DAY CONSTRUCTION CORP.
SATICOY VILLAGE APARTMENTS
Insurance Credit Worksheet

SECTION I (Subcontract/Bid Information)
Construction Participant Name		
Project Site (Project Name):		
Gross Subcontract Value (including insurance cost):		
Estimated On-Site Payroll:		  Estimated Work-Hours:		

SECTION II 
(Complete if you are subcontracting out any work)

Subcontractor’s Name	
Trade	Work
Hours	Subcontract
Amount	Estimated
Insurance Cost	

					

SECTION III (Calculate your insurance premium)
	
General Liability: (Current rate X on-site payroll or Gross Subcontract Value)
Current Rate	 Payroll	 Receipts     (check one)	Premium	
	 per $100
      (hundreds)	 per $1000
      (thousands)	 (check one)    		

1.	Do you have an SIR or Deductible on your General Liability Policy?	
	 Yes	 No  (Check One)	If Yes, Indicate Amount	$	
		
2.	Do you include a charge in your bid to pay for claim costs under your SIR deductible?	
	 Yes	 No  (Check One)	If Yes, Indicate Amount	$	

Excess Liability: (Complete only if Excess is needed to comply with your insurance requirements for this Wrap Up)
Current Rate	 Payroll	 Receipts     (check one)	Premium	
	 per $100
      (hundreds)	 per $1000
      (thousands)	 (check one)    		

TOTAL INSURANCE COST	$	

****Please provide Declarations, Rate Pages and SIR/Deductible Endorsements (if applicable) for your General Liability Policies****

I hereby warrant that this worksheet reflects the projected insurance cost that would apply in the event that my regular insurance program was in force for work at this location.  I also recognize that the Wrap Up Sponsor or the Administrator may request complete copies of my actual policies to confirm these costs and/or information provided in this worksheet.
Signature:		Dated:		
PLEASE RETURN VIA FAX TO ANDREW PHILLIPS AT 310.398.2968