MADUB 1000 04 17
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EVANSTON INSURANCE COMPANY
State Transaction Code:
COMMERCIAL EXCESS LIABILITY POLICY DECLARATIONS
POLICY NUMBER: EZXS3060513
RENEWAL OF POLICY: NEW
Named Insured and Mailing Address (No., Street, Town or City, County, State, Zip Code)
APERTURE HOMEOWNERS ASSOCIATION INC
C/O TOAD PROPERTY MANAGEMENT, P.O. BOX 2776
CRESTED BUTTE, CO 81224
Policy Period: From
09/18/2021
to
09/18/2022
at 12:01 A.M. Standard Time at your mailing address shown above.
IN RETURN FOR THE PAYMENT OF THE PREMIUM, AND SUBJECT TO ALL THE TERMS OF THIS POLICY,
WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY.
Limits Of Insurance
Each Occurrence Limit:
$
5,000,000
Aggregate Limit:
$
5,000,000
Retained Limit / Each Occurrence:
$
Premium
Policy Premium:
$
3,000.00
Terrorism Premium:
$
Not Covered
Fees (Where Applicable):
$
296.00
Total Premium:
$
3,296.00
Payable At Inception
Audit Period: Not Applicable Annual Semi-Annual Quarterly Monthly
Rating Basis (If Subject To Audit)
Premium Basis:
Rate:
THIS CONTRACT IS DELIVERED AS A SURPLUS LINE COVERAGE UNDER THE "NONADMITTED INSURANCE
ACT". THE INSURER ISSUING THIS CONTRACT IS NOT LICENSED IN COLORADO BUT IS AN APPROVED
ELIGIBLE NON-ADMITTED INSURER. THERE IS NO PROTECTION UNDER THE PROVISIONS OF THE "COLORADO
INSURANCE GUARANTY ASSOCIATION ACT".
Producer Number, Name and Mailing Address
214077
RT Specialty, LLC
5680 Greenwood Plaza Boulevard, Suite 100S
Greenwood Village, CO 80111
Endorsements
Forms and Endorsements applying to this Coverage Part and made part of this policy at time of issue:
Per Forms Schedule
Schedule Of Underlying Insurance
Per Schedule Of Underlying Insurance
These declarations, together with the Coverage Form and any Endorsement(s), complete the above
numbered policy.
Countersigned:
09/22/2021
By:
DATE
AUTHORIZED REPRESENTATIVE
MJIL 1000 08 10
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A STOCK COMPANY
EVANSTON INSURANCE COMPANY
10275 West Higgins Road, Suite 750
Rosemont, IL 60018
INSURANCE POLICY
Coverage afforded by this policy is provided by the Company (Insurer) and named in the
Declarations.
In Witness Whereof, the company (insurer) has caused this policy to be executed and attested and
countersigned by a duly authorized representative of the company (insurer) identified in the Declarations.
Secretary
President
THIS CONTRACT IS DELIVERED AS
A SURPLUS LINE INSURANCE
UNDER THE 'NONADMITTED
INSURANCE ACT'. THE INSURER
ISSUING THIS CONTRACT IS NOT
ADMITTED IN COLORADO BUT IS
AN APPROVED NONADMITTED
INSURER. THERE IS NO
PROTECTION UNDER THE
PROVISIONS OF THE 'COLORADO
INSURANCE GUARANTY
ASSOCIATION ACT.
RSG Specialty, LLC
MPIL 1041 02 20
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HOW TO REPORT A CLAIM
How to report a new claim:
Email:
FAX:
(855) 662-7535 (855) 6MARKEL
*Phone:
(800) 362-7535 (800) 3MARKEL
Mail:
P.O. Box 2009, Glen Allen, VA 23058-2009
Please complete the appropriate ACORD form in detail and include the name and phone number of
the contact person at the location of the reported incident. If possible, please attach a copy of the facility
incident report. When reporting an auto claim, please identify the unit # on the schedule along with the
VIN#. If the loss/claim involves a building or damage to property, please provide the physical address
of the property.
*Please refer to your specific policy language for new claim reporting requirements. Some
policies require you to report all claims in writing only.
How to send Supplemental Information / Questions on an existing claim:
Email:
FAX:
(855) 662-7535 (855) 6MARKEL
Phone:
(800) 362-7535 (800) 3MARKEL
Mail:
P.O. Box 2009, Glen Allen, VA 23058-2009
If you have questions about a claim, please call 1-800-362-7535.
Inquiries may also be faxed to 1-855-662-7535.
MDIL 1002 01 10
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INTERLINE
POLICY NUMBER: EZXS3060513
EVANSTON INSURANCE COMPANY
SCHEDULE OF TAXES, SURCHARGES OR FEES
State
Description
Amount
Policy Fee
$
200.00
CO
Surplus Lines Tax
$
96.00
$
$
$
$
$
$
$
$
$
$
$
$
$
$
TOTAL
$
296.00
