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Wednesday, 22 May 2013
Contractor - All Risks
  1. Full Name(*)
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  2. Occupation
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  3. Street Address(*)
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  4. PO Box
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  5. Settlement, Island(*)
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  6. Email(*)
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  7. Telephone(*)
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  8. Work Phone
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  9. Fax
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  10.  
  1. Do You Have Any Other Insurance With Us?(*)
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  2. Have you had any insurance refused or subjected to special terms?(*)
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  3. Have you had any losses during the past 3 years? (Include premises other than this one.)(*)
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  4. If you have answered “YES” to any of these questions, please provide full details below.
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  5.  
  1. The Contract Site
  2. Site Address
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  3. Street Address & Exact Location - Including Lot #, Block #, Settlement and Island.
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  4. Building Construction
  5. Walls
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  6. Roof
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  7. Distance From the Sea
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  8. What is the elevation of the site?
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  9. Number of Stories
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  10. Intended Occupancy
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  11. Is Site Fenced?
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  12. Does the public have access to the site?
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  13.  
  1. Estimated Construction Period From

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  2. Estimated Construction Period To

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  3. Date the Work Started
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  4. Loss Payee
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  5. Sums Insured
  6. Contract Works and temporary works and the materials, i.e. Contract Price
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  7. Constructional plant, tools, equipment, temporary buildings, being the property of the Insured or for which he is responsible
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  8. Debris Removal
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  9. Architects’, surveyors’ and consulting engineers’ fees necessarily incurred in reinstatement.
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  10. Public Liability Limit (if required)
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  11. Total
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  12.  
  1. I declare to the best of my knowledge and belief the information on this form is true in every respect. I also declare that if anything on this form was written by another person, he or she acted as my agent for this purpose. I agree to keep the property in a good state of repair during the currency of this Insurance. I agree that this proposal and declaration will be the basis of the contract between me and the Insurer.
  2. By selecting the submit button you agree to this statement.
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