安装工程一切险保险合同_1.doc
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1、【精品文档】如有侵权,请联系网站删除,仅供学习与交流安装工程一切险保险合同_1.精品文档.安装工程一切险保险合同1.安装工程一切险投保单ERECTIONALLRISKSINSURANCEAPPLICATION保单号PolicyNo.本投保单由投保人尽可能如实地、详细地填写并签章后作为向本公司投保安装工程险的依据。本投保单为该工程保险单的组成部分。TheApplicantisrequiredtofillinfollowingitemswithutmostfaithandasdetailedaspossi-ble,andaffixsignaturetothisApplication,whi1.安装
2、工程一切险投保单ERECTIONALLRISKSINSURANCEAPPLICATION保单号PolicyNo.本投保单由投保人尽可能如实地、详细地填写并签章后作为向本公司投保安装工程险的依据。本投保单为该工程保险单的组成部分。TheApplicantisrequiredtofillinfollowingitemswithutmostfaithandasdetailedaspossi-ble,andaffixsignaturetothisApplication,whichshallbethebasisofapplicationtotheCompanyforErectionAllRisksIns
3、uranceandconstituteanintegralpartoftheInsurancePolicycoveringthepro-ject.-1.工程关系方的名称和地址|NameandAddressofPartiestoProject|工程所有人|Principal-|承包人|Contractor-|工程分包人|Sub-Contractor-|其他关系方|OtherParty(ies)Concerned-|-|2.被保险人名称和地址:|NameandAddressoftheInsured:|-|3.被保险工程名称|TitleofContract/Project:|-|4.被保险工程地点L
4、ocationofErection:|-|5.被保险项目、保险金额/赔偿限额及每次事故*免赔额|InsuredItems、SumsInsured/LimitsofIndemnityandDeductibleforAnyOneAccident*:|5.1物质损失MaterialDamage|项目投保金额每次事故免赔额|InsuredItemsSumsInsuredDeductibleforAnyOneAccident*|-|安装工程|ErectionWorks|(1)安装工程设备价|(包括设备价、运费、保费、关税等)|ValueofEquipmenttobeErected(including|V
5、alueofEquipment,Freight,Insurance|PremiumandCustomsDuty,etc.)-|(2)安装费|CostofErection-|土建项目|CivilEngineeringWork-|-*每次事故指不论一次事故或一个事件引起的一系列事故Thewords“ANYONEACCIDEMT”shallmeananyoneaccidentorseriesofaccidentarisingoutofoneevent.-工程所有人或承包人在工地上的其他财产|Principal”sorContractor”sPropertyExisting|ontheSite-|施工
6、用机具及设备(详见所附清单)|ConstructionPlantandEquipment|(AccordingtotheAttachedList)-|清除残骸费用|RemovalofDebrisExpenses-|灭火费用|FireExtinguishmentExpenses-|专业费用|ProfessionalExpenses-|其他费用|OtherExpenses-|总保险金额|TotalSumInsured-|5.2特种危险赔偿限额LimitsofIndemnityforSpecialRisks|赔偿限额LimitsofIndemnity(不超过保额80%Limitto80%ofSumI
7、nsured)|危险种类Risks-|地震、海啸|Earthquake,Tsunami-|洪水、风暴、暴雨|Flood,Storm,Tempest-|每次事故免赔额(不低于损失的20%)|DeductibleforAnyOneAccident(NotLessthan20%ofLoss)-|5.3费率|PremiumRate-|5.4总保险费|TotalPremium-|-|6.保险期限PeriodofInsurance|6.1安装期:个月,自年月日起至年月日止|ErectionPeriod:Months,Fromto|6.2试车期(可独立分开的项目单独试车)个月,自年月日起至年月日止|Test
8、ingorCommissioningPeriod:Months,Fromto|6.3是否投保有限责任保证期?如是,请列明-是-否|WhetherMaintenanceVisitsPeriodistobeCovered?Ifso,PleaseState-Yes-No|保证期个月,自年月日起至年月日止|MaintenanceVisitsPeriod:Months,Fromto|-|7.是否投保第三者责任?如是,请列明-是-否|WhetherThirdPartyLiabilityistobeCovered?Ifso,PleaseState-Yes-No|7.1每次事故赔偿限额|LimitofInde
