UNIVERSITY OF CALGARY
ALL RISKS COURSE OF CONSTRUCTION APPLICATION Project Name: _________________________
1. Name and Address of Applicant:
Governors of the University of Calgary
c/o Department of Insurance & Risk Management, MSC 260 2500 University Dr. N.W., Calgary, Alberta T2N 1N4
2. Name and Address of General Contractor if not Applicant:
3. Name and Address of Owner:
Governors of the University of Calgary
c/o Department of Insurance & Risk Management, MSC 260 2500 University Dr. N.W., Calgary, Alberta T2N 1N4
4. List all course of construction losses in excess of $10,000 sustained by the applicant and/or General Contractor during the past three years:
5. Location and Description of Project (includes number of floors, gross square meters, building use (i.e. offices, labs, etc.) and any connections to existing buildings):
6. Term and Value:
a) Estimated commencement date: b) Estimated completion date: c) Estimated full completed value: 7. Limits and Deductibles:
d) Other Perils $ e) Transit $ f) Off Site $
N.G. Transit & Offsite coverages are optional and shall only apply if a sub-limit is
stated above.
8. The following enclosures are required for major projects and assist in the prompt underwriting of all projects. Please include with proposal:
a) General Arrangement Drawings: b) Soils report:
c) Construction Schedule: d) Plot or Site Plan:
e) Breakdown of Values: f) Resume for Project Engineer
9. Prime Consultant's Name and Address:
10. Prime Consultant's Names and Addresses: Structural:
Mechanical:
Electrical & Civil:
Soils:
11. Will Consultants provide full supervision of Construction? If not, who will be responsible for supervision?
12. What is the nature of contract between Owner and Contractor? a) Fixed Price b) Cost Plus c) Combination
d) Other (Specify)
What is the nature of contract between Owner and Consultant?
a) Consulting Fee b) Owners Representative c) Project Management What is the nature of relationship between Contractor and Consultant? a) None b) Associated (Amplify) c) Other (Amplify) 13. Bonds:
Indicate if Performance and/or Labour and Material Bonds will be provided for this project by the General Contractor, and name of Surety.
____Performance Bond; ____Labour & Materials Payment Bond 14. Site Location:
a) Distance away from nearest river, lake, pond or any other mass or water?
b) Is the river dammed above the site? If so, indicate the name and location of nearest upstream dam.
c) Is there any history of flooding in the vicinity? If so, what precautions will be taken to prevent damage by flood?
15. Soils Data:
a) Describe nature of soils on which project will be constructed.
b) Have (or will) soil investigations been(be) carried out? If so, by whom?
17. Construction (Bldg.): Type of Structure:
Construction of Exterior Walls: Construction of Roof:
Height of Structure: Number of Floors:
Are there any unusual or experimental features incorporated in the design or the construction? If so, describe and attach sketch or drawing.
18. Protection:
a) Is project within 500' of public fire hydrants?
b) Will fire extinguishers or standpipe risers be installed as construction progresses?
c) If there is private fire protection, describe :
d) If private watchman service, give details:
e) If any bush exposure, indicate clear space in feet:
19. Temporary Buildings and Contents (if coverage is to apply - include value in 6c.): Note: Contents values should not include Contractor's Equipment or other
uninsured property:
Total Values: Max. any one building and contents
a) Bunkhouses & Cookhouses $ $
b) Storage Buildings $ $
c) Garages & Repair Shops $ $
20. Are wood forms used? If so, describe:
21. Winter Conditions:
a) Weather enclosures - describe:
b) Type of heaters - describe:
22. Machinery & Equipment:
a) List all major machinery and equipment (unit value in excess of $100,000) to be installed by whom and the manufacturer of each (attach list if necessary) - include elevators over $100,000:
Type Manufactured by Installed by Value Installed
b) Indicate if any of the machinery listed above is custom manufactured, and also indicate the estimated length of time it would take to receive replacement of this machinery.
23. Process and Process Equipment:
a) Was pilot plant built and evaluated?
b) Has the process been incorporated previously in actual construction? c) Is similar process equipment currently in satisfactory operation? 24. Access to Information:
Insurers to sell, nor does it obligate the applicant to purchase this insurance, but should this insurance be effected, the statements and particulars declared herein shall form the basis of contract with insurers.
_______________________________ ______________________________
Date Applicant
Please ensure that the following documents are attached to this application form: a) General Arrangement Drawings
b) Soils report
c) Construction Schedule d) Plot or Site Plan
e) Breakdown of Values
f) Resume for Project Engineer
