Questionnaire Proposal Contractors’ All Risks Insurance · Questionnaire and Proposal are, to the best of our knowledge and belief, complete Executed at and true and we hereby agree

PO BOX. 3230, Manama, Kingdom of Bahrain Tel : (+973) 17 565656 Fax : (+973) 17 582988

1

Questionnaire and Proposal for

Contractors’ All Risks Insurance No

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 and address Of principal

4. Name(s) and address(s) of contractor(s)’

5. Name(s) and address(es) of subcontractor(s)’

6. Name and address Of consulting engineer

7. Description of contract work? (Please give detailed technical information. 1)

Dimensions (length, height, depth, Spans, number of floors)

1 If necessary on a separate sheet.

2 For harbours, piers, docks, tunnels, galleries, dams, roads, airports, railway facilities, sewerage and water supply systems and bridges, see additional questionnaires.


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Type of foundation and level

of deepest excavation

Construction method

Construction materials

8 Is the contractor experienced in this type of work or construction method?

Yes No

9 Period of Insurance Commencement of work

Duration of construction months

Date of completion

Maintenance period months

10. What work will be done By subcontractors?

11. Special risks Fire explosion? Yes No

Flood, inundation? Yes No

Landslide, storm, cyclone? Yes No

Blasting work? Yes No

Other risks

Volcanism, tsunami? Yes No

Have earthquakes been observed in this area? Yes No

If so, please state intensity (Mercalli) magnitude (Richter)

Is the design of the structure to be insured based Yes No

on regulations for earthquake-resistant structures

Is the design standard higher than that stipulated

In the relevant regulations ? Yes No

12. Details of subsoil

rock gravel sand clay filled ground

Other subsoil conditions

Do geological faults exist in the vicinity ? Yes No


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13. Ground Water

Level below grade m

Ft

14. Nearest river, lake, sea, etc., Name

Distance

Levels Low water Mean water

Highest ever recorded Date

15. Meteorological conditions Rainy season from to

Max rainfall (mm)

per hour per day per month

(in)

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 separate 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, owned by or held in care, custody or control of the contactor(s) of the principal, to be insured against loss or damage arising as a direct or indirect consequence of the contract work

Yes No Limit of indemnity

Exact description of these buildings/ structures.


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20. State hereunder the amounts you wish to insure and the limits of indemnity required (see policy wording, Section 1, Memo 1, and Section II)

Currency

Section I Material damage

Items to be insured Sums to be insured

1. Contract work

(permanent and 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 machinery (please attach list)

4. Clearance of debris

Total sum to be insured under Section I:

Special risk to be insured Limit of indemnity3

Earthquake, volcanism, tsunami

Storm, cyclone, flood, inundation,

landslide

Section II Third party liability

Item to be insured Limit of Indemnity4

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 of each and every loss or damage and/or series of losses arising out of any one event. 4 Limit of indemnity in respect of any one accident or series of accidents arising out of any one event

We hereby declare that the statements made by us in this Questionnaire and Proposal are, to the best of our knowledge and belief, complete Executed at

and true and we hereby agree that this Questionnaire and Proposal forms the basis and is part of any policy issued in connection with the this

above risk. It is agreed that the Insurers are liable in accordance with the terms of the Policy only and that the Insured will not day of

lodge any other claims of whatever nature. The Insurers undertake to deal with this information in strict confidence. 20

Signature


5

Additional Questionnaire for the Construction of

Roads and Railway Facilities No.

1. Title of contract

2. Size

flat hilly mountainous

built-up area semi-built-up area open area

If project is in built-up or semi-built-up area, state distance from and type of nearest neighbouring structures

3. Breakdown of values Item Value (currency )

Site installations and temporary work

Workshops, stores, camps, etc.,

Earthwork

Culverts, underpasses and overpasses

Base course / ballast

Wearing course / track system

Electromechanical equipment

Other work

Total value

4. Type of trace

highway country road municipal road

Number of lanes/tracks Dual carriageway? yes no

unsurfaced surfaced surfacing only

5. Technical data

Culverts, underpasses and overpasses1

Fills Cuts

Length km

Width m Max gradient % miles ft

Number precast cast in situ steel

Max span m

ft

Total length km

Max Height of single fill m

miles ft

Indication of slope Material to be filled in

Total length km

Max depth of single cut m

miles ft

Blasting work?

