tag:blogger.com,1999:blog-241945152024-02-20T20:00:39.064-05:00ACORD FormsACORD Forms and Agency Management System for the Insurance Industry.Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.comBlogger32125tag:blogger.com,1999:blog-24194515.post-32941534582537923142013-12-31T11:21:00.001-05:002013-12-31T11:21:30.478-05:00ACORD Forms Files ReviewA Comprehensive Review of Your Files Can Determine E-Doc Direction – articleonlinedirectory.com <br />
Intro: Advancing technologies are providing businesses more opportunities to work remotely. Employees can perform their duties using mobile devices and laptops. Establishing an efficient e-document management system is critical and improving cloud storage systems enable administrators an avenue for staying connected to their employees and maintaining an up-to-date database.<br />
During these difficult economic times, companies are keeping their eyes open for money-saving strategies. Technological improvements have opportunities such as mobile and cloud computing included. Today most businesses use laptops and PCs in their day-to-day trade and many also use smart phones and tablets. Because they have already invested in the hardware any additional investment will be for employee training and software solutions. The timing is right for administrators to construct procedures for an e-document management system. <br />
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Concentrate on keeping the system simple and logical. If the existing paper operation is working then reflect its structure and procedures. This approach will save time and energy. If you are considering cloud computing, ascertain how much space you need for your records and research your options. It may make more sense to use free services similar to Google drive; however, you can get greater security and more features if you look into buying some server space to store your e-documents. <br />
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If you elect to overhaul your system so you can improve efficiency and productivity, make a plan that is easy to carry out and end-user friendly. While developing your structure or plan, check with your employees and get their comments. Take a look at the different filing schemas: alpha, chronological, numerical and geographical. Which method best fits your business? If you handle home financing, using location could be a good plan. Insurance agencies may manage their filing by alpha or numeric systems. Whatever is most logical for your firm is the best selection. If you use industry-specific or controlled vocabulary, acronyms or abbreviations, be sure to give an index to your personnel to help them when they are creating or filing e-documents. Help your workers visualize the process by furnishing a flowchart once you establish the structure you want. <br />
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You should decide upon a security plan as you set up your system. One way to control access or police permissions to certain files or folders is to "password protect" them. Many software programs have built-in security controls which allow you to set different permission levels for each employee. You can also buy business security software that has built-in features that can insure against data theft and can erase records from your android, laptop or PC if it is lost or stolen. Such features will aid you in guarding your clients' information while complying with applicable state laws and industry regulations. <br />
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Make routine daily backups of your data. Retain a copy of these daily backups in a safe location off-site. Appoint a responsible staff member for this assignment along with overseeing periodic audits of your e-doc files. Determine how you want to manage out-of-date files: whether to delete or file away in archival folders with limited access controls. Consistent system reviews will assure that e-docs are filed correctly and help you notice areas in which future staff training may be required.<br />
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There is not a cookie-cutter solution for everyone because each company is unique in its structure and needs. To ascertain solutions for your business you should administer a comprehensive review of your operations and outline your needs and how best to meet them. Including your personnel in the creation of a more efficient system will make the execution of your new system easier and should increase everyone's confidence.<br />
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<a href="http://www.formsboss.com/">Click here to view my web site ACORD Forms. </a>Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.comtag:blogger.com,1999:blog-24194515.post-15978881296936280212013-01-16T10:22:00.000-05:002013-01-16T10:35:53.777-05:00What To Do When There's No More Room On The ACORD Form?I hear this question a lot. What am I supposed to do when there's not enough room on the ACORD Form to put everything I need?<br />
