Single Construction Project Insurance


Thank you for considering our on-line single construction project insurance service.   Because Greater National Group is an insurance broker, not an insurance company, we will process your application with major insurance companies in order to find the right single construction project insurance for you.

Please fill in the following form as fully as possible, then click 'submit' at the end of the form.
You can use the TAB key to move to the next field. We will respond with your terms as soon as we have researched the market for the right available deals that fit your requirements.

General Information:
1. Others Insureds (Principal, Contractor or Owner Builder):
2. Construction Period: months OR Period of Insurance: to
3. Full Description / Nature of Contract Works:
4. Full Address of Contract Site:
5. Maintenance Period (nil months if owner builder):
0 3 6 9 12 18 24 Other months
6. Construction Material:
Brick Only Brick Timber Frame Concrete EPS
Wood Steel Sandwich Panel Polyurethane
Other (please specify)
7. Ground Conditions:
Sand Rock Clay Gravel Filled
Other (please specify)
8. Maximum Number of Floors:
9. Maximum Depth of Excavation: meters
Material Damage:
10a. Contract Value: $
10b. Principal Suppled Materials: $
10c. Total Contract Value (10a + 10b): $
10d. Escalation Allowance (up to 15%): %
11a. Removal of Debris?
Yes No $ OR % of Contract Value
11b. Professional Fees?
Yes No $ OR % of Contract Value
11c. Expediting Expenses?
Yes No $ OR % of Contract Value
12a. Pre-existing Property: $
12b. Details of Pre-existing Property (Please supply additional information such as age and condition of existing structure; any load bearing walls affected; restumping):
13. Mitigation Costs: $
14. Material in Transit: $
15. Material in Storage Off-Site: $
16. Plant and Machinery: $
17. Employee Effects: $
18. Temporary Buildings, Fencing, Scaffolding Tools of Trade: $
19. Excess Options (minimum excess may apply depending on Contract Value):
$500 $1,000 $2,500 $5,000
$10,000 $20,000 $25,000
other $
Third Party Liability:
20. Number of years client has been in business:
21. Does insured carry out any of the following: use of explosives, bridge construction/maintenance, demolition only activities (incidental demolition to ground +1 storey and excavation work to single basement depth allowed), construction or maintenance work involving chemical works, underground mines, offshore platforms, aircraft, petrochemical plants, power stations, ships?
Yes No
22. If contractors/sub-contractors are included, are their policies policed?
Yes No
23. Are contractors/sub-contractors required to carry their own liability insurance?
Yes No
24. Are contractors/sub-contractors covered under this Insured's Workers Compensation Policy?
Yes No
25. Does the insured have hot works permit system in place (N/A for owner builder)?
Yes No
26. Excess Options (minimum excess may apply depending on Contract Value):
$500 $1,000 $2,500 $5,000
$10,000 $20,000 $25,000
other $
27. Additional Information / Covers Required:
Claims:
28. Have the Insured had any Material Damage or Third Party Liability Claims in the past 5 years? If Yes, please provide details below.
Yes No
Date of Loss Nature of Claim (Theft, Malicious Damage, etc) Turnover for Period Excess Amount Paid
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
$ $ $
29. Have you ever alone or in partnership or jointly with any other party, or if a corporation, any of its directors:
a. Suffered any loss(es) (insured or otherwise) totalling more than $5,000 in the last 12 months or totalling more than $20,000 in the last three (3) years or suffered two (2) or more bodily injury claims in any one period of insurance in the last three (3) years?
Yes No
If Yes, please provide details:
b. In the last five (5) years had any insurer decline any claim or proposal, cancel or refuse to renew a policy or increase the premium or impose special conditions?
Yes No
If Yes, please provide details:
c. In the last five (5) years ever been placed in receivership or liquidation or declared bankrupt?
Yes No
If Yes, please provide details:
d. In the last ten (10) years been convicted of or had any fines or penalties imposed for any crime involving drugs, dishonesty, arson, theft, fraud or violence against any person or property?
Yes No
If Yes, please provide details:


Duty of Disclosure:
Are you aware of any matters not disclosed above that is relevant to the underwriter's consideration of this insurance?
Yes No
If so, please provide details:
I/We hereby declare that:
My/Our attention has been drawn to the Important Notices accompanying this form and further I/we have read these notices carefully and acknowledge my/our understanding of their content. The above statements are true, and I/we have not suppressed or mis-stated any facts and should any information given by me/us alter between the date of this form and the inception date of the insurance to which this relates I/we shall give immediate notice thereof. I/We authorise GNG and the Insurer to collect or disclose any personal information about another individual (for example, an employee, or client), I/we declare that the individual has been or will be made aware of that fact and the Privacy Policy. I/We also confirm that I/we am/are authorised to act for and on behalf of all persons who may be entitled to indemnity under any policy which may be issued pursuant to this form and I/we complete this form on their behalf.
Any other comments, requests or relevant information you need to add:
Contacting you about your quote:
In order to select the most appropriate cover for you, it may be important to discuss quote details in person. Please leave a contact phone number and best time to call to facilitate this.
Your full name:
Company/Business/Name of Applicant to be Insured:
ABN:
Your phone number (please include area code):
Your mobile phone number:
Best time(s) to call:
Please send my quote by (select at least one):
email phone fax mail
Your email address:
Your website address:
Your fax number:
Your postal address:
Country: