CATHOLIC CHURCH INSURANCE ASSOCIATION

Catholic Schools, Colleges and Academies Insurance Scheme –

This form is completed and submitted as part of the evaluation of options for Catholic Schools from the Diocese of Westminster.

Catholic Church Insurance Association
Oakley House, Mill Street, Aylesbury, Buckinghamshire. HP20 1BN
Tel: 01296 422030
Email:

If Property insurance is required, please complete Proposal Form A
(Property insurance will include Buildings, Contents, Minor Contract Works, Consequential Loss and Loss of Revenue).

If the School comprises more than one site, please complete a Proposal Form A for each site.

If Property and other general insurances are required, please complete both Proposal Form A and Proposal Form B.

When completed, please return Proposal Form(s) to:-

Catholic Church Insurance Association (CCIA)
Oakley House
Mill Street
Aylesbury
Buckinghamshire
HP20 1BN

If any help is required in completing these forms please contact CCIA for assistance.

Electronic copies of these forms are available on request.

Proposal Form A

Catholic Church Insurance Association
Oakley House, Mill Street, Aylesbury, Buckinghamshire. HP20 1BN
Tel: 01296 422030
Email:

Catholic Schools, Colleges and Academies Property Insurance Scheme

Diocese/Order
Name of School/College/Academy
School etc. Address
Post Code
Contact Name
Tel. No.
Email Address
Type of School
(e.g.VA, Academy, Independent)
And Category (Primary/Secondary)
If considering conversion to Academy status, please state expected date of conversion
Total Number of Pupils at this site
Number of post-16 Pupils included in Total
Planned Admission Number
Floor area of school buildings at this site
Construction of Buildings
If Buildings are of “consortia” construction (e.g. CLASP, SCOLA or SEAC)
in whole or part, please give details, including steps taken to reduce fire spread risks
Is a Fire Alarm installed?
If yes, please give details
Is and Intruder Alarm installed?
If yes, please give details
Is a caretaker resident on site?
Please detail any other security measures
If current insurance Sums Insured are available, please state Buildings and Contents Sums Insured
Is cover required on portable computers taken off-site? / Yes / No
If yes, please state number of units that may be taken off-site, and their value.
Is “loss of revenue” cover, for hirings etc., required?
If yes, please give an estimate of hiring income for 12 months
Policy Excess Required:
a)“Standard” excesses of £250 in respect of Malicious Damage, Impact Own Vehicle, Theft; £500 Storm, Escape of Water and Accidental Damage; £2,500 Subsidence; or
b)£2,000 per claim; or
c)£5,000 per claim.
Please provide details of any loss or damage to School property suffered in the past 3 years, including type of damage/loss date and amount
Signed
Position
Date

Please return completed form to: -

Catholic Church Insurance Association (CCIA)
Oakley House
Mill Street
Aylesbury,
Buckinghamshire
HP20 1BN

Proposal Form B

Catholic Church Insurance Association
Oakley House, Mill Street, Aylesbury, Buckinghamshire. HP20 1BN
Tel: 01296 422030
Email:

Catholic Schools, Colleges and Academies Property Insurance Scheme

Supplementary Insurances

Name of School/College/Academy
Number of Governors
Number of Volunteers
Financial Data
Annual revenue budget
Staff / FTE / Wages and salaries
Teaching/clerical/admin
All other (caretaker etc.)
Totals for school

Money

Cover Required / Yes / No
The limits applicable are those stated. Please specify any different limits required
Limit
In the private residence of any Governor, Employee or Volunteer / £250.00
In transit in the custody of any Governor, Employee, or Volunteer or in a bank night safe / £5,0000.00
On the Premises / £5,000.00
In a locked safe or strongroom / £5,000.00
In a locked receptacle other than above / £250.00
Crossed Cheques / £250,000.00
Excess / £50.00

Public & Products Liability

Limit of Indemnity / £25,000,000
Cover Required / Yes / No
Excess / £0.00
Do you open your own sports hall to the public?
Do you have a swimming pool open to the public?
Do you wish to include Public Liability for the PTA?
If yes, will hazardous activities be organised
(e.g. fireworks displays?)
Additional Information

Employers’ Liability

Limit of Indemnity / £25,000,000.00
Cover Required / Yes / No

Libel & Slander

Limit of Indemnity / £1,000,000.00
Cover Required / Yes / No
Excess / £1,000 or 10%
(whichever is lower)

Governors’, Trustees’ plus Directors’ & Officers’ Indemnity

Limit of Indemnity / £2,000,000.00
Cover Required / Yes / No
Excess / £0.00

Hirers Liability

Limit of Indemnity / £2,000,000.00
Cover Required / Yes / No
Excess / £100.00
Do you hire out your premises?
Do you have a written agreement all hirers must sign?
If yes, please forward a copy of the standard agreement.
Additional Information
Annual fee income from hiring to those who are uninsured elsewhere

