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MICHAEL ZIOBROWSKI
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Last modified
6/15/2022 12:41:51 PM
Creation date
6/14/2021 9:20:23 AM
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Contracts
Company Name
MICHAEL ZIOBROWSKI
Contract #
N-2021-126
Agency
Public Works
Expiration Date
6/30/2021
Destruction Year
2026
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Burns& <br />Wilcox <br />101 California Street, Suite 975, San Francisco, CA 94111 <br />Phone: (415) 421-4244 OR (800) 759-4855 Fax: (415) 421-0820 <br />DATE: 4/7/2021 INSURANCE BINDER Page 2 of 4 <br />LIMITS ! DEDUCTIBLES: <br />Loc Sub Coverage <br />Limit(s) <br />1 General Aggregate <br />$2,000,000 <br />1 Products and Completed Operations <br />$2,000,000 <br />1 Each Occurrence <br />$1,000,000 <br />1 Personal and Advertising Injury <br />$1,000,000 <br />1 Medical Expense / Any One Person <br />$5,000 <br />1 Damage to Premises Rented to You / Each Occurrence <br />$100,000 <br />TOTAL CHARGES: <br />Premium: $ 600.00 Commercial General Liability <br />Fee: $ 200.00 Brokerage Fee (Fully Earned) <br />Tax: $ 1.50 Stamping Tax <br />Tax: $ 18.00 Surplus Lines Tax - GenLiab <br />TOTAL: $ 819.50 <br />EXCLUSIONS: <br />SEE "ENDORSEMENTS' SECTION BELOW / NEXT PAGE <br />ENDORSEMENTS: <br />Deductible(s) <br />$500 Per Claim BI/PD <br />100% MINIMUM & DEPOSIT <br />MINIMUM RETAINED PREMIUM: <br />100.00 % EARNED <br />MINIMUM PREMIUM = $600.00 <br />Co Ins <br />RlekMans�em¢nEDtWalan <br />z� *g REVIEWED&APPROVED BY: <br />' ' ' <br />��� Risk Management Analyst <br />
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