Private Roads Services
Barnwell Farm, Station Road, Marsh Gibbon, Bicester OX27 0HN
Telephone: 01869 278390

PRIVATE ROADS SCHEME  STATEMENT OF FACT
 
If you are unable to comply with this Statement of Fact please return all documentation to Private Roads Services Ltd in order that an alternative quotation can be provided. Please note there will be no cover in force while an alternative quotation is being arranged.
Part 1: insurance
 
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BUSINESS DESCRIPTION: The ownership and/or management of one or more private roads and any area of field or woodland accepted by us as part of the premises but excluding any area of field or woodland in commercial use



Property Damage Sum Insured

Single Item Limit


£25,000

£10,000


      

         No        Yes
     



                                                 No        Yes 


       


£100,000
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ELIGIBILITY

1) You and/or any director or trustee, have never had an insurance:

a) proposal declined or cancelled or a renewal refused
b) premium increased at renewal apart from inflationary or additional cover adjustments
c) cover where special conditions have been imposed

2) You and/or any director or trustee, have:

a) never been convicted, charged with, or received a caution for a criminal offence other than motor offences
b) never been declared bankrupt, insolvent or the subject of any unsatisfied County Court Judgement.
c) never been prosecuted under any Health & Safety at Work Act or Consumer Protection Act.
d) not sustained any loss or damage or incurred any liability caused by any of the risks proposed within the last 3 years.

3) You have not assumed responsibility for any services other than surface water drains.
4) There is no discharge of effluent fumes or anything of a noxious nature.
5) The road has a hard surface such as concrete, tarmac or block paving and is regularly inspected and maintained in a good condition.
6) Any road humps are constructed in accordance with statutory measurements, at least 900mm long, between 25 – 100 mm high and no vertical face exceeding 6mm.
7) No cover is required for land other than parking areas, verges, pavements and land within circles or loops of road except where Field or Woodland Cover is selected.
8) There are no unusual features such as ponds, bridges, railway crossings, steep slopes, tunnels or fuel stores that you are responsible for.
9) The road is owned and/or managed by a Residents Association or Company.
10) If you are responsible for a pumping station you must ensure that there is in force a maintenance and repair contract and you must call out the contractor promptly in the even of any accident or malfunction affecting the pumping station.


Can you confirm the above statements are applicable to you?

YES           NO                IF NO PLEASE REFER TO PRIVATE ROADS SERVICES LTD
 
The following statements are only applicable if Trustee Indemnity over is required

• T1) The association or company is entitled to purchase this cover for it’s committee members or directors or other officers.
• T2) The association, company or any present director or officer is not aware of any circumstance or incident where there is any reason to suppose a future claim might result.
• T3) The association or company has not been the subject of an investigation by any regulatory body in the last 5 years.
• T4) The association or company's assets do not exceed £2.5m.
• T5) The association or company's income does not exceed £100,000 a year. 

Can you confirm the above statements are applicable to you?  
   
       YES            NO        IF NO PLEASE REFER TO PRIVATE ROADS SERVICES LTD


IMPORTANT


• Ansvar’s liability does not commence until this Statement of Fact has been accepted by Private Roads Services Ltd.
• Failure to disclose all material facts, which are facts that might influence the acceptance or assessment of your proposal, may render the policy voidable by Ansvar. If you are in any doubt whether certain facts are material, these should be disclosed.
• You should keep a record (including copies of letters) of all information supplied to Private Roads Services Ltd for the purposes of entering into any contract of insurance arising out of this Statement of Fact.
• English Law will apply unless your legally registered address is in Scotland when Scottish Law will apply.
• We will communicate with you in English at all times.
• Insurers pass the information to the Claims and Underwriting Exchange register, run by Insurance Database Services (IDS Ltd). The aim is to help the insurer check information provided and also to prevent fraudulent claims. When Ansvar deal with your request for insurance, they may search the register. When you tell Ansvar about an incident (such as fire, water damage or theft) which may or may not give rise to a claim, Ansvar will pass information relating to it to the register. You can ask Private Roads Services Ltd or Ansvar for more information about this. You should show this notice to anyone who has an interest in property insured under the policy.

                         
This Statement of Fact must be returned to
Private Roads Services Ltd, Barnwell Farm, Station Road, Marsh Gibbon, Bicester OX27 0HN
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Underwritten by Ansvar. Registered Office: Beaufort House, Brunswick Road, Gloucester, GL1 1JZ Registered No: 661060 England
Member of Association of British Insurers and the Financial Ombudsman Service. Authorised and regulated by the Financial Services Authority
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Part 2: membership If you have applied for insurance, the answers to questions A to G will be the same as above; in which case please tick here and start at question H -
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I agree to act as the sole contact for the association/company,
in accordance with PRS's Terms and Conditions, until a change of contact is agreed by PRS.  		Please tick to confirm your agreement -
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