yes no Rock crushing ? yes no

Materials to be removed

1 For bridges complete Additional Questionnaire for the Construction of Bridges


6

Superstructure Material Sub-base Base course Wearing course

Thickness cm

in

Compacted

Stabilized

Sleepers imported timber steel concrete

Level of ground water below grade min m

ft

6. Construction schedule (unless separate sheet is attached)

Component Execution dates, anticipated period of work (months)

Earthwork

Culverts, underpasses and overpasses

Base course/ballast

Wearing course / track system

Other work

Max. length of road under construction any one time2 km miles

7. Must traffic be maintained during construction ? yes no If so, please specify

8. Will the new road be open to traffic

before completion of wearing course ? yes no If so, please specify

9. To what extent might the contract

work be destroyed in one loss event?

10. What work will be done by

subcontractors?

11.

Which contractors will work independently of the insured at the site or in its immediate vicinity ? What work will be done by such contractors ?

12. Where are the offices, stores,

workshops, camps, etc located ? Where are construction plant and equipment and construction materials stored? Give details or attach drawings.

If contract provides for completed sections to be handed over individually,

please indicate on seperate sheet number of section, their lengths and anticipated dates of handing over.


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Additional Questionnaire for the Construction of Bridges No.


2. Size


built-up area semi-built-up area open area





Earthwork and approaches

Foundations

Piers and abutments

Falsework and cantilever formwork, etc

Superstructure and roadway

Other work (railing, lighting, installations etc)

Total value

4. Type of bridge

beam bridge arch bridge suspension bridge

truss bridge cable-stayed bridge

5. Technical data a. Superstructure

Length m

Width m ft ft

Number of spans Max length of span m

ft

Max height above grade m

ft

steel reinforced concrete pre-stressed concrete

post-tensioned concrete other (if so, specify)

b. Piers

Max height m concrete other materials (if so, specify)

ft


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6. Construction of Superstructure

precast concrete members

Distance from works

km files

Transport by rail by lorry by barge

Assembly by mobile crane with traveling shutter

In free cantilever construction

cast in situ falsework travelling shutter

free cantilever

construction

incremental launching orthotropic plate

7. Type of foundation

caissons

Depth

m ft

piles

Depth

m ft

slabs

Depth

m ft

8. Details of subsoil Attach soil strata diagram

9. Ground water Level below grade

m ft dewatering required

Quantities of water to be removed m3/s

Reserve capacity of pumps m3/s

Pumps are driven electrically by combustion engines

Electric power supply off the main by site generator(s)

10. Bridge over body of water

river lake bay other (if so, specify)

Name of body of water

tidal non-tidal

High and low water levels Observation period years months

Normal in dry season m ft

Normal flood

Highest ever recorded m ft

Date

Flow rates Observation period years months

Normal in dry season m3/s

Normal flood discharge m3/s

Highest ever recorded m3/s Date

Protection from flood damage

cofferdam Height above normal m Dimensioned for

flood level ft return period of years

filled sheet pile wall cellular cofferdam other

Interior bracing of Cofferdam yes no

diversion channel

Discharge m3/s

Is risk of flooding reduced by upstream dams ? yes no

Details Is there a flood

Warning system yes no


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Time lapse between warning and

Time when flood reaches site hours




Earthwork and approaches

Flood protection facilities

Foundations

Piers and abutments

Superstructure and roadway

Other work (railing, lighting, installations, etc.,)

12. Must traffic be maintained during construction of the bridge?

yes no

Details

13. To what extent might the contract work be destroyed in one loss event?

14. What work will be done by subcontractors?

15. Which contractors will work independently of the insured at the site or in its immediate vicinity? What work will be done by such contractors?

16.

a. Where are the offices, stores, workshops, camps, etc., located? Where are construction materials stored? Give details or attach drawings. b. To what extent will these facilities be protected against flood? Give details


10

Additional Questionnaire for the Construction of Harbours Breakwaters, Quay Accommodations, Piers, Docks No.


