Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
2. Location of Site
Country/Province/District
City/Town/Village
7. Description of Contract
work
(Please give detailed
technical information)
Construction methods
Construction materials
E 54.0-E 1
8. Is the Contractor experienced
in this type of work or yes no
construction methods?
Date of completion
Blasting yes no
Other
Other
Distance
Limit of Indemnity
1. Bodily injury
1.2 Total
2. Property damage
We hereby declare that the statements made by us in this Questionaire and Proposal are complete
and true to the best or our knowledge and belief, and we hereby agree that this Questionaire and
Proposal shall form the basis and be part of any policy issued in connection with the above risk or
risks. It is agreed that the Insurers shall be liable in accordance with the terms of the Policy only and
that the Insured will not lodge any other claims of whatever nature.
Signature:
Owner/Manager