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Well, fortunately ACORD makes an extra form that you can attach for that. It's called "ADDITIONAL REMARKS SCHEDULE" form 101<br />
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So, whenever you need more room simply attach this form. The ACORD forms are getting so complex these days that there’s simply not enough room to put critical information.<br />
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Here’s a link to ACORD’s FIG file which is a PDF. FIG is short for Form Information Guide. Basically it describes the fields and what data is proper for those fields. <a href="http://www.formsboss.com/fig/101_FIG.PDF" target="_blank">101 FIG</a><br />
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Click here to view my web site <a href="http://www.formsboss.com/"><strong><span style="color: #d6a0b6;">ACORD Forms</span></strong></a>.</div>
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Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.comtag:blogger.com,1999:blog-24194515.post-64676971135319570612012-04-24T19:43:00.000-04:002012-04-24T19:43:46.048-04:00Introduction to the Property and Casualty Business and ACORD Forms<span lang="EN"><div style="text-align: center;">
<strong>Introduction to the Property and Casualty Business and ACORD Forms.</strong></div>
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In this article I’d like to talk about the property and casualty insurance business. This is the arena where you go to insure your personal property like your automobile, home, motorcycle, recreational vehicle or jewelry for instance. Also commercial businesses insure their property and a host of other things like worker compensation. Worker compensation is where the businesses insure themselves against on the job injury of their employees. They may also insure a fleet of vehicles, or inventory of their merchandise.</div>
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Then theirs a lot of certificates of insurance, insurance binders and notice forms that independent insurance agents use regularly. A certificate of insurance is proof that you actually have a valid current insurance policy with adequate coverage. A lien holder like a commercial bank may require a contractor for example to show evidence that they actually have the appropriate amount of coverage since the bank has a vested interest in the property. In the insurance business the bank would be referred to as a Holder. </div>
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Business must protect themselves from all kinds of dangers. If someone is injured while on their property they may be liable and are subject to claims filed against them. So they purchase insurance from an agent then the agent has to complete the appropriate forms to protect their business from law suits.</div>
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These ACORD forms are then sent to a carrier for submission. The carrier then process the forms to bind the policy, settle claims and such as that.</div>
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Each State in the United States of America has its own set of laws so theirs an appropriate ACORD forms that’s legal in each and every state. Some forms are standard across the country like the certificate of insurance form number 25 but others require their own version. For instance, the personal auto form number 90, there is one of them for every state due to the different laws in each state. Now you see why there are so many ACORD forms! It’s a daunting task to keep these forms current seeing how often the laws change.</div>
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Independent insurance agents all over the country must deal with a number of different items that they insure. In the industry that’s known as a risk. It’s really complicated and they have over seven hundred forms that they need when doing the paperwork on each item. For instance, when you insure your car the agent has to complete an application form then they need to print an auto id card. If you’re involved in an accident then they have to complete a claim form. So, you can imagine how many forms they have to keep track of. In fact they have a collection of over seven hundred forms at their disposal.</div>
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These forms are produced by a non profit organization called ACORD. They license their forms to software vendors for distribution to the agents. You can get more information by clicking on one of the links in this article; there you’ll find samples and instructions on how to complete the forms. Also, training videos are posted so it’s a great over all learning experience. </div>
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Forms Boss is the best software for managing ACORD forms. Our program will track clients, prospects as well as create any one of over seven hundred <a href="http://www.formsboss.com/" target="_blank">ACORD forms</a>. We’ve automated the process to save time and money. Plus, it’s really simple and easy to use. </div>
