Cemac: Contractors Plant Insurance Specialists


	ENQUIRIES
	QUOTES
	ENDORSEMENTS
	CLAIMS ENQUIRY
	ACCOUNT ENQUIRY

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Quoting

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1. Your Details


Broker:
Contact Person:
Email Address:
Phone Number:
Fax:

2. Proponent Details


Proponent (Legal Entity):
Proponent’s Street Address:
Years in Business:

3. Please describe the proponent’s business activities as fully as possible:

4. Is the proponent involved in the installation of utilities, road maintenance or road surfacing?

Yes No

If yes, provide details.

5. In the past five (5) years, has the owner or directors of the legal entity proposed been convicted of any criminal offence?

Yes No

If yes, provide details.

6. Is the plant used underground (i.e. underground mine sites)?

Yes No

If yes, please give details of type of mining (i.e. gold or coal etc)

7. Is the plant used over water or any other hazardous activities?

Yes No

If yes, provide details.

8. Will the plant be used for anything other than manufacturer's design purpose?

Yes No

If yes, provide details

Does the proponent Dry Hire their machines out?

Yes No

If so, do they offer a damage waiver?

Yes No

Does the proponent use sub contractors?

Yes No

If so, how frequently (per annum)?

Does the proponent insist sub contractors have their own Public Liability insurance and sight proof thereof?

Yes No

9. Claim Details

Please provide details of the proponent’s claims history for the past three (3) years.

Date of Loss	Quantum
Claim Description
Date of Loss	Quantum
Claim Description
Date of Loss	Quantum
Claim Description

Please attach a separate sheet if you require more space.

10. Previous Insurance

Insurer Name:
Due Date:

11. Has any insurance company:

Declined to accept a proposal from the proponent?	Yes No
Cancelled a policy other than at the proponent’s request?	Yes No
Declined to renew a policy held by the proponent?	Yes No

If you answered yes to any of the above, please provide more information:

12. Operators

In the past five (5) years, have any of the operators of the proponent's machines had any traffic offences?	Yes No
In the past ten (10) years, have any of the operators of the proponent's machines committed a criminal offence?	Yes No

If you answered yes to either of the above, please provide more information:
If you answered yes to either of the above, special conditions may be applied.

13. Schedule of Plant

Please provide all of the information below for each machine you require insurance for.

Note: Please supply as much information as you can. Please tick ‘RR?’ for each item that requires Road Risk TPPD. Sums Insured are ex GST.

1.	Year	Make	Model	Lift Cap	RR?	Reg No.	Serial/Engine Number	Sum Insured


Description
2.	Year	Make	Model	Lift Cap	RR?	Reg No.	Serial/Engine Number	Sum Insured


Description
3.	Year	Make	Model	Lift Cap	RR?	Reg No.	Serial/Engine Number	Sum Insured


Description
4.	Year	Make	Model	Lift Cap	RR?	Reg No.	Serial/Engine Number	Sum Insured


Description
5.	Year	Make	Model	Lift Cap	RR?	Reg No.	Serial/Engine Number	Sum Insured


Description

Total Sum insured: $

If you need more than 5 plant schedules, please attach an extra document with the additional details
Please advise if interested parties are to be noted

14. Optional Extensions

Do you require a quotation for the following options:

SHC	Substitute Hire Costs Covers cost of hiring of substitute equipment following loss Cover required $50,000/3 Mths or $25,000/2 Mths	Yes No
FGP	Finance Gap Payment (total loss) Requires advice of finance payout figure Financial Gap Amount is $	Yes No
AV	Agreed Value Requires valuation from accredited valuer or recent purchase invoice	Yes No
AMV	Appreciation in Machine Value Cover if value of machine increases during period of insurance	Yes No
EDH	Extended Dry Hire Allows insured to pass on insurance to hirer, subject to conditions	Yes No
OHC	Ongoing Hire Costs Covers hire fees for damaged hired plant	Yes No
UR	Underground Risk Cover for machines operating underground in mines or tunnels	Yes No
FPP	Finance Payment Protection Covers finance payments when machine suffers loss Monthly Financial Repayment Amount is $	Yes No
CAC	Consequential Additional Costs SHC/OHC/FPP Bundle (Conditions Apply)	Yes No
HIP	Hired In Plant Covers plant hired in on a temporary basis Confirmation of types of machines to be included is required Estimated Annual Hired In Costs are $ Maximum Amount Any One Loss is $ Maximum Amount Any One Item is $	Yes No
AD	Accidental Damage - To goods lifted Covers damage to goods when being lifted by lifting devices Please indicated sub-limit (Max $250,000) $	Yes No
DHC	Down Hole Cover Covers items such as directional borer, drilling rods & drilling attachments when lost down hole Please indicate sub-limit $	Yes No

NOTE: Automatic inclusions are Unintentional Non-Deliberate Overload, Multi-Lift, Hold Harmless, Dry Hire, Expediting Expenses, Recovery Costs (when no loss), Innocent Breach & others as policy.

Road Risk (TPPD - excluding Tool of Trade)
We will automatically quote for registered, permitted or conditionally registered vehicle where you have entered a Registration Number and ticked the ‘RR?’ column in the schedule above.

NOTE: Please be aware that throughout Australia, some type of conditional registration may be required on all moving machinery.

15. Public & Products Liability

Please indicate limit of public liability required.

$5,000,000

$10,000,000

$20,000,000

Note: Crane operators liability automatically includes a sub-limit of $500,000 for $5,000,000 limit and $1,000,000 for $10,000,000 and $20,000,000

Please supply below total estimated annual turnover for upcoming 12 months (and percentage split if more than one activity engaged in):

Estimated Annual Turnover $

Activity %

Does the proponent’s business incorporate permanent Dry Hire of any of their machines?	Yes No
If so, please indicate the percentage of the machines in the schedule on permanent Dry Hire?	%

16. Further Information

Please provide any other information you believe may be relevant to us when quoting this risk.

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