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VillageGuard Quotation Form Demo

Step 1 of 9

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Prefix(Required)

Name

First Last

Contact Phone Number

Contact Correspondence Address

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Full name of the Village Hall(Required)

Full name of the legal body responsible for the Village Hall

e.g. (XYZ Village Hall Management Committee or Trustees)

Type of Organisation

Recognised Charity

Applying for Charity Status

Registered Charity

Limited by Guarantee

Charitable Incorporated Organisation

Voluntary Organisation

Not-For-Profit Company/Organisation

Hall Website (if applicable)

Hall Use & Statement of Fact

Is the Hall used by the public at least once per month?

Yes

Please provide further details on the use of the Hall:

Details of Regular Hirers

Please list the Village Hall organised Activities, Events and Functions in and away from the Hall: (please confirm which are away from the hall)

Is any part of the property, including outbuildings, let to a third party on a long term basis?

Yes

Please provide more details below: (What part of the hall is let? Is the let part self-contained? Who are the tenants? What is the length of the tenancy?)

Has the Village Hall ever been declined, refused insurance or had any additional terms imposed?

Yes

Please provide details of the declination, refusal of insurance or the additional terms imposed:

Have you or any Trustee or Officers of the Village Hall ever been convicted of or charged (but not tried yet) with any offence other than driving offences?

Yes

Convictions regarded as spent by virtue of the Rehabilitation of Offenders Act 1974 do not need to be disclosed

Please provide details of the conviction, charge or offence:

Is the Village Hall (including any outbuildings) currently undergoing renovation or construction work or will be in the next 3 years?

Yes

Please provide details of the renovation or construction:

Has the Village Hall ever suffered from flooding or is it in an area with a history of flooding?

Yes

Please provide details of the flooding:

Has the Village Hall (including any outbuildings) or any adjacent property ever suffered from, or does it show any visible signs of damage from subsidence, landslip or ground heave?

Yes

Please provide details of the damage from subsidence, landslip or ground heave:

Have you ever had a claim for arson?

Yes

Please provide details for the arson claim, include amounts paid and dates (mm/yyyy):

Is the Village Hall (including any outbuildings) in a good state of repair and will it be so maintained?

Yes

Please provide details for the Condition of the Property:

Do you own the Village Hall?

Yes

Please provide details of the Village Hall Ownership?

Do you currently comply with all the relevant Health & Safety Laws and Regulations (i.e. No Smoking, Fire Safety Regulations, etc.)?

Yes

Please provide details of what does not comply with the relevant Health & Safety Laws and Regulations:

Date EICR advises for next Inspection

MM slash DD slash YYYY

Are all electrical circuits at the premises tested at least every 5 years by an approved electrical contractor and was an EICR (Electrical Installation Condition Report) for a commerical property issues?

Yes

Date of Inspection on last EICR

MM slash DD slash YYYY

Was your last EICR Satisfactory or Unsatisfatory?

Satisfactory

Unsatisfactory

Please provide details of your electrical circuits testing, including any remedial works noted on your last EICR:

Do you have a key safe?

Yes

When was the key safe installed?

MM slash DD slash YYYY

Have there been any incidents involving the key safe since installation?

Yes

Please provide more details of the incidents, including when they occured?

Claims and or/losses over the past 5 years whether insured or not?

Yes

Please provide details of the claim(s) include amounts paid, dates (mm/yyyy) and cause of incidents:

Existing Insurer:

Renewal date of existing policy or start date.

MM slash DD slash YYYY

Existing Renewal Premium:

Does the hall have a central heating system, if so what type?

Please provide details of the heating system, including if all heaters are fixed or if there are any portable heaters:

Please advise what the hall's roof, and walls are constructed from including details of any insulation you are aware of:

If any part of the building roof is flat, please give approximate percentage:

No flat roof, or up to 5%

5% to 20% flat roof

20% to 50% flat roof

Over 50% flat roof

Please provide further details of what the construction of the flat roof is:

When was the Village Hall built?

2000 onwards

1980 – 1999

1951 – 1979

1921 – 1950

1850 – 1920

Pre 1850

Do you require Building Cover?

Yes

Is the Hall a listed Building?

Yes

Please provide the grade:

What is the rebuild cost of the premises, including the main hall and any other permanent structures?

The building sum insured must be no less than the total rebuild costs including any walls, gates, fencing and car parks.

Does the Hall have any Outbuildings?

Yes

How many outbuildings do you have?

Please tell us about any outbuildings you have, including when it was built, constructions type, 'sum insured', and any other useful information such as percentage of flat roof.

Does the Hall have any solar panels?

Yes

What is the replacement cost of the solar panels, including any ancillary equipment and batteries?

the replacement cost should include the cost of removing and disposing of the existing panels and batteries.

