Project Enrollment Form 2009-10 - The California State University

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Project Enrollment Form 2009-10 - The California State University Powered By Docstoc
					                          CSU BUILDER'S RISK INSURANCE PROGRAM (BRIP)
                                              Project Enrollment Form
                                 Construction beginning July 1, 2009 to June 30, 2010

Campus:                                                                Auxiliary Organization:
Project Name:                                                          CPDC Project #:
                                                                       Campus Project #:

Project Location:                                                      # Stories above grade:
Project Description:                                                   # Stories below grade:
General Contractor:                                                    Total Sq. Ft. (building):

Funding Source: (select one)
o    State Appropriation (provide):                                    o    Donor
o    Systemwide Revenue Bond                                           o    Auxiliary
o    Public Works Bond                                                 o    Other (specify):

                                  PREMIUM RATE TABLE                                                    New
                                    Construction Class
                                                                                                   or Nonseismic      Seismic
                    (select one for largest component and insert in F. below)                        Renovation      Renovation
     Wood Frame Construction (over $10,000,000)                                                       0.4200            0.5670
     Wood Frame Construction (up to $10,000,000)                                                      0.3570            0.4640
     Masonry Construction                                                                             0.0945            0.1210
     All Other Construction (describe on next line)                                                   0.0683            0.0800
     Site Preparation                                                                                0.0473               na
     OPTION: Delay in Construction Coverage (all construction classes)                               0.4720             0.4720

                                                 PREMIUM CALCULATION

A.   Start of Construction - estimated (mm/dd/yr)                                                                  ____________
B.   Completion of Construction - estimated (mm/dd/yr)                                                             ____________
C.   Awarded Contract Amount
D.   Construction Cost (total building cost, less design cost)
E.   Delay in Construction Coverage (optional); indicate value to be insured for Loss of Rental Income->
F.   Applicable Rate (from Rate Table, based on D. Construction Cost)                                                      0.0000
G.   Number of Coverage Days (from A & B)                                                                                #VALUE!
H.   Construction Coverage Premium = (D/100) x Rate x (G/365) x Tax (1.03225)                                            #VALUE!
I.   Delay in Construction Premium = (E/100) x Rate x (G/365) x Tax (1.03225)                                            #VALUE!
J.   BRIP Insurance Cost                                                                                                 #VALUE!
K.   CSU Construction Project Seismic Fund = (D/100 x .1)                                                                #VALUE!
L.   TOTAL COST                                                                                                          #VALUE!

                                (Submitted by)                                                                 (Date)

                                    (E-mail)                                                                   (Phone)

                              For Questions and to submit completed Enrollment Form:
Barbara Nicholson, Chancellor's Office CPDC                                 Rob Leong, CSURMA
Email:                                              Email:
Phone: 562-951-4117     Fax: 562-951-4921                                   Phone: 415-403-1441     Fax: 415-402-0773


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