cable Avoidance Tools (CAT & Genny) and adhere to HSG47 guidelines? (Essential for cover)

4. Use of Heat: Do your activities involve the use of heat (e.g., welding, blowtorches, asphalt/tar boilers, angle grinders)?

5. Work at Height: Maximum height worked at (meters): Do you use scaffolding (erected by yourselves or others)?

6. Plant Owned:

Total Current Market Value of Owned Plant (Previously £12,500 as per Hadron policy 1742/01850603/2024/005)

Updated Total Market Value: Please attach/provide an updated list of owned plant if significantly changed.

7. Hired-In Plant:

Previous Hired-In Plant Limit (Hadron policy 1742/01850603/2024/005): £25,000

Maximum Value of any one item of Hired-In Plant: Total Value of Hired-In Plant at any one time: Do you always hire under CPA (Construction Plant-hire Association) conditions or similar?

8. Motor Fleet (Aviva Policy 97MF18181816):

Vehicle schedule as per policy document effective 24/09/2024. Includes: CO03BSO (Range Rover), R300MBS (Audi A5), NJ63GPK (Audi Q3), CO02BSO (Bentley), HJ17WPW (Transit), VO13UMY (Vivaro), HF17PPV (Transit), PO14KKH (Sprinter), CK13SFF (Berlingo), BT73FKG (Interstar), BT73EYH (Interstar), CK73EFP (Maxus), CK73EFO (Maxus).

Confirm schedule is accurate OR provide updated list: Any changes to regular drivers or their driving history (convictions, accidents) in last 12 months? Do all high-value vehicles requiring tracking devices have operational Thatcham Category S5 trackers (or Tesla OEM equivalent) with active subscriptions, as per policy FTMF011? (Essential for theft cover)

SECTION 4: Health & Safety and Accreditations

1. Do you have any current Health & Safety accreditations (e.g., CHAS, SMAS, SafeContractor, ISO 45001)?

2. Do you have a written Health & Safety Policy, which is regularly reviewed and communicated to employees?

3. Do you conduct and document Risk Assessments and Method Statements (RAMS) for your projects?

SECTION 5: Claims History & Declarations

1. In the last 5 years, have you or any director/officer sustained any losses or had any claims made against you (whether insured or not) relating to your business activities?

AXA Statement of Fact (AC DIR 4516414, 05/08/2024) states: "You have not had any claims or incidents giving rise to claims in the last 3 years". Aviva Motor SOF (97MF18181816) does not specify a period but asks if directors have had various issues (no claims mentioned directly).

2. Are you aware of any circumstances which might give rise to a claim under any of the insurances being renewed?

AXA Statement of Fact (AC DIR 4516414, 05/08/2024) states: "You are not aware of circumstances which might give rise to a claim".

3. Have any director, partner, or trustee ever, either personally or in connection with any business:

AXA Statement of Fact (AC DIR 4516414, 05/08/2024) states:

The company/organisation had a net profit in at least one of the last three reported audited accounts.
0% of the company's turnover / income to or from the United States of America.
The company does not operate in the following sectors: financial, legal or professional sports clubs.
Litigation has not been brought against past or present directors or officers of the company.
You have not had any insurance previously declined, renewal refused or any special terms imposed.
No insured party is disqualified, or has been disqualified in the past, from holding a licence or position.

Aviva Motor SOF (97MF18181816) confirms for policyholder, director, partner or family member involved:

No proposal declined, renewal refused, insurance cancelled by insurer.
Not convicted/charged (non-motoring) or cautioned for criminal offence (not spent).
Not declared bankrupt/insolvent in last 10 years.
Not disqualified as company director in last 10 years.
Not subject to CCJ, IVA, CVA or Sheriff Court Decree in last 10 years.

Please confirm ALL the above statements (from both AXA and Aviva documents) remain true and accurate:

4. Sanctions Compliance (from Aviva Motor SOF 97MF18181816):

You are not owned by an individual or entity which appears on the financial sanctions list of the United Nations, the European Union, United Kingdom or United States of America or any of its states.
Neither You, nor any director or partner of Yours involved with The Business:
- has any company or business in any sanctioned territory
- exports to or operates in any sanctioned territory or has any business dealings with individuals or entities that are known to be sanctioned...
- has any involvement with any products or components associated with weaponry, arms, or military goods.

Please confirm these statements regarding sanctions remain true and accurate:

SECTION 6: Additional Information & Confirmation

Please provide any other information relevant to your insurance renewal that has not been covered above, or clarify any "Edit" responses:

Declaration: I/We declare that the information provided in this questionnaire is true and complete to the best of my/our knowledge and belief, and that I/we have not withheld any material information. I/We understand that it is my/our duty to make a fair presentation of the risk to insurers and that failure to do so could result in the policy being voided, claims not being paid, or terms being altered.

Name of Person Completing Form: Position in Company: Date: