Quotation Request

Self-Build Zone Eire Structural Warranty – Direct

Project Details
Site Information
Construction Information
Additional Information
Proposer Details
Project Finance
Declaration
Contractor/Builder Details
Professional Team
UnderwritingNotes
Hidden Information
Calculation Page

Project Details

Does the project involve the construction of any detached garage/outbuilding?
Is each stage of the outbuilding being built at the same time as the house (eg foundations being poured at the same time etc)?
Total project floor area in square metres including garages built at the same time:
Professional Reinstatement Cost of new works - NEW BUILD PROJECTS ONLY (this should include professional fees, site clearance and VAT)
Professional cost of conversion/renovation works:
Professional Reinstatement Cost of any retained structure:
Site address:
EirCode
Estimated start date of works:
Estimated completion date:
Local Authority

Site Information

Has a Site Investigation Report been carried out, including soil strength and contamination tests?
Please provide brief details:

Is the site subject to any of following the hazards or ground conditions?


• High water table

• Sulphates/Sulphides

• Peat

• Made-up ground

• Landfill gas

• Soft ground

• Old foundations

• Mining

• Steep slopes

• Existing drains

• Existing or felled trees

• Hedges on clay sub-soil

• Contaminated land (other than land gas)

• Sink holes
If Yes, please give more details.
Please keep your response to a maximum of 20 characters.
Is the site a brownfield site?
Please confirm:
Current use(s)
Historic use(s)

Construction Information

If Mixed/Other, please give details.
Will you be carrying out underpinning?
Will you be carrying out piling?
Will you be carrying out ground improvement works?
Is there any building on a sloping site, basement or part-basement?
Please provide details of any building on a sloping site/basement/part basement including materials used and tanking arrangements. If the development includes tanking work, we may require a separate 10 year insurance backed guarantee for materials and workmanship.
Please keep your response to a maximum of 50 characters.
If Mixed/Other, please give details.
Details of bespoke timber frame kit manufacturer
Please keep your response to a maximum of 50 characters.
If Mixed/Other, please give details:
What is the final external finish (eg render, brick etc)?
Does the development consist (in part or whole) of any of the following:


• Modular construction

• Pre-fab sections

• Pre-cast heavy panels

• Curtain walling

• Unseasoned timber
Please give details:
Please keep your response to a maximum of 50 characters.
What is the approximate area of any flat roof in sq metres?
Have you arranged a 10 year flat roof insurance backed guarantee?
Please note that if your development includes a flat roof area we may require a separate 10 year insurance backed guarantee for materials and workmanship.
If Mixed/Other, please give details:
Please provide details of any existing/retained structure, describing its previous use, building materials and details of any known previous alteration works carried out prior to this application. PLEASE NOTE: WE MAY REQUEST A FULL CONDITION AND/OR STRUCTURAL SURVEY OF THE EXISTING/RETAINED STRUCTURE.

Additional Information

Is there any additional information that you think may be relevant to your application?
Please provide details.
Please keep your response to a maximum of 100 characters.

Proposer Details

Proposer name:
Proposer date of birth:
Are there any additional insured persons to be noted?
Please enter name of first additional insured person
First additional insured person date of birth:
Please enter name of second additional insured person
Second additional insured person date of birth:
Please enter name of third additional insured person
Third additional insured person date of birth:
Please enter name of fourth additional insured person
Fourth additional insured person date of birth:
Proposer address:
Contact telephone number:
Alternative contact telephone number:
Contact Email:


Site contact name:
Site contact telephone number:
Alternative site contact telephone number:
Site contact email:

Project Finance

Please advise if the project is being funded by a mortgage lender.
The lender's interest may need to be noted on the policy.
Lender name:
Mortgage amount:
Do you require Stage Completion Certificates?

Declaration

THE FOLLOWING ASSUMPTIONS HAVE BEEN MADE. If you disagree with any of these please advise which ones you disagree with and give details in the box below:

In respect of You, any Director, Partner or Principal:-

  1. You have never been refused structural warranty insurance or had any additional or special terms imposed by any insurer.
  2. You have never been convicted of any criminal offence (other than motoring convictions) and there are no prosecutions pending.
  3. You have never been prosecuted or received notice of intended prosecution under the Safety, Health and Welfare at Work (Construction) Regulations 2013.
  4. You have never been subject to insolvency or bankruptcy proceedings or any form of voluntary arrangement.
  5. You have never been a director, partner or principal of a House Builder or Construction Company that has gone into liquidation in the past.
  6. You are using a Professional Team who have appropriate Professional Indemnity insurance.
  7. During the last five years you have not sustained any losses or had any claim made against you (insured or otherwise) that would be covered by the type of insurance you are applying for here.
Please provide details of why you disagree with the above declaration

It is understood that you have provided complete and accurate information to Insurers and that you have complied with your legal duty to disclose, before inception of the insurance contract, all material matters relating to the risk (ie all information which would influence the judgement of a prudent Insurer in determining whether to underwrite the risk and if so, upon what terms and at what premium).

