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Cover arranged by Meadons Insurance Brokers Ltd

 

 

 

 

 

  

 

                                                                                                                                                                                             ©Duncan.Harris.31.8.2013

 

OWZAT INSURE - PROPOSAL FORM

Full name of Club:
Correspondence Address:
If CLUBMARK accredited (Number):
Address of MAIN premises to be insured:
Phone:
-
Fax:
-
E-mail:
Name of Current Insurer:
Date cover to commence:
Please describe fully, all sporting activities carried out at the club:
General Questions/Club Activities

1. Has the club held any insurances which have subsequently been declined, terminated, subjected to special terms or refused insurance?
2. Had any losses whether insured or not or had any claims made against you or your club or are aware of any circumstances/ incidents which might give rise to a claim against you or your club in the last 5 years?

3. Have the club, any directors, officials or committee members ever:

a. been convicted or charged (but not yet tried) or been given an Official Police Caution, in respect of any criminal offence?
b. been the subject of any County Court Judgments or Sheriff Court Decrees?
c. been declared bankrupt or insolvent?
4. Any other material circumstances to disclose?
5. Is your club in use all year round (i.e. outside cricket season)?; During periods of unoccupancy, you will be expected to inspect the premises at least every 14 days
6. Is Hot Food prepared on the premises? If yes, is Deep Fat Frying Equipment Used?
7. Do you hold a Bonfire Night and/or Firework display? If yes, please state maximum Spectator Attendance, below
8. Is there any entertainment provided at the premises? If yes, please confirm the type and how often, below
9. Do you operate a Licenced bar?
10. Is the clubhouse hired out for Social Functions (e.g. Weddings, Disco’s)? If YES, please state approximate number per year, below
If you answer ‘Yes’ to any of the above questions, please supply additional information in the box below:
ASSET PROTECTION AND THEFT

Tick if cover required:

Are the building and ground(s) which you occupy:


(a) In good state of repair?
If No, please give details:
(b)Built of brick, stone or concrete and roofed with slate, tile, concrete, metal or asbestos?
If No, please give details.
(c) Does the roof of your premises include more than 25% felt on timber?
If ‘yes’ please state approximate percentage %
(d) Are the buildings and grounds in an area affected by flooding or at risk of flooding?
If YES, please give details.
(e) in your sole occupation?
If NO, please give details.
(f) Does the security of the Premises comply with the minimum protections? (See Minimum Security Conditions at end of proposal form for details)
(g) protected by an intruder alarm system? (If ‘Yes’ please complete the questions below)
i) What is the name of the Alarm Company?
ii) What is the date of the Alarm Specification?
iii) Are the installers/maintainers members of NACOSS?
iv) Is the system connected to a Central Station Alarm?
If Yes, what is the method of signalling?
If 'Other', please state here:
h) Other Security, please tick:
If 'Other',please state here:
i) Is there a fire alarm and if so, what type - eg. manual, automatic
j) Please tick and attach details if you have had

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Sum Insured


Club Buildings (reinstatement cost including debris removal costs and professional fees)
OR,Tenants’ Improvements and Decorations (replacement cost)
Machinery/Equipment
Stock
Wines, Spirits & Tobacco Goods
Fixtures, Fittings and All Other Contents
BUSINESS ALL RISKS

Specified Items – Items usually kept in the open or likely to be taken away from the Club Premises can be insured on an All Risks Basis as a specified item. Please indicate the SUM INSURED below
Business ALL Risks -Cover Required?
Cups & Trophies
Club Bags
Non-Turf Pitches
Netting and Poles
Sight Screens and Covers
Electronic Scoreboard
Bowling Machine
Cricket Square
Machinery/Equipment kept in the open
Other, Please State
GOODS IN TRANSIT

Our standard Limits of Indemnity are stated below. Please advise if increased limits are required.
Goods in Transit - Cover Required?
Tobacco, Wines, Spirits - Limit Provided £500
All other Goods - Limit Provided £2000
MONEY AND ASSAULT

