CONSTRUCTION “ALL RISKS” INSURANCE
PROPOSAL FORM
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A. PROJECT INFORMATION |
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1)
Project Name and Location:
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2)
Project Description:
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3) Process Description for each Plant Section:
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4) Total Contract Price:
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5) Construction Period: |
Start Date: Finish Date: No. of Months: |
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6) Will the Plant use New or Prototype technology, equipment or processes? Yes No
If Yes, please provide a detailed description giving the brand
and type (model / size) of new or prototype technology to be used (attach supporting documentation) |
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7) Describe the testing period, explaining the type of tests to be performed and the duration
of each.
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8) Will the Plant be handed
over in sections (phased handover)? Yes No
If Yes, please describe
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9) Describe the fire
protection at the site
and distance
to nearest fire department
that could respond.
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10) Describe security at the site.
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11) Please attach a schedule of all the new
and existing buildings, free-standing equipment (not in buildings) and materials in storage.
Show individual values
for each.
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12) Please attach
a schedule
of any
temporary or permanent off-site facilities (i.e. warehouses, storage yards, fuel terminals etc.).
Show individual values for each.
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13) Will there be any boilers? Yes No
If Yes, please provide details
(including values)
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14) Are there any critical components which, if lost or damaged, would cause a delay in completion of the project?? Yes No
If Yes,
please list each critical
component and identify
how long the associated delay could be.
If a delay were to occur, what would be the cost per day? |
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B. SITE DETAILS |
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15) A. In which
seismic zone is the site located? B. What is the seismic
/ earthquake history
at the site? |
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16) For which seismic zone will the plant be designed?
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Max. Rainfall: per year Max. Wind Velocity Direction Tidal Fluctuations Wave Height |
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18) Detail any volcanic activity in the region. |
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19) Provide history of any flooding at the site. |
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20) Details of
town,
city
or village nearest to the site |
Name of town, city or village:
Distance to site: Population: |
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21) Identify and describe all roads which provide access to the site.. |
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22) What is the name and distance from the site of the nearest airfield capable of handling commercial cargo
planes? |
Airport:
Distance to site: |
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C. EXHIBITS |
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23) Please attach
copies of the following documents:
(please mark all included with an “X”)
Site Plan, showing
distances between all structures and equipment
Bar Chart showing
project schedule
Contour Map showing elevation of plant
site and distances to closest stream, rivers and other bodies of water
Sub-soil and test boring report
Copies of contracts
and agreements pertaining to the project
Table showing build-up of values by month |
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D. CONTRACTUAL
INFORMATION |
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24) Who are the equity
partners in the project?
Please identify percentage ownership and
if
any
partner
is
a
government-controlled
entity. |
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25) Main office address: |
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27) Who is the contractor for the project? |
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28) What type of fuels
will be used at the site? (Include a description of how the fuel will be delivered
and stored) |
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29) List
all major
sub-contractors and vendors,
showing what
type
of
work,
service
or equipment they will provide and the value of the work / equipment.
Sub-Contractor / Vendor Work / Equipment Supplied Contract Value a) b) c) d) e) |
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30) Does any contract with
suppliers, contractors or sub-contractors provide
for Liquidated Damages in the event of a delay? Yes
No Do you have a similar contract with your customer? Yes
No Do the Force Majeure clauses match
in all contracts? Yes
No Are the amounts of Liquidated Damages the same? Yes
No Do you wish to consider Force Majeure coverage? Yes
No
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DECLARATION
I/We do hereby declare that
the above answers and statements are true, and that I/We have withheld no
material information regarding this Proposal. I/We agree that this declaration,
and the answers above given, as well as any proposal or declaration or
statement mad in writing by me/us or any one acting on my/our behalf shall form
the basis of the contract between me/us
and the Company, and I/We
further agree to accept the indemnity subject to the conditions in and endorsed
on the Policy
Date
Signature of Proposer
(Company Stamp)
The liability
of the Company
does
not commence until
the proposal has
been accepted and
the first premium paid.
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