CONTRACT WORKS INSURANCE APPLICATION
CIVIL WORKS SUPPLEMENT – complete applicable sections
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1. BRIDGES
Type of Structure (e.g. arch, suspension, etc.):______
Over Water/OverLand:______
Height & Length:______
Construction Substructure (foundations, abutments & piers):______
______
Construction of Superstructure:
Number of Spans:______
Maximum Length of Spans:______metres
Maximum height above sub-structure:______metres
Material: ______
Contract Value for Culverts: $______
Construction (e.g. box, pipe, steel):______
2. CABLES & TRANSMISSION LINES
Overhead
Proportion of Contract Value:______
Maximum height of pylons/masts:______metres
Construction of pylons/masts:______
Max. cable length between towers:______metresvalue $______
Total cable length:______km.
Underground
Type of Cable:______
Cable laying method:______
Trench Depth:______metres
Maximum Trench length worked upon at any one time: ______metres
3. CANALS AND CHANNELS
Dimensions of Excavation:width:______length:______maximum depth: ______
Type of Lining:______
Lock Gate details:______
4. COFFER DAMS
Construction Type:______
Dimensions:width:______length:______height:______
Built to allow Overtopping: Yes No
if no, freeboard above highest recorded flood level? ______metres
5. DAMS & BARRAGES (& Reservoirs including Dam)
Dimensions: width:______length:______height:______
Type and Construction: ______
Breakdown in Contract Value:
Main Dam:$______
Coffer Dams (see also 4):Number ______Value $______
Tunnels (see also ):Number ______Value $______
Outfall:$______
Spillway:$______
Penstocks:Number ______Value $______
Piping above ground Yes No
Power Station:$______ including or excluding machinery
6. DEWATERING
Method:______
Water table reduced: from ______metres to ______metres
Where will water be discharged: ______
Main Equipment & power source: ______
Standby equipment & power source: ______
Number of well points: ______
7. LAND RECLAMATION
Proportion of Contract Value: ______
Nature of reclamation (e.g. from marshland, sea, etc.): ______
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Area: ______Frontage to Major Water exposure: ______
Method of Work: ______
8. PILING (other than coffer dam)
Type of piles: ______
Number of Piles: ______Dimensions:Diameter ______Length ______
Method of Placing: ______
Maximum Value any one pile: $______
9. PIPELINES (land only)
Proportion of Contract Value: ______
Maximum depth of any Cuttings:______metres
Maximum depth of trenches:______metres
Diameter of pipelines (including maximum):______cm
Maximum trench length being worked on:______metres
Type of Pipe: ______
Details of Water Crossings: ______
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Describe significant Gradients: ______
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10. WORK IN & ADJACENT TO WATER
Proportion of Contract value: ______
Name of Waterway (e.g. lake, river, etc.): ______
Nature of Waterway (e.g. slow/wide/tidal/flash flood, etc.): ______
Description of Work & Protection:______
______
Period during which Work carried out:from______to______
History of flooding:______
Maximum recorded flood level: ______metres
Width of Watercourse:______metresDepth of Watercourse: ______metres
Bank height above normal water level: ______metres
Flow of Current:normal ______cu.sec’sflood ______cu.sec’s
TidalRange:from ______metresto ______metres
Flood Warning Facilities: ______
Proximity to Watercourse traffic and precautions: ______
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11. ROADS
Excavation/Cuttings: Value $ ______
Maximum depth ______metres, Incline of Sides ______degrees
Method of Support ______
Description of Water Crossings______
______
______Value $ ______
Embankments or other earth works including levelling / grading:
Value $ ______
Maximum height ______metres,Incline of Sides ______degrees
Retaining walls:Value $ ______
Height ______metres,Thickness ______metres
Method of Construction: ______
How Secured: ______
Type / Method of Road Surfacing: ______
Maximum road length without weatherproof course at any time: ______metres
Value: $______
Details of significant gradients: ______
______
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12.SEA WORKS: (e.g. piers, dolphins, jetties, wharves, docks, seawalls, breakwaters, etc.)
Details of tides, currents, wind speeds & direction: ______
______
______
Wave height & frequency: ______
Structure:Length ______metresWidth ______metresHeight ______metres
Protection from direct sea action: ______
Method of Work: ______
______
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Structure Details (including purpose):______
______
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Armouring Details: ______
Fill Details: ______
Dredging Details: ______
Work from Water Details: ______
Jetties / Piers – Length of span between support: ______
Breakwaters (or similar) – Maximum length without final armouring at any time: ______metres
Contract Value Breakdown:Concreting $______
Stanchions or support work $______
Decking, bollards, ancillaries $______
Major Stonework $______
______
13. SEWAGE WORKS
Proportion of Contract Value: ____%
Tanks/Beds : value $ ______maximum depth of excavations: ______metres
Outfall: value $ ______method & type of construction:______
Pumphouse: value $ ______substructure, maximum depth of excavations: ____metres
Superstructure – construction: ______
14. TUNNELS & SHAFTS
Proportion of Contract Value: ____%
Dimensions: ______
Method of excavation: ______
______
Compressed air in use? yes noIf yes, pressure: ______
Explosives used? yes no If yes, type: ______quantities: ______
Explosives storage: ______
Linings: Type: ______Dimensions: ______
How constructed: ______
Length of unlined excavations behind face: ______metres
15.WATER TOWERS & TANKS
Proportion of Contract Value: ____%
Type / Method of Construction: ______
Tank Dimensions: ______
Foundation Details: ______
Supporting Structure: ______
The undersigned declares that all statements made in this Application are true. Signing of this document does not bind the Applicant to complete the insurance, but it is agreed that the Application shall be the basis for the contract, should the policy be issued.
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information provided byTitle
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SignatureDate
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