Please provide details of the Solar Panels:

What is the total generating capacity of the Solar Panels in kW?

What Village Hall Buildings Excess is required?

£250

£500

£1,000

£250 is the standard excess, with a premium discount applied if increased

Would you like SUBSIDENCE COVER included in your quote?

Yes

Are you responsible for any playing fields, playgrounds or sports grounds?

Yes

Please provide further details of any playing field or sportsground including their location, size and if there are any items permanently location there:

What is the value of out-door playground equipment?

Please note, if you input a value we will send you a short questionnaire with your quotation. Cover cannot be provided until we have received a satisfactorily completed questionnaire.

What is the Sum insured for Greens and Playing Surfaces, including Tennis Courts & Playground Flooring?

Do you own a ride-on lawnmower?

Yes

Do you drive the ride-on lawnmower on public roads?

Yes

What is the replacement cost of ALL your contents?

£5,000 contents cover is included as part of the insurance package.

Do you have any individual items valued at over £2,000 belonging to the Village Hall?

Yes

Number of Items valued at over £2,000 belonging to the Village Hall:

Please provide details of the items valued at over £2,000

Do you have any items belonging to the Village Hall which require cover away from the Hall?

Yes

Number of belonging to the Village Hall which require cover away from the Hall:

Please provide details for the items that are away from the Hall requiring cover including the address they are location at:

Do you require cover for any items belonging to third parties?

Yes

Number of items belonging to Third Parties:

Please provide details for the items that belong to third parties requiring cover, including who they belong to, what they are and what their total replacement cost is:

Do you require cover for any stock?

Yes

Value of Stock:

Please provide details of your stock:

Do you require cover for Computer & Electronic Equipment?

Yes

Value of Computer & Electronic Equipment:

Please provide details for the Computer & Electronic Equipment requiring cover:

Do you require details for any Lamps, Signs or Nameplates valued over £1,000 requiring cover:

Yes

Please provide details for any Lamps, Signs or Nameplates valued over £1,000 requiring cover:

Do you require cover for Marquees/Gazebos/Tents?

Yes

Number of Marquees/Gazebos/Tents:

Will the Marquees/Gazebos/Tents be used at the Hall and it's grounds only or will the Marquees/Gazebos/Tents be used away from the Hall?

At the Hall and its grounds only

Away from the Hall

Please provide details of the Marquees/Gazebos/Tents including their size and replacement cost:

Are you responsible for a Defibrillator?

Yes

Value of Defibrillator:

Please tell us where the Defibrillator is Location:

What Village Hall Contents Excess is required?

£250

£500

£1,000

£250 is the standard excess, with a premium discount applied if increased.

Do you have an Employers Reference Number (ERN)?

Yes

Sometimes also called a PAYE number

How many Full Time Employees do you have?

How many Part time Employees do you have?

Please provide your ERN:

How many Volunteers do you have?

Please note: Public Liability Cover and Employer's Liability Cover are automatically included at £10,000,000 for the VillageGuard Policy. The definition of an employee on the VillageGuard policy is as follows:

Employee(s) means any person under a contract of service or apprenticeship with you and authorised volunteers. Authorised Volunteers means voluntary workers normally resident in the geographical limits* acting under your authority while engaged in your business. *Geographical limits means England, Scotland, Wales, Northern Ireland, the Channel Islands and the Isle of Man.

Annual Turnover:

Trustee Indemnity Cover required?

Yes

I confirm that the trust deed, constitution or charity charter allows us to have Trustees Indemnity Insurance

Yes

Final Day of Last Accounts

MM slash DD slash YYYY

Period Accounts Covered (Months)

Have the accounts have been audited or independently examined by a professionally qualified accountant?

Yes

Are you aware of any circumstances or incidents where there is any reason for future claims?

Yes

Trustee Indemnity Amount?

£100,000

£250,000

£500,000

Legal Expenses Cover required?

Yes

Is Loss of Revenue Cover required?

Yes

What amount of Loss of Revenue Cover is required?

What Indemnity Period is required?

Is Loss of Rent Cover required?

Yes

What amount of Loss of Rent Cover is required?

What Indemnity Period is required?

Is Loss of Licence Cover Required?

Yes

What amount of Loss of Licence Cover is Required?

What Indemnity Period is required?

Is Employee/Trustee Dishonesty Cover required?

Yes

Is Money Cover required?

Yes

What amount of Money Cover is required?

£1,000

£2,000

£3,000

£4,000

£5,000

How many units of Personal Accident Cover do you require?