Our standard Limits of Indemnity are stated below. Please advise if increased limits are required.
Money & Assault - Cover Required?
During Business Hours, or Whilst in Transit - Limit Provided £2,500
After Business Hours whilst in a locked safe Limit Provided £1,500
After Business Hours not in a locked safe Limit Provided £250
In Gaming Machines Limit Provided £250 (per Machine)
In authorized members’ homes Limit Provided £500
Loss of crossed cheques, credit company sales vouchers and other non- negotiable forms of payment - Limit provided £250,000

ASSAULT BENEFITS


Death, loss of limb(s) or eye(s)£10,000

Permanent & Total Disablement
£10,000

Total Disablement
£100 per week

Partial Disablement£50.00 per week



GLASS

Our standard Limits of Indemnity are stated below. Please advise if increased limits are required.
Glass - Cover Required?
ALL External and Internal Glass Limit Provided £2000 (per Machine)
FROZEN FOODS

Frozen Foods - Cover Required?
Description of Unit
Year of Make
Sum insured:
BUSINESS INTERRUPTION

Our standard Limits of Indemnity are stated below. Please advise if increased limits are required. Cover is included for loss of trading profit for up to 12 months from the date of damage at your premises which causes business interruption, provided we accepted a claim for such damage under the Contents or Buildings Sections of the policy.
Business Interruption - Cover Required?
Gross Revenue Sum Insured - Limit Provided £100,000
LOSS OF LICENCE

Our standard Limits of Indemnity are stated below. Please advise if increased limits are required.
Loss of Licence - Cover Required?
Loss of Club Premises Certificate - Limit Provided £60,000
GENERAL LIABILITY

Our standard Limits of Indemnity are stated below. Please advise if increased limits are required. Note: For Terrorism, limits will be restricted to £5,000,000 (Employers’ Liability) and £2,000,000 (Public and Products Liability)
General Liability - Cover Required?
Employers Liability - Limit Provided £10,000,000
Public Liability including Member to Member - Limit Provided £2,000,000
Products Liability - Limit Provided £2,000,000
PAYE Number:
PERSONAL ACCIDENT

Persons Insured – Club Members whilst:
1. playing cricket as a member of the club team or any representative team under the recognized rules of cricket and under the control of an umpire.
2. taking part in cricket practice including net practice under club arrangements.
3. performing official duties as an umpire or scorer in any match played by the club.
4. travelling as a member of a team (other than by motorcycle) under club arrangements to and from away matches.
5. involved in routine maintenance of the grounds and buildings
6. Aged 80 years or under.
Personal Accident - Cover Required?
Death, Loss of Eye(s) or Limb(s)Permanent Total Disablement
£25,000,00 (MAX)
One Unit of Temporary Disablement
£20 per week


Please state the number of units required:
Note: Cover is also provided for:
1. The breakage or damage to Dentures and Spectacles whilst playing or officiating in any one match up to a limit of £500 in any one claim, subject to the first £25 being excluded.
2. Hospitilisation Benefit following a PA Claim Benefit : £25 per day up to a maximum of £500 subject to £25 excess
3. Physiotherapy Benefit – Maximum Payable £500 subject to £25 Excess

Note: Under 16’s – Death, loss of limb(s) or eye(s) or Permanent Total Disability is restricted to £2,500
Note: For persons not gainfully employed the benefits are limited to 50% of the normal benefit payable
Note: Up to 10 units are available in respect of Temporary Disablement


COMMERCIAL LEGAL EXPENSES

(This Section is underwritten by ARAG Legal Expenses Insurance Company Limited)

The ARAG Commercial Legal Protection policy offers comprehensive cover in all the main areas where legal disputes may arise including the following:

> Employment Disputes and Compensation Awards
> Statutory Licence Protection
> Contract disputes
> Property Protection
> Bodily Injury
> Tax Protection
> Attendance Expenses
> 24 hour helpline services and much more.
Commercial Legal Expenses - Cover Required?
LIMIT PROVIDED: £100,000

Has there been any legal dispute, action, prosecution, customs and excise or Inland Revenue investigations during the last five years?

