SLTX-2025-00001236
ReceivedGulf Coast Medical Group PA
Transaction Information
Transaction Type
Renewal
Policy Number
SL-2025-PL-000456
Effective Date
Mar 1, 2025
Expiration Date
Mar 1, 2026
Insured Information
Gulf Coast Medical Group PA
2100 Medical Center Pkwy
Dallas, TX 75201
Coverage Information
Policy Type
Professional Liability
Locations
5 locations
Coverage Description
Medical professional liability coverage for physician group practice
Insurer Information
Insurer Name
Evanston Insurance Company
NAIC Number
35378
Premium & Taxes
Gross Premium$250,000.00
Surplus Lines Tax (4.85%)$12,125.00
Stamping Fee (0.04%)$100.00
Total Due$12,225.00
Diligent Search / Exemptions
Diligent search completed and certified
Filing Timeline
Received
Jan 28, 2025
Filing submitted by broker
Broker Information
Broker Name
Robert Martinez
License Number
TX-SL-485721
Agency
Southwest Specialty Brokers LLC
Filed Date
Jan 28, 2025