PUBLIC LIABILITY INSURANCE

New Business Quotation

Dear Valued Client(s)

Herewith to confirm our Quotation for General Liability insurance coverage with term and conditions as
follows:

Type of Cover : General Public Liability Insurance

Policy Form : Public liability Insurance PUB 0209 v4

The Insured : Chapung Se Bali Resort & Spa

Insured Address : Jl. Raya Sebali, Keliku

Kecamatan Ubud, Kabupaten Gianyar
Bali 80561

Insured Business : Property Owner & Operator of The Chapung Se Resort & Spa

Claim Trigger : Occurrence Basis

Period of : 18/05/2022 – 18/05/2023 (dd/mm/yyyy)

Insurance Both dates inclusive at midnite Local Standard Time

Coverage : Company will pay to or on behalf of the Insured all sums which the Insured
shall become legally liable to pay by way of compensation (excluding
punitive and/or exemplary and/or aggravated damages and/or any additional
damages resulting from multiplication of compensatory damages) in
respect of Personal Injury or Property Damage happening during the Period of
Insurance caused by an Occurrence in connection with the Business of the
Insured.

Limit of Liability : Public Liability

USD 500,000.00 Combined Single Limit (Personal Injury and Property Damage)
any one occurrence and in the aggregate during the policy period.

Except:
Sublimit of liability in respect of:
• PUB 20A – Carpark lability clause (sublimit 20% of limit, max IDR
500,000,000. - in the aggregate)
• Cross Liability Clause (sublimit 20% of limit, max IDR 250,000,000. - in
aggregate)
• Defective Sanitary Installation (sublimit 20% of limit, max IDR
250,000,000. - in the aggregate)

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 • Demonstration/ Exhibition/Promotion Clause (within Indonesia Territory,
maximum 7 days per events and sublimit IDR 100,000,000. - in
aggregate)
• Fire and Full Exclusion Clause (sublimit 20% of limit, max IDR
500,000,000. - in the aggregate) – Deletion of Exclusion 4.5
• First Aid Facilities Clause (sublimit 20% of limit, max IDR 500,000,000. -
in aggregate)
• Loading and Unloading Clause (sublimit IDR 50,000,000. – anyone
occurrence and in the aggregate)
• Neon Signe and Advertising Sings (excluding Act of God) – (Sublimit IDR
50,000,000. - in the aggregate
• Social and Sport Club Clause (Excluding Water sport activities) (sublimit
20% of limit, max IDR 250,000,000. - in aggregate)
• PUB71 Sudden and Accidental Pollution (Sublimit 20% of limit, max IDR
250,000,000. - in the aggregate)
• PUB20 Visitor’s Effect Clause (sublimit IDR 50,000,000. - in the
aggregate)
• Water Pollution, Flood, Fumes (Sublimit IDR IDR 100,000,000.- in the
aggregate)

Jurisdiction : Worldwide Excluding North America, but only Indonesia in respect of Automobile
Liability

Deductible : Public Liability

• Nil for Bodily injury
• USD 250.- anyone occurrence in respect to Third Party Property Damage
• 10% of Claim, minimum USD 250.- anyone occurrence in respect of Theft
and losses for Motor Vehicle/ Motorcycle

Applicable Clauses : 1. Loss Notification Clause (30 days)

Major Exclusion : As per Standard Wording

Additional : 1. Excluding Act of God, Animal Attacks/Bugs Attct

Exclusion 2. Total Professional Liability Exclusion
3. CAR and EAR Risks Exclusion
4. Sanction Limitation Exclusion Clause
5. LMA 5396 Communicable Disease Exclusion

Premium : USD 850

: Policy Cost and Stamp duty USD 5.00
Total Premium : USD 855.-

Security : PT. Great Eastern General Insurance Indonesia – 100%

Subjectivity : Subject to:

- No claim nor claim circumstances up to binding date
- No change in the risk profile
- Validity as per expiry
Otherwise we have the right to modify our T/C

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IMPORTANT NOTICE.
Please ensure that above limit of liability is adequate with Your need and requirements. We reserve the
right to review the terms and conditions in the event of claim(s) lodged after date of issue of this Quotation
Slip.

Signed on half of the company

PT Great Eastern General Insurance Indonesia

ACCEPTANCE :

Herewith to confirm your quotation slip as provided in the above:

Date Company Name Named Person / Title Sign and Company Chop

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