Fidelity guarantee

Limit of Indemnity / £250,000.00
Cover Required / Yes / No
Excess / £100.00
Above what amount do cheques need two signatures?
Do you obtain written references for all employees?
If your accounting systems are computerised how often are passwords altered and systems audited
Passwords
Systems

Engineering Inspection

Required / Yes / No
Boiler and Pressure Plant / Number
Autoclaves / sterilisers
Hot Water Boilers
Steam Boilers – Café Boiler
Steam Boilers – Model
Lifting and Handling Plant / Number
Access Platforms / Lifts
Axle Stand
Chain Blocks
Davits
Jacks
Ladders
Lifting Tackle
Manual Pallet Trucks
Pallet trucks
Passenger Lift
Roller Shutter Door
Runways
Vehicle Lifting Tables
Electrical and Mechanical Plant / Number
Air Conditioning Unit
Electrical Distribution Board
Fans
Firing Units
Motorised Valves
Motors
Pumps
Switchgear
Transformer
Other / Number
LEV – Other Dust / Fume / Vapour
LEV – Fume Cupboards

If Zurich currently provides Engineering insurance or inspection services via the Local Education Authority, please provide the relevant policy number and schedule number/s if known. If Engineering insurance or inspection services are currently provided by another supplier please provide an item specification (which may be obtained from the existing inspection authority)

Engineering Insurance

Do you require Engineering insurance? / Yes / No
Cover applicable:
Boiler and pressure plant / Explosion/Collapse, Sudden & Unforseen Damage
Lifting and handling plant / Breakdown/Sudden & Unforseen Damage
Electrical and mechanical plant / Breakdown/Sudden & Unforseen Damage
Limits of Indemnity:
Insured damage to plant / £500,000
Own surrounding property damage / £500,000
Excess:
£100 each and every loss

Deterioration of Stock

Do you require cover for Deterioration of Stock? / Yes / No
This cover applies in respect of foodstuffs only.
Fridge/Freezer reference / Sum insured of contents
1.
2.
3.
4.
5.

Excess:

£50 each and every loss

Personal Accident

Cover is available for:

  • Staff and/or;
  • Governors/Volunteers and/or;
  • Pupils

Cover can be arranged on a fixed benefit or a multiple of income basis. Standard benefits are set out below. These can be amended on request.

Staff
Cover Required? / Yes / No
Cover / Full Accident Cover – Occupational Activity
or
Assault Only
Capital Sum Benefit
(units of £5k required) / £100,000.00 / ORX Annual Earnings / 3x
Weekly Benefit
(units of £25 required) / £200.00 / OR% OF Weekly Earnings / 50%
Governors & Volunteers
Cover Required? / Yes / No
Cover / Full Accident Cover – Occupational Activities
Governors / Volunteers
Capital Sum Benefit
(units of £5k required) / £50,000.00 / £50,000.00
Weekly Benefit
(units of £25 required / £100.00 / £100.00
In respect of cover for volunteers please estimate the total average hours volunteered per week (e.g. 12 persons @ average 4 hours = 48 hours)
Pupils
Cover Required? / Yes / No
Cover / All school and leisure activities within the UK
Capital Sum Benefit / £20,000.00 / add commuting
add school trips abroad

School Journey (Travel)

Cover Required? / Yes / No
Cover / Annual Blanket Cover – All Trips
Type of journeys / School Journeys - Worldwide
Number of pupils
Is cover required for winter sports? / Yes / No
If yes, please specify the number of person days engaged on winter sports trips annually

Legal Expenses

Do you require Legal Expense cover? / Yes / No
Do you wish to include Contract Disputes? / Yes / No
Do you wish to include Debt Recovery? / Yes / No
Has any employee been made redundant or received written or verbal warnings in the past 12 months?
Details of redundancies or staff dismissals

Motor

Cover Required? / Yes / No
Do you require:
  • Comprehensive Cover;
/ Yes / No
  • Third Party Fire and Theft; or
/ Yes / No
  • Third Party only cover?
/ Yes / No

If more than four vehicles please send a separate list.

Make and Model / Reg / CC / Seats / Value / Cover
1.
2.
3.
4.
Occasional Business Use – if your employees drive their own vehicles on the business of the School please provide the number of employees
Are vehicles hired or loaned to third party organisations?
If yes, please provide below details of the organisations and the frequency
Excess required / Excess applies to all own damage
add Uninsured Loss recovery / Legal expenses
add Loss of No Claims Discount

5 Year Claims Expense – Non Property Claims

Date / Class / Details / Paid / Reserved / Post Loss Risk Improvement
Totals
Signed
Position
Date

Please return this Proposal Form B with completed Proposal Form A to: -

Catholic Church Insurance Association (CCIA)
Oakley House
Mill Street
Aylesbury
Buckinghamshire
HP20 1BN

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