9、mnityforAnyOneAccident-|7.2累计赔偿限额|LimitofIndemnityinAggregateduringPeriodofInsurance-|7.3每次事故物质损失免赔额|DeductibleofMaterialDamageforAnyOneAccident-|7.4费率及保险费|PremiumRateandPremium-|-|8.被安装机器设备的情况ConditionoftheMachineryandEquipmenttobeErected|-8.1项目主体|PrincipleWork-|8.2如系单项设备,逐一列明名称、型号、技术指标、|制造商及价值;如系成
10、套设备,列明主要设备的|名称、技术指标、制造商及价值;如有旧品,逐|一列明名称及价值|ForSingle-ItemEquipment,SpecifyDescription,|Type,TechnicalStandard,Manufacturerand|Value;ForCompleteSetsofEquipment,Specify|Names,TechnicalStandard,Manufacturerand|ValueofthePrincipleEquipment;ForUsed|Machinery,ifany,SpecifyDescriptionsand|ValueSeparately-|
11、8.3安装前设备储存地点、条件及保管方法|Location,ConditionandMethodofTemporary|StorageoftheEquipmentPriortheErection-|8.4主体工程施工方法及起止时间|ConstructionMethodofPrinciplePartof|ProjectandtheDateofCommencement|andExpiry-|-|9.工地及附近的自然条件NaturalConditionsonandarroundtheWork-Site:|9.1地形特点|TopograghicalFeatures-|9.2地质及底土条件|Geolog
12、yandSubsoilConditions-|9.3地下水水位|LevelofUndergroundWater-|9.4最近的河、湖、海的名称、距离和以往最低、一般和最高水位|NameandDistanceofTheNearestRiver,|LakeandSeaandTheirRecordsofThe|Lowest,NormalandHighestWaterLevels-|9.5以往最大降雨量记录PastRecordoftheMaximumRainfall|(24小时,月/年Within24Hours,Month/Year)-|9.6以往遭受自然灾害(如洪水、台风)记录|PastRecord
13、ofOccurrencesofNatural|Calamities(suchasFlood,Typhoon)-|-|10.该工程为-新建-改建-扩建|TheProjectis-NewProject-Reform/Up-grade-Extented|-|11.安装工程在建筑物内进行还是露天进行?-建筑物内-露天|TheErectionWorkwillbeCarriedoutIndoororOutdoor-Indoor-Outdoor|-|12.施工过程中可能会造成损坏他人财产的分布情况|DistributionofThirdParty”sPropertieswhichmaybeDamagedDu
14、ringthePeriodofErection|-|13.施工承包人是否有同类工程的施工经验或同类施工方法的经验?-是-否|IstheContractorExperiencedinthisTypeofWorkOrErectionMethod-Yes-No|-14.工程关系方中的任何一方是否已向其他保险公司投保与本工程有关的保险?|AnyInsuranceRelatingtothisProjecthasbeenEffectedwithOtherInsuranceCompanybyanyPatriestoProject?|-是保险公司保险种类|-YesInsuranceCompany_Covera
15、geofInsurance_|保险金额-否|SumsInsured_-No|-|15.特别条款SpecialPorvisions:|-|16.备注Remarks:|-|请随同本投保单提供下列文件ThisApplicationshallbeSubmittedtogetherwiththeFollowingDocuments:|(1)工程合同ConsrtuctionContract|(2)承保金额明细表BreakdownoftheContractValue|(3)工程设计书BlueprintofthePorject|(4)工程进度表ProgressScheduleoftheErectionSite
16、|(5)工程地质报告GeologicalReportofErectionSite|(6)工地概图SketchoftheProjectSite|-|投保人及被保险人兹声明所填上述内容属实,对贵公司就安装工程一切险条款及附加内容(包括责任免除部分)的说明已经了解,同意按照该条款和附加内容投保安装工程一切险。I/We(theApplicant&theInsured)toherebydeclarethattheabovecontentsaretrulyfilledin,andthatI/WehaveunderstoodtheCompany”sexplanationontheclausesofE
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