Owners And Contractors Protective Liability Form
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1Markel International Applications
Owners and Contractors Protective Liability
1)
NAME AND MAILING
ADDRESS OF
APPLICANT
2)
DESCRIPTION OF
PROJECT (include whether
New or Rehab)
3)
ADDRESS OF PROJECT:
4)
CONSTRUCTION START
DATE?
5)
ANTICIPATED
COMPLETION DATE?
6)
NAME AND ADDRESS
OF GENERAL
CONTRACTOR?
Note – Contractor must name Applicant on their CGL policy as an Additional Insured for both Premises-Operations
and Products-Completed Operations coverages
7)
CONTRACTORS
TOTAL CGL LIMITS CARRIED
PRIMARY CGL
(INCLUDING
INSURANCE CARRIER
EXCESS/UMBRELLA)
8)
TOTAL COST OF THE
PROJECT
9)
DESCRIBE THE
SURROUNDING
PROPERTY EXPOSURES
10)
JOB SITE SECURITY
11)
COMMENTS
APPLICANT’S SIGNATURE:
DATE:
Sept 2004
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Parent category: Business