Carter & Company, L.L.P. 

 

 

 

(If not in Texas, please click here to view a list of states in which we currently have non-resident licenses.  If your state is not listed then we would not currently have a market for you.)    

CONTROL OF WELL QUESTIONNAIRE
First Name:
Last Name:
Business Name:
Address:
City:
State:
Zip Code:
Phone Number:
Fax Number:
E-Mail Address:
*Fed. Tax I.D. # or *Social Security #
*Required by insurance company in order to quote.
Additional Insured:
Address:
City:
State:
Zip Code:
Years In Business
Term of Coverage
Interest Insured
(If not 100%)
Type of Drilling Contractor(s) IADC  OTHER:
Name(s) of Drilling Contractor(s) Used:
Has Drilling Contractor Had Any Control of Well Losses?  Yes No
Have You Had Similiar Coverage Canceled or Not Renewed Yes No
Have You Had A Claim Under A Similiar Policy? Yes No
Present Carrier: (If Any)  
Control of Well
Limit of Liability:		 $
Deductible: $
Care, Custody and Control Limit of Liability: $
Deductible (Includes Redrilling Expense): $
Other Coverages Desired As Indicated Below:

1.    Seepage & Pollution
2.   Clean-Up & Containment
3.   Make Well Safe
4.   Underground Blowout
5.   Evacuation Expense
6.   Unlimited Redrill
7.   Deliberate Well Firing
8.   Removal of Wreck/Debris
9.   Contigent Rig Coverage (Sound Well Site & Corrosion)
10. Include Coverage For Work-Over Wells (Show Factors)
11. Include Coverage For Producing Wells (Show Factors)
12. Include Turnkey (Credit) Endorsement
13. Unintentional Error, Delay or Omission In Well Reporting

ESTIMATED DRILLING PROGRAM
(Next 12 Months) Indicate Horizontal with "H"

Depth

Area I
No. of Wells

 Area IIa
No. of Wells		 Area IIb
No. of Wells

0-5,000'

5,001'-7,500'

7,501'-10,000'

10,001'-17,500'

17,501' and Over

What County(ies) Will You Be Drilling In Next?
What is A.F.E. For Next Well?
What Is Dry Hole Cost For Next Well?
If Horizontal, What Method Of Drilling Will You Use?

Balanced   Under Balanced Producing While Drilling
Advise Of Any High - Pressure or Sour Gas Wells That Might Be Expected In Area To Be Drilled:

Type Well:

In Field   Offset   Wildcat
Mud Weight
Target Zone

Field Name

PRODUCING WELLS
If Coverage Is Desired, Please Fill Out Attached Schedule
Area I includes Alabama, Alaska, Arizona, Colorado, Florida, Louisiana, Mississippi, Montana, New Mexico and Texas Railroad Commission Districs 5 through 10 (North Texas).

Area IIa includes all other land areas worldwide other than Area I (South Texas), areas north of the Arctic Circle and south of the Antarctic Circle and Alaska.

Area IIb includes inland waters of U.S.,  Canada, Lake Maracaibo and territorial waters of the United States of America adjacent to the Continent of NOrth America of water depths less than 10 fee but excluding north of the Arctic Circle and south of the Antarctic Circle and Alaska.  Area III includes inland waters of U.S., Canada, Lake Maracaibo and territorial waters of the United States of America adjacent to the Continent of North America of water depths greater than 10 feet.

IF COVERAGE IS DESIRED FOR PRODUCING AND/OR SHUT-IN WELLS, PLEASE COMPLETE THE FOLLOWING SCHEDULE

PRODUCING WELLS:

Name

County

State

TX RRC District

Area I Footage

 Area II Footage Area III Footage

SHUT-IN:

Name

County

State

TX RRC District

Area I Footage

 Area II Footage Area III Footage

 

 

 

 

 

Send mail to info@cartercompany.com with questions or comments about this web site.