4260 KAA - Atifsha

‫‪Chubb Arabia Cooperative Insurance Company‬‬ ‫ﺷﺮﻛﺔ ﺗﺸﺐ ﺍﻟﻌﺮﺑﻴﺔ ﻟﻠﺘﺄﻣﻴﻦ ﺍﻟﺘﻌﺎﻭﻧﻲ‬
‫‪Saudi Public Listed Company‬‬ ‫ﺷﺮﻛﺔ ﻣﺴﺎﻫﻤﺔ ﻋﺎﻣﺔ ﺳﻌﻮﺩﻳﺔ‬

‫‪CR. 2051043431 - Paid up Capital SR 300,000,000‬‬ ‫ﺕ‪ - .2051043431‬ﺭﺃﺱ ﻣﺎﻝ ﻣﺪﻓﻮﻉ ‪ 300‬ﻣﻠﻴﻮﻥ ﺭﺱ‪.‬ﺱ‬
‫‪King Faisal Bin Abdul-Aziz Road‬‬ ‫ﻃﺮﻳﻖ ﺍﻟﻤﻠﻚ ﻓﻴﺼﻞ ﺑﻦ ﻋﺒﺪﺍﻟﻌﺰﻳﺰ‬
‫‪P.O. Box 2685, Al Khobar 31952‬‬ ‫‪ 31952‬ﺏ‪ 2685 .‬ﺍﻟﺨﺒﺮ‪.‬ﺹ‬
‫‪Kingdom of Saudi Arabia‬‬ ‫ﺍﻟﻤﻤﻠﻜﺔ ﺍﻟﻌﺮﺑﻴﺔ ﺍﻟﺴﻌﻮﺩﻳﺔ‬
‫‪T +966 13 804 7600‬‬
‫‪F +966 13 849 3650‬‬
‫‪Saudi.arabia@chubb.com‬‬
‫‪SAMA Product ID : A-CHUB-1-B-13-033‬‬

‫ﺷﻬﺎﺩﺓ ﺗﺄﻣﻴﻦ‬
‫ﺗﺸﻬﺪ ‪ :‬ﺷﺮﻛﺔ ﺗﺸﺐ ﺍﻟﻌﺮﺑﻴﺔ ﻟﻠﺘﺄﻣﻴﻦ ﺍﻟﺘﻌﺎﻭﻧﻲ ﺑﺄﻥ ﺍﻟﺴﻴﺎﺭﺓ ﺍﻟﻤﺬﻛﻮﺭﺓ ﺃﻭﺻﺎﻓﻬﺎ ﺃﺩﻧﺎﻩ ﻣﺆﻣﻦ ﻋﻠﻴﻬﺎ ﻟﺪﻯ ﺍﻟﺸﺮﻛﺔ ﺑﻤﻮﺟﺐ ﻭﺛﻴﻘﺔ‬
‫‪:‬‬ ‫ﺍﻟﺘﺄﻣﻴﻦ ﺍﻟﺘﺎﻟﻴﺔ‬
‫‪20/10/2024‬‬ ‫ﺍﻟﻰ‬ ‫‪05/11/2023‬‬ ‫ﻣﻦ‬ ‫‪28CHB1 3812/23-05 END # 6‬‬ ‫ﻭﺛﻴﻘﺔ ﺗﺄﻣﻴﻦ ﺭﻗﻢ‬
‫‪ \ Sany - CRANE‬ﺳﺎﻧﻲ ‪ -‬ﻛﺮﻳﻦ‬ ‫ﻧﻮﻉ ﺍﻟﺴﻴﺎﺭﺓ‬ ‫ﺭﻗﻢ ﺍﻟﻠﻮﺣﺔ‬

‫‪2023‬‬ ‫ﺳﻨﺔ ﺍﻟﺼﻨﻊ‬ ‫‪3023217538‬‬ ‫ﺍﻟﺮﻗﻢ ﺍﻟﺠﻤﺮﻛﻲ‬ ‫ﺍﻟﺮﻗﻢ ﺍﻟﺘﺴﻠﺴﻠﻲ‬
‫ﺭﻗﻢ ﺍﻟﺸﺮﻛﺔ‬ ‫‪LFCNRG7P5P3200180‬‬ ‫ﺭﻗﻢ ﺍﻟﺸﺼﻲ‬
‫‪ARK CONTRACTING COMPANY‬‬ ‫ﺷﺮﻛﺔ ﺃﺭﻙ ﻟﻠﻤﻘﺎﻭﻻﺕ‬ ‫ﺍﻟﻤﺆﻣﻦ‬
‫‪48‬‬ ‫ﺗﺴﻠﺴﻞ ﺍﻟﺴﻴﺎﺭﺓ‬ ‫‪7011007080‬‬ ‫ﺭﻗﻢ ﺍﻟﻬﻮﻳﺔ‬

