Page 158 - claims information pack ebook_e

Section A

Example Claim Form
PART 2 Section A
Costs of clean up and preventive measures

● Travel, accommodation and living costs for ● Cost of temporary storage (if applicable)
response personnel and of final disposal of recovered oil and
oily material, including quantities of waste
● Equipment costs (types of equipment used,
handled, unit cost and method of calculating
supplier, rate of hire or cost of purchase,
the claimed rate
method of calculation of hire rates, quantity
used, period of use), and relevant information Be sure to provide all documents required,
(invoices, contracts, hire or charter including those listed above which are relevant
to your claim.
agreements, worksheets, log books, etc.)
Please identify the individual worksites at It would be useful to have the above
which the equipment was used information also presented in a spreadsheet, 13
in particular to link the supporting
● Cost of replacing equipment damaged
documentation to the cost of the item claimed.
beyond reasonable repair (type and age of
equipment, supplier, original purchase cost For further information please refer to section
and circumstances of damage supported by 3.1 in the Claims Manual.
photographs, video or other recording media)

● Consumable materials (description, supplier,
quantity, unit cost and where used) and
relevant information (purchase orders,
invoices, receipts, etc.)

● Any remaining value at the end of the
operations of equipment and materials
purchased specifically for use in the incident
in question

● Age of equipment not purchased specifically
for use in the incident in question, but used in
that incident

● Transport costs for personnel, equipment,
waste material, etc. (number and types of
vehicles, vessels or aircraft used, number of
hours or days operated, distance travelled
or start and end locations, rate of hire or
operating cost, method of calculating rates
claimed) and relevant information (tickets,
weighbridge reports, manifests, log
books, etc.)