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ABATE -1 <br />[.V V =KAUtb <br />OP ID: CL <br />COMMERCIAL GENERAL LIABILITY <br />DATE__ <br />HAZ <br />N <br />SECTION <br />111 <br />AGENCY PItOIYi; '�,ri3-�� j. jSQ(� <br />AfC,.Nq;f�k); <br />2,000,000 <br />APPLICANT Abate of Washington <br />� Noy]�. 20-851-06bl <br />"attlu Insu�@rIC9erVlces <br />PRODUC rS3 COMPLETED OPERATIONS AGGREGATE <br />rse <br />NAMED <br />LLC <br />1208 <br />PREMISESIOPE RATIONS <br />Insured) <br />50th St Ct NW, S uite 0104 <br />: <br />1,000,000 <br />3" Flarbor WA 98335 <br />Susie K Nelson <br />. <br />EFFECTIVE DATE F.XPtRATIDN DATE <br />DIRECTi31L! PAYMENT PLAN AUDIT <br />�?C 1 <br />1,fl0n 000 <br />PRODUCTS <br />01/14/20 01/14/21 <br />ACFNi:Y 6kl,l <br />$ <br />100.000 <br />FOR <br />_ PROPERTY DAMAGE $ <br />MEDICAL EXPENSE (Any one person) <br />COMPANY <br />CODE: SUB CODE: <br />OTHER <br />Use Only <br />ABATE -1 <br />[.V V =KAUtb <br />LIMITS <br />L{IC <br />HAZ <br />N <br />X COMMERCIAL GENERAL LIABILITY <br />GENERAL AGGREGATE <br />S <br />2,000,000 <br />PREMIUMS <br />I CLAIMS MADE I x j OCCURRENCE <br />PRODUC rS3 COMPLETED OPERATIONS AGGREGATE <br />E <br />2,000,000 <br />PREMISESIOPE RATIONS <br />OWNER'S & CONTRACTOR'S PROTECTIVE <br />PERSONAL & ADVERTISING INJURY <br />: <br />1,000,000 <br />°d• <br />. <br />EACH OCCURRENCE <br />s <br />1,fl0n 000 <br />PRODUCTS <br />DEDUCTIBLES <br />DAMAGE TO RENTED PREMISES (each occurrence) <br />$ <br />100.000 <br />RiaGlf Thur s�cla R1A <br />h than <br />_ PROPERTY DAMAGE $ <br />MEDICAL EXPENSE (Any one person) <br />S <br />5,000 <br />OTHER <br />BODILY INJURY $ <br />c niM EMPLOYEE BENEFITS <br />S <br />63217 <br />001 <br />S <br />orcuHneNcr;' <br />TOTAL <br />OTHER COVERAGES, RESTRICTIONS ANDIOR ENDORSEMENTS (For hlredlnan.owned auto coverages attach the applicable state Business Auto Section, <br />ACORD 137) <br />$ <br />.71,KCIJUL.0 <br />VP 110-Z KU5 <br />L{IC <br />HAZ <br />N <br />CLASSIFICATION <br />Class <br />CODE <br />004 <br />01 <br />Spring opener RIA ! <br />10378 <br />001 <br />061 <br />02 <br />Eastivals 111 <br />IMating- Other than not for <br />48557 <br />prop it <br />001 <br />009 <br />03 <br />RiaGlf Thur s�cla R1A <br />h than <br />48557 <br />0a1 <br />r <br />not z1o�proM <br />001 <br />04 <br />"Pringg swag mea[ ria <br />exhibRlvn IrmI <br />63217 <br />001 <br />Cla <br />05Hast <br />liquor liability <br />06 <br />Qa forgn CG 20 26 for add'I <br />nSure <br />49950 <br />11000% fully earned) <br />I <br />RATING AND PREMIUM BASIS <br />(S) GROSS SALES - PER $1,000/SALES <br />I. <br />(P) payroll -per S1,0001pay <br />(A) area - per 1,0001sq It <br />PREMIUM <br />BASIS <br />U <br />U <br />U <br />U <br />U <br />EXPOSURE <br />3 <br />12 <br />1 • <br />INCLUDED <br />TERR BATE I PREMIUM <br />Nk8.MI0P8 1 PRPOILl Y8 PREWOPS PRODUCTS <br />3 <br />(C) TOTAL COST - PER 51.000/COST <br />(M) admissions - per 1,000/adm <br />(U) unit - per unit <br />IT) OTHER <br />CLAIMS MADE lExplain all "Yes" res onseS <br />EXPLAIN ALL "YES" RESPONSES <br />1 PROPOSED RETROACTIVE DATE: — <br />2. ENTRY DATE INTO UNINTERRUPTED CLAIMS MADE COVERAGE <br />150,00 <br />3, HAS ANY PRODUCT, WORK, ACCIDENT, OR LOCATION BEEN EXCLUDED, UNINSURED OR SELF-INSURED FROM ANY PREVIOUS COVERAGE? <br />4 WAS TAIL COVERAGE PURCHASED UNDER ANY PREVIOUS POLICY,) <br />Y/N <br />1. DEDUCTIBLE PER CLAIM: $ 3. NUMBER OF EMPLOYEES COVERED BY EMPLOYEE BENEFITS PLANS: <br />2, NUMBER OV hMPL YEER 4. REiRDAC VE CA E: <br />ACORD 126 (2007105) Page 1 of 4 © ACORD CORPORATION 1993.2007. All rights reserved. <br />The ACORD name and logo are registered marks of ACORD <br />