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1、编号: _安装工程一切险保险合同甲 方：_乙 方：_签订日期：_年_月_日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,whichshallbethebasisofapplica
2、tiontothecompanyforerectionallrisksinsuranceandconstituteanintegralpartoftheinsurancepolicycoveringthepro-ject1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otherpartyiesconcerned2被保险人名称和地址：nameandaddressoftheinsured:3被保险工程名称titleofcontract/project:4被保
3、险工程地点locationoferection: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*:51物质损失materialdamage项目投保金额每次事故免赔额insureditemssumsinsureddeductibleforanyoneaccident*-安装工程erectionworks1安装工程设备价（包括设备价、运费、保费、关税等）valueofequipmenttobeerectedincludingvalueofequipment
4、,freight,insurancepremiumandcustomsduty,etc2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”spropertyexistingonthesite施工用机具及设备（详见所附清单）constructionplantandeq
5、uipmentaccordingtotheattachedlist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totalsuminsured52特种危险赔偿限额limitsofindemnityforspecialrisks赔偿限额limitsofindemnity（不超过保额80limitto80ofsuminsured）危险种类risks地震、海啸earthquake,tsunami洪水、风暴、暴雨flood,storm,te
6、mpest每次事故免赔额（不低于损失的20）deductibleforanyoneaccidentnotlessthan20ofloss53费率premiumrate54总保险费totalpremium6保险期限periodofinsurance61安装期：个月，自年月日起至年月日止erectionperiod:months,fromto62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testingorcommissioningperiod:months,fromto63是否投保有限责任保证期？如是，请列明是否whethermaintenancevisitsperiodisto
7、becovered?ifso,pleasestateyesno保证期个月，自年月日起至年月日止maintenancevisitsperiod:months,fromto7是否投保第三者责任？如是，请列明是否whetherthirdpartyliabilityistobecovered?ifso,pleasestateyesno71每次事故赔偿限额limitofindemnityforanyoneaccident72累计赔偿限额limitofindemnityinaggregateduringperiodofinsurance73每次事故物质损失免赔额deductibleofmaterialda
8、mageforanyoneaccident74费率及保险费premiumrateandpremium8被安装机器设备的情况conditionofthemachineryandequipmenttobeerected81项目主体principlework82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,manufacturerandvalue;forcompletese
9、tsofequipment,specifynames,technicalstandard,manufacturerandvalueoftheprincipleequipment;forusedmachinery,ifany,specifydescriptionsandvalueseparately83安装前设备储存地点、条件及保管方法location,conditionandmethodoftemporarystorageoftheequipmentpriortheerection84主体工程施工方法及起止时间constructionmethodofprinciplepartofproject
10、andthedateofcommencementandexpiry9工地及附近的自然条件naturalconditionsonandarroundthework-site:91地形特点topograghicalfeatures92地质及底土条件geologyandsubsoilconditions93地下水水位levelofundergroundwater94最近的河、湖、海的名称、距离和以往最低、一般和最高水位nameanddistanceofthenearestriver,lakeandseaandtheirrecordsofthelowest,normalandhighestwaterl
11、evels95以往最大降雨量记录pastrecordofthemaximumrainfall（24小时，月年within24hours,month/year）96以往遭受自然灾害（如洪水、台风）记录pastrecordofoccurrencesofnaturalcalamitiessuchasflood,typhoon10该工程为新建改建扩建theprojectisnewprojectreform/up-gradeextented11安装工程在建筑物内进行还是露天进行？建筑物内露天theerectionworkwillbecarriedoutindoororoutdoorindooroutdoor12施工过程中