‫‪ARK CONTRACTING COMPANY‬‬ ‫ﺍﻟﺴﺎﺋﻖ ‪ /‬ﺍﻟﻤﺎﻟﻚ ﺷﺮﻛﺔ ﺃﺭﻙ ﻟﻠﻤﻘﺎﻭﻻﺕ‬
‫ﻭ ﺃﺩﺍﺀ ﻟﻠﺤﻖ ﺍﻟﺨﺎﺹ ﻟﻠﻄﺮﻑ ﺍﻟﺜﺎﻟﺚ ﻋﻦ ﺍﻷﺿﺮﺍﺭ ﺍﻟﻤﺎﺩﻳﺔ ﺃﻭ ﺍﻟﺠﺴﺪﻳﺔ ﺍﻟﻨﺎﺗﺠﺔ ﻭﻋﻠﻴﻪ ﺗﻌﺘﺒﺮ ﻫﺬﻩ ﺍﻟﺸﻬﺎﺩﺓ ﺑﻤﺜﺎﺑﺔ ﻛﻔﺎﻟﺔ ﻏﺮﻡ‬
‫ﻋﻦ ﻣﺴﺆﻭﻟﻴﺔ ﺍﻟﻤﺆﻣﻦ ﻟﻪ ﺃﻭ ﺃﻱ ﺷﺨﺺ ﻣﺼﺮﺡ ﻟﻪ ﻣﻦ ﻗﺒﻠﻪ ﺑﻘﻴﺎﺩﺓ ﺍﻟﺴﻴﺎﺭﺓ ﻋﻦ ﺍﻟﺤﺎﺩﺙ ﺷﺮﻳﻄﺔ ﺃﻥ ﻳﻜﻮﻥ ﺣﺎﻣﻼ ﻟﺮﺧﺼﺔ‬
‫‪ .‬ﻭ ﺿﻤﻦ ﺣﺪﻭﺩ ﺍﻟﻤﺴﺆﻭﻟﻴﺔ ﻗﻴﺎﺩﺓ ﺳﻌﻮﺩﻳﺔ ﺳﺎﺭﻳﺔ ﺍﻟﻤﻔﻌﻮﻝ ﻭﺣﺴﺐ ﻧﺴﺒﺔ ﺇﺩﺍﻧﺘﻪ ﻭﻛﺎﻥ ﻣﻠﺰﻣﺎ ﺑﺄﺩﺍﺀ ﺍﻟﺘﻌﻮﻳﺾ ﻃﺒﻘﺎ ﻟﻠﻘﺎﻧﻮﻥ‬
‫ﺍﻟﺤﺪ ﺍﻻﻗﺼﻰ ﻟﻤﺴﺌﻮﻟﻴﺔ ﺍﻟﺸﺮﻛﺔ ﻓﻲ ﺍﻟﺤﺎﺩﺙ ﺍﻟﻮﺍﺣﺪ ﺍﻭ ﻣﺠﻤﻮﻋﺔ ﺍﻟﺤﻮﺍﺩﺙ ﺧﻼﻝ ﻓﺘﺮﺓ ﺳﺮﻳﺎﻥ ﻭﺛﻴﻘﺔ ﺍﻟﺘﺄﻣﻴﻦ ﺑﺎﻟﻨﺴﺒﺔ ﻟﻸﺿﺮﺍﺭ‬
‫ﺍﻟﻤﺎﺩﻳﺔ ﻭﺍﻟﺠﺴﺪﻳﺔ ﻣﻌﺎ ﻟﻦ ﺗﺘﺠﺎﻭﺯ ﻣﺒﻠﻎ ﺍﺟﻤﺎﻟﻲ ﻗﺪﺭﻩ ‪ ) 10,000,000‬ﻋﺸﺮﺓ ﻣﻼﻳﻴﻦ ﺭﻳﺎﻝ ﺳﻌﻮﺩﻱ( ﻛﺤﺪ ﺍﻗﺼﻰ‬
‫ﻟﻤﺴﺆﻭﻟﻴﺔ ﺍﻟﺸﺮﻛﺔ ﻟﻠﺤﺎﻻﺕ ﺍﻟﺘﻲ ﺗﻠﺘﺰﻡ ﺍﻟﺸﺮﻛﺔ ﺑﺘﻌﻮﻳﺾ ﺍﻟﻐﻴﺮ ﻋﻨﻬﺎ ﻣﻊ ﺍﺣﺘﻔﺎﻇﻬﺎ ﺑﺤﻖ ﺍﻟﺮﺟﻮﻉ ﻋﻠﻰ ﺍﻟﻤﺆﻣﻦ ﻟﻪ ﺃﻭ ﺍﻟﺴﺎﺋﻖ‬
‫‪ .‬ﺃﻭ ﺍﻟﻤﺴﺌﻮﻝ ﻋﻦ ﺍﻟﺤﺎﺩﺙ ﻓﻲ ﺣﺎﻟﺔ ﻋﺪﻡ ﺍﻟﺘﻘﻴﺪ ﺑﺸﺮﻭﻁ ﺍﻟﻮﺛﻴﻘﺔ‬
‫‪.‬ﻭ ﺍﺳﺘﺜﻨﺎﺀﺍﺕ ﻭﺛﻴﻘﺔ ﺍﻟﺘﺄﻣﻴﻦ ﻭ ﺃﺣﻜﺎﻡ ﻭ ﺷﺮﻭﻁ ﻭ ﻓﻴﻤﺎ ﻋﺪﺍ ﺫﻟﻚ ﺗﻄﺒﻖ ﻧﺼﻮﺹ‬
‫‪ .‬ﻣﻼﺣﻈﻪ ﻫﺎﻣﺔ ‪ -‬ﻫﺬﻩ ﺍﻟﺸﻬﺎﺩﺓ ﻏﻴﺮ ﻗﺎﺑﻠﺔ ﻟﻠﺘﻨﺎﺯﻝ ﻟﺼﺎﻟﺢ ﺃﻱ ﺷﺨﺺ ﺃﺧﺮ ﻓﻲ ﺣﺎﻟﺔ ﻧﻘﻞ ﻣﻠﻜﻴﺔ ﺍﻟﺴﻴﺎﺭﺓ‬
‫ﻋﻦ ‪ /‬ﺷﺮﻛﺔ ﺗﺸﺐ ﺍﻟﻌﺮﺑﻴﺔ ﻟﻠﺘﺄﻣﻴﻦ ﺍﻟﺘﻌﺎﻭﻧﻲ‬

