PT.

ASURANSI UMUM BUMIPUTERAMUDA 1967

Cabang Batam
Komplek Bintang Raya Blok A no.2
Batam Centre Kota Batam
Telp. (0778)7483477, 7483488
Fax. 7483466.Email batam@bumida.co.id

QUOTATION
No. 105-Pnw/Ext/Bmd-Tng/VIII/2013

Yth. PT. SAMUDERA BATAVIA LOGISTIC

Jl. Gorontalo IV No. 30 Tanjung Priuk
Jakarta Utara
Dengan Hormat,
Bersama ini kami sampaikan penawaran sebagai berikut
1. TYPE OF INSURANCE : LIABILITY INSURANCE POLICY INCLUDING
ENVIRONMENTAL LIABILITY
2. INSURED

: PT. SAMUDERA BATAVIA LOGISTIC

3. ADDRESS

: Jl. Gorontalo IV No. 30 Tanjung Priuk

Jakarta Utara

4. RISK LOCATION

TBA, and transportation route as Ijin /Rekomendasi

Menteri Lingkungan Hidup yang valid & definitive

5. PERIOD OF INSURANCE : 1 year (tba)

6. SCOPE OF COVERAGE : Section I Comprehensive General Liability
Section II Automobile Liability
Including Sudden and Accidental Pollution 72 Hours
(Environmental Liability)
7. TIPE OF POLLUTANT

: Sludge oil, Slope Oil, Used Oil, Use battery/Accu, Paint

sludge, Acetylene Residual and Used Copper Sludge

8. DETAILS OF WORK

: Collecting, storage & B3 waste transportation (B3

waste processing)

9. LIMIT OF LIABILITY

: Section I & Section II

Bodily injury and Property Damage
Each Occurance Limit :Rp 5.000.000.000,-/ any one accident
Agregate limit each policy year : Rp 5.000.000.000,Including Sudden and Accidental Pollution
Each Occurance Limit :Rp 5.000.000.000,-/ any one accident
Agregate limit each policy year : Rp 5.000.000.000,-

10.DEDUCTIBLE

:
-

10% of claim min Rp 50.000.000,- each and every

loss (Property Damage & Bodily Injury)

PT. ASURANSI UMUM BUMIPUTERAMUDA 1967

Cabang Batam
Komplek Bintang Raya Blok A no.2
Batam Centre Kota Batam
Telp. (0778)7483477, 7483488
Fax. 7483466.Email batam@bumida.co.id

Remediation Cost for Sudden & Accidental

Pollution : 10% of claim min Rp 50.000.000,- each
& every claim

11.CLAUSES

12.EXCLUSION

13.PREMIUM

: - Claim made basis of Indemnity

-

Extra Contractual obligations Exclusion Clause

Indonesia Jurisdiction Clause

Exclude Punitive or Exemplary Damages

Sudden and accidental pollution

Including Remediation costs

No known claim(s) or circumstances which could

give to a claim as per policy issued for last 3 years

Penerapan K3 & SOP sesuai standard Kementrian

Lingkungan hidup Republik Indonesia

Loss Notification Clause (30 days)

NMA 2921 War and Terrorism

NMA 2915 Cyber Risk Exclusion Clause

Visitor clause (Exclude USA & Canada visitor)

(72

hours)

: - Exclude Contractual Liability (Tanggung Jawab

kontraktual untuk menutup tanggungjawab yang
dikenakan dalam kontrak)
-

Exclude Terrorism & Sabotage

Exclude Offshore Activities

:
Premium

= Rp

18.750.000,00
Admin & Stamp Duty

= Rp

32.000,00
TOTAL

= Rp

18.782.000,00
Tangerang, 24 Desember 2016
Regards,

Agreed,

PT.ASURANSI BUMIPUTERAMUDA 1967

LOGISTIC

PT. SAUDERA BATAVIA

PT. ASURANSI UMUM BUMIPUTERAMUDA 1967

Cabang Batam
Komplek Bintang Raya Blok A no.2
Batam Centre Kota Batam
Telp. (0778)7483477, 7483488
Fax. 7483466.Email batam@bumida.co.id

Sayuri, SE., AAAIK

Kepala Cabang