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Wrap-Up Liability Application

Named Insureds (list)
Program participants
Owner name
Owner address / City / Prov / Postal code
General Contractor name
Contractor address / City / Prov / Postal code
Project/Construction Manager
Prime architectural/engineering consultant
Geotechnical engineer
Project Name
Project address/location / City / Prov / Postal code
Project type and description

Project Duration

Design / from / to
Construction / from / to
Maintenance/Warranty / from / to
Estimated substantial completion date
Estimated final completion date
Closing Date
/ Date required by
Please attach
PDF Copy of Contract, Request for Proposal, or Tender Documentsshowing
a) Risk of Loss Clauses
b) Hold Harmless and Indemnity Clauses
c) Insurance Specifications
d) Bonding Specifications (including BondForm) – efficiency/output guarantee clauses
e)Warranties
f)Liquidated Damages Clause

General Information

Joint venture proposals / Name of joint venture
Joint venture address / City / Prov / Postal code
Percentage of participation in joint venture / % / Name of surety of each partner
Separately registered Corporation / yes no
Testing/start-up/commissioning required? / yes no
Describe testing operations/procedures to be undertaken
Indicate any watercraft requirements by type of watercraft and whether owned or non-owned or chartered.
Indicate any transport of cargo risks by air or water, along with brief description of cargo, values and route of shipment.

Breakdown of Values

Contractor Portion / Subcontractors / Total
Concrete (Flatwork) ** curb/gutter / $ / $ / $
Bridge over Land / $ / $ / $
Bridge over Water / $ / $ / $
Grading / $ / $ / $
Sewer and Watermain / $ / $ / $
Mechanical works / $ / $ / $
Electrical works / $ / $ / $
Value of client supplied material / $ / $ / $
Consulting engineer/design / $ / $ / $
Engineering/falsework design / $ / $ / $
Transit costs (mobilization) / $ / $ / $
Other (please specify) / $ / $ / $
Total estimated contract value / $ / $ / $
Owner Contingency / $ / $ / $

Cables and Transmission Lines

Overhead

Proportion of contract value / % / Max. height of pylons/masts / metres
Construction of pylons/masts
Max. cable length between towers / metres / Value / $
Total cable length / km

Underground

Type of cable / Cable laying method
Trench depth / metres / Max. trench length worked on at any one time / metres

Canals and Channels

Dimensions of excavation / width / length / Max. depth / metres
Type of lining
Lock gate details

Coffer Dams

Construction type
Dimensions (metres) / width / length / height
Built to allow overtopping? / yes no
If no, freeboard above highest recorded flood level? / metres

Dams and Barges (and reservoirs including dam)

Dimensions (metres) / width / length / height
Type of construction
Breakdown in contract value
Main Dam / $
Coffer Dams / number / value / $
Tunnels / number / value / $
Outfall / $
Spillway / $
Penstocks / number / value / $ / Piping above ground? / yes no
Power Station / $ / including machinery / excluding machinery

Dewatering

Method
Water table reduced (metres) / from / to
Where will water be discharged?
Main equipment and power source
Standby equipment and power source
No. of well ports

Land Reclamation

Proportion of contract value / %
Nature of reclamation (e.g. from marshland, sea, etc.)
Area / Frontage to major water exposure
Method of work

Pipelines (land only)

Proportion of contract value / %
Max. depth (metres) / cuttings / trenches
Max. diameter of pipelines (cm)
Max. trench length being worked on(metres)
Type of pipe
Details of water crossings
Describe significant gradients

Work In and Adjacent to Water

Proportion of contract value / %
Name of waterway (e.g. lake, river)
Nature of waterway (e.g. slow/wide/tidal/flash flood)
Description of work and protection
Period during which work carried out / from / to
History of flooding
Max. recorded flood level (metres)
Width of watercourse (metres) / Depth of watercourse (metres)
Bank height above normal water level (metres)
Flow of current / normal / cu sec’s / flood / cu sec’s
Tidal range / from / metres / to / metres
Flood warning facilities
Proximity to watercourse traffic and precautions

Roads

Value of excavation/cuttings / $
Max. depth (metres) / Incline of sides(degrees) / °
Method of support
Description of water crossings
Value / $
Embankments or other earth works including leveling/grading
Value / $ / max. height (metres) / incline of sides / °
Retaining walls
Value / $ / height(metres) / thickness(metres)
Method of construction
How secured
Type/method of road surfacing
Value / $
Details of significant gradients
Traffic Controls (Please describe or attach from contract)
Is there winter shutdown?
If so, how is jobsite protected during shutdown?

Sea Works (e.g. piers, dolphins, jetties, wharves, docks, seawalls, breakwaters, etc.)

