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A) Questionnaire and Proposal Form for Contract Works Insurance

Building and Civil Engineering & Machinery Erection

Proposal No. ___________________

1 Names and addresses of Parties To The Contract: To be insured under


this Policy?
1.0 Principal Yes / No
1.1 Main Contractor Yes / No
1.2 Sub- Contractor(s) ……………………………. Yes / No
…………………………….
……………………………
1.3 Manufacturers (s) of main groups of industrial plant and installations Yes / No
1.4 Supervisory Firm (if engaged in project) Yes / No
1.5 Consulting Engineer Yes / No
Which of the above is the Proposer of this insurance?
1.0) 1.1) 1.2) 1.3) 1.4)

2 LOCATION (exact identification of contract site)


……………………………………………………………………………

3 TITLE OF PROJECT …………………………………………………………


Construction Erection
Please enclose
3.0 General description civil engineering works, buildings, plant, machinery, structures to be
construction methods erected, and operational
processes
3.1 Technical characteristics main dimensions, capacities, design main operational data
specifications temperatures / Pressures
3.2 Individual values main parts of project main machinery, plant, structural
(cost breakdown) (bill of quantities) items with manufacturer’s name
3.3 General layout drawings main sections’ layout main groups’ layout
3.4 Plans, cross sections main parts showing construction main machinery, plant items
type, dimensions, construction
methods
3.5 Work progress chart, Time
schedule
3.6 Tender conditions and/or copy of stipulations stating copy of stipulations stating
Contract conditions insurance requirements, insurance requirements,
maintenance obligations, maintenance obligations,
contractors’ guarantees contractors’ guarantees

4 INSURANCE COVER DATES AND PERIOD Duration in Remarks


PERIODS months
From To
4.0 Storage of machines, material,
equipment on site before
construction starts
4.1 Construction
4.2 Storage of machines, material,
equipment on site before erection
starts
4.3 Erection
4.4 Testing /Commissioning

4.41 Total Period from PERIOD OF


commencement to estimated INSURANCE
completion date
4.5 Maintenance Construction
Erection
4.51 Final handing over date

4.6 Standard extensions of cover Please mark what is Aggregate limit Rs.
(Endorsements) desired
4.61 Existing Property Yes / No
4.62 Contractors’ Plant and Equipment Yes / No
4.63 Consequences of Faulty design
4.64 Expediting Costs
4.65 Airfreight
4.66 Riot & Strike
4.67 Maintenance (M): For Civil Works Visits / Extended
For Machinery Visits / Extended
4.7 Other extensions of cover (possibly by special
endorsement)
4.71 ……………………………………………
4.72 ……………………………………………
SUM INSURED
5 MATERIAL DAMAGE – Rs.
Detailed breakdown of values as per separate
enclosure
5.0 BUILDING AND CIVIL ENGINNERING WORKS
5.00 Permanent works - Is it included under 5.0 ? Yes / No
5.01 Temporary works - Is it included under 5.0 ? Yes / No
5.02 Principal’s suppliedf materials- Is it included Yes / No
under 5.0 ?
SUM INSURED– Building and Civil Engineering
(item 1 in the Schedule)

5.1 ERECTION WORKS


5.10 Principal’s suppliedf materials- Is it included Yes / No
under 5.1 ?

SUM INSURED – Erection Works


(item 2 in the Schedule)

5.2 Clearance of Debris


5.3 Existing property as per 70
5.4 Contractors’ plant and machinery– enclose list
5.5 Contractors’ equipment camp with actual values

5.6 Architects’, Surveyors’ and Consulting Engineers’


fees

TOTAL SUM INSURED 5.0 -5.6

6 EXCESS Amounts
6.0 BUILDING AND CIVIL ENGINNERING WORKS
6.1 ERECTION WORKS
6.2 Testing/Commissioning (hot testing) Period,
Maintenance Period
6.3 Major or Special Perils
6.4 Existing Property
6.5 Contractors’ Plant and Machinery
6.6 Contractors’ Equipment, Camp with installations

7 PROJECT INFORMATION –
Complementary to 3 and 5
7.01 Is the project an extension of existing plant, Yes / No
building, construction, facility?
7.02 If yes – will operation of existing facilities Yes / No
continue
during construction and erection?
7.03 Existing Property details to be attached  Description Limit
 Layout
7.1 Previous Experience of Manufacturer(s) or
Contractor(s)
7.2 Subcontractor – Information
Subcontractors name
Previous experience
Subcontracted work Contract value
7.3 Civil Engineering Work
7.31 Will civil engineering work be completed before Yes / No
erection starts?
7.32 If no, for how many months will civil engineering
works be carried on in parallel?
7.4 Exposure to Perils of Nature
7.41 Rainy season From ………To…….. month &
Max. rainfall
7.42 Distance to nearest River (whether dry or
running),
Sea
Lake
7.43 Difference between Lowest plant level: elevation
and
Highest FloodLevel
7.44 Maximum wind velocity
Storm frequency- high  medium  low 
7.45 Earthquake Zone details

8 THIRD PARTY LIABILITY SECTION

8.0 Do parties to the contract have existing Third Party Liability policies which also cover the
activities for which the present insurance is proposed?

If yes – mark: Principal  Main contractor  Subcontractors 


Supervising firm  Consulting Engineer 
Amounts:
801 Limits for bodily injury.
802 Limits for property damage
803 Limits for combined (single) limit
8.1 Is Third Party Liability to be included in this policy? Yes / No

Limit of indemnity in respect of any one accident LIMITS EXCESS


Any one event deductible
or series of accident arising out of one from property damage
event claims only

811 for bodily injury – per person


I – any one event
812 for property damage any one event.
813 financial consequential losses
814 combined (single limit)
815 aggregate limit of indemnity under the policy

8.2 Surroundings not belonging to the Insured Enclosures

Give description of exposure, size and value of  Description


neighbouring buildings, plants and installations and indicate importance of streets
(enclose maps and layout)

8.3 Cross Liability for Contract Works Period Yes  No 


Are the Insured (Contractor, Sub-Contractors, Principal) to be considered as Third Parties
amongst each other? Yes / No

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
any 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 claim of
whatever nature.

Signed by the Insured on this day of

Signature