Professional Indemnity Insurance Specialists

Liability Brokers Pty.Ltd.
PI Insurance - Architects & Building Designers

Premiums start at - $950.00 for	$1,000,000 Professional Indemnity cover

*	GST & the relevant State Stamp Duty need to be added to the premium
	Payment options are available

To receive a confirmed quote, please complete the form below. You will receive a confirmed quote on the same business day or the next business day if received after hours.

If you would prefer to talk to a broker first, please 1300 881 779 between 8.15am and 5.15pm E.S.T. business days and receive an indicative quote over the phone.

Insured Name:
Trading Name:
ABN No.(if applicable):
Street Address:
Suburb or town:	Postcode:
Email Address:
Website Address (if applicable):
Telephone No:

If you have already spoken to someone in our office, please note their name here so that this form can be processed by them as they will know something about you already.

Brokers Name:

How many years have you been working as an architect?

Do You require cover for any subsidiary or associated company?
Yes No

Does Your business incorporate any prior trading entities?
Yes No

Qualifications...

Please detail your qualifications &/or experience in this field:

Have you been previous insured for Professional Indemnity ?
Yes No

If you answered "Yes", please provide the following details:

Insurers Name
Limit of Indemnity ($)
Expiry date

Professional Duties...

Please provide Us with a breakdown of Your business activities.
Income by Type of Service - (must add up to 100%)

Architect		%
Architect - Contract Management		%
Architect - Drafting		%
Architect - Heritage		%
Architect - Interior Design		%
Architect - Landscape		%
Architect - Naval		%
Architect - Project Management		%
Building Designer		%
Draftsman		%

Please provide us with a full description of Your business activities.

Area of Work...

Please provide a percentage breakdown of the area of work performed:
Income by area of work - (must add up to 100%)

Individual Dwellings		%
Low Rise Buildings		%
Medium Rise Buildings (4 - 10 floors)		%
High Rise Buildings (above 10 floors)		%
Schools, Hospitals, Municipal		%
Retail Shops, Flats, Townhouses		%
Modular and Industrial Buildings		%

Type of Work...

Please provide a percentage breakdown of the type of work performed:
Income by type of work - (must add up to 100%)

Feasibility Studies, Reports		%
Town Planning		%
Pre-purchase building inspections		%
Industrial & Commercial Inspections		%
Swimming Pools, Dams		%
Bridges, Tunnels, Harbours, Jetties		%
Roads		%
Mechanical Plant, Bulk Handling		%
Silos		%
Mines		%
Foundations, Underpinning		%
Sewerage, Water Systems (Housing)		%
Sewerage, Water Systems (Other)		%
Environmental Assessments, Audits		%
Waste Disposal, Treatment		%
Oil & Gas Pipelines		%
Other (specify)		%

If "Other", please provide us with a full details.

Quote Required...

Please nominate the amount of covers you require:

Professional Indemnity	Public Liability
$1,000,000	Not required
$2,000,000	$5,000,000
$5,000,000	$10,000,000
$10,000,000	$20,000,000

Underwriting questions...

No. of directors / partners
No. of qualified staff (not directors)

Gross Fees last 12 months
Australia	If Nil, put in "0"
USA/Canada	If Nil, put in "0"
Elsewhere	If Nil, put in "0"
.
Est. Fees next 12 months
Australia	If Nil, put in "0"
USA/Canada	If Nil, put in "0"
Elsewhere	If Nil, put in "0"

Please state the percentage of Your activities (based on income) applicable to each State

ACT	NSW	NT	QLD	SA	TAS	VIC	WA	O/Seas	Total
%	%	%	%	%	%	%	%	%	%

Manual Risk Exposure...

This policy is not available for occupations that involve a manual risk exposure ie. if you are involved in performing manual labour or the supervision of manual tasks. This would include showing others how to perform manual works eg how to lift goods.

Does your business involve any of the following?