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Check us out by <a href="http://www.formsboss.com/">clicking here</a>.Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.comtag:blogger.com,1999:blog-24194515.post-90979375131301355592011-06-08T14:09:00.003-04:002011-06-08T14:15:44.965-04:00ACORD Forms: How to complete an Evidence of Commercial Property Insurance Instructions 28ACORD 28 (2006/07) 1 of 10 Universal wording updates to improve clarity and intent were made to all FIG text for this form on 05/29/2009. <br /><br />Section Name Field Name Field and/or Section Description <br />TITLE ACORD 28 (2006/07) Evidence of Commercial Property Insurance The title of the form. ACORD 28, Evidence of Commercial Property Insurance, provides a coverage statement for mortgagees, additional insureds and loss payees who provide mortgages or loans on real property or business personal property insured under a Commercial Lines policy, and are named in the policy. Insurance coverage on large commercial property can have many variables. Coverages, coinsurance percentages, deductibles and other details can vary widely and are important considerations to mortgagees and other lenders. In addition, The Terrorism Risk Insurance Act and the recent increase in exposure to mold and fungus losses have resulted in a greater need to know more about the specific terms of the insurance contract. ACORD 28 provides check boxes and pre-printed text to communicate important insurance details. The intent is to minimize follow-up conversations and correspondence with respect to information that is required in most cases involving large commercial real estate. ACORD 28 provides information about coverages currently in force on a policy. IMPORTANT <br />TITLE Use ACORD 27, Evidence of Property Insurance, to provide information to mortgagees and loss payees who provide mortgages or loans on residential property, personal property or small commercial properties where less detail is required by the mortgagee or loss payee. IMPORTANT Kansas, Kentucky, Minnesota, Missouri, North Carolina, Oklahoma and Wisconsin require the filing of certificate of insurance forms. ACORD has filed all of its certificates in these states. In these states, the text of ACORD's certificates cannot be modified, unless the modified form is filed for approval by the respective state Department of Insurance. <br />IDENTIFICATION SECTION Date <br />IDENTIFICATION SECTION Producer Name, Contact Person and Address Additionally, virtually every other state will not allow any change in a certificate of insurance that would attempt to modify a policy unless the revised certificate is filed and <br />IDENTIFICATION SECTION Producer Name, Contact Person and Address Enter text: The name of the individual at the producer's establishment that is the primary contact. <br />ACORD 28 (2006/07) 2 of 10 <br /> Section Name Field Name Field and/or Section Description <br />IDENTIFICATION SECTION Producer Name, Contact Person and Address Enter text: The mailing address line one of the producer/agency. <br />IDENTIFICATION SECTION Producer Name, Contact Person and Address Enter text: The mailing address line two of the producer/agency. <br />IDENTIFICATION SECTION Producer Name, Contact Person and Address Enter text: The mailing address city name of the producer/agency. <br />IDENTIFICATION SECTION Producer Name, Contact Person and Address Enter code: The mailing address state or province code of the producer/agency. <br />IDENTIFICATION SECTION Producer Name, Contact Person and Address Enter code: The mailing address postal code of the producer/agency. <br />IDENTIFICATION SECTION Phone (A/C, No, Ext) Enter number: The producer's contact person's phone number. If applicable, include the area code and extension. <br />IDENTIFICATION SECTION Fax (A/C, No) Enter number: The fax number of the producer/agency. <br />IDENTIFICATION SECTION E-Mail Address Enter text: The producer's contact person e-mail address. <br />IDENTIFICATION SECTION Code Enter code: The identification code assigned to the producer (e.g. agency or brokerage firm) by the insurer. <br />IDENTIFICATION SECTION Subcode Enter code: The identification code assigned by the insurer to the sub-producer (e.g. person) within a producer's office (e.g. agency or brokerage). <br />IDENTIFICATION SECTION Agency Customer ID Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage). <br />IDENTIFICATION SECTION Named Insured and Address Enter text: The named insured(s) as it/they will appear on the policy declarations page. <br />IDENTIFICATION SECTION Enter text: The named insured's mailing address line one. <br />IDENTIFICATION SECTION Enter text: The named insured's mailing address line two. <br />IDENTIFICATION SECTION Enter text: The named insured's mailing address city name. <br />IDENTIFICATION SECTION Enter code: The named insured's mailing address state or province code. <br />IDENTIFICATION SECTION Enter