Computer Consultants Professional Indemnity

Proposal Form

The Proposal Form, if accepted, will form the basis of your contract with GFA INSURANCE LTD and it is, therefore, essential that the questions asked have been understood and answered correctly.

 

If in answering any of the questions in this Proposal Form you find there is insufficient space, please complete on your firm's headed notepaper and attach it to this form.

 

In the event that you require any assistance in completing this Proposal Form, please do not hesitate to contact GFA INSURANCE LTD.

Please provide, in addition to completing this form, the following information to assist GFA INSURANCE LTD in considering its terms:

  1. Principals’ curricula vitaes.

  2. Standard Contract Terms and Conditions.

  3. Copies of any brochures that the Firm issue.

  1. Trading names and styles and all addresses of the Companies and or Partnerships and/or Sole Proprietors (hereinafter referred to as the "Firm"):

    2.  

     

  2. Please list below details of all Principals and Senior Technical Staff:

Name: Qualifications: Years in the Industry:

 

 

 

 

 

 

3. Please provide the total number of personnel in the following categories:

  1. Directors, Partners or Sole Practitioner:

  2. Managers:

  3. Technical Personnel

  4. Support Personnel

  5. Sales and Marketing

 

4. Does the Firm use independent sub-contractors? Yes / No

If Yes:

  1. What approximate percentage of the Firm's turnover will be paid to sub-contractors: %

  2. Please provide details of the work that sub-contractors are required to undertake.

    3.  

     

  3. How does the Firm select and manage sub-contractors?

    4.  

     

  4. Does the Firm ensure that sub-contractors have their own Professional Indemnity insurance? Yes/No

  1. Please provide details of the Firm's turnover, including fee income:

  1. Total turnover, including fee income, for the past financial year?

    2.  

  2. Estimated turnover, including fee income, for the current financial year?

    3.  

  3. Estimated turnover, including fee income, for the next financial year?

    4.  

  4. When does the Firm's financial year end?

    5.  

  5. What percentage of the Firm's turnover, Including fee income, is derived from clients domiciled in the United Kingdom? %

  6. What percentage of the Firm's turnover, including fee income, is derived from clients domiciled in the United States of America and/or Canada? %

  7. What percentage of the Firm's activities as disclosed in question 5.f) above are subject to the laws of the United States of America and/or Canada? %

  8. What percentage of the Firm’s turnover, including fee income, is derived from clients domiciled elsewhere in the World? %

 

 

  1. Please provide details of the Firm’s five largest contracts carried out in the past five

    2. years:

    Start Date: Completion Date: Business of Client: Nature of Contract: Contract Value: Firm’s Fee:

     

     

  2. Please provide details of the Firm's turnover, including fee income, for the past

financial year, split between the following categories (for new Firms please provide an estimate):

  1. Hardware:

  1. Sales of own brand: RS

  2. Distribution of other brands: RS

  3. Installation: RS

  4. Maintenance RS

  1. Software Product Sales:

  1. Shrink wrapped and/or off the shelf software: RS

    1. Third Party RS

    2. Own written RS

  1. Customisable software: RS

  1. Software Services:

  1. Installation including configuration (no code changes): RS

  2. Customisation including code changes: RS

  3. Developing bespoke applications: RS

  4. Maintenance RS

  1. Services:

  1. Consultancy RS

  2. Contract Staff: RS

  3. Facilities Management: RS

  4. Training: RS

  5. Contract Programming: RS

  6. Internet Services: RS

  7. Systems Integration: RS

  1. Any other activities (please provide details): RS

    2.  

     

  2. Will the split of the Firm’s activities change in the current, or coming, financial year? Yes/No

    3. If yes, please provide details:

  3. Please give a brief description of what the Firm regards as their speciality within the industry:

 

 

 

8. If the Firm carry out any activities in the following areas please provide details:

  1. Software Installation, including Configuration and Customisation Services

(including code changes):

i) How long is a typical installation?

  1. What percentage of the Firm's clients has their own in house IT expertise?

    2. %

  2. How often does the Firm specify the business requirements for their client and also implement the solutions?

 

  1. Bespoke Development Services and Consultancy Services:

i) How often does the Firm specify the business requirements for their client and also implement the solution?

 

ii) How often is the Firm given authority to manage project on behalf of their clients?

 

  1. Is the failure of any of the Firm’s products or services liable to result in any of the following outcomes?

  1. Loss of life or injury to any person? Yes / No

  2. Destruction or damage to physical property? Yes / No

  3. Immediate and large financial loss? Yes / No

  4. Significant cumulative financial loss? Yes / No

  5. Insignificant financial loss (i.e. more of a nuisance)? Yes / No

If you have answered yes to any of the above please provide details:

 

 

10.Does the Firm only carry out their activities under their standard Contract Terms and

Conditions? Yes / No

If no please provide details:

 

 

 

11. Does the Firm currently have Professional Indemnity Insurance? Yes / No

If yes please provide the following information:

  1. Name of the Insurer:

  2. Renewal Date:

  3. Limit of Indemnity:

  4. Excess:

  5. Premium:

  6. Retroactive Date:

 

12. Has any cIaim, or potential claim, been made against the Firm, their predecessors in

business or any past or present Director, Partner or Principals of the Firm?

Yes / No

If yes please provide full details, including the amounts paid and outstanding:

 

 

13. Is any Director, Partner or Principal aware, after enquiry, of any circumstance that

may result in a claim being made against the Firm, their predecessors in business,

or any past or present Directors, Partners, Principals or Employees of the Firm?

Yes / No

If yes please provide full details:

 

 

 

 

14. Has the Firm been involved in any dispute or arbitration concerning fees, products or intellectual property rights? Yes / No

If yes please provide full details:

 

 

15. In respect of any Insurance, has any Insurer ever declined a proposal or renewal, imposed specials terms, cancelled or avoided an insurance policy?

Yes / No

 

If yes please provide full details:

 

 

 

 

 

 

16. What limits of indemnity would you like quotations for?

RS

RS

RS

Declaration:

I / We declare that this proposal has been completed, after appropriate enquiry, and that the statements and particulars in this proposal (including any attachments) are true and that I / we have neither misrepresented nor suppressed any material facts.

I / We undertake to inform Insurers of any material alteration to these facts whether occurring before or after the completion of the contract of insurance.

I / We agree that this proposal (including any attachments) is incorporated into and forms the basis of any contract of insurance.

Signature of Director, Partner or Principal:

 

 

Name of Signatory:

Date: