RAILROAD PROTECTIVE LIABILITY COVERAGE FORM EXPOSURE ANALYSIS CHECKLIST

(November 2022)

INTRODUCTION

This checklist is designed to assist in application of the Insurance Services Office (ISO) Railroad Protective Liability Coverage Form to a given operation. This is only a starting point and additional risk specific questions may arise as the exposures are developed. This analysis should be combined with exposure analysis checklists for other coverages to develop a complete picture of the insured’s operations.

This checklist is designed to supplement the ACORD application.

A list of endorsements may be helpful as you discuss exposures with your client.

Railroad Protective Liability Coverage Form Available Endorsements and Their Uses

Railroad Protective Liability Coverage Form Endorsements Checklist

GENERAL CLIENT INFORMATION

Named Insured Complete Name: ____________________________________________________________

_______________________________________________________________________________________

Named Insured Mailing Address: ____________________________________________________________

_______________________________________________________________________________________

Designated Contractor Complete Name: ______________________________________________________

_______________________________________________________________________________________

Designated Contractor Mailing Address: _______________________________________________________

_______________________________________________________________________________________

Job Name, Number, and Description: _________________________________________________________

_______________________________________________________________________________________

Job Location: ____________________________________________________________________________

_______________________________________________________________________________________

Operations to be performed or work done: _____________________________________________________

_______________________________________________________________________________________

Date work is scheduled to begin: __________________

Date work is scheduled to end: ___________________

Does the named insured have any contracts or agreements that establish minimum required limits to do business or conduct operations with another entity? ___ Yes ___ No If yes, describe: _______________________________________________________________________________________

_______________________________________________________________________________________

What is the value of the work or operations within 50 feet of a railroad track? $_________________________

GENERAL INFORMATION

Describe in detail the nature of the operations to be performed or work to be done within 50 feet of a railroad track, including exact distances from the track: ______________________________________________________

_______________________________________________________________________________________

Are any designated employees of the named insured involved to any extent at the job location? ___ Yes ___ No

If yes, provide names, job titles, type of involvement, and duties performed:

_______________________________________________________________________________________

Provide the number and type of each railroad employee assigned to the project, if any: __________________

_______________________________________________________________________________________

List, identify, and describe the type of railroad equipment involved: __________________________________

_______________________________________________________________________________________

List, identify, and describe the type of construction equipment involved: _______________________________

_______________________________________________________________________________________

Provide the number and type of tracks:

Main: _____ Branch: _____ Siding: _____ Sidetrack: _____ Yard: _____

Provide the number and type of tracks within 50 feet of the job:

Main: _____ Branch: _____ Siding: _____ Sidetrack: _____ Yard: _____

Provide the number and type of trains on each type of track per day:

Passenger: _________ Freight _________ Other (describe below): _________

Provide the normal or expected speed of trains by type:

Passenger: ________ Freight: _________ Other (describe below): __________

Provide the expected speed of trains due to slow order for this job:

Passenger: ________ Freight _________ Other (describe below): _________

Does any equipment cross tracks at grade? ___ Yes ___ No

If yes, provide details: _____________________________________________________________________

_______________________________________________________________________________________

Is any equipment on or next to any track? ___ Yes ___ No

If yes, provide details: _____________________________________________________________________

_______________________________________________________________________________________

Does any excavating activity present a hazard to tracks or underground utilities, such as pipes and cables?

___ Yes ___ No

If yes, describe: __________________________________________________________________________

_______________________________________________________________________________________

Are any blasting operations expected near any track as part of the job? ___ Yes ___ No

If yes, describe the blasting operations, the method used to perform them, and the exposure to tracks:

________________________________________________________________________________________

If operations must be performed or work done beneath overhead power lines, will the lines be moved?

___ Yes ___ No

If no, describe the precautions to be taken: ______________________________________________________

________________________________________________________________________________________

Do any operations performed or work done present any special problems, such as cofferdams, dikes, levees, and dams? ___ Yes ___ No

If yes, provide details: ______________________________________________________________________

________________________________________________________________________________________

Identify the contractor's current limits of insurance and insurance company by line of business:

Commercial General Liability:

Limits: $_____________________

Insurance Company: _______________________________________________________________________

Commercial Umbrella/Excess:

Limits: $_____________________

Insurance Company: _______________________________________________________________________

Additional Comments/Remarks:

________________________________________________________________________________________

Attach a copy of the indemnification clause of any contract or agreement between a contractor and the railroad, between a contractor and the owner, and/or between the contractor and any other contractor.