Certificate of Insurance — Insurance Covering Railway Third Party Liability for Freight and
Passenger Operations |
Certificate issued to Canadian Transportation Agency
Ottawa, Ontario K1A 0N9
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Name and address of insured: |
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Sections 1-6 are to be completed by Agent/Broker |
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3. General liability insurance including but not limited to the following extensions:
_________________________________________________________
Other (Specify: _____________________________)
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4. Coverages |
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Participation Percentages |
Policy Numbers |
Effective Date
Expiry Date |
Limits of Liability* |
Self-Insured Retention |
Deductible |
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Specify: * Aggregate limit and/or each occurrence limit
Exclusions (in part or in whole) : _____________________________
________________________________________________________
________________________________________________________
________________________________________________________
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5. Notification
The insurer shall provide the Agency with no less than 30 days' prior written notification of cancellation, expiration or material alteration of the insurance coverages certified herein. |
6. This is to certify that the policies of insurance listed above issued to the insured named above for the policy period indicated and that the operating risks, as listed in section 7, are known to the insurer. |
Name (printed) and signature of insurer's authorized representative |
Date |
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(If space provided in insufficient please reference)
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(see over) |
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Sections 7-8 are to be completed by insured |
7. The insured or authorized representative has fully disclosed to the insurer the operating risks arising from the insured's proposed construction or operation of the railway as identified below, in order to enable the insurer to issue the insurance coverage necessary for the proposed construction or operation. Information provided below must relate to annual forecast for the policy term and latest complete calendar year. |
a) Proposed construction or operation being insured (location/termini and route/mileage/subdivision) |
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b) Total Canadian and Foreign passenger ridership
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c) Total freight train-miles
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d) Total passenger train-miles
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e) Volume of traffic (tons)
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| f) Name, classification & volume (in tons) of dangerous commodities carried |
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g) Types of areas served |
Rural Urban Both |
h) Number of level crossings
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i) Maximum train speed (Operating timetables)
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j) Number of claims for each of the last 10 years
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| k) List the amount of each claim paid and outstanding (from lowest recorded dollar) for each of the last 10 years |
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| l) What are the risks associated with a proposed construction? |
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m) Third party maintenance operations?
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n) Training for enginemen provided by
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o) Crew size?
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8. If the proposed operation is on or over any portion of the railway of any other railway company then the applicant proposes to operate from
______________ to ______________ and over the following railway/route
_________________________________________________
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Name (printed) and signature of insured's authorized representative
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Date |
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R001 (05/96) |
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