Building Industry Solutions Pty Ltd Construction & Public Liability Insurance Questionnaire Single Risk Project
Name of Insured:
Address (Postal):
Contact Phone Number:	Email:
The Policy will insure the owner or principal, subcontractors and/or contractors. Will all insured’s, other than client, be required to arrange their own Public Liability insurance? Yes No
Have you ever had insurance refused, cancelled or declined? Yes No
Have you ever made any claims on construction policies, or construction related policies on the subject matter to be insured in the past 5 years? Yes No
Has the Project already commenced? Yes No
If your response was yes for any of the above, please provide details:
Address of Project
Number & Street:
Suburb, State & Post Code:
Project Duration: 6 Months 12 Months
(Please note: if the construction value is less than 50k the initial policy period must be for 6 months, unless otherwise agreed with BIS)
What Does the Project Entail:   --Select-- Construction of a new residential dwelling Refurbishment and alteration to existing dwelling Construction of a free standing garage Construction of residential units/townhouses Construction of commercial building Refurbishment, fit out to a commercial building Completion of a residential Dwelling Completion of addition to residential Dwelling Other (please supply details)
Further information (if requested):
Number of Storeys: 1 2 3 4 5 or more
Is there any Basements: Yes No
If yes please provide excavation depth, length etc.
Is there any demolition involved? Yes No
If yes, is it greater than 25% of Project? Yes No
Will the Existing Structures be occupied during Project? Yes No
Is insurance for Existing Structures required? Yes No
Predominant geology of the Site: Rock Sand Clay Loam
Please describe the property/s bordering the Project Site and its/their proximity to the work being undertaken (i.e., Domestic dwellings no less than 1m from site)
Does the Project involve any of the following?
Underpinning or shoring: Yes No
Removal or weakening of supports of any nature: Yes No
Retaining walls greater than 15m in length & 1.5m in height: Yes No
Excavation deeper than 2 metres: Yes No
Swimming pools : Yes No
Heritage listed property: Yes No
Adjoining Property Protection: (If yes, please contact BIS) Yes No
Contract Works Value: $
Existing Structure Value: $
Public Liability Value:
Any other general information:
Commencement Date: (dd/mm/yyyy)
(Please note: Cover cannot be back dated. We cannot bind cover without a closing and a signed and dated proposal form.)
Further Information:
Upon receiving this information an online quotation and completed proposal form will be supplied by B.I.S. Please note: there are further questions on the system that B.I.S will assume the answers are NO, we trust that you will check over these items and confirm that they are correct before dating and signing the proposal form. If any details differ please contact B.I.S to amend the quotation, any changes may reflect a change in premium or conditions.
How would you like us to provide you with a quotation:
Phone call (please ensure you have included your phone number above)
Email (please ensure you have included your email address above)