Carter & Company - Insurance Managers

Carter & Copany, LLP -- Insurance Managers

Carter & Company - Insurance Managers
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Downhole Tool Insurance Equipment Data Sheet

For the fastest and most accurate insurance quote, please provide as much information possible in the form below.
This information will be kept confidential and will be used for quote purposes ONLY!

Applicant Information
  1. Assured (company name):
  2. Assured Address:
  3. Assured Phone #:
  4. Operator (company name):
  5. Operator Address:

Well Information
  6. Well site Contractors
      (drilling, drilling mud, directional driller):
  7. Well Name on Permit:
      New well or Redrill:
      If re-entry, any sticking or loss problems:
  8. Well Location
      (Field Name)(Nearest Town)(County, State, Country):
  9. Well Information:
  • Maximum Mud Weight (oil, water or synthetic)
  • Attach Schematic or fill out below
    Casing size   Depth Mud Weight
     @ 
     @ 
     @ 
     @ 
     @ 
  •  
    Total Vertical Depth Total Measured Depth
    Horizontal Displacement Target Formation
    Kick-off Point Smallest ID
    Max Bottom Hole Temp Max Est Bottom Hole Pressure
    Max Angle Developmental Well or Exploratory
    Target Form. Lithology Formation Geologic Age
    Gas or Oil well, %HxS, %CO2

    Miscellaneous Information
    10. Approximate date tools go below rotary:
    11. Estimate time tools are in use below rotary:
    12. Is operator (this well) insured under a Control of Well
          Policy?:
    13. Is the MWD wireline retrievable?:
    14. Will you use a top drive or a conventional rotary rig?:
    15. Years in business:
    16. Experience of application supervisors:
    17. What are your past tool losses in this type of
          application (when, location, reason for lost)?:

     

    PLEASE ATTACH A WELL SCHEMATIC IF AVAILABLE

     

    Equipment Schedule
    Value: Total Replacement Cost of Tools     Option 1: 100% Replacement Cost Schedule     Option 2: 50% Replacement Cost Schedule
    Quantity Description Serial No. Value Opt. 1 Opt. 2

     

    Maximum value of tools downhole at any one time:
    Date:
    Name/Title of person submitting form:
    Email Address:

     

    Disclaimer
     
    I have reviewed the information that I have entered above and confirm it is accurate to the best of my knowledge.
     

    Please click on the "Submit Request" button to send your certificate of insurance request.
    One of our representatives will respond to your submission as soon as possible.

       

     

    Important Note: This web site provides only a simplified description of coverages and is not a statement of contract. Coverage may not apply in all states. For complete details of coverages, conditions, limits and losses not covered, be sure to read the policy, including all endorsements, or prospectus, if applicable. Coverage CANNOT be bound, amended, or altered by leaving a message on, or relying upon, information in this Website or through E-MAIL.
             Carter & Company - Insurance Managers
    522 E. Crockett, Luling, Texas 78648    Address:
    522 E. Crockett
    Luling, TX 78648
    (Across from Post Office)
    Carter & Company - Insurance Managers
    P.O. Drawer 672, Luling, Texas 78648-0672    Mailing Address:
    P.O. Drawer 672
    Luling, Texas 78648-0672
    Carter & Company - Insurance Managers
    Phone: (830)875-3164 - Toll Free: (800)967-0972 - Fax: (830)875-9362    Phone:
    Toll Free:
    Fax:
       (830)875-3164
    (800)967-0972
    (830)875-9362
    Carter & Company - Insurance Managers
    Hours: Monday - Friday -- 7:30 am - 5:00 pm    Office Hours:
    Monday thru Friday
    7:30 a.m. - 5:00 p.m.
     
    Carter & Company - Insurance Managers
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    Carter & Company - Insurance Managers
    Carter & Company - Insurance Managers