2.

Site river mouth coast river

lagoon bay lake




Dredging

Excavation

Filling

Breakwaters

Quay walls

Piers

Warehouses, silos, office buildings

Road and railway facilities

Supply lines (gas, water, electricity, telephone, etc.,)

Technical installations (cranes, elevators, etc.,)

Other work

Total value

4. Type of harbour

commercial military sports other

Specify

5. Type of quay/pier

passenger traffic bulk material containers other

Details

6. Technical data a. Breakwaters

Type rock fill concrete blocks/tetrapods caissons

sheet piling other

Dimensions Length

m ft

Top width

m ft

Base width

m ft

Maximum depth of water m ft

Other particulars


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b. Piers/quays Number of piers / quays Top of piers above

water mark-ean highM

m ft

sheet-pilled Sheet pile wall

backfilled with sand concrete

other

caisson round; diameter

m ft

square; length m ft

Width m ft

cast in situ

cast in dock

Pulled into final position

by barge by winch

on piles made of timber steel concrete

Capped by

in-situ concrete precast beams

If other methods, specify

7. Traffic links

rail road both

8. Buildings / structures

sheds warehouses terminals club houses

railway stations offices tank farms other

Details

9. Natural hazards

monsoon tropical storms (hurricane, typhoon, cyclone)

Maximum rainfall per month mm in

per hour mm in

Observation period years

Max wind velocity km/h

mph Observation period years

Main wind direction

Has the area been subject to

Flood or tidal waves Height

m

ft Observation period years

Direction Frequency

Protective measures

10. To what extent might the

contract work be destroyed

in one loss event ?


12

11. Construction schedule

(unless separate sheet is

attached)

Component Execution dates, anticipated period of work

(months)

Site Installations and temporary work

Dredging

Excavation

Filling

Breakwaters

Quay walls

Piers

Warehouses, silos, office buildings

Road and railway facilities

Supply lines (gas, water, electricity, telephone, etc)

Technical installations

(cranes, elevators, etc.)

Other work

12. What work will be done by

subcontractors?

13. Which contractors will work

independently of the

insured at the site or in its

immediate vicinity?

What work will be done by

such contractors

14. a. Where are the offices,

stores, workshops,

camps, etc., located?

Where are construction

Plant and equipment and

Construction materials

stored?

Give details or attach

drawing.

b. To what extent will

these facilities be

protected against

flood?

Give details


13

Additional Questionnaire for the Construction of Dams No.


2. Size

Exposure to landslide rock fall avalanche

earthquake flood

Distance to nearest downstream settlement

Type of settlement (farm, village, etc.,)

To what extent might this settlement be destroyed in case of a dam failure ?




Diversion works (cofferdams, tunnels, etc.,)

Dam

Galleries, underground chambers

Spillway

Intake and outlet works

Steel hydraulics structures

Power house (construction part)

Electromechanical equipment, Substation, transmission lines

Other

Total value

4. Type of dam

earth dam rock fill dam

impervious core of waterlight skin of

clay bitumen concrete other

gravity dam slab and butteress dam multiple-arch dam

round-head buttress dam arch dam dam of combined design

(if so, specify)


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5. Technical data Top length m Height m Base width m

Top width m Upstream slope 1: Downstream slope 1 :

Spillway Location

in the dam area adjacent to dam

Type

overflow

through/ beneath dam overflow

gallery

separate shaft spillway

Power Plant

underground above ground at some distance from dam

If so, distance

km miles

6. Foundation

on loose material lying on top of solid rock with grout curtain (if so, specify)

on solid rock Type of rock

Depth of rock below surface

m ft

blasting work necessary (if so, specify where)

