SACOS INSURANCE COMPANY LTD
P.O Box 636
Republic of Seychelles
Telephone: 295000
Fax: 224495
E-mail: [email protected]
Website: www.sacos.sc
QUESTIONNAIRE/PROPOSAL FOR CONTRACTORS’ ALL RISKS INSURANCE
1. Title and Brief Description of Contract: Total Contract Value:
Location:
2. (A) Parties to be named in the Policy as “Insured”. (i) Principal(s) Address(es): (ii) Contractor(s) Address(es): (iii) Sub-Contractor(s) Address(es):
(B) Other parties involved in contract but not to be insured. Losses falling on such parties are not covered by the insurance and rights of recourse are retained against them.
3. Give full descriptions of contract works e.g. for buildings include type of construction, number of storeys etc. Describe: -
(A) Diversion or restriction of waterways (B) Any underground workings
(C) Piling (and type of piles)
(D) Any machinery to be installed. (Supplement by a scale plan of the site showing the buildings and identifying their uses.)
(E) State (or make clear on plan) “Fire Breaks” occur and how wide and effective they are.
YOU SHOULD FULLY AND FAITHFULLY GIVE THE FACTS YOU KNOW OR OUGHT
TO KNOW, OTHERWISE YOU MAY RECEIVE NOTHING FROM THIS POLICY
4. State the contract value for: (i) Site Works (prior to buildings) (ii) Permanent Structures
(iii) Permanent plant and machinery (iv) Any other permanent works
(v) Temporary works
(vi) Professional fees (if included)
Total
5. Is this a fixed price contract? Yes/No If “no” has the contract value been increased to
cater for the effects of inflation? If so, by what percentage?
6. State the anticipated duration of:
(A) Construction of permanent structures From To
(B) Maintenance Period From To
7. Describe the site and location of the works relative to:
(A) Existing buildings, installations etc.
(B) Fire/Explosion potential from adjacent areas and possibility of spread of fire within the site (A sketch would be helpful.)
8. Is the site liable to flooding? Yes/No If “yes”, give details of:
(A) Nearby rivers, lakes, the sea
(B) Any retaining walls in existence or to be constructed.
(C) Highest water level ever recorded (D) Freeboard
9. Give details of any testing operations including: (A) Purpose
(B) Duration (C) Nature/Scope
10. Is there any evidence or knowledge of:
(A) Subsidence Yes/No
(B) Landslip Yes/No
(C) Underground workings Yes/No If “yes”, give details and extent of any geological
Surveys, soil tests etc made.
11. Is the site situated in an area subject to
earthquake? Yes/No
If “yes”, state frequency and magnitude on the Richer Scale (including last major earthquake) and State whether construction will be to earthquake- Resistant specifications.
12. Is the site particularly exposed to storm,
winds etc? Yes/No
What precautions have been taken to guard Elemental perils?
13. What is the estimated maximum probable loss which could be caused by a single incident?
14. Does the site present special problems regarding security/risk of theft/malicious damage etc.? State precautions taken, e.g. fencing, day/night time patrols.
15. Is the site area subject to a recognized rainy
season? Yes/No
If “yes”, state its duration From To
What is the maximum rainfall recorded?
16. Are there any features of the site preparation Yes/No structures or machinery which present unusual
or significantly new features of design, method of construction (e.g. dual lifts) or testing?
If “yes”, give details
17. Will the execution of the contract affect any existing Yes/No buildings/structures e.g. by alterations, extensions
etc.?
18. What style of contract conditions (e.g. ICE, R.I.R.A. etc are in force between (a) the principal (s) and contractor(s) and (b) the contractors(s) and subcontractors)?
If special variations or conditions used, please indicate scope of contractor‟s responsibility for loss/damage and insurance obligations
19. Are the works to be taken over by the principal on a phased basis?
If “yes”, state anticipated acceptance dates for
major sections. Yes/No
20. Is maintenance cover to be included?
If “yes”, state scope of cover required Yes/No
21. Have similar works been satisfactorily constructed Yes/No (a) elsewhere (a) by the contractor and (b) by others? Yes/No (b) If “yes”, give details
What is the contractors loss record over the last 3 years? (Details any major losses.)
22. Is constructional plant to be included? Yes/No If “yes”, give values and identify:
(a) any large units (b) floating craft
(c) huts or labour camp
Are constructional plant spares to be included?
If “yes”, state value(s) and details of how stored Yes/No
23. Is extra cost of debris clearance to be included? Yes/No If “yes”, for what sum?
24. Is land transit to be included? Yes/No If “yes”, state:
(a) between what points
(b) value of largest consignment (c) means of transportation
25. Are professional fees to be covered in the event of a Yes/No claim?
If “yes”, for what sum?
26. Is extra cost of overtime and express delivery to be Yes/No covered?
27. State the value of any free issue materials.
28. Is cover desired against damage due to defects of Yes/No design?
If “yes” technical investigation may be necessary
29. Are third party risks to be covered? Yes/No If “yes”, complete separate questionnaire
30. Is the premium to be adjustable on the basis of: Yes/No (a) final contract value
(b) actual contract period? Yes/No 31. Enclose where available copies of (a) contract
conditions relating to insurance, (b) plans showing cross-sections, type(s) of construction, dimensions and construction methods, (c) works progress chart.
NB
1. If the space provided is insufficient for answers or for any supporting information please use additional sheet(s) and attach.
2. The information contained herein will form the basis upon which the premium computed and the policy issued.
Signature of Proposer ………. Date ………..………. Signature of Insurer‟s Representative ……….
LIST OF MACHINERY/PLANT/STRUCTURES TO BE ERECTED (INCLUDING ANY BUILDING/CIVIL WORKS) EACH MAJOR ITEM OF MACHINERY/GROUP OF ITEMS/STRUCTURE TO BE
ENTERED SEPARATELY WITH ITS OWN IDENTIFICATION DETAILS
Full description including location, values, maker‟s name(s),
size(s), capacity(s) etc
Total contract value including freight and
erection and testing costs, customs dues
etc. Period of erection operations Period of „hot‟ testing or other working operations Maintenance period Date of handover to principal(s)
Contract Works Insurance (Third Party Risks)
Questionnaire
1. Whose interests are to be insured?
2. What “accident” limit is required?
3. What is the wage roll of all employees on the site (if the interests of sub-contractors are to be insured the separate wage rolls of the sub-contractors should be shown)?
4. If work is to be undertaken over roads or railways what is the amount of traffic and what precautions will be taken to prevent accident?
5. If the work involved the risk of damage to shipping what type of shipping is involved and to what extent?
6. Is there any property belonging to third parties near to the site? Are there any special risks of damage to property or injury to persons of third parties?
8. Are there any known underground electricity, water, telephone etc. cables/pipes within the site?
9. Are there any other special factors affecting the Third Party risk?