Operacion de energia

DECLARATIONS

1. ASSURED

(Insert Assured’s Name and Address)

All notices to the Assured, be they one or more, shall be effective upon mailing to the Assured named immediately above at it’s address shown immediately above.

2. LOSS PAYABLE

Loss, if any, payable to ……………………………… or order.

3. PERIOD

……………………………………………………………………

4. COVERAGESubject always to the General Conditions herein and as provided for in the Declarations and the following section(s) as may be purchased in connection herewith; such purchased sections to be only those indicated below by the placing of an “X” in the block(s) adjacent thereto:

a. / / Control of Well Insurance (as per Section A attached hereto).

b. / / Redrilling/Extra ExpenseInsurance (as per Section B attached hereto).

c. / / Seepage and Pollution, Clean-up and Contamination Insurance (as per Section C attached hereto).

5. COMBINED SINGLE LIMIT OF LIABILITY

$ ……………. in respect of 100% interest, any one accident or occurrence, as respects all coverages as may be set forth in the Declarations and General Conditions and such of Sections A, B and/or Cas may be purchased in connection herewith.

This policy provides to the Assured (be they one or more) insurance coverage only up to but not exceeding the Combined Single Limit of Liability set forth above, including defence costs, which is the total combined single limit of Underwriters’ liability to the Assured for any one occurrence and over all of such Sections A, B and/or C as may bepurchased in connection herewith, subject always to applicable underlying retention(s).

6. ASSURED’S RETENTION

The Combined Single Limit of Liability specified in Clause 5 of these Declarations is excess of the Assured’s retention(s) of:

a. $ …………….. as respects Section A;

b. $ ……………….. as respects Section B;

c. $ ……………….. as respects Section C;any one occurrence, in respect of 100% interest, as respects all coverages as set forth in the Declarations and General Conditions and in such of Sections A, B and/or C as may be purchased in connection herewith.

7. REPORTING CLAUSE

This policy is issued in consideration of a minimum and deposit premium of $ …………. and the Assured shall report to ………………. for transmittal toUnderwriters within thirty (30) days after the end of each quarter during the period of this policy the status of all wells insured hereunder during the period of this policy the status of all wells insured hereunder during the preceding reporting period and further agrees to pay premium at the rates provided herein. Premiums accruing from reports as required herein are due and payable as thereports are made.

The rates scheduled below reflect a credit based on a total estimated footage insured hereunder of ………….. feet, which is subject to adjustment when the total actual footage insured is reported.

8. AREAS INSURED AND RATES

Area Operations Depth Rate

9. SERVICE OF SUIT

Service of process upon Underwriters in accordance with Clause 18 of the GeneralConditions herein may be made upon:

…………………………………………………………………………………

and/or …………………………………………………………………………

GENERAL CONDITIONS APPLYING TO ALL SECTIONS

1. CO-VENTURERS

It is understood and agreed that, subject to the provisions of Clause 7 of these General Conditions, this insurance may insure the interest of Co-Venturers (defined as co-owners, partners and/or otherparty(ies) having a financial and insurable interest in the wells insured hereunder), all of whom individually and collectively are non-operators (all hereinafter referred to as “Co-Venturers”), and provided the agreement to include such Co-Venturers is executed in writing between and/or among the parties prior to any occurrence giving rise to claim for reimbursement hereunder.

Such...