intra Asia

QUOTATION SLIP OF
PUBLIC LIABILITY INSURANCE

TYPE OF COVER PUBLIC LIABILITY INSURANCE

THE INSURED PT ARAH ENVIRONMENTAL INDONESIA

ADDRESS JL. Tulodong Bawah II No. 3, Kebayoran Baru Jakarta Selatan 12190

PERIOD OF COVER until (TO BE ADVISED 2 Years)

Both dates inclusive at 12.00 o'clock local time

LOCATION OF RISK Capital Place Building, Jl Jend Gatot Subroto Kav 18, Kuningan Barat, Jakarta
Seiatan 12710

THE PROJECT Pengangkutan Limbah B3

INTEREST INSURED Covering to indemnify the insured against alt sums which (he Insured shall
become legally liable to pay to any third par
ty as damages in respect of :

1. Accidental bodily injury to any person

2. Accidental loss or damage to material proper
ty

Happening in connection with the business and occurring within the

territorial limits during the period of insurance / contract

Limit Liability : USD 1,000,000.00 any one occurrence for bodily injury
and/ or property damage/ combined single limit and in aggregate for the
whole period of Insurance.

DEDUCTIBLE 10% of claim, min. USD. 2,500 any one occurrence for third par
ty property
damage only

TERM/CONDITIONS : As per standard Insurer Policy Wording, polis:

- Claim Made Basis indemnity with Retroactive Date as per Acceptance
Extra Contractual Obligation Exclusion Endorsement
- Electronic Date Recognition Endorsement A (NMA 2800)
Indonesian Jurisdiction and Area Clause
- Loss Notification Clause (30 days)
- Waiver right of subrogation against principal(s)
- 30 days advance written notice to company in the event of cancellation,
expiration or intend charges in the terms and conditions
Payment of Premium Warranty Clause 30 days

EXCLUSION : (a) Absolute Pollution

(b) Absolute Asbestos & Silica
(c) Act of God
(d) business description i.e. spor
ts, social and welfare facilities, fire
ambulance services and first aid
(e) Car Park Liability
(f) Contingent Liability Clause
(g) Contractual Liability Clause
(h) Cyber Non Aggregation Clause NMA 2915
(i) Direct Drilling Activities
(j) Diving and Deep Water Actives
(k) Failure to Supply

PT. Asuransi Intro Asia

MENARA HIJAU 8"'Floor
Jl. Letjen. MT. Haryono, Kav. 33 , Jakarta 12770. Indonesia
V. (62-21) 7986129 ,(62-21)7986169,7985871 a info@intrassia.id
www.intraasia.id
 intra Asia

(I) Fire and Explosion Liability Clause

(m) Food and Drink Poisoning Clause
(n) Fines, Penalties, and any kind of financial losses
(o) Ionizing radiation, contamination etc.
(p) IT Hazard Clarification Clause NMA 2912- 12/11/01
(q) Loading and Unloading Clause
(r) Liability for loss of or damage to property under care, custody and
control of the insured
(s) Marine Liability
(t) Pollution Contamination Exclusion Clause
(u) Product Liability & Completed Operation
(v) Professional Indemnity
(w) Punitive or exemplary damages
(x) Riot, Strike and Malicious Damage Plus Civil Commotion Endorsement
(Code RSMD 4.1B/2007)
(y) Sudden & Accidental Pollution
(z) Seepage and Pollution Clause NMA 1685.
(aa) Sanction, Embargo Prohibited Transaction
(bb) Transmission & Distribution Lines Exclusion Clause,
(cc) Terrorism and Sabotage as per NMA 2921
(dd) Underground Activities
(ee) Watercraft Liability
(f
t) War

PREMIUM CALCULATIONPremium USD. 2,000.00

Admin Cost USD. 5.00

Total Premium : USD. 2,005.00

Jakarta, November 215 , 2019

PT ASURANSI INTRA ASIA

BAMBANG PNUGROHO
Marketing Director

PT. Asuransi Intro Asia

HEMARA H1JAU 8'" Floor
Jl. Letjen. MT. Haryono, Kav. 33 , Jakarta 12770. Indonesia
M62-21) 7986129 3(62-21)7986169,7985871 r a iiifo(f>intraasia.id
www.intraasia.id