If Yes, Please provided more details:
Has your club merged or been taken over or bought another company or organization within the last two years, or are you proposing to merge, take over or be taken over within the next twelve months?
If Yes, Please provided details:
To the best of your knowledge and belief are any redundancies envisaged within the next 12 months?
If Yes, Please provided more details:.
OTHER REQUIREMENTS

Other Requirements - Cover Required?
SUBSIDENCE

Damage at the Premises caused by Subsidence or ground heave of the site of the Property Insured or Landslip. Subsidence Cover is available for a premium charge. Do you require further details of this cover and a quotation?

TERRORISM

Please note that in addition to its other terms, conditions, exceptions or exclusions, the policy wording may incorporate provisions which exclude or limit loss, damage or liability caused by acts of Terrorism, and the terms of any quotation should be read as having been adjusted accordingly

Full details are available on request. Additional terrorism insurance cover is available for a premium charge. Do you require further details of this cover and a quotation?

DIRECTORS & OFFICERS INDEMNITY

Do you require further details of this cover and a quotation? If so please provide the Club’ s estimated annual turnover and limit of indemnity required .

Turnover (£)
Limit of Indemity:
If you have any further cover requirements which are not catered for elsewhere in this Proposal Form please give details below or on a separate sheet:

If You Have a Complaint

We hope that you will be happy with the service that we provide. However, if for any reason you are unhappy with it, we would like to hear from you. In the first instance, please write to your Insurance Adviser or us at

Meadons Insurance Brokers Limited
11 Cheshire Street
Market Drayton
Shropshire
TF9 1PD

or telephone us on 01630 658455.

Meadons Insurance Brokers Limited and Aviva are covered by the Financial Ombudsman Service for complaints from private individuals, certain small businesses, charities and trusts. If you have complained to us and we have been unable to resolve your complaint, you may be entitled to refer it to this independent body. Following the complaints procedure does not affect your right to take legal action.

Further details of our complaints procedure can be found in our policy booklet.

Telephone Call Charges and Recording

Calls to 0800 numbers from UK landlines and mobiles are free. The cost of calls to 03 prefixed numbers are charged at national call rates (charges may vary dependent on your network provider) and are usually included in inclusive minute plans from landlines and mobiles. For our joint protection telephone calls may be recorded and/or monitored.

Choice of Law

The appropriate law as set out below will apply unless you and the insurer agree otherwise:

1. The law applying in that part of the UK, Channel Islands or Isle of Man in which you normally live or (if applicable) the first named policyholder normally lives; or
2. In the case of a business, the law applying in that part of the UK, Channel Islands or Isle of Man where it has its principal place of business; or
3. Should neither of the above be applicable, the law of England and Wales will apply.

Data Protection Act - Information Uses

For the purposes of the Data Protection Act 1998, the Data Controllers in relation to any personal data you supply are Meadons Insurance Brokers Limited and Aviva Insurance Limited.

Insurance Administration

Your information may be used for the purposes of insurance administration by the insurer, its associated companies and agents, by re-insurers and by your intermediary. It may be disclosed to regulatory bodies for the purposes of monitoring and/or enforcing the insurer’s compliance with any regulatory rules/codes. Your information may also be used for offering renewal, research and statistical purposes and crime prevention. It may be transferred to any country, including countries outside the European Economic Area for any of these purposes and for systems administration. Where this happens, we will ensure that anyone to whom we pass your information agrees to treat your information with the same level of protection as if we were dealing with it.

If you give us information about another person, in doing so you confirm that they have given you permission to provide it to us and for us to be able to process their personal data (including any sensitive personal data) and also that you have told them who we are and what we will use their data for, as set out in this notice.