code: The named insured's mailing address postal code. <br />IDENTIFICATION SECTION Additional Named Insured(s) Enter text: The named insured(s) as it/they will appear on the policy declarations page. <br />ACORD 28 (2006/07) 3 of 10 <br /> Section Name Field Name Field and/or Section Description <br />IDENTIFICATION SECTION Company Name and Address Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. <br />IDENTIFICATION SECTION Enter text: The first line of the insurer's mailing address. <br />IDENTIFICATION SECTION Enter text: The second line of the insurer's mailing address. <br />IDENTIFICATION SECTION Enter text: The city of the insurer's mailing address. <br />IDENTIFICATION SECTION Enter code: The state or province of the insurer's mailing address. <br />IDENTIFICATION SECTION Enter code: The postal code of the insurer's mailing address. <br />IDENTIFICATION SECTION NAIC No. Enter code: The identification code assigned to the insurer by the NAIC. <br />IDENTIFICATION SECTION Policy Type Enter text: The type of policy issued to the insured (e. g., personal auto, truckers, garage liability, commercial property, builders risk, etc.). <br />IDENTIFICATION SECTION Loan Number Enter identifier: The loan number, account number or other controlling number that the additional interest may have assigned the insured. <br />IDENTIFICATION SECTION Policy Number Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. <br />IDENTIFICATION SECTION Effective Date Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. <br />IDENTIFICATION SECTION Expiration Date Enter date: The date on which the terms and conditions of the policy will expire. <br />IDENTIFICATION SECTION Continued Until Terminated if Checked Check the box (if applicable): Indicates the policy was issued on a continuous basis. <br />IDENTIFICATION SECTION This Replaces Prior Evidence Dated Enter date: The date the prior Evidence of Property Insurance, which this form replaces, was issued to this additional interest. <br />PROPERTY INFORMATION Building (checkbox) Check the box (if applicable): Indicates that Building Coverage applies. <br />PROPERTY INFORMATION Business Personal Property Check the box (if applicable): Indicates that Business Personal Property Coverage applies. <br />PROPERTY INFORMATION Location/Description Enter text: The first address line of the physical location. <br />ACORD 28 (2006/07) 4 of 10 <br /> Section Name Field Name Field and/or Section Description <br />PROPERTY INFORMATION Enter text: The second address line of the physical location. <br />PROPERTY INFORMATION Enter text: The city of the physical location. <br />PROPERTY INFORMATION Enter code: The state or province of the physical location. <br />PROPERTY INFORMATION Enter code: The postal code of the physical location. <br />PROPERTY INFORMATION Enter text: The description of the location used to differentiate locations such as vacant land, apartment buildings, townhouses, single family dwellings, farms. Provide the number of acres if farm land. <br />COVERAGE INFORMATION Basic Check the box (if applicable): Indicates the type of policy/perils insured is basic. <br />COVERAGE INFORMATION Broad Check the box (if applicable): Indicates the type of policy/perils insured is broad. <br />COVERAGE INFORMATION Special Check the box (if applicable): Indicates the type of policy/perils insured is special. <br />COVERAGE INFORMATION Other Peril Check the box (if applicable): Indicates the type of policy/perils insured is other than those listed. <br />COVERAGE INFORMATION Describe Other Peril Enter text: The description of the type of policy issued to the insured. <br />COVERAGE INFORMATION Commercial Property Coverage Amount of Insurance Enter limit: The limit applicable to the commercial property coverage. <br />COVERAGE INFORMATION Deductible Enter deductible: The deductible applicable to the commercial property coverage. <br />COVERAGE INFORMATION Business Income Check the box (if applicable): Indicates business income coverage applies. As used here, if the mortgage or loan requires Business Income coverage, indicate the applicable limit, or the number of months of coverage if coverage is provided on an actual loss sustained basis. <br />COVERAGE INFORMATION Rental Value Check the box (if applicable): Indicates rental value coverage applies. As used here, if the mortgage or loan requires either Rental Value coverage, indicate the applicable limit, or the number of months of coverage if coverage is provided on an actual loss sustained basis. <br />COVERAGE INFORMATION Business Income Or Rental Value -Yes Check the box (if applicable): Indicates business income or rental value coverage exists. <br />ACORD 28 (2006/07) 5 of 10 <br /> Section Name Field Name Field and/or Section Description <br />COVERAGE INFORMATION Business Income Or Rental Value Limit Enter limit: The limit applicable to the business income or rental value coverage. <br />COVERAGE INFORMATION Actual Loss Sustained Checkbox Check the box (if applicable): Indicates the coverage