OWNERSHIP CERTIFICATE
This is to certify that the equipment unit bearing the company body number description and
model is stated here under is a property of
ARK Contracting Company.

Post Box No. 4658
Al-Khobar-34432
Eastern Province
Kingdom of Saudi Arabia
Equipment MOBILE CRANE

Manufactured Year 2023
Model no. STC1100T7
Plate no 4260 KAA
Unit Serial no. 128423020
Manufacturer SANY
Chassis no LFCNRG7P5P3200180
Capacity 110 Ton
Color YELLOW
Internal Machine No. ARK-PEM-0050
For ARK Contracting Company.
Safeel
MOHAMMED SAFEEL
Marketing Manager
ENGINEERING CORNER for INSPECTION
P.O.Box 235, Rastanura 31941 Kingdom of Saudi Arabia
Tel. No's : (013)667 6999/6676895 Fax#:(013)667 6894
Email: Address: eci@eccgroupksa.com / info@eccgroupksa.com / Website : www.eccgroupksa.com
No : 21693
Area Inspection Date Inspection Time Previous Sticker
LIFTING EQUIPMENT ARK YARD , 2ND 21-Nov-2023 2:30 pm No
Initial
INSPECTION REPORT INDUSTRIAL, Initial
DAMMAM
Department / Equipment Number Equipment Location Inspection Result New Sticker No.
Contractor ARK-PEM-0050 ARK YARD , 2ND INDUSTRIAL, 22819
Pass
ARK CONTRACTING DAMMAM Fail
CO.
Manufacturer Model Capacity Type Equipment Serial No. Sticker Expiration Date
SANY 2023 STC1100T7 110 ton MOBILE TC0110CD0526 20-Feb-2024
CRANE/TRUCK
MOUNTED
Above Equipment was inspected by Engineering Corner for Inspection in accordance with
applicable Saudi Aramco Gi's, ASME and ANSI Standards. Deficiencies that require corrective action
are listed below. Specific repairs to correct each deficiency Should be Noted in the corrective action
taken column.
No. DEFICIENCIES CORRECTIVE ACTION TAKE
Initial Visual Inspection & Functional test Carried out,
1 Manufacturer load test certificate Provided & Verified Pass At the
time of inspection As Per ASME B30.5 & Aramco GI 7.030 standard
Main hook block Cap 100 ton, With 6 Part Line, Aux Hook Block Cap
2 8 ton,20.2 mm Actual Dia Wire rope & No Fly jib Attachment During
Inspection
RECEIVER NAME : Amir shashad SIGNATURE : INSPECTOR NAME : H CARINGAL
BADGE #: Erm-0069 TELEPHONE NO : 0594168983 TELEPHONE NO : 0555900287