You understand that if you purchase the policy, the statements made in this proposal shall form the basis of the contract between you and the Underwriter.

Contractor/Builder Details

Name of main contractor:
Company reg no:
Address:
EirCode
Contact name:
Contact tel no:
Contact email:
What ‘form of contract’ has been or will be used?
Are there any collateral warranties in place?
Is the contractor registered with Self-Build Zone or Build-Zone or any other warranty provider?
Warranty provider name:
Registration number:
Rating category:
Has there been any warranty claims or losses in the last 5 years by either the client or the contractor?
Please give details:

Professional Team

Architect

Company Name of Architect:
Contact Name:
Address:
EirCode
Qualifications:
Tel no:
Email address:

Structural Engineer

Company Name of Structural Engineer:
Contact Name:
Address:
EirCode
Qualifications:
Tel No:
Email address:

Project Manager

Company Name of Project Manager:
Contact Name:
Address:
EirCode
Qualifications:
Tel No:
Email address:

Design Certifier (if applicable)

Company Name of Design Certifier:
Contact Name:
Address:
EirCode
Qualifications:
Tel No:
Email address:

Assigned Certifier (if applicable)

Company Name of Assigned Certifier:
Contact Name:
Address:
EirCode
Qualifications:
Tel No:
Email address:

Other Professionals

Do you wish to add details of any other professional team members?
Company Name:
Contact Name:
Profession:
Address:
EirCode
Qualifications:
Tel No:
Email address:
Add further Professional team members?
Company Name:
Contact Name:
Profession:
Address:
EirCode
Qualifications:
Tel No:
Email address:
Add further Professional team members?
Company Name:
Contact Name:
Profession:
Address:
EirCode
Qualifications:
Tel No:
Email address:
Add further Professional team members?
Company Name:
Contact Name:
Profession:
Address:
EirCode
Qualifications:
Tel No:
Email address:
Add further Professional team members?
Company Name:
Contact Name:
Profession:
Address:
EirCode
Qualifications:
Tel No:
Email address:
Add further Professional team members?
Company Name:
Contact Name:
Profession:
Address:
EirCode
Qualifications:
Tel No:
Email address:
Add further Professional team members?
Company Name:
Contact Name:
Profession:
Address:
EirCode
Qualifications:
Tel No:
Email address:
Add further Professional team members?
Company Name:
Contact Name:
Profession:
Address:
EirCode
Qualifications:
Tel No:
Email address:
Add further Professional team members?
Company Name:
Contact Name:
Profession:
Address:
EirCode
Qualifications:
Tel No:
Email address:
Add further Professional team members?
Company Name:
Contact Name:
Profession:
Address:
EirCode
Qualifications:
Tel No:
Email address:

Underwriting Notes

Number of inspections:
Additional information:
Technical Audit Approved?
Practical Completion Date

Hidden Information

Year of account:
Policy excess:
If not 30 days, how many days will the quotation be valid for?
Only enter a value in this field if the quotation valid days are different from the standard 30 days for this product, otherwise please leave this field blank
Sanctions Check First Name:
Sanctions Check Surname:
Sanctions Check Additional Insured Firstname 1:
Sanctions Check Additional Insured Surname 2:
Sanctions Check Additional Insured First name 2:
Sanctions Check Additional Insured Surname 2:
Sanctions Check Additional Insured First name 3:
Sanctions Check Additional Insured Surname 3:
Sanctions Check Additional Insured First name 4:
Sanctions Check Additional Insured Surname 4:

Calculation Page

Premium:
Basement Load
Build Type Load
Technical Audit
Additional TA Fee
2nd Additional TA Fee
Further Additional TA Fees
Adjustment Charge
Legal Expenses Premium
Contractstore Premium
LE Adjustment
Contractstore Adjustment