编号：QJ-HT-0423安装工程一切险保险合同书(官方版)In order to clarify their rights and obligations, sign contracts to ensure that their legitimate rights and interests are not harmed.甲方：_____________________乙方：_____________________日期：_____________________--- 专业合同范本系列下载即可用---安装工程一切险保险合同书(官方版)说明：该合同书适用于甲乙双方为明确各自的权利和义务，经友好协商签署合同，在合同期限内按照合同规定或者依照法律规定履行义务，保证权利双方合法权益不受损害，文档可下载收藏或打印使用（使用时请先阅读条款是否适用）。
1.安装工程一切险投保单erection all risks insurance application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 following items with utmost faith and as detailed as possi-ble, and affix signature to this application, which shall be the basis of application to the company forerection all risks insurance and constitute an integral part of theinsurance policy covering the pro-ject.---------------------------------------------------1.工程关系方的名称和地址|name and address of parties to project |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 the insured: |--------------------------------------------------|3.被保险工程名称|title of contract/project: |--------------------------------------------------|4.被保险工程地点location of erection: |--------------------------------------------------|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 and deductible for any one accident*: |5.1 物质损失material damage |项目投保金额每次事故免赔额|insured items sums insured deductible for any one accident* | ------------- ------------ ------------------------------- |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 be erected (including |value of equipment, freight, insurance |premium and customs duty, etc.) ----------- |(2)安装费|cost of erection ----------- |土建项目|civil engineering work ----------- |---------------------------------------------------*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 one accident or series of accident 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 property existing |on the site ----------- |施工用机具及设备(详见所附清单) |construction plant and equipment |(according to the attached list) ----------- |清除残骸费用|removal of debris expenses ----------- |灭火费用|fire extinguishment expenses ----------- |专业费用|professional expenses ----------- |其他费用|other expenses ----------- |总保险金额|total sum insured ----------- |5.2 特种危险赔偿限额limits of indemnity for special risks |赔偿限额limits of indemnity(不超过保额80% limit to 80% of sum insured) |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 of insurance |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, from to |6.3 是否投保有限责任保证期如是,请列明---是---否|| | | | |whether 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, from to |------------------------------------------------------------|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 if so, 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 of insurance----------- |7.3 每次事故物质损失免赔额|deductible of material damage for any one accident ----------- |7.4 费率及保险费|premium rate and premium ----------- |------------------------------------------------------------|8. 被安装机器设备的情况condition of the machinery and equipment to be erected |---------------------------------------------------------------------------------------------------------------------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, manufacturer and |value; for complete sets of equipment, specify | names, technical standard, manufacturer and |value of the principle equipment; for used | machinery, if any, specify descriptions and |value separately ----------- |8.3 安装前设备储存地点、条件及保管方法|location, condition and method of temporary | storage of the equipment prior the erection ----------- | 8.4 主体工程施工方法及起止时间|construction method of principle part of |project and the date of commencement |and expiry ----------- |-------------------------------------------------------|9. 工地及附近的自然条件natural conditions on and arround the work-site: |9.1 地形特点|topograghical features ----------- |9.2 地质及底土条件|geology and subsoil conditions ----------- |9.3 地下水水位|level of underground water ----------- |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 and sea 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 the maximum rainfall |(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 of natural |calamities(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 or outdoor ---indoor ---outdoor |-------------------------------------------------------|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 may be 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 work or erection 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 been effected with other insurance company by any patries to project |---是保险公司保险种类|| | |---yes insurance company _____ coverage of insurance ____ |保险金额---否|| | |sums insured____ ---no |------------------------------------------------------------|15. 特别条款special porvisions: |||------------------------------------------------------------|16. 备注remarks: |||------------------------------------------------------------||请随同本投保单提供下列文件this application shall be submitted together with the following documents: |(1)工程合同consrtuction contract |(2)承保金额明细表breakdown of the contract value |(3)工程设计书blueprint of the porject |(4)工程进度表progress schedule of the erection site |(5)工程地质报告geological report of erection site |(6)工地概图sketch of the project site ||------------------------------------------------------------|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。