When re-inspection is requested, a complete copy of this report should be ready reviewed by the Distribution : Original-Proponent : 1st Inspection Agency, 2 nd copy
inspector Inspector
SAUDI ARAMCO INSPECTION SAIC NUMBER ISSUE DATE DISCIPLINE

SAIC-U-7007 1-Jan-23 ELEVATING/LIFTING
CHECKLIST EQUIPMENNT
MOBILE / CRAWLER CRANES
PROJECT TITLE WBS/BI/JO TASK COMPLETED INSPECTION COMPANY
NUMBER DATE ECI
3261
EQUIPMENT ID NUMBER EQUIPMENT DESCRIPTION/TYPE SERIAL NO. REPORT NO.:
ARK-PEM-0050 TRUCK MOUNTED TC0110CD0526 21693
CAPACITY (SWL) Manufacturer FACILITY / LOCATION
110 ton SANY 2023 ARK YARD , 2ND
INDUSTRIAL,
DAMMAM
REQUESTED INSPECTION DATE RFI No. TASK COMPLETED EQUIPMENT OWNER
21-Nov-2023 DATE ARK CONTRACTING CO.
21-Nov-2023
ITEM. Comments /
ACCEPTANCE CRITERIA REFERENCE PASS FAIL N/A
NO. Remarks
1 GENERAL REQUIREMENTS
Equipment documentation is ASME B30.5
1.1
available Sec:5-2.1.5
Preventive Maintenance is
ASME B30.5
1.2 established and updated
Sec:5-2.3.1
records are maintained
Daily pre-operational
GI 7.030 Para:
1.3 inspection checklists are
5.1.2
checked
Vehicle government
registration card (ISTIMARA)
and Government periodic
GI 7.030 Para:
1.4 inspection are maintained and 7.1.2 Note:5
valid at all times for
equipment that has a vehicle
plate.
Durable load chart is provided ASME B30.5
1.5
in an accessable location Sec: 5-1.1.3 (b)
G.1.7,025ASME
1.6 Work areas chart is available B30.5 Sec 5-
1.1.3(2)
Operator is certified (for the G.I. 7.025
1.7 inspected crane type/model) ASME B30.5
and licensed Sec: 5-3.1.1
A sign is posted warning the
operator not to rely solely on
SAES-B067
1.8 any automatic device as a
Sec:4.4
substitute for safe operating
practice
SAES-B067
1.9 Crane is painted safety yellow
Sec:4.4
Crane is painted safety
SAES-B067
1.10 yellow-and-black stripes on
Sec:4.4
o!shore facilities

NUMBER DATE ECI
3261
INDUSTRIAL,
DAMMAM
21-Nov-2023 3261 DATE ARK CONTRACTING CO.
Rated capacity of crane is SAES-B067
1.11
marked (Arabic & English) Sec:4.4
Fire extinguisher is in place ASME B30.5
1.12
with minimum rating 10 BC Sec: 5-3.4.10
Markings and direction of all ASME B30.5
1.13 control levers are clearly Sec:5-1.6.1-1
displayed Sec:5-1.6.1-2
Crane backward stability is in
accordance with
ASME B30.5
1.14 manudacturers standard
Sec:5-1.2.1
(minimum radius and no load
condition )
2 INSPECTION POINTS (MOBILE & CRAWLER CRANES)
Load- holding check valve for ASME B30.5
2.1
boom is operational Sec:5-1.3.1 (d)
Two (2) full wraps of rope
remain on the drum when ASME B30.5
2.2
hook is in the extreme low Sec:5-1.3.1
position
Swing control is smoothly
ASME B30.5
2.3 operating on acceleration and
Sec:5-1.4.1
deceleration
Swing braking operates, as
ASME B30.5
2.4 well as positive locking
Sec: 5-1.4.2
devices (manual and auto)
Travel controls are properly ASME B30.5
2.5
operating/functioning Sec: 5-1.1.3
Auxiliary travel controls
ASME B30.5
2.6 function correctly for multiple
Sec: 5-1.5.1
control- station cranes
Travel brakes and locks for
ASME B30.5
2.7 crawler cranes are correctly
Sec: 5-1.5.3
operating
SAIC NUMBER ISSUE DATE DISCIPLINE

SAUDI ARAMCO INSPECTION
NUMBER DATE ECI
3261
INDUSTRIAL,
DAMMAM
Travel brakes and locks for
ASME B30.5
2.8 wheel-mounted cranes are
Sec: 5-1.5.3
correctly operating
Power plant controls of ASME B30.5
2.9 superstructure -mounted
power plant working properly Sec: 5-1.6.3
Rotation-resistant and fiber-
ASME B30.5
2.10 core ropes are not used for
Sec: 5-1.7.2
boom hoist reeving
Sheave grooves have surface
ASME B30.5
2.11 smoothness without any
Sec: 5-1.7.4
defects
Sheave guards are in place on ASME B30.5
2.12
the lower block Sec: 5-1.7.4
All sheaves can be lubricated
ASME B30.5
2.13 (except permanently
Sec: 5-1.7.4 (d)
lubricated types)
All cab glazings are safety ASME B30.5
2.14
glazing material Sec: 5-1.8.1
Verify cab doors functionality ASME B30.5
2.15
and condition Sec: 5-1.8.1
Seat belt is fitted and in good ASME B30.5
2.16
condition Sec: 5-1.8.1 (f)
Walking platforms and areas ASME B30.5
2.17
of structure are skid-resistance Sec: 5-1.8.2
ASME B30.5
2.18 Guard rails are fitted
Sec: 5-1.9.7

NUMBER DATE ECI
3261
INDUSTRIAL,
DAMMAM
Fixed or telescoping bumper
ASME B30.5
2.19 for boom stop is functional (if
Sec: 5-1.9.1
fitted)
Shock absorbing bumper for
ASME B30.5
2.20 boom stop is functional (if
Sec: 5-1.9.1
fitted)
Hydraulic boom elevating
ASME B30.5
2.21 cylinder, used as boom stop, is Sec:5-1.9.1
functional (if fitted)
Boom angle indicator is fitted,
ASME B30.5
2.22 operable, and can be read
Sec:5-1.9.1
from the operator station
Boom shut-o! or hyraulic
ASME B30.5
2.23 relief is provided for high
Sec: 5-1.9.1 (d)
angle boom condition
Boom length indicator is fitted
ASME B30.5
2.24 for telescoping booms ,and is
Sec: 5-1.9.1
working
Anti-two-blocking devices are
ASME B30.5
2.25 fitted and working (main and
Sec: 5-3.2.3
auxiliary)
Operation and accuracy of the
ASME B30.5
2.26 fitted Load Indicator, RCI or
Sec: 5-1.9.10.2
RCL (compare with load chart)
LMI is fitted, Operational and
accurate for boom length, ASME B30.5
2.27
rated load, angle, radius, etc. Sec: 5-1.9.10.2
(for 3 ton cranes or more)
Outriggers and jacks are not ASME B30.5
2.28
leaking oil Sec:5-2.1.3
Jack is in good operating ASME B30.5
2.29
condition at each outrigger Sec:5-2.1.3 (d)

NUMBER DATE ECI
3261
INDUSTRIAL,
DAMMAM
Each outrigger jack locking ASME B30.5
2.30
device is functional (if fitted) Sec: 5-1.9.3 (c)
No leakage from each jack ASME B30.5
2.31 seal when the crane is jacked Sec: 5-1.9.3 (c)
up
Outrigger jack bolts are fully ASME B30.5
2.32
secure Sec: 5-1.9.3 (b)
All road wheel nuts are fully ASME B30.5
2.33
secure Sec: 5-2.1.3(b)
All tyres are serviceable and
ASME B30.5
2.34 without damage or excess
Sec: 5-2.1.3(k)
wear
Fuel tank supports and straps ASME B30.5
2.35
are secure Sec: 5-2.1.3(g)
Hydraulic oil tank supports ASME B30.5
2.36
and straps are secure Sec: 5-2.1.3(g)
Underside of chassis shows ASME B30.5
2.37
no obvious faults Sec: 5-2.1.3
Outrigger boxes are not ASME B30.5
2.38
cracked Sec: 5-2.1.3
Front and rear steering
ASME B30.5
2.39 cylinder anchor points and
Sec: 5-2.1.3
pins are secure
Track rod end joints are not ASME B30.5
2.40
worn and are secure Sec: 5-2.1.3

