Inland Marine
Bridge Builders Risk Application and Inspection Report
Instructions:
1. Applications are not acceptable unless all pertinent questions are answered. If the answer is "none", or "not applicable",
so state
2. Sections I II and VI must be completed. Sections III, IV and V are to be completed when applicable.
Submit narrative report of work to be performed including general plans or photographs which will assist in evaluating
risk; also those portions of specifications which describe the scope of work to be performed and requirements, if any,
for builder's risk insurance.
SECTION I
1.
2.
3.
4.
5.
6.
7.
8.
Name of applicant:
Address:
Name or other identification of structure:
Specific location of structure:
Name of body of water or railroad etc. crossed
Description of type of structure:
Scheduled starting date
Contract price:
$
9.
Specify whether applicant is general contractor, subcontractor or owner
Estimated completion date
10. Present or future operating agency or owner:
11. Name and address of engineer(s) on design:
12. Name and address of independent consulting engineers, if any or if already started, date started
SECTION II
13. Fire and Lightning
Describe any wood or other combustible material in structure or in temporary supports, forms or structures and other
construction materials
Describe any exposure from buildings, brush, oil or gas tanks near by or up stream, gas mains, etc.
What public fire protection is available at job site? Describe other fire protection at job site
14. Floods and Rising Waters
a.
Location:
Is natural water flow to be diverted during construction? Yes
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No
Describe in detail:
b.
Bridge Proper
Elevation mean low water:
Elevation tops of piers:
Are piers and abutments liable to scouring? Yes
No
State reasons:
Elevation highest flood recorded:
Elevation bottom of superstructure
What method will be used to protect against scouring?
c.
Approaches:
Elevation of roadway surface at lowest point:
Describe relation between this elevation and highest flood elevation
Describe abutment wing walls
Is approach liable to wash-out? Yes
d.
Maximum velocity of current:
e.
General remarks on flood:
No
Are there dams upstream for flood control? Yes
No
If so, describe
Tabulate on separate sheet dates and elevations of high waters for as many years as possible (cover frequency,
velocity and duration). Stage of construction to be reached at time of seasonal flood waters
Precautions to be taken to protect construction from flood waters
15. Ice
Is waterway subject to freezing?
Yes
Describe protection against damage by ice
No
Is there danger of an ice gorge?
No
Yes
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16. Collision
Depth of channel
Width of channel
Kind and size of craft navigating:
Will any portion of work be exposed to collision damage? If so, describe and indicate protection provided
17. Windstorm
What windload was figured in design?
Anticipated stage of construction during hurricane or windstorm season
18. Explosion
Describe any conditions which may lead to damage from this cause
19. Earthquake
Indicate the known probability of earthquake in the area in which the structure is located
What percent of gravity was used in figuring design stresses by horizontal and vertical thrusts during construction and
when the structure is completed?
SECTION III
20. Substructure
a.
Foundation: Which piers and abutments will be supported on the following?
Bed-rock: (how anchored in bed-rock)
Gravel, clay or other material (Describe)
Piling: (Describe)
b.
Piers: Size and type:
Material:
c.
Cofferdam and caisson: (Describe in detail)
Will top of cofferdam be below maximum high water?
Yes
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No
SECTION IV
21. Superstructure
a.
Fixed Spans:-Describe each, giving number, length and type
`
b.
Towers:-Describe cable towers if suspension bridge
c.
Movable Spans:-Describe each, giving number, length and type
d.
Flooring:- (Describe)
SECTION V
22. Approaches
For the purpose of this application, approaches are the portion of the project beyond the abutments at each end.
a. Describe each approach, giving location, length, materials, road material, and protection against washout
b.
Will earth approach be natural grade, hydraulic fill, or dry fill?
SECTION VI
23. Miscellaneous
a.
Describe falsework, temporary structures and materials to be used
Has consulting or designing engineer approved design of falsework etc.?
b.
Will barges be used to handle equipment, construction materials, trusses etc.?
c.
Will cranes operate from barges from ground level or on sections of superstructure? (Describe)
d.
e.
f.
If bridge is to be built adjacent to an existing bridge, give distance between bridges:
Will existing bridge be used for construction purpose?
If contract is for repair or replacement of a portion of a bridge, will the contractor be responsible for damage to the
existing bridge?
Date
Engineer
** A signed application is required upon binding **
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