Total Project Protection Application

TOTAL PROJECT PROTECTION APPLICATION

COVERAGE REQUESTED APPLICATION ATTACHED

r CONTRACT WORKS r YES r NO

r CIVIL WORKS SUPPLEMENT r YES r NO

r BUSINESS INTERRUPTION r YES r NO

r WRAP-UP LIABILITY r YES r NO

r CARGO TO CONSTRUCTION r YES r NO

r TEAMCOVER r YES r NO

r CONTRACT SURETY r YES r NO

GENERAL INFORMATION

1.  Name and Address of Applicant: ______

______

2.  Named Insureds (list): ______

______

3.  Name of Project: ______

4.  Address/Location of Project: ______

______

5.  Description of Project: ______

______

6.  Total Project Value: ______(attach breakdown in values)

Hard Costs: ______Soft Costs: ______

Details on soft costs: ______

7.  Project Participants:

Owner: ______

Project/Construction Manager: ______

General Contractor: ______

Prime Architectural/Engineering Consultant: ______

Geo-technical Engineer: ______

8.  Construction Period: From ______To ______

Policy Term: From ______To ______

9.  Construction Details:

Note: This section to be completed for buildings under construction only. For other structures complete the Civil Works supplement.

Height of Structure Stories Metres

Below Grade: ______

Above Grade: ______

Total Building Area: ______sq. metres

Foundation: ______

Framework: ______

Beams or girders with spans > 25 metres? r Yes r No

Exterior Walls: ______

Roof: Structure ______Covering ______

Floors: Structure ______Covering ______

10.  Adjacent Structures: (attach site plan if available)

Type of Construction Occupancy Distance

North ______

East ______

South ______

West ______

11.  Site Security:

Fencing r Yes r No Details: ______

Watchman Service r Yes r No Details: ______

12.  Neighbourhood (describe): ______

13.  Site: r Greenfield r Brownfield (describe): ______

Access to Fire fighting facilities:______

14.  Is the project a renovation/alteration/addition? r Yes r No

If yes, provide details on existing property: ______

______

Is existing property to be covered by this policy? r Yes r No

Describe how fire protection systems will be maintained: ______

______

15.  Subsurface Operations:

Describe nature, duration, value and relationship to both the project and to adjacent properties.

Blasting: ______

Shoring: ______

Pile Driving: ______

Underpinning: ______

Excavation: ______

16.  Project Manager/General Contractor/Owner Experience:

Experience in this type of work: ______

______

______

______

Gross construction project losses over last 3 years: ______

______

______

17.  Attachments:

Breakdown of Values for various structures and type of work: r Yes r No

Site Plan: r Yes r No

Construction Schedule: r Yes r No

Geo-technical Report: r Yes r No

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.

______

information provided by Title

______

Signature Date

1