NUMBER DATE ECI
3261
INDUSTRIAL,
DAMMAM
Axle bolts and nuts are fully ASME B30.5
2.41
secure Sec: 5-2.1.
Wheel hub oil seals are not ASME B30.5
2.42
leaking Sec: 5-2.1.3
Brake linings are not oil ASME B30.5
2.43
contaminated Sec: 5-2.1.3
Brake hoses have not ASME B30.5
2.44 deteriorated, e.g. cracks, Sec: 5-2.1.3
splits, leaks, etc.
All chassis cross members are ASME B30.5
2.45
not cracked or corroded Sec: 5-2.1.3
Transmission mounting bolts ASME B30.5
2.46
and bushings are secure Sec: 5-2.1.3
All drive sha" bolts and ASME B30.5
2.47
universal joints are not worn Sec: 5-2.1.3
Ring gear bolts are fully ASME B30.5
2.48
secure Sec: 5-2.1.3
All hydraulic hoses under
ASME B30.5
2.49 chassis have not deteriorated
Sec: 5-2.1.2
(cracks , splits , leaks )
Engine shows no major oil ASME B30.5
2.50
leakage Sec: 5-2.1.3
ASME B30.5
2.51 Radiator does not leak water
Sec: 5-2.1.3

NUMBER DATE ECI
3261
INDUSTRIAL,
DAMMAM
Rope is free of
kinking,crushing,birdcaging,or
any other damage resulting in
distortion of the rope structure
.No more 1 broken wire
protruding from the core
.There are no reductions from
nominal rope diameter of
more than 5% for running
ropes: .No more than 6
randomly broken wires in 1 lay ASME B30.5
2.52
or 3 broken wires in 1 for Sec: 5-2.4.3
strand of 1 lay rotation
resistance ropes .No more
then 2randomly distributed
broken wires in six rope
diameters or 4 randomly
distributed broken wires in 30
rope diameters .Evidence of
any heat damage from any
cause.
Main hoist drum mounting ASME B30.5

2.53
bolts are secure Sec: 5-2.1.3
Rear telescope side and top ASME B30.5
2.54
wear pads are serviceable Sec: 5-2.1.3
Bottom and side wear pads of
ASME B30.5
2.55 telescope sections are
Sec: 5-2.1.3
serviceable
Boom heel pin bushes are not
ASME B30.5
2.56 worn (rock boom up and down
Sec: 5-2.1.3
to check this)
Center swivel coupling pipes ASME B30.5
2.57
and hoses do not leak Sec: 5-2.1.3
Center swivel coupling bolts ASME B30.5
2.58
are all secure Sec: 5-2.1.3
Boom li" cylinder anchor ASME B30.5
2.59
bolts and bushings are secure Sec: 5-2.1.3
Swing gearbox bottom oil seal
and drive gear are in a ASME B30.5
2.60
serviceable condition (Should Sec: 5-2.1.3
be well lubricated)
Wire rope clips shall be drop-
forged steel of the single
ASME B30.5
2.61 saddle U bolt or doubled
Sec: 5-1.7.3(b)
saddle type clip for end
termination.
Emergency switch / Power
ASME B30.5
2.62 take o! switch need to be
Sec: 5-1.6.1(e)
verified
3 CRANE CAB

NUMBER DATE ECI
3261
INDUSTRIAL,
DAMMAM
Horn and wind speed ASME B30.5
3.1
anemometer are working Sec: 5-3.2.1.6
Crane level indicator is fitted ASME B30.5
3.2
and working Sec: 5-1.9.10.6
Engine gauges and associated ASME B30.5
3.3
indicators are working Sec: 5-2.1.3 (g)
The warning sign stating
ASME B30.5
3.4 power line required clearances
Sec: 5-1.9.12(g)
is visible to the operator
Load block sheaves turn freely ASME B30.5
3.5
and are undamaged Sec: 5-2.1.3 (c)
Dead end rope anchor is
correctly made with a suitable ASME B30.5
3.6
wedge socket and loop- back Sec: 5-1.7.3 (d)
termination
Hook assemblies are ASME B30.5
3.7
equipped with safety latches Sec: 5-1.7.6
Hook assembly labeling and
ASME B30.10
3.8 manufacturer data is clearly
Sec : 10-1.8
marked
ASME B30.10
Hooks weight is clearly
3.9 Sec: 10-1.10.5
marked/printed on the hook
(b)
Safe working load of hook is ASME B30.10
3.10
clearly marked on the item Sec : 10-1.8
Hook does not show defects ASME B30.10
3.11 such as nicks, cracks and Sec : 10-1.10.5
gouges (d)

