Primo plc
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Primo plc
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Track Operators' Proposal Form

Complete 0%

1 Qualify 2 Business Details 3 Liability 4 All Risks 5 Declaration

To save wasting your time

Just a couple of quick qualifying questions to save you filling out the entire form if we cannot help.

Are you based outside of the UK? (i.e. Southern Ireland)*

Yes

No

Do you need your insurance to start within the next 7 days?*

Yes

No

Sorry, we are unable to obtain an insurance quote for you at this time.

Great, click next and we can gather some information for your quote.

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Complete 20%

1 Qualify 2 Business Details 3 Liability 4 All Risks 5 Declaration

Contact Details

Your Title*

First Name*

Last Name*

Contact Telephone*

+44

Email*

Confirm Email*

Please enter postcode to select your address*

House Number/Name*

How did you find us?*

About the Business

Trading As*

Company, Charity, Trust etc. Registration Number

Please describe your business*

Partner's Name*

Partner's Telephone*

+44

Partner's Address

Add Partner*

Yes

No

Second Partner's Name*

Second Partner's Telephone*

+44

Second Partner's Address

Add Third Partner*

Yes

No

Third Partner's Name*

Third Partner's Telephone*

+44

Third Partner's Address

Add Fourth Partner*

Yes

No

Fourth Partner's Name*

Fourth Partner's Telephone*

+44

Fourth Partner's Address

Add Fifth Partner*

Yes

No

Fifth Partner's Name*

Fifth Partner's Telephone*

+44

Fifth Partner's Address

Business Trading Name*

Business Address Site 1*

Any additional sites?*

Yes

No

Business Address Site 2*

Business Address Site 3

Website Address*

Are you a member of a trade association/professional body? If yes tell us which one here.

How many years experience have you within your business' activities?*

What year was the business established?*

Is this a new business or start-up*

Yes

No

Do you have health & safety experience operating this equipment?*

Yes

No

Do you intend to obtain the services of third party health & safety expertise?*

Yes

No

Do you have previous experience in operating this activity?*

Yes

No

Do you have previous experience running a business?*

Yes

No

Please attach copy of a completed risk assessment*

Drag & Drop Files Here Browse Files

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Complete 40%

1 Qualify 2 Business Details 3 Liability 4 All Risks 5 Declaration

Public Liability Questions

When do you wish your cover to commence? Please give our brokers 7 days to contact insurers. Insurance providers will not provide a quote beyond 30 days.*

Last year's premium or best quote so far.*

Current insurer or your best quote provider's name.*

Choose level of indemnity (cover).*

Do you undertake risk assessments before the start of activities?*

Yes

No

Do you have a written statement outlining safety procedures for the participants, and are these shown to the participant before the start of any activity?*

Yes

No

Do you offer First Aid facilities at your location(s)?*

Yes

No

Do you have an incident/accident log for minor injuries?*

Yes

No

Do you give safety briefings before every event?*

Yes

No

Estimated Annual Turnover Split:

Mini Tank Driving*

Minimum age limit for activity*

Segway*

Minimum age limit for activity*

Electric Go-Karts*

Minimum age limit for activity*

Petrol Karts*

Minimum age limit for activity*

Other Activities*

Minimum age limit for activity*

Total Estimated Annual Turnover

0.00

If you offer other activities please provide details of what they are here

Are the units fitted with remote engine cut offs?*

Yes

No

Is the track activity supervised?*

Yes

No

Do all participants wear protective clothing, helmets, overalls etc.?*

Yes

No

Are all races and activities fully supervised by a qualified marshal?*

Yes

No

What materials are used for the barriers?*

Please give full details as to what safety arrangements are in place to prevent unauthorized access on to the site, whilst games are in operation:*

Do you provide food?*

Yes

No

Which of the following do you offer?*

Hot Food

Cold Snacks

Drinks

Do you have a deep fat fryer?*

Yes

No

Type of fryer*

Freestanding

Fixed Unit

Do you have a license to sell alcohol?*

Yes

No

Employers' Liability Questions

Read carefully before proceeding!

Employers’ liability insurance is a legal requirement if you employ any of the following: full-time - part-time employees/self-employed contractors you hire/temporary staff, apprentices and volunteers/people taking part in work experience or training schemes

Do you require Employers' Liability Insurance?*

Yes

No

Do you provide full training and adequate training to all your employees?*

Yes

No

Do you have any volunteers or unpaid workers?*

Yes

No

Do you use subcontractors?*

Yes

No

Annual Manual Wage Roll?*

Number of manual full/part time employees?*

Number of Manual Volunteers*

Annual Clerical Wage Roll?*

Number of clerical full/part time employees?*

Number of Clerical Volunteers*

What is your employer's reference number (ERN / PAYE)?*

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Complete 60%

1 Qualify 2 Business Details 3 Liability 4 All Risks 5 Declaration

Equipment and Buildings Cover (All Risk)

Do you require cover for your equipment?*

Yes

No

Value of Equipment

Value of Ancillary Equipment

Are the premises built of brick, stone, concrete, metal or other non-combustible materials and roofed with slate, tiles, concrete, metal or other non-combustible materials?*

Yes

No

Please describe construction of premises*

Do you have an alarm?*

Yes

No

What type of alarm is it?*

Is the alarm maintained under contract?*

Yes

No

Are the premises secured by a minimum of 5 lever mortise Deadlock on all externally accessible doors and key operated window locks on all accessible windows?*

Yes

No

How are they secured?*

Are the premises occupied solely by yourselves?*

Yes

No

Who else occupies the premises?*

Do you have CCTV?*

Yes

No

Has there been any previous flooding at the premises or in the neighbourhood?*

Yes

No

Do you require buildings cover?*

Yes

No

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Complete 80%

1 Qualify 2 Business Details 3 Liability 4 All Risks 5 Declaration

Declaration

Claims History

Have you made any claims or had any claims made against you?*

Yes

No

Please Give Claim Details*

Are you aware of any shortcomings that could lead to claims?*

Yes

No

Please Provide Details*

Are you aware of any loss through employee dishonesty?*

Yes

No

Please Provide Further Details*

Have you or any partner or director:

Ever been convicted of or charged with (but not yet tried) or been given an official police caution in respect of any criminal offence other than a motoring offence?*

Yes

No

Please Provide Conviction Details*

Ever been declared bankrupt or been a director of a company that has been declared bankrupt or insolvent?*

Yes

No

Please Provide Details of Bankruptcy or insolvency*

Ever been declined or refused insurance cover, had insurance cancelled or had special terms imposed?*

Yes

No

Please Provide Details of Why Insurance Was Cancelled*

Been prosecuted in the last 5 years under Health and Safety Legislation?*

Yes

No

Please Provide Details of H&S Prosecution*

Does the business have any ongoing employee disputes?*

Yes

No

Please Provide Dispute Details*

Material Facts

Is there any other information of which the Underwriters should be made aware?*

Before submitting this form please confirm you have read and agree to the use of your data in accordance with our Privacy Policy 2018*

I Agree

Privacy Policy 2018

No Liability is accepted by the insurers until the risk is accepted and the premium paid.

Please check your answers before submitting, should you have any questions or require any assistance contact our brokers on

01702 225 440

Submit

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Call Us

01702 225400

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Monday to Friday 9am-5pm

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Copyright Primo Plc 2018 | All Rights Reserved

Primo plc is registered in England and Wales, Reg No 1008700 at Cumberland House, Baxter Avenue, Southend-on-Sea, Essex SS2 6HZ
Tel: +44 (0)1702 225400

Primo Plc is authorised and regulated by the Financial Conduct Authority.

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