QUESTIONAIRE AND PROPOSAL FOR CONTRACTORS' ALL RISKS INSURANCE         1. Title of contract (if project consists of several sections, specify section(s) to be insured)   2. Site   Country/Province/District   City/Town/Village   .3. Name(s) and Address(es) of Principal   4. Name(s) and Address(es) of Contractor(s)   5. Name and Address(es) of Subcontractor(s)   6. Name and Address of consulting Engineer   7. Description of Contract Work       (a) Dimensions (length, height, depth and no. of floors)     (b) Type of foundation and level of deepest excavation     (c) Construction Method     (d) Construction Materials   8. Is the contractor experienced in this type of work or construction method ?   9. Period of Insurance   Commencement of work:       Duration of Construction:       Date of Completion       Maintenance period 10. What work will be done by Sub-contractors ?   11. Sepicial Risks     Fire Explosion ?   YES NO Flood, Inudation ?   YES NO Landslide, Storm, Cyclone ?   YES NO Other Risks ?   YES NO Vulcanizing ?   YES NO Have eaethqake been observed in this area ?   YES NO If so, please state intensity:   12. Details of Subsoil     Rock   Gravel   Sand   Clay   Filled Ground   Others Subsoil Conditions:   13. Ground Water     Level Below Grade (mm/in):   14. Nearest River, Lake, Sea etc.     Name :   Distance :   Levels :   Low Water :   Mean Water :   Highest Ever Recorded :   15. Meterological Conditions     Rainy Season       From : To: Max Rainfall (mm/inch): per hr per day per month Storm Hazard   minor medium high 16. Are extra charges for overtime, night work, work on public holidays to be included ?   YES NO Limit of Indemnity :   17. Is Third Party Liability to be included ?   YES NO   Has the contractor concluded a seprate policy for TPL ?   YES NO   Limit of Indemnity :   18. Details of existing buildings or surrounding property possibly affected by the contract work (excavating, underpinning, piling, vibrating, ground water lowering etc. )   19 Are existing buildings and/or structures on or adjacent to the site, ownedby or held in cre, custody or control of the contractor(s) or the principalto be insured against loss or damage arising as a direrct or indirect consequence of the contract work?   Y N         20. State here under the amounts you wish to insure and the limits of indenminity required (See policy wording, section-I, Memo-1 and Section-II)         Current contact Address:     Concerned Person   Contact Phone   Email Address   Address         Section I, Material Damage Items to be Insured Sums to be Insured(Nrs)       1. Contract work (permanent & temporary work. Including all materials to be incorporated herein) 1.1 Contract price 1.2 Materials or items supplied by the principal(s) 2. Construction Plant and Equipment 3. Construction of machinery 4. Clearance of debris Total sum to be insured under section I Special Risks to be insured Limit of Indemnity Earthquake, Volcanic Erosion Storm, cyclone, Flood, Hurricane   Section II, Material Damage Items to be Insured Limit of Indermnity 1. Bodily injury 1.1 Any one person 1.2 Total 2. Property damage Total Limit under section II 3. Limit of indemnity in respect ofeach and every loss or of losses arising out of any one event damage and or series 4. Limit of Indemnity in respect of any one accident or series of accidents arising out of one event.   We hereby declare that the statements made by us in this questionare and proposal are to the best of our knowledge and belief, complete and true and we hereby agree that this questionare and proposal forms the basis nd is part of any policy issued in connection with the above risk. It is agreed that the insurers are accordnce with the terms of the policy only and that the insured will not lodge any other claims of whatever nature. The Insurers undertake to deal with information in strict confidence. Executed at this day of       | Fire | Burglary/House beraking | Motorcycle | Private vehicle | Commercial Vehicle | | Personal Accident | Marine(Cargo) | Contractor's all risks | Workmen compensation | Overseas mediclaim | Hospitalization mediclaim | Fidelity guarantee | Cash in Transit | Comprehensive Household | Public liability | Loss of profit |   Site designed and maintained by: INFOCOM Pvt. Ltd.