None

2 Units

4 Units

6 Units

8 Units

10 or more units

Personal Accident Cover (not to be confused with Public or Employers’ Liability) Two units provide cover for Accidental Bodily Injury with the following benefits: £5,000 in respect of death, permanent loss of sight or hearing, permanent loss of limbs £50 a week Temporary Total Disablement £25 a week Temporary Partial Disablement Cover is available for Managing Charity Trustees, Holding Trustees, Custodian Trustees or Representative of the Management Committee aged 85 or under whilst engaged in activities or undertaking duties on behalf of the Hall

How many units of cover do you require? (if over 10)

Terrorism Cover Required?

Yes

Does the hall have any mechanical equipment such as a Lift, Industrial Boiler or Wind Turbine?

Yes

Type of Device:

How often is an Independent Inspection carried out?

Do you have Engineering Cover?

Yes

Is your Village Hall a member of a Consortium of Halls in your area?

Yes

Numerous consortia/associations qualify for a ‘group discount’

What is the name of the Consortium?

Does your Hall have a Hallmark/Keystone status?

Yes

We recognise and reward with a premium discount those Village Hall management committees who have achieved the Hallmark/Keystone standard.

What is your Hallmark/Keystone status?

HallMark Level 1 Status Achieved

HallMark Level 2 Status Achieved

HallMark Level 3 Status Achieved

Keystone Level 1 Status Achieved

Keystone Level 2 Status Achieved

Would you like to receive a discount for accepting a long-term undertaking (LTU)?

Yes – 3-year

Yes – 5-year

How did you hear about us?

Promotional Cose

Additional details you may like to provide or questions you may want to ask us?

That completes the questions necessary to obtain a quotation for VillageGuard You can either stop now or send us the form and we’ll provide you with a quotation by return. -OR- You can answer the additional questions in a following page without supplementary form to also obtain a highly detailed valuation report that will allow you to accurately assess your sums insured for buildings and property assets, as well as rebuild times to calculate how long your Hall may have to close for repair. The report is available for £100.00 for clients who sig up for VillageGuard. Those who requested the valuation report but choose not to sign up with VillageGuard the cost is £200.

How would you like to continue?

I am interested in the valuation and will complete the supplementary questionnaire now.

I am interested in the valuation, but I would prefer further details to be sent with my quotation.

I am not interested in the valuation and just require a quotation.

Is the building situated in a conservation area?

Yes

Is the hall a listed buidling?

How many floors does the Hall have?

Is there a basement or cellar?

Yes

Please provide details and measurements of the basement or cellar?

What is the number of additional rooms available to hire?

additional meaning; in addition to the Main Hall

How many toilets (i.e. cisterns) in the buildings?

Does any building have a Stage?

Yes

Please provide details of the Stage:

Does any building contain Asbestos?

Yes

Have you had an Asbestos survey carried out at the premises?

Yes

Do you have an update to date Asbestos management plan?

Yes

What is the total floor area of the building? (m2)

What is the total perimeter of the building? (m)

What are the external walls mainly built of?

Brick

Ages/Period Brick

Timer Cladding

Profiled Cladding

Stone

Other

Please provide further details of the external walls:

What is the roof style and main covering?

Pitched Roof with Standard Tiles

Pitched Roof with Slate

Flat Timber Roof

Flat Concrete Roof

Other

Please provide further details of the roof style and main covering:

How many windows does the hall have?

What are the window frames made of?

Metal

uPVC

Timber

Other

Tick as appropriate

Please provide further details of the window frames:

How many external doors does the hall have?

What are the doors in the Hall made of?

Metal

uPVC

Timber

Other

Tick as appropriate

Please provide any further details of the Doors:

Please provide details of the floors type and percentage throughout all the buildings:

Please provide details of the Wall finish and percentage throughout all the buildings:

Please provide details of the ceiling finish and it's percentage throughout all the buildings:

Does the hall have a kitchen, if so what type?

Please provide more details of the kitchen:

Does the Hall have a Bar?

Yes

Please provide further details of the Bar:

Does the hall have any other internal facilities?

Yes

Please provide further details of the Internal facilities?

Does your Hall have any Hard landscaping?

Yes

Car Park, Fencing, Walls, or other

Does your hall have a car park?

Yes

How many spaces are there in the car park?

What material is the surface of the car park?

How much surface area does the car park have?

Does your Hall have any Fencing or Walls?

Yes

What material are the Walls/Fences?

What Height are the Walls/Fences?

What Length are the Walls/Fences?

Other – Please provide further details:

Are you able to recover VAT?

Yes

Further details where appropriate

Please use this box to give more information about construction details or anything which may be unusual about your hall:

Accepting Terms and Conditions

First Choice

Second Choice

Third Choice

We hereby authorise a Rebuild Evaluation Survey and have read and accepted the Terms & Conditions. I agree to pay the £200.00 fee knowing I will receive a refund of £100.00 if I choose to proceed with my VillageGuard quotation, as per the terms and conditions.