is on an actual loss sustained basis. <br />COVERAGE INFORMATION Actual Loss Sustained Number Of Months Enter number: The number of months of coverage. <br />COVERAGE INFORMATION Business Income Or Rental Value -No Check the box (if applicable): Indicates business income or rental value coverage does not exists. <br />COVERAGE INFORMATION Business Income Or Rental Value -NA Check the box (if applicable): Indicates business income or rental value coverage is not applicable. <br />COVERAGE INFORMATION Blanket Coverage YES Check the box (if applicable): Indicates blanket coverage exists. As used here, if yes, indicate value(s) reported on properties identified in the Property Information section. <br />COVERAGE INFORMATION If YES, Indicate value(s) reported on property identified above Enter amount: The value for each property in accordance with the valuation method and the subject of insurance. <br />COVERAGE INFORMATION Blanket Coverage No Check the box (if applicable): Indicates blanket coverage does not exist. <br />COVERAGE INFORMATION Blanket Coverage N/A Check the box (if applicable): Indicates blanket coverage is not applicable. <br />COVERAGE INFORMATION Terrorism Coverage YES Check the box (if applicable): Indicates terrorism coverage exists. As used here, if yes, attach Disclosure Notice / DEC. <br />COVERAGE INFORMATION Terrorism Coverage No Check the box (if applicable): Indicates terrorism coverage does not exist. <br />COVERAGE INFORMATION Terrorism Coverage N/A Check the box (if applicable): Indicates terrorism coverage is not applicable. <br />COVERAGE INFORMATION Is there a terrorism-specific exclusion? Yes Check the box (if applicable): Indicates a terrorism exclusion applies. <br />COVERAGE INFORMATION Is there a terrorism-specific exclusion? No Check the box (if applicable): Indicates a terrorism exclusion does not exist. <br />COVERAGE INFORMATION Is there a terrorism-specific exclusion? N/A Check the box (if applicable): Indicates a terrorism exclusion is not applicable. <br />COVERAGE INFORMATION Is domestic terrorism excluded? Yes Check the box (if applicable): Indicates a domestic terrorism exclusion applies. <br />COVERAGE INFORMATION Is domestic terrorism excluded? No Check the box (if applicable): Indicates a domestic terrorism exclusion does not exist. <br />ACORD 28 (2006/07) 6 of 10 <br /> Section Name Field Name Field and/or Section Description <br />COVERAGE INFORMATION Is domestic terrorism excluded? N/A Check the box (if applicable): Indicates a domestic terrorism exclusion is not applicable. <br />COVERAGE INFORMATION Limited Fungus Coverage YES Check the box (if applicable): Indicates limited fungus coverage applies. As used here, if yes, indicate the limit for this coverage and the applicable deducible. <br />COVERAGE INFORMATION Limited Fungus Coverage Limit Enter limit: The limit applicable to limited fungus coverage. <br />COVERAGE INFORMATION Limited Fungus Coverage Deductible Enter deductible: The deductible applicable to limited fungus coverage. <br />COVERAGE INFORMATION Limited Fungus Coverage No Check the box (if applicable): Indicates limited fungus coverage does not exist. <br />COVERAGE INFORMATION Limited Fungus Coverage N/A Check the box (if applicable): Indicates limited fungus coverage is not applicable. <br />COVERAGE INFORMATION Fungus Exclusion YES Check the box (if applicable): Indicates a fungus exclusion applies. As used here, if yes, indicate the form number, the form date and the owner (name of organization) of the form. <br />COVERAGE INFORMATION Form Number Enter identifier: The number used by the insurer for this form. <br />COVERAGE INFORMATION Form Date Enter date: The edition date of the form. <br />COVERAGE INFORMATION Name of Organization Enter code: Indicates the entity that has copyright ownership of the form. <br />COVERAGE INFORMATION Fungus Exclusion No Check the box (if applicable): Indicates a fungus exclusion does not exist. <br />COVERAGE INFORMATION Fungus Exclusion N/A Check the box (if applicable): Indicates a fungus exclusion is not applicable. <br />COVERAGE INFORMATION Replacement Cost YES Check the box (if applicable): Indicates replacement cost coverage exists. <br />COVERAGE INFORMATION Replacement Cost No Check the box (if applicable): Indicates replacement cost coverage does not exist. <br />COVERAGE INFORMATION Replacement Cost N/A Check the box (if applicable): Indicates replacement cost coverage is not applicable. <br />COVERAGE INFORMATION Agreed Value YES Check the box (if applicable): Indicates a valuation type of agreed amount exists. <br />COVERAGE INFORMATION Agreed Value No Check the box (if applicable): Indicates a valuation type of agreed amount does not exist. <br />ACORD 28 (2006/07) 7 of 10 <br /> Section Name Field Name Field and/or Section Description <br />COVERAGE INFORMATION Agreed Value N/A Check the box (if applicable): Indicates a valuation type of agreed amount is not applicable. <br />COVERAGE INFORMATION Co-insurance YES Check the box (if applicable): Indicates