Details of tides, currents, wind speeds and direction
Waves / height / frequency
Structure (metres) / length / width / height
Protection from direct sea action
Method of work
Structure details (including purpose)
Armoring details
Fill details
Dredging details
Work from water details
Jetties/piers – length of span between support
Breakwaters (or similar) – max. length without final armoring at any time (metres)
Contract value breakdown
Concreting / $ / Decking, bollards, ancillaries / $
Stanchions or support work / $ / Major stonework / $

Sewage Works

Proportion of contract value / %
Tanks/beds / value / $ / max. depth of excavation (metres)
Outfall / value / $ / method and type of construction
Pumphouse / value / $ / substructure, max. depth of excavations (metres)
Superstructure construction

Tunnels and Shafts

Proportion of contract value / %
Dimensions (metres) / diameter / length

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Method of excavation
Compressed air in use? / yes no / If yes, pressure
Explosives used? / yes no / If yes, type / quantities

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Method of explosive storage
Linings / type / dimensions (metres)
Method of construction

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Length of unlined excavations behind face (metres)

Water Towers and Tanks

Proportion of contract value / %
Method of construction
Tank dimensions (metres) / diameter / length
Foundation details
Supporting structure

Long Form Project Application

Will the Owner be supplying material/equipment etc for incorporation into the project? / yes no
If yes, please provide the following details, including value, with regard thereto:
  • age and condition all materials and equipment, (if not new), including unoccupied structures provided by the Owner for incorporation into the project
  • if an occupied structure is to be provided to the Contractor, provide details of age, condition, construction and occupancy of structure

Adjacent Structures (attach site plan if available)

Type of Construction / Occupancy / Distance
North
East
South
West

Site Details

Neighborhood (describe, i.e. industrial , commercial, residential)
Describe site (e.g. sheltered valley, flood plain, hilly)
Describe existence of mine workings, caves, underground rivers, etc.
History of subsidence/landslip

Site Security

Fencing / yes no / Details
Watchman service / yes no / Details
Close circuit camera / yes no / Details

Construction Details

Will construction operations be performed in compliance with geo-technical recommendations? /
yes no
With modifications (details)
Describe unusual/experimental design or construction features or methods
Details of any specialized, unique or unusual machinery to be incorporated into the project (e.g. tower cranes, TBM’s etc.)
Anticipated replacement times for key machinery if replacement is required
Item / Delivery period / Supplier location
Describe any temporary buildings, structures or trailers to be covered and their value.
Detail any off-site locations for which coverage is required. Provide details of what is to be covered, why and value.

Transportation

State type and total value of any single piece of material or equipment of any unusual nature to be transported to the job site.

Type of Material / Total Value / Shipment Point of Origin / Shipment Destination / Distance (km)
$
$
Who will be responsible for transportation risk of such material or equipment?
insured / contractor / subcontractor / supplier / other (specify)
Shipments will be made by:
truck / water / air / other land conveyance (specify)

Hazardous Operations Details

Check all that apply. Describe exposure and controls.

Exposure / Exposure / Controls / Cost
Blasting
Shoring
Underpinning
Railways
Demolition
Excavation
Asbestos
Temporary heating / yes no / Describe
Flammable liquids on site / yes no / Describe
Explosives storage / yes no / Describe
Describe any Project specific Contractors Equipment to be covered(TBM’s, tower cranes, scaffolding)and their value.

Flood Exposure

Name and distance to nearest body of water
Past flood history at site/in the area
Height of project above maximum flood stage
Describe exposure during and after excavation from surface water
Describe precautions to be taken to prevent damage from flood
What is being done to prevent run-off damage
Describe dewatering facilities on site (adequacy and backup)
Site Risks

Wrap-Up Liability Coverage Requirements

Limit / $
Term of Completed Operations coverage (following date of acceptance by owner)

Exposures to Surrounding Sites

Attach a site plan or sketch (with scale) showing distances to surrounding properties, subways, railways, gas and other
utilities and roads:
Provide brief description of EACH such exposed property etc.
Where work is done close to adjacent properties, please attach plans for the following:
Excavation Foundation Shoring Underpinning Blasting

Exposures to Existing Structure

Does the project abut/attach to an existing structure? / yes no
If yes, manner in which structures will attach/communicate.
Occupancy of existing structure during construction
Business Interruption/Loss of Use for damage to existing structure
Is coverage required for damage to existing structure? / yes no
If yes, detail what is to be covered and value
Will the project or part thereof be occupied prior to completion? / yes no
If yes, provide period, and detailed description of reason for occupation and purpose

Risk Control Procedures

Provide information on pprocedures to identify (existing and potential) and minimize exposure to third party person or property
Preconstruction surveys
Vibration monitoring
Traffic control procedures
Will the road be opened prior to completion? If so, detail breakdown of openings and associated values

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

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Aboriginal Insurance Services Inc. - Wrap-up Liability Application / 1
w:\aecon group inc\construction\2006\general\aon produced\project applications\milena\june 14 - civil app w bonding.doc