In the case of personal data, with limited exceptions, and on payment of the appropriate fee, you have the right to access and if necessary rectify information held about you.

In assessing your application now or at renewal, the insurer or its agents may undertake checks against publicly available
information (such as electoral roll, county court judgments, bankruptcy orders or repossessions). Similar checks may be
made in assessing any claims made.

Information may also be shared with other insurers either directly or via those acting for the insurer (such as loss adjusters or investigators).

Credit Searches and use of Third Party Information

To ensure the insurer has the necessary facts to assess your insurance risk, verify your identity, to help prevent fraud
and to provide you with their best premium and payment options, the insurer may obtain information relating to you and
your business from third parties at quotation and renewal and in certain circumstances where policy amendments are
requested. This information may include a quotation search from a credit referencing agency which will appear on your
credit report and will be visible to other credit providers. It will be clear that this is a quotation rather than a credit
application by you to pay by monthly instalments.

The insurer is a responsible provider of credit which is regulated by the Consumer Credit Act, and they take these
responsibilities seriously to ensure their customers are able to meet their monthly instalment commitments.

When you agree to pay monthly, the status of your quotation search from their credit reference agency will be updated to
reflect your credit application and this will be visible to other credit providers. Credit reference agencies may keep a record of the search. The insurer may also pass to credit reference agencies information it holds about you and your payment record. The information will be used by other credit lenders for making credit decisions about you and the people with whom you are financially associated for fraud prevention, money laundering prevention and for tracing debtors.

Sensitive Data

In order to assess the terms of the insurance contract or administer claims which may arise, the insurer may need to collect data which the Data Protection Act defines as sensitive (such as medical history or criminal convictions). By proceeding with this application you will signify your consent to such information being processed by the insurer or its agents.

Marketing

Aviva group and its agents may use your information to keep you informed by post, telephone, e-mail or other means about
products and services which may be of interest to you. Your information may also be disclosed and used for these purposes
after your policy has lapsed. If you do not wish your information to be used for these purposes please write to Aviva,
FREEPOST, Mailing Exclusion Team, PO Box 6412, Derby DE1 1SB.

Fraud Prevention and Detection

In order to prevent and detect fraud we may at any time:
• Share information about you with other organisations and public bodies including the Police;
• Undertake credit searches and additional fraud searches;
• Check and/or file your details with fraud prevention agencies and databases, and if you give us false or inaccurate
information and we suspect fraud, we will record this to prevent fraud and money laundering.
We can supply on request further details of the agencies and databases we access or contribute to and how this information
may be used. If you require further details please contact us at:
Policy Investigation Unit, Aviva, Cruan Business Centre, Westerhill Business Park, 123 Westerhill Road, Bishopbriggs,
Glasgow, G64 2QR.Telephone: 0345 300 0597. Email PIUUKDI@AVIVA.COM
We and other organisations may also search these agencies and databases to:
• Help make decisions about the provision and administration of insurance, credit and related services for you and members
of your household;
• Trace debtors or beneficiaries, recover debt, prevent fraud and to manage your accounts or insurance policies;
• Check your identity to prevent money laundering, unless you provide us with other satisfactory proof of identity;
• Check details of job applicants and employees.

Claims History

Under the conditions of your policy you must tell us about any Insurance related incidents (such as fire, water damage, theft or an accident) whether or not they give rise to a claim. When you tell us about an incident we will pass information relating to it a database.

We may search these databases when you apply for insurance, in the event of any incident or claim, or at time of renewal to
validate your claims history or that of any other person or property likely to involved in the policy or claim.

You should show these notices to anyone who has an interest in the insurance under the policy.

Material Circumstances

Please remember that you must make a fair presentation of the risk to us. This means that you must:

(1) disclose to us every material circumstance which you know or ought to know or, failing that, sufficient information to alert us that we need to make further enquiries; and

(2) make such disclosure in a reasonably clear and accessible manner; and

(3) ensure that, in such disclosure, any material representation as to a: (a) matter of fact is substantially correct; and (b) matter of expectation or belief is made in good faith.

