Public liability notice

Save, print and post the completed form to Building Control, Ground Floor, Cecil Ward Building, 4-10 Linenhall Street, Belfast, BT2 8BP or email [email protected].

Revised: August 2018

Road Closures - Guidance note

When holding an event that will involve a road closure, you must have suitable public liability insurance cover of £10m.

This guidance note (entitled Declaration of Public Liability Insurance) sets out the details that we require from you.

The applicant should complete Part 1 of this declaration first and then it must be given to your insurance company/broker for them to complete and endorse Part 2 of the form, before returning it to us. 

The form must be completed and returned within 28 days of making your application for a road closure and must be in place before the event commences.

Any public liability insurance and relevant policy or policies for a road closure must be valid and effective throughout the operational period of the event.

The name of the insured must be the same as that of the applicant or must otherwise specifically state that such person is insured in respect of public liability risks (death or injury) arising from or consequential to the provision of a road closure order.

Belfast City Council hereby reserves the right to make any relevant enquiries regarding the existence of valid and adequate insurance from insurance companies and brokers.

(Keep a copy of the completed declaration for reference purposes)

Declaration of Public Liability Insurance for road closures

Part 1

To be completed by the applicant before forwarding to the insurance broker.

I (applicant) _________________________________________________

Role or position  _________________________________________________  of (home or business address)  __________________________________________________________________________________________________  and (Company, club or society name) _________________________________________________ intend to apply for a road closure of type

(Tick your answer)
▢ Full road closure
▢ Restriction

(Tick your answer)
For the purpose of:
▢ Entertainment
▢ Social event
▢ Sports
▢ Filming

Which will include the following structures and equipment: ___________________________________________________________________________________________________________________________________________________

Part 2

To be completed by the insurance company or broker

We hereby confirm that we have read the declaration in Part 1 and further confirm there is, in force, a policy
insuring the applicant for £10m cover, in respect of any liability which may be incurred by him/her in respect
of the death of, or bodily injury to, any person on a road which is being used for the purposes as indicated
above.

Current Insurer: _________________________________________________

Effective Dates:

From: _________________________________________________

To: _________________________________________________

Current Limit of Indemnity: _________________________________________________

Policy No: _________________________________________________

Restrictive endorsements (if any): (specify copy of policy conditions) ___________________________________________________________________________________________________________________________________________________

Name (print your name): _________________________________________________

Signed: _________________________________________________

For and on behalf of: _________________________________________________

Date: ____________________