7. Details of subsoil Attach diagram of strata indicating

Type

Thickness

Inclinations relative to a. horizon b. dam

Ground Water Level below grade

m ft dewatering required





8. Body of water Name

spruit seasonal flow river

High and low

water levels Observation period years months

Normal in dry season

m ft

Normal flood m ft

Highest ever recorded m ft

Date

Flow rates Observation period years months

Normal in dry season m3/s

Normal flood discharge m3/s

Highest ever recorded m3/s Date

9. Protection from

flood damage cofferdam

Height above normal flood level

m ft

Dimensioned for return period of years

filled sheet pile wall cellular cofferdam other


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Is risk of flooding reduced by upstream dams ? yes no

Details

Is there a flood warning system?

yes no

Time lapse between warning and time when flood reaches site hours

10 Site sheeting

natural slope sheet pile wall diaphragm wall piles shotcrete

Anchoring planned ?

yes no

11 Construction

schedule (unless

separate sheet is

attached)

Component Anticipated period of work (months)


Diversion works

Dam

Galleries underground chambers

Spillway

Intake and outlet works

Steel hydraulics structures

Power house (construction part)

Electromechanical equipment, Substation, transmission lines

12 To what extent

might the contract

work be destroyed in

one loss event ?

13 What work will be

done by

subcontractors ?

14 Which contractors

will work

independently of the

insured at the site or

in its immediate

vicinity ?

What work will be

done by such

contractors ?


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15. a. Where are the offices,

stores, workshops,

camps, etc., located ?

Where are construction

plant and equipment

and construction

materials stored?

Give details or attach

drawings ?

b. To what extent will

these facilities be

protected against

flood ?

Give details


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Additional Questionnaire for the Construction of Tunnels and Galleries No.


2. Site Subsoil1


built-up area semi-built up area open area


sand gravel rock

Properties soft medium hard

Inclination of strata

Is supporting structure/propping required yes no

If so, specify

Water-bearing strata anticipated ? yes no

If so, at how many locations Estimated quantity of water m3/s

Gas-bearing strata anticipated ? yes no




Driving work

Lining work

Road construction, rail installation (including base)

Finishing work (eg. lighting, ventilation)

Total value

4. Type of underground structure tunnel gallery

underground chamber shaft

for road railway other (if so, specify)

single tunnel double tunnel

Distance between tunnels

m ft

1Attach drawings and soil expertise


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5. Technical data Length

m ft Gradient % Number of access tunnels

Overburden Min m ft

Max m ft

Average m ft

circular semi-circular horseshoe parabolic

rectangular square other (if so, specify)

Height m ft

Width m ft

Diameter m ft

unlined partly lined fully lined

Specify.

Lining

concrete cast in situ precast

brick stone steel

other (if so, specify)

Lining fixed by roof bolts rock anchors

6. Tunnelling method

drilling / blasting Length

m ft

Details

shotcrete Length

m ft

Details

shield Length

m ft

Details

cut-and-cover Length

m ft

Details

7. Dewatering

by gravity by pumps

Total capacity of pumps m3/s Reserve capacity of pumps m3/s

Pumps are driven electrically by compressed air

Electric power supply of the mains by site generator(s)

Standby generators in case of mains failure ? yes no

8. Construction schedule

(unless separate sheet is

attached)


Site Installations and temporary work

Driving work

Lining work

Road construction rail installation (including base)

Finishing work (eg., lighting, ventilation)


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9. To what extent might the

contract work be destroyed in one loss event?

10. What work will be done by subcontractors ?

11. Which contractors will work independently of the insured at the site or in its immediate vicinity ? What work will be done by such contractors ?

12. Where are the offices, stores, workshops, camps etc., located ? Where are construction plant and equipment and construction materials stored? Give details or attach Drawings.

The following questions to be answered in case of underwater tunnels only.

13. Tunnel to be constructed under river lake bay other

If other, specify

Minimum rock overburden under body of water

m ft

Max. depth of water

m ft

14. Tunnel constructed in situ Are caissons to be used ?

yes no

If so, describe method

Total capacity of compressors kW

Capacity of compressors on stand-by kW

15. Tunnels using prefabricated

Sections

Method of placing

Length m ft Height

m ft

Width m ft

Max weight of a section t

self-floating by barge by crane by winch

16. Body of water used for

commercial traffic pleasure boats


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17. Water and storm hazard


Max rainfall per month mm

in Per day (24 hrs) mm in

per hour

mm in Max wind velocity

km/h mph

Main wind direction

Max. water level anticipated above normal

m

ft

Total waves anticipated?

yes no

If so, max height

m ft

Direction Frequency

Protective measures

Max water current velocity

m/s ft/s

If tidal, max velocity in each direction

Incoming

m/s ft/s

Outgoing m/s ft/s


21

Additional Questionnaire for the Construction of Sewerage and Water Supply Systems No.