A material circumstance is one that is likely to influence an insurer in the acceptance and assessment of the application. You must also make a fair presentation to us in connection with any variations, e.g. changes you wish to make to your policy. If you fail to make a fair presentation of the risk then this could affect the extent of cover provided or could invalidate your policy, so if you are in any doubt as to whether a circumstance is material then it should be disclosed to us.

Disclosures should be specific and made in a reasonably clear and accessible manner. We will not be deemed to have knowledge of any information generally referred to (for example the contents of company websites listed in the risk presentation) or any matter not expressly drawn to our attention.

Each renewal invitation is made on the basis of the information we have at the time it is issued. We may revise or withdraw it if, before the date your renewal takes effect, any event occurs that gives rise to a claim or alters the material circumstances under this insurance, even if we are notified after your renewal date.

A specimen copy of the policy wording is available on request. You should keep a record (including copies of letters) of all information supplied to us for the purposes of the renewal of this insurance. A copy of the completed application will be supplied on request within a period of three months after its completion. Please state any other material circumstances here.
Declaration

I/We understand that the contents of this completed application and I/we declare that the
information given is, to the best of my/out knowledge and belief correct and complete.

I/We agree that the statements in this application shall form the basis of the contract between the
insurer and myself/ourselves and if the risk is accepted I/we undertake to pay the premium when
called upon to do so.

I/We understand that my/our information may also be disclosed to the
Financial Conduct Authority and other regulatory bodies for the purpose of monitoring and/or
enforcing the insurer's compliance with any regulatory rules/codes.


By ticking this box I confirm that I fully understand and agree with this declaration.
*
Name:
Position:
Date:

CLUB MINIMUM SECURITY

CONDITION - Please read 

Minimum Security Condition in the Policy states:

If in relation to any claim for Damage to the Property Insured caused by theft or attempted theft at The Premises, which occurs more than 30 days after the inception of this policy, You have failed to fulfil any of the following conditions, You will lose Your right to indemnity or payment for that claim. If in relation to any claim for Damage to the Property Insured at The Premises, which occurs more than 30 days after the inception of this policy, You have failed to fulfil any of the following conditions,  You will lose Your right to indemnity or payment for that claim. You must ensure that in respect of all those parts of  The Premises occupied by You in connection with The Business (1) all hinged single leaf doors used as final exit doors are secured as follows  (a) timber framed doors - by a lock certified as meeting BS3621 and which if it is a mortice lock has a corresponding boxed striking plate. (b) aluminium framed doors by a five pin cylinder mortice swing lock.

