QUESTIONNAIRE AND PROPOSAL FORM FOR CONTRACTOR'S ALL RISKS INSURANCE

QUESTIONNAIRE AND PROPOSAL FORM FOR CONTRACTOR'S ALL RISKS INSURANCE

(The Insurers undertake to deal with this information in strict confidence)
Principal's Name Address

NameAddress
To be insured under the Policy

YesNo
Main Contractor's Name Address

NameAddress
To be insured under this Policy

YesNo
Sub Contractors' Name Address

NameAddress
To be insured under this Policy

YesNo
Consulting Engineer
Name and kind of Project
Description and details of Contract Works
Location
Dimensions; number of Storey
Foundation (methods level of deepest excavation)
Level of ground water if dewatering necessary
Dates and Periods

MonthDayYear
Date
Construction Period from:

MonthDayYear
Date
Construction Period to:

MonthDayYear
Date
Maintenance Period from:

MonthDayYear
Date
Maintenance Period to:

MonthDayYear
Date
Type of Maintenance

VisitsExtended
Total Aggregate Amount to be Insured Contract Works Including
Permanent Works Amount
Temporary Works Amount
Specify and indicate value of material supplied by Principal (not included under A) Amount
Clearance of debris (limit of indemnity) Amount
Architects, Surveyors Consulting Engineers Fees sum insured for works Amount
Construction equipment and installations such as scaffolding, supports, sheet piles, stages for bridges, tools tackles etc Amount
Construction Machinery (Mobile Plant) Amount
Stationary Plant Amount
*Please enclose list showing above items with their new replacement value
Excess envisaged for each and every occurrence Amount
for contract works and equipment arising out of earthquake, storm, subsidence, landslide, collapse and water damage
any other cause
for construction machinery
Are existing building and/or structures on or adjacent to the site, owned by or held in care, custody or control of the Principal or any Contractor to be insured against loss or damage arising out or in connection with the contract works?

YesNo
If yes indicate limit of indemnity For those buildings or structures indicate
value
type of construction
Condition
Third Party Liability to be included?

YesNo
If yes, what limits arising out event are required?
Bodily injury Property damage
Per event
For any one person
Total limit for any one event
In connection with surroundings not belonging to the insureds give description of type size conditions and value of neighbouring building and other construction and indicate importance of streets and existence or railways (enclose maps and layouts)
Cross liability Are the Insureds (contractor; sub-contractor, Principal to be considered As Third Parties amongst each other?

YesNo
We hereby declare that the statements made by us in this questionnaire are complete and true to the best of our knowledge and belief and we hereby agree that this questionnaire shall form the basis and be part of the policy or Policies issued in connection with the above risk or risks. It is agreed that the Insurers shall be liable in accordance with the terms of the Policy only and that the Insured will not lodge any other claims or whatever nature.
Date

MonthDayYear
Date
INSURED SIGNATURE

Clear
AGENCY
Should be Empty:

QUESTIONNAIRE AND PROPOSAL FORM FOR CONTRACTOR'S ALL RISKS INSURANCE

*Please enclose list showing above items with their new replacement value

If yes, what limits arising out event are required?