Larsen General Liability Binder 11-24-2020III
MARKED
November 18, 2020
Melissa McFarlane
Brown & Riding - Select Accounts Division
901 5th Avenue Suite 2300
Seattle, WA 98164
mmcfarlane@brcins.com
Binder
Thank you for your request to bind the below referenced account. We appreciate your business and are pleased
to bind coverage as follows.
Named insured:
Mailing Address:
Policy number:
Company:
Term:
Premium Summary
General liability
Sharon Larsen & Carl Larsen
9832 Marine View Drive
Mukilteo, WA 98275
3EZ9725
Evanston Insurance Company
11/24/2020to 11/24/2021
Total Premium without TRIA
Total amount due
This bind is subject to the following:
$2,500 MP
$2,500
$2,500.00
10
kc
General Liability Coverage
Limits of Insurance
General Aggregate Limit
Products/Completed Operations Aggregate Limit
Personal/Advertising Limit
Each Occurrence Limit
Damage to Premises Rented to You Limit
Medical Expense Limit (Any one person)
Deductible
Location schedule
$2,000,000
Excluded
$1,000,000
$1,000,000
$100,000
$5,000
None
Sharon Larsen & Carl Larsen
Transaction #: 3989927
Policy #: 3EZ9725
Loc
state - Territory
Address
1
WA - 502
7329 158th Street Southwest, Edmonds, WA 98026
Classification and premium
Loc
Class
Description
Rating
Exposure
Rate
Premium
Code
Basis
1
91580
Contractors - executive supervisors or executive
Per
750,000
3.12
$2,340
superintendents
$1,000 of
Total
Cost
Additional Coverages
Coverage
Limit
Qty.
Premium
Markel contractors bundle - Blanket Additional
n/a
n/a
Included
Insured/Blanket Waiver of Subrogation/Blanket
Primary and Noncontributory/Blanket Per Project
Aggregate
Total General Liability Premium (25% minimum earned) $2,500 MP minimum and deposit
10
kc
Forms and Endorsements
Sharon Larsen & Carl Larsen
Transaction #: 3989927
Policy #: 3EZ9725
MJIL 1000 08 10 Policy Jacket (Evanston)
MPIL 1007 0120 Privacy Notice
MPIL 104102 20 How To Report A Claim
MPIL 1083 04 15 U.S. Treasury Department's Office Of Foreign Assets Control (OFAC)
Advisory Notice To Policyholders
MDIL 1000 08 11
Common Policy Declaration
MDIL 100108 11
Forms Schedule
IL 00 17 1198
Common Policy Conditions
IL 00 2109 08
Nuclear Energy Liability Exclusion Endorsement
MEIL 1200 02 20
Service Of Suit
MEIL 1225 10 11
Change - Civil Union
MIL 1214 09 17
Trade Or Economic Sanctions
MDGL 1008 08 11
Commercial General Liability Coverage Part Declarations
CG 00 0104 13
Commercial General Liability Coverage Form
CG 20 0104 13
Primary And Noncontributory - Other Insurance Condition
CG 2104 1185
Exclusion -Products -Completed Operations Hazard
CG 2107 05 14
Exclusion - Access Or Disclosure Of Confidential Or Personal Information
And Data -Related Liability - Limited Bodily Injury Exception Not Included
CG 2136 03 05
New Entities Exclusion
CG 2144 04 17
Limitation of Coverage to Designated Premises, Project or Operation
CG 2147 12 07
Employment - Related Practices Exclusion
CG 2149 09 99
Total Pollution Exclusion Endorsement
CG 2173 0115
Exclusion Of Certified Acts Of Terrorism
CG 2186 12 04
Exclusion -Exterior Insulation and Finish Systems
MEGL 000108 20
Combination General Endorsement
MEGL 0008 04 20
Exclusion - Continuous or Progressive Injury or Damage
MEGL 0009-01 09 18
Blanket Additional Insured
MEGL 0103 07 18
Limitation - Contractor Or Subcontractor Management
MEGL 0170 05 16
Premium Basis
MEGL 0241-01 05 16
Blanket Waiver of Transfer of Rights Against Others To Us
MEGL 0313 02 17
Construction Project(s) - General Aggregate Limit
MEGL 136105 16
Excl - Tainted Drywall/Gypsum Containing Bldng Materials
MEGL 1592 05 16
Limited Exclusion - Specified Underground Hazards
MEGL 1628-A 02 18
New Residential Work Limitation
MEGL 1637 10 19
Exclusion - Employer's Liability And Bodily Injury To Contractors,
Subcontractors, Or Independent Contractors
MEGL 2322 03 20
Exclusion - Communicable Disease
MGL 1319 0116
Exclusion - Unmanned Aircraft