(c) plastic framed doors by a multi-point lock assembly certified as meeting PAS 3621 or a multi-point fastening device comprising at least three moving fastening points operated by a central handle secured by a five pin cylinder lock. (d) steel doors by the means shown in (1) (a) or (c) above or by a five pin cylinder mortice lock. (2) all hinged double leaf doors used as final exit doors are secured as follows (a) first closing leaf (timber framed doors) by having, at the top and bottom of the leaf, rebate bolts or internal key operated mortice rack bolts or key operated lockable bolts. (b) first closing leaf (aluminium framed doors) by having, at the top and bottom of the leaf, rebate bolts or internal  key operated lockable bolts. (c) first closing leaf (plastic framed doors) by having a multi-point lock assembly certified as meeting PAS 3621 or a multi-point fastening device comprising at least two moving bolts operated by a central handle secured by a five pin cylinder lock or, at the top and bottom of the leaf, rebate bolts or internal key operated lockable bolts. (d) first closing leaf (steel doors) by the means shown in (2) (c) above.(e)final closing leaf by the means shown in (1) (a), (b), (c) or (d) above. (3) all hinged external cellar trap doors are secured as follows (a) single leaf doors - by an internal, centrally positioned, steel padlock bar secured by a padlock having a hardened steel shackle or, at the top and bottom of the door, internal key operated lockable bolts. (b) double leaf doors by having each leaf fastened to the other by an internal, centrally positioned, steel padlock bar secured by a padlock having a hardened steel shackle. (4) all other hinged external doors and any internal doors which lead into areas of  The Premises not occupied by You, or into any common areas including stairwells or walkways, or into any adjoining premises, are secured as follows; (a) single leaf doors by the means shown in (1) (a), (b), (c) or (d) above or by having, at the top and bottom of the door , internal key operated lockable bolts or key operated mortice rack bolts. (b) double leaf doors by the first closing leaf being secured by the means shown in (2) (a), (b), (c) or (d) above and the final closing leaf being secured as in (2) (e) above or having, at the top and bottom of the leaf, internal key operated lockable bolts or key operated mortice rack bolts. (5) all external rolling shutter or rolling panel doors, including any which lead into areas of The Premises not occupied by You or into any common areas including stairwells or walkways, or into any adjoining premises, are secured as follows (a) manually operated doors by having the operating chain secured into an internal chain stop, housing or wall bracket by means of a padlock having a hardened steel shackle. (b) electrically operated doors by having an internal operating switch secured in the off position by means of an integral lock or padlock. Alternatively , such doors are to have the power supply to the operating switch isolated at a suitable electrical power distribution board. (c) where (5) (a) or (b) above cannot be satisfied such doors are to be secured by having the door secured to one of the side runners by means of an internal key operated lockable bolt or a padlock having a hardened steel  shackle. (d) any personnel (wicket) gate incorporated into such doors is to be secured by having an internal, centrally positioned, steel padlock bar secured by a padlock having a hardened steel shackle or, at the top and bottom of the door, by internal key operated lockable bolts. (e) such doors, or any personnel (wicket) gate incorporated into them, are not to be used as a final exit door unless notified to Us and then secured by the means subsequently stipulated or agreed by Us in writing. (6) all external opening windows on basement and ground floors, any opening windows which lead into areas of  The Premises not occupied by You or into any common areas including stairways or walkways, or into adjoining premises, and any external opening windows on upper floors which can be reached by a person standing on adjacent or adjoining external structural features including stairways, communal walkways, lower storey roofs, porches, balconies, or similar external structural features which can readily be climbed onto; are secured in their closed position as follows (a) any roof lights by an integral or internal fastening device designed and manufactured for the task (b) any louvre windows by internal or external steel bars or grilles. (c) all other windows by an integral lockable fastening device or an internal key operated window lock. Alternatively such windows are to be secured by means of at least two internal screws of sufficient length to pass through the windows surround and penetrate the window frame to a depth of at least 10mm. (7) doors to Marine Cargo Containers, Sheds,  Attached or Detached Garages or Storage Areas are secured by a closed shackle padlock having a hardened steel shackle. (8) any type of door

, lock or fastening device that is not mentioned above is notified to Us and then secured by the means subsequently stipulated or agreed by Us in writing. (9) motorised plant/equipment not secured within a Marine Cargo Container is secured (a) by either being secured to each other by means of cable locks or padlocks and chains, or by being secured to part of the building structure e.g. a wall or floor anchor point by means of a padlock and chain. (10) all locks or fastenings are positioned and fitted (including striking plates, escutcheons, cylinder roses or other door furniture) in accordance with the manufacturers instructions or in a conventional manner. (11) all the aforementioned locks and fastenings are put into full and effective operation and any keys to them removed from the site or stored within The Premises in a secure place, that is one which is not within sight or reach of any external glazing, letter flap or other opening, whenever those parts of The Premises occupied by You in connection with The Business are unattended. Any door or window that is designated, and appropriately signed, as being for use solely as an emergency fire exit by the person(s) legally responsible under fire safety legislation for fire safety at The Premises, is excluded from requirements (1) (6) above.

However, any such door or window must be secured by an integral or internal fastening device designed and

manufactured for the securing of such emergency