1. Manual labour or manual tasks performed by yourself (apart from measuring)
2. The supervision of manual labour or manual tasks performed by other parties or
3. The responsibility of manual labour or manual tasks performed by other parties.
4. The training of others on how to perform manual tasks

Yes No

Contractors...

Do you employ contractors, sub-contractors?
Yes No

Do You require cover for sub-contractors?
Yes No

If "NO", do You insist they carry their own insurance?
Yes No

Insured's History...

The term "You" has the following meaning in the questions below: principals, partners, directors or staff members, or any of the Intended Insured's predecessors, or any prior practice of any of its present or former partners, principals or directors

Have "You" ever been subject to disciplinary proceedings or actions for misconduct in a professional respect? Yes No

Have "You" ever been subject to any claims for civil liability or breach of professional duty in the last ten years? Yes No

Have "You" notified circumstances to insurers that may give rise to such a claim? Yes No

Are "You", after reasonable enquiry of all staff and managers, aware of any other facts or circumstances which may give rise to a professional indemnity insurance claim? Yes No

Declaration...

By submitting this Declaration, I/we declare and agree that:

I/we have the consent of all other persons covered by this policy to make this Declaration,
the contents of this Declaration are true and complete,
I/we have read the information concerning the duty of disclosure (immediately below this declaration) and other important notices;
I/we have answered every question fully and frankly, have been truthful and accurate in completing this application and have not withheld any information likely to affect the acceptance of this insurance;
I/we realise that if I/we have not complied with the duty of disclosure, any claims may not be met
if anything happens during the Period of Cover which alters any of the information provided, I/we will promptly inform the insurer;
I/we confirm that I/we have read and understood that this policy operates on a claims made and notified' basis; (refer - Claims Made Policy below)
they authorise the insurer to give or obtain from other insurers or insurance reference bureaus or credit reporting agencies, any information about this insurance or any other insurance held by the Applicant/s.

Name of person making this declaration:

Duty of Disclosure: What you must tell us
Under the Insurance Contracts Act 1984 (the Act), you have a Duty of Disclosure. You are required before you enter into, renew, vary, extend or reinstate your Policy, to tell us everything you know and that a reasonable person in the circumstances could be expected to know, is a matter that is relevant to our decision whether to insure you, and anyone else to be insured under the Policy, and if so, on what terms.

You do not have to tell us about any matter
that diminishes the risk
that is of common knowledge
that we know or should know in the ordinary course of our business as an insurer, or
which we indicate we do not want to know.
If you do not tell us

If you do not comply with your Duty of Disclosure we may reduce or refuse to pay a claim or cancel your Policy. If your non-disclosure is fraudulent we may treat this Policy as never having worked.

Claims Made Policy
The Professional Indemnity section of this Policy operates on a 'Claims made and notified' basis. This means that the Policy covers you for Claims made against you and notified to us during the Period of Insurance.
This Policy does not provide cover in relation to:

acts, errors or omissions actually or allegedly committed prior to the retroactive date of the Policy (if a date is specified);
claims made after the expiry of the period of insurance even though the event giving rise to the Claim may have occurred during the period of insurance;
claims notified or arising out of facts or circumstances notified (or which ought reasonably to have been notified) under any previous Policy;
claims made, threatened or intimated against you prior to the commencement of the period of insurance;
facts or circumstances of which you first became aware prior to the period of insurance, and which you knew or ought reasonably to have known had the potential to give rise to a Claim under this Policy;
Claims arising out of circumstances noted on the proposal form for the current period of insurance or on any previous proposal form.

Where you give notice in writing to the insurer or any facts that might give rise to a claim against you as soon as reasonably practicable after you become aware of those facts but before the expire of the period of cover, you may have rights under Section 40(3) of the Insurance Contracts Act 1984 to be indemnified in respect of any claim subsequently made against you arising from those facts notwithstanding that the claim is made after the expiry of the period of cover. Any such rights arise under the legislation only. The terms of the Policy and the effect of the Policy is that you are not covered for claims made against you after the expiry of the period of cover.