2. Site


built-up area semi-built up area open area





Earthwork

Pipelaying

Pipes

Crossings

Other work

Total value

4. Type of piping Pipelaying

State lengths and diameters together with type of piping

precast concrete concrete cast in situ cast iron

steel plastic

above ground below ground Depth of excavation

m ft

Max length of single excavation

km miles

Crossings

rivers roads railways (attach plan)

5. Details of subsoil Attach soil strata diagram

Blasting work

yes no

6. Ground water Level below grade

m

ft dewatering required




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7. Natural hazards


Maximum rainfall per month

mm in

per hours mm in

Observation period years


Component Execution dates, anticipated period of work(months)

Earthwork

Pipelaying

Pipes

Crossings

Other work

9. Are transmission lines in Operation during construction work?

yes no

If so, specify

10. To what extent might the contract work be destroyed in one loss event?

11. What work will be done by subcontractors ?

12. Which contractors will work independently of the insured at the site or in its immediate vicinity ? What work will be done by such contractors?

13. Where are offices, stores, workshops, camps etc., located ? Give details


23

Additional Questionnaire for the Inclusion of Existing Structures in the Case of Extensions or Conversions No.

1. Name and location of existing structure (attach location plan or sketch) Name and address of owner

2. Details of existing structure Used as

year of construction value cubic content m3

residential building office building hotel school

hospital theatre/cinema factory storel

mixed use other (specify)

Condition excellent good poor delapidated

Dimensions length m width m

height

(above ground) m

foundation depth

(below ground) m

Number of storeys

basement(s)

ground floor 1 mezzanine(s) upper utility Floor(s) floor(s)

Roof shape flat roof gable roof hip roof other (specify)

Distance to extension Or conversion (note in location plan) Foundation

m

individual foundations strip footing pile foundation

raft foundation other (specify)

Outer basement walls concrete cast stone brickwork

masonry other (specify)

Loadbearing structure reinforced concrete skeleton construction

reinforced concrete solid construction

solid brick construction

perforated brick construction

hollow block masonry construction

framed construction

masonry precast construction steel skeleton construction

other (specify)

Façade plastering precast concrete members concrete curtain wall

steel / aluminium Curtain wall

other (specify)

Storeys and ceilings wooden ceilings RC solid ceilings ceilings of prefab members

(specify system)

other (specify)

Roof structure wooden roof framing RC roof trusses steel structure

RC solid roof other (specify)

Roofing roof tiles tin black roofing

asbestos-cement sheets insulated flat roof other (specify


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Evidence by

Which parts are converted ? What type of work is done ? Are loadbearing components affected

photos taken prior to beginning of construction

observations made by the insurer expert’s opinion

glass fibre or gypsum tapes other (specify)

yes no if yes, which ones?

dead shoring applied or are roadways driven ?

Other details

If so, specify scope and method used

3. Details of extension or conversion work (in the Case of new construction

Name and address of contractor

Subsoil

rock compacted sand, gravel sand, gravel

clay, mart other (specify)

Ground water level m

Predraining of ground water

yes no

Construction pit length m width m depth m

Securing of pit by wooden formwork steel formwork sheet pile walls

diaphragm walls ground anchors inward shoring

other (specify)

Risk aggravation due to

roads lines if so, specify Other details

4. General information

construction period cost of extension/ conversion

cubic content m3

Maximum probable loss To existing structure

Existing Fire/CAR/TPL insurance(s) taken out by principal and/ or contractor Other

for existing structure

for construction project


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Documents

Questionnaire Proposal Contractors’ All Risks Insurance · Questionnaire and Proposal are, to the best of our knowledge and belief, complete Executed at and true and we hereby agree