a coinsurance percentage exists. As used here, if yes, indicate percent. <br />COVERAGE INFORMATION Co-insurance Percent Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage. <br />COVERAGE INFORMATION Co-insurance No Check the box (if applicable): Indicates a coinsurance percentage does not exist. <br />COVERAGE INFORMATION Co-insurance N/A Check the box (if applicable): Indicates a coinsurance percentage is not applicable. <br />COVERAGE INFORMATION Equipment Breakdown (If applicable) YES Check the box (if applicable): Indicates equipment breakdown coverage exists. As used here, if yes, indicate the limit for this coverage and the applicable deductible. <br />COVERAGE INFORMATION Equipment Breakdown Limit Enter limit: The limit applicable to equipment breakdown coverage. <br />COVERAGE INFORMATION Equipment Breakdown Deductible Enter deductible: The deductible applicable to equipment breakdown coverage. <br />COVERAGE INFORMATION Equipment Breakdown No Check the box (if applicable): Indicates equipment breakdown coverage does not exist. <br />COVERAGE INFORMATION Equipment Breakdown N/A Check the box (if applicable): Indicates equipment breakdown coverage is not applicable. <br />COVERAGE INFORMATION Ordinance or Law - Coverage for loss to undamaged portion of building YES Check the box (if applicable): Indicates building ordinance or law undamaged portion of building coverage exists. <br />COVERAGE INFORMATION Ordinance or Law Coverage to undamaged portion of building No Check the box (if applicable): Indicates building ordinance or law undamaged portion of building coverage does not exist. <br />COVERAGE INFORMATION Ordinance or Law Coverage to undamaged portion of building N/A Check the box (if applicable): Indicates building ordinance or law undamaged portion of building coverage is not applicable. <br />COVERAGE INFORMATION Ordinance or Law Demolition Costs Yes Check the box (if applicable): Indicates building ordinance or law demolition costs coverage exists. As used here, if yes, indicate the limit for this coverage and the applicable deductible. <br />COVERAGE INFORMATION Ordinance or Law Demolition Costs Limit Enter limit: The limit applicable to building ordinance or law demolition costs coverage. <br />ACORD 28 (2006/07) 8 of 10 <br /> Section Name Field Name Field and/or Section Description <br />COVERAGE INFORMATION Ordinance or Law Demolition Costs Deductible Enter deductible: The deductible applicable to building ordinance or law demolition costs coverage. <br />COVERAGE INFORMATION Ordinance or Law Demolition Costs No Check the box (if applicable): Indicates building ordinance or law demolition costs coverage does not exist. <br />COVERAGE INFORMATION Ordinance or Law Demolition Costs N/A Check the box (if applicable): Indicates building ordinance or law demolition costs coverage is not applicable. <br />COVERAGE INFORMATION Ordinance or Law Increase Cost of Construction Yes Check the box (if applicable): Indicates building ordinance or law increased cost of construction coverage exists. As used here, if yes, indicate the limit for this coverage and the applicable deductible. <br />COVERAGE INFORMATION Ordinance or Law Increase Cost of Construction Limit Enter limit: The limit applicable to building ordinance or law increased cost of construction coverage. <br />COVERAGE INFORMATION Ordinance or Law Increase Cost of Construction Deductible Enter deductible: The deductible applicable to building ordinance or law increased cost of construction coverage. <br />COVERAGE INFORMATION Ordinance or Law Increase Cost of Construction No Check the box (if applicable): Indicates building ordinance or law increased cost of construction coverage does not exist. <br />COVERAGE INFORMATION Ordinance or Law Increase Cost of Construction N/A Check the box (if applicable): Indicates building ordinance or law increased cost of construction coverage is not applicable. <br />COVERAGE INFORMATION Earth Movement Yes Check the box (if applicable): Indicates earth movement coverage exists. As used here, if yes, indicate the limit for this coverage and the applicable deductible. <br />COVERAGE INFORMATION Earth Movement Limit Enter limit: The limit applicable to earth movement coverage. <br />COVERAGE INFORMATION Earth Movement Deductible Enter deductible: The deductible applicable to earth movement coverage. <br />COVERAGE INFORMATION Earth Movement No Check the box (if applicable): Indicates earth movement coverage does not exist. <br />COVERAGE INFORMATION Earth Movement N/A Check the box (if applicable): Indicates earth movement coverage is not applicable. <br />COVERAGE INFORMATION Flood Yes Check the box (if applicable): Indicates flood coverage exists. As used here, if yes, indicate the limit for this coverage and the applicable deductible. <br />COVERAGE INFORMATION Flood Limit Enter limit: The limit applicable to flood coverage. <br />COVERAGE INFORMATION Flood Deductible Enter deductible: The deductible applicable to flood coverage. <br />COVERAGE INFORMATION Flood No