NUMBER DATE ECI
3261
INDUSTRIAL,
DAMMAM
Hook is not bent or twisted.
Max. bending or twisting not
ASME B30.10
to exceed 10 degrees from
3.12 Sec : 10-1.10.5
plane of unbent hook or as per
(f)
manufacturer
recommendations.
Hook is not distorted in the
throat opening. .Max
allowable throat opening is ASME B30.10
3.13 5% not to exceed 1/4 in.(6mm) Sec : 10-1.10.5
compared to new hook,or as (g)
per manufacturer
recommendations
Maximum wear in the hook
bowl is not exceeding 10% ASME B30.10
3.14 (compared to new hook) or as Sec : 10-1.10.5
per manufacturer (e)
recommendations
ASME B30.10
Hook is not cracked, gouged
3.15 Sec : 10-1.10.5
or shows nicks
(d)
ASME B30.10
Hook can lock (if it is a self-
3.16 Sec : 10-1.10.5
locking hook)
(h)
Inoperative latch (if provided)
ASME B30.10
any damaged latch or
3.17 Sec : 10-1.10.5
malfunctioning latch that does
(i)
not close the hooks throat
Rope guards and locked in
ASME B30.5
3.18 position with pins (hook
Sec:5-1.7.4
block)
ASME B30.5
Dead end rope anchor is fitted
3.19 Figure 5-1.7.3-
with a lock pin (hook block)
1
Dead end rope anchor is
ASME B30.5
correctly made with a suitable
3.20 Figure 5-1.7.3-
wedge socket and loop- back
1
termination
Reverse travel alarm is
3.21 General
operational.
Turning signals and indicators
3.22 General
are working correctly

NUMBER DATE ECI
3261
INDUSTRIAL,
DAMMAM
Road lighting, including
3.23 spotlights, are in good General
condition and operable
Dry friction brakes and
clutches shall be protected ASME B30.5
3.24
against rain and other liquids Sec 5-1.9.8
such as oil and lubricants
4 CRAWLER CRANE
ASME B30.5
4.1 Track pads are undamaged
Sec: 5-2.1.3 (h)
Drive sockets and tumblers ASME B30.5
4.2
are serviceable Sec: 5-2.1.3 (h)
Top and bottom swing rollers
and tracks are in good overall ASME B30.5
4.3
condition (Should be well Sec: 5-2.1.3 (a)
lubricated)
ASME B30.5
4.4 Track idlers are serviceable
Sec: 5-2.1.3 (a)
Back boom stops are ASME B30.5
4.5
functioning Sec: 5-1.9.1 (a)
Back A-Frame is in good ASME B30.5
4.6
condition Sec: 5-2.1.3 (a)
ASME B30.5
Boom cut-out (at maximum
4.7 Sec: 5-1.9.1 (a-
angle) is operable
2)
ASME B30.5
Power low lowering is Sec: 5-1.9.1 (a-
4.8 operational
2)
Boom hoist safety auxiliary ASME B30.5
4.9
ratchet / pawl lock is engaging Sec: 5-1.3.1(c)
Boom chords and lacings are ASME B30.5
4.10
undamaged (bent) Sec: 5-2.1.3

NUMBER DATE ECI
3261
INDUSTRIAL,
DAMMAM
Sheave grooves are free from
ASME B30.5
4.11 surface defects that could
Sec: 5-1.7.4 (a)
cause rope damage.
Pendant ropes are showing no ASME B30.5
4.12
broken wires (see no. 48) Sec: 5-2.4.2
Operation of steering brakes is ASME B30.5
4.13
satisfactory Sec: 5-1.5.3
Main machinery guarding is in ASME B30.5
4.14
place Sec: 5-1.6.4
Main clutch is fully ASME B30.5
4.15
operational Sec: 5-1.6.4
ASME B30.5
Main boom and hoist drum
4.16 Sec: 5-1.3.2(a-
brakes are fully functional
1)
Remarks:
Reference Documents:
1- ASME B30.5 - 2021 Issue: Mobile & Locomotive Cranes

2- ASME B30.10 - 2019 Issue: Hooks
3- SAES-B067 - 2020 Issue: Safety Identification and Safety Colors
4- SA GI 7.025-2018 Issue: Heavy Equipment Operator and Rigger Testing and Certification
Load Tested By (if Applicable):
Name, Signature, & Date:
Technical
Inspected Witnessed by 3rd Party Certified Inspector:

