Contact Details: Title:
-please select-
Mr
Mrs
Miss
Ms
Dr
other
If other:
* Last name:
* First name(s):
* Email address:
Your telephone number:
Alternative Contact Number
Correspondence Address:
Leave Blank if same as hospital below
Post Code:
Registered Charity
yes no If yes please state charity no.
Legal Title of Radio Station
Full Hospital or broadcasting address and postcode:
Post Code:
Web Site Address
How long have been operating?
years (or year of commencing broadcasting)
Do you undertake outside broadcasts?
yes no
Have there been any incidents, whether insured or not, in the last 5 years
COVER IS PROVIDED AS STANDARD FOR THE FOLLOWING :
PUBLIC LIABILITY:
Indemnity limit of £5,000,000.
Legal liability for damages, legal costs and expenses as a result of injury to the public or damage to their property, including
fund raising and other special events agreed by us.
costs and expenses in defending proceedings under the Health and Safety at Work etc. Act 1974
Damage to hired or rented property occupied by you (first £100 of third party property damage is not covered)
EMPLOYERS LIABILITY:
Indemnity limit of £10,000,000.
Legal liability for damages, legal costs and expenses as a result of injury to employees or voluntary workers
LEGAL EXPENSES
Standard Indemnity Limit is £50,000 Please tick if you require a higher limit
Legal costs and expenses for you, your employees and voluntary workers in connection with matters arising from your activities
Increased Limit of Indemnity £100,000
OPTIONAL COVERS:
CONTENTS
Do you require contents cover? yes no
Studio Electrical Equipment:
Please provide the total value of this equipment and the basis on which it is calculated.
Equipment that remains in the studio
Basis of calculation:
-please select-
Value of replacement of all equipment as new
Value of equipment to replace second hand
Please provide the total value of this equipment and the basis on which it is calculated.
Library stock in studio - please indicate %age taken outside
Basis of calculation:
Value of equipment to replace second hand
CD's, Records and Tapes:
%age take out of studio
Any other contents
Basis of calculation:
-please select-
Value of replacement of all equipment as new
Value of equipment to replace second hand
Tenants Improvements
Sound Proofing, room alterations made by you
Basis of calculation:
Total cost of replacing the improvements
ALL RISKS
Do you require cover for equipment out of the studio? yes no
Outside Equipment:
Please provide the total value of this equipment and the basis on which it is calculated.
Equipment that is taken out (e.g. PA Equipment)
Basis of calculation:
-please select-
Value of replacement of all equipment as new
Value of equipment to replace second hand
If you specify a minimum sum insured of £1000, single items within this limit will be covered up to £500. A single article limit of £1000 is available, but the minimum sum insured is £3000. It is cheaper to specify items, but may be more onerous to keep items up to date. Please ensure that you specify items over £500 or £1000 as appropriate. Failure to do so will mean those items are not covered.
BUILDINGS
Do you require cover for buildings? yes no
Buildings :
Please provide the rebuilding cost of the property.
Buildings - see question on construction below
Basis of calculation:
Total cost of rebuilding the property
Construction of building:
-please select-
Brick, Stone or Concrete with a tiled roof
Brick, Stone or Concrete with a flat roof
Portacabin
Other
If Other Construction, please specify
CARAVAN
Do you require cover for a caravan or trailer yes no
Caravans:
Please provide the cost of replacing the caravan and the basis on which it is calculated.
Cover whilst in storage or static at an event
Basis of calculation:
Value of caravan to replace second hand
Make:
PERSONAL ACCIDENT
Do you require cover for Personal Accident? yes no
Personal Accident (Age 16 to 75 years):
Injury to employees/officials/volunteers arising from accidents while working in connection with the hospital radio station.
No of Employees/Officials/Volunteers
Benefits: Death or Loss of one or more limbs or eyes or Permanent total disablement £10000. Temporary total disablement £100 per week (£50 per week aged 66-75)
OTHER QUESTIONS AND COVER
Please state annual income for this year
No of active volunteers at any time
Do you require money cover? yes no Total amount of cash carried
Do you require a quote for Motor Policy Excess Protection? yes no If yes number of drivers
R eimbursement of volunteers motor excess up to £250
Do you require a quote for Trustee Indemnity?
A separate policy will be required if you require cover for professional services.
yes no We will provide quotes for £100,000 and £250,000 cover
NOTE: Trustee Indemnity Insurance is only available to recognised charities and if the trust deed, constitution or charter of your charity allows you to indemnify the trustee or officer. Please see the Charity Commission website for full information.
Do you require a quote for Terrorism cover? yes no
Do you require a quote for Extra Expenses?
yes no If so amount:
Additional expenditure necessarily and reasonably incurred by you in order to minimise the interruption or interference with charitable activities including the cost of a) removal to and from temporary premises and fitting up for your use, b) the additional rent, rates and taxes for such temporary premises c) salaries of additional employees and overtime payments
Do you undertake any fund raising?
yes no
If Yes, please confirm type of fundraising activities undertaken
Please detail Studio/Premises security including locks, alarm etc.
If you have an alarm, please state if UKAS, NSI, NACOSS, ICON or SSAIB and if the alarm is monitored and maintained.
Please insert any other details or comments you wish to make here
Number of years 'No Claims Bonus' held:
Nil
1
2
3
4
5
6
7
7+
years
To your knowledge, have you or any official or trustee of the organisation been:
a) convicted or charged with, or received a caution for any criminal offence other than motoring offences? yes no
b) declared bankrupt or had any unsatisfied County Court Judgement? yes no
Date cover required:
(subject to prior approval)
Best quote so far:
£ from: with: £ excess
How would you like to receive your quote?
telephone fax e-mail
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