爱华网安装工程一切险保险合同 (中英文)
CONTRACT OF ERECTION ALL RISKSINSURANCE
１．安装工程一切险投保单
erection all risks insuranceapplication
保单号policy no.
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。
the applicant is required to fill in followingitems with utmost faith and as d etailed as possible, and affixsignature to this application, which shall be the basisof
appli cation to the company for erection all risksinsurance and constitute an integral part of the insurance p olicycovering the project.
1.工程关系方的名称和地址name and address of partiestoproject
工程所有人principal
承包人contractor
工程分包人sub-contractor
其他关系方other party(ies)concerned
2.被保险人名称和地址：
name and address of theinsured:
3.被保险工程名称title ofcontract/project:
4.被保险工程地点locationoferection:
5.被保险项目、保险金额／赔偿限额及每次事故＊免赔额
insured items、sums insured/limits of indemnity anddeductible for any one
accident:
5.1物质损失materialdamage
项目投保金额每次事故免赔额
insured items sums insured deductible for any oneaccident
安装工程erection works
(1)安装工程设备价（包括设备价、运费、保费、关税等）
value of equipment to beerected (including valueof equipment, freight, insurance
premium and customs duty, etc.)
(2)安装费cost oferection
(3)土建项目civil engineeringwork
(4)每次事故指不论一次事故或一个事件引起的一系列事故
the words "any one accidemt" shall mean any oneaccident or series of acciden t arising
out of one event.
工程所有人或承包人在工地上的其他财产
principal"s or contractor"s propertyexisting onthe site
施工用机具及设备（详见所附清单）
construction plant andequipment (according to theattached list)
清除残骸费用removal o————f debrisexpenses
灭火费用fire extinguishment expenses
专业费用professional expenses
其他费用otherexpenses
总保险金额total sum insured
5.2特种危险赔偿限额limits of indemnity for specialrisks
赔偿限额limitsof indemnity（不超过保额80% limit to 80% ofsuminsured）
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%）
deductible for any one accident (not less than 20%of loss)
5.3费率premium rate
5.4总保险费total premium
6.保险期限period ofinsurance
6.1安装期：个月，自年月日起至年月日止
erection period: months, from to
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
testing or commissioning period: months, fromto
6.3是否投保有限责任保证期？如是，请列明－是－否
maintenance visits period is to be covered? if so,please state－yes－no
保证期个月，自年月日起至年月日止
maintenance visits period: months, fromto
7.是否投保第三者责任？如是，请列明－是－否
whether third party liability is to be covered? ifso, please state－yes－no
7.1每次事故赔偿限额
limit of indemnity for any one accident
7.2累计赔偿限额
limit of indemnity in aggregate during period ofinsurance
7.3每次事故物质损失免赔额
deductible of material damage for any oneaccident
7.4费率及保险费premium rate andpremium
8.被安装机器设备的情况
condition of the machinery and equipment to beerected
8.1项目主体principle work
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
for single-item equipment, specify description,type, technical standard, manufacturerand value; for complete setsof equipment,specify names, technical standard, manufacturerandvalue of the principle equipment; forused machinery, if
any, specify descriptionsand valueseparately
8.3安装前设备储存地点、条件及保管方法
location, condition and methodof temporary storageof the equipment prior the erection
8.4主体工程施工方法及起止时间
construction method of principle partof projectand the date ofcommencement and
expiry
9.工地及附近的自然条件natural conditions on andarround thework-site:
9.1地形特点topograghical features
9.2地质及底土条件
geology and subsoilconditions
9.3地下水水位level of undergroundwater
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
name and distance of the nearest river,lake andsea and their records of the lowest,
normal and highest water levels
9.5以往最大降雨量记录
past record of themaximumrainfall（24小时，月／年 within 24 hours,month/year）
9.6以往遭受自然灾害（如洪水、台风）记录
past record of occurrences ofnaturalcalamities(such as flood, typhoon)
10.该工程为－－－新建－－－改建－－－扩建
the project is－－－new project－－－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
the erection work will be carried out indoor orutdoor－－－indoor－－－outd
oor
12.施工过程中可能会造成损坏他人财产的分布情况
distribution of third party"s properties which maybe damaged during the period
of erection
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
is the contractor experienced in this type of workor erectin method－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？
any insurance relating to this project has beeneffected with other insurance
company by any patries toproj－－－yes ect?
是保险公司保险种类insurance company＿＿＿coverage of insurance＿＿＿
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
this application shall be submitted together withthe following documents:
(1)工程合同consrtuctioncontract
(2)承保金额明细表breakdown of the contractvalue
(3)工程设计书blueprint oftheporject
(4)工程进度表progress schedule of theerection site
(5)工程地质报告geological report of erectionsite
(6)工地概图sketch of the projectsite
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(the applicant & the insured)to hereby declare that the above contents ar
e truly filled in, and that i/we have understoodthe company"s explanation on the
clauses of erection all risks insurance and itsadditional contents (including exclusions), and that i/we agree toapply for erection all risks insurance subject
to the above-menti oned clauses and its additionalcontents.
投保人及被保险人（签章）电话
signatures of the applicant & theinsured＿＿＿teleph one＿＿
地址日期
address＿＿＿date＿
以下内容由保险公司填写
for office useonly｜
经办人及日期＿＿核保人及日期＿＿＿＿