Name, Signature, Certificate No. & Company:
H CARINGAL
User Representative:
Name, Signature, & Date:
Engineering Corner for Inspection (ECI)

P.O.Box 235 Rastanura 3941 Kingdom of Saudi Arabia
Tel.:(013)667-6999 / 667-6895 - Fax:(013)667-6894
E-mail: eci@eccgroupksa.com
No. ECI - 22819

EQUIP. NO.: ARK-PEM-0050
EQUIP. S.N.: TC0110CD0526
DATE INSPECTED: 21-Nov-2023
NEXT INSPECTION DATE: 20-Feb-2024
INSPECTED BY: H CARINGAL
S.A. INSPECTION DEPARTMENT APPROVED CONTRACTOR AGENCIES

4260 KAA - Atifsha

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4260 KAA - Atifsha

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‫‪Chubb Arabia Cooperative Insurance Company‬‬ ‫ﺷﺮﻛﺔ ﺗﺸﺐ ﺍﻟﻌﺮﺑﻴﺔ ﻟﻠﺘﺄﻣﻴﻦ ﺍﻟﺘﻌﺎﻭﻧﻲ‬

‫‪Saudi Public Listed Company‬‬ ‫ﺷﺮﻛﺔ ﻣﺴﺎﻫﻤﺔ ﻋﺎﻣﺔ ﺳﻌﻮﺩﻳﺔ‬

‫‪SAMA Product ID : A-CHUB-1-B-13-033‬‬

‫‪ \ Sany - CRANE‬ﺳﺎﻧﻲ ‪ -‬ﻛﺮﻳﻦ‬ ‫ﻧﻮﻉ ﺍﻟﺴﻴﺎﺭﺓ‬ ‫ﺭﻗﻢ ﺍﻟﻠﻮﺣﺔ‬

‫‪ARK CONTRACTING COMPANY‬‬ ‫ﺷﺮﻛﺔ ﺃﺭﻙ ﻟﻠﻤﻘﺎﻭﻻﺕ‬ ‫ﺍﻟﻤﺆﻣﻦ‬

‫‪48‬‬ ‫ﺗﺴﻠﺴﻞ ﺍﻟﺴﻴﺎﺭﺓ‬ ‫‪7011007080‬‬ ‫ﺭﻗﻢ ﺍﻟﻬﻮﻳﺔ‬

‫ﻋﻦ ‪ /‬ﺷﺮﻛﺔ ﺗﺸﺐ ﺍﻟﻌﺮﺑﻴﺔ ﻟﻠﺘﺄﻣﻴﻦ ﺍﻟﺘﻌﺎﻭﻧﻲ‬

ARK Contracting Company.

Equipment MOBILE CRANE

For ARK Contracting Company.

BADGE #: Erm-0069 TELEPHONE NO : 0594168983 TELEPHONE NO : 0555900287

SAUDI ARAMCO INSPECTION SAIC NUMBER ISSUE DATE DISCIPLINE

SAUDI ARAMCO INSPECTION SAIC NUMBER ISSUE DATE DISCIPLINE

SAIC NUMBER ISSUE DATE DISCIPLINE

SAUDI ARAMCO INSPECTION SAIC NUMBER ISSUE DATE DISCIPLINE

SAUDI ARAMCO INSPECTION SAIC NUMBER ISSUE DATE DISCIPLINE

SAUDI ARAMCO INSPECTION SAIC NUMBER ISSUE DATE DISCIPLINE

SAIC NUMBER ISSUE DATE DISCIPLINE

Main hoist drum mounting ASME B30.5

SAIC NUMBER ISSUE DATE DISCIPLINE

SAUDI ARAMCO INSPECTION SAIC NUMBER ISSUE DATE DISCIPLINE

SAUDI ARAMCO INSPECTION SAIC NUMBER ISSUE DATE DISCIPLINE

SAIC NUMBER ISSUE DATE DISCIPLINE

1- ASME B30.5 - 2021 Issue: Mobile & Locomotive Cranes

Inspected Witnessed by 3rd Party Certified Inspector:

Engineering Corner for Inspection (ECI)

No. ECI - 22819

EQUIP. S.N.: TC0110CD0526

DATE INSPECTED: 21-Nov-2023

NEXT INSPECTION DATE: 20-Feb-2024

INSPECTED BY: H CARINGAL

S.A. INSPECTION DEPARTMENT APPROVED CONTRACTOR AGENCIES

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