asuransi staco mandiri

CABANG JAKARTA 2
(General Insurance) Tlp. 021 – 3911840
Wisma Tugu Raden Saleh Lt. 3, Fax. 021 – 3911844 / 3911845
Jl. Raden Saleh 44 Jakarta 10330

COVER NOTE
PERPANJANGAN POLIS NO. 12-N0003427/2019/1/0

Ex-POLICY NO : 12-N0003427/2019/1/0

TYPE OF INSURANCE : Property All Risks Insurance

FORM : Munich Re Wording amended with Riots, Strikes and Malicious Damage plus Civil
Commotion (4.1B/2007)

THE INSURED : PT. INTI BAROKAH UTAMA and / or respective subsidiary companies and only other
companies owned, operated, managed or controlled and / or affiliated with any of the above
mentioned companies and / or all for their respective rights and interests.

ADDRESS : Perum Giri Asri Blok D/10A, Kel. Ngargosari, Kec. Kebomas, Kab. Gresik

PERIOD OF COVER : 25th September 2020 up to 25th September 2021

(both date inclusive at 12.00 noon local time).

RISK LOCATION : Jl. Desa Semampir 9A, Rt. 04 Rw. 04, Sedati, Sidoarjo

OCCUPATION : Private Warehouse / 29371

CLASS CONSTRUCTION : 1st Class

COVERAGE : All risks on Physical loss and/or damage to the insured property from any cause except as
hereinafter excluded

SUM INSURED : Material Damage

Stock mesin x-ray IDR. 250,000,000.00

DEDUCTIBLES : - Fire, Lightning, Explosion, Impact of falling by Aircraft and Smoke : 5% of claim min
0.1% of TSI
- Riots, Strike, Malicious Damage : 10 % of claim, minimum IDR 10,000,000.00
- CC : 10% of claim, minimum IDR. 10,000,000.00
- Typhoon, Storm, Flood and Water Damage : 10 % of recoverable claim
- Other (including Burglary & Theft) : IDR. 2,000,000.00 each and every loss
- Vehicle Impact : IDR. 2,000,000.00 each and every loss.
CLAUSES : Section I – Material Damage
1. Alteration Clause
2. All Other Content Clause (Limit IDR. 5.000.000,-)
3. Appraisement Clause (5 % of Total Sum Insured)
4. Architects, Surveyor and Consulting Engineers Clause
5. Average Relief Clause (85 %)
6. Awnings, blind, Signs or other Outdoor Fitting or every description Clause
7. Capital Addition Clause (max. 10 % of Total Sum Insured)
8. Cancellation Clause (30 Days)
9. Civil Authorities Clause
10. Cyber Risk Exclusion Clause NMA 2915
11. Designation Clause
12. Dispute Clause
13. Electronic Date Recognition Exclusion Clause EDRC “A”
14. Extra Contractual Obligation Exclusion Clause
15. Error and Omission Clause
16. Fire Brigade Charges Clause (max. IDR. 25,000,000.00)
 asuransi staco mandiri

17. Fire Extinguishing Cost Clause (max. IDR. 25,000,000.00)

18. General Interest Clause
19. Impact of Vehicle clause
20. Internal Removal Clause
21. Industries Seepage, Pollution and Contamination Clause (NMA 1685)
22. Information Technology Hazards Clarification Clause (NMA 2912)
23. Loss Notification Clause (30 days)
24. Minor Alteration and Repairs Clause
25. Miss description Clause
26. Outbuilding Clause
27. Payment on Account Clause (25%)
28. Payment of Premium Warranty (30 days)
29. Public Authorities Clause
30. Reinstatement Value Clause
31. Removal of Debris Clause (10%)
32. Riots, Strikes And Malicious Damage plus Civil Commotion Endorsement (4.1B/2007)
33. Terrorism Exclusion Endorsement (NMA 2920)
34. Transmission and Distribution Lines Exclusion Clause
35. Typhoon, Storm, Flood and Water Damage Endorsement (4.3A)
36. War and Civil War Exclusion Clause
37. Klausula Administrasi Barang Dagangan
38. Klausula Kepemilikan dan Pengelolaan Gudang
39. Subject to no clim up to 24 September 2020
Warranty :
 Larangan Merokok diterapkan dan di butuhkan.Tanda Larangan Merokok
 Tersedia APAR memadai dan berfungsi dengan baik
 Penjagaan Keamanan 24 jam

RATE PREMIUM : FLEXAS = 1.127 %o

RSMDCC = 0.250 %o
TSFWD = 0.500 %o
OTHER = 0.100 %o +
PAR = 1.977 %o

PREMIUM CALCULATION : IDR. 250.000.000,00 x 1.977 %o = IDR. 494,250.00

Policy Cost = IDR. 50,000.00
Stamp Duty = IDR. 6,000.00 (+)
Total Premium = IDR. 550,250.00
================

Jakarta, 25th September 2020

Signed for and on behalf of
PT. ASURANSI STACO MANDIRI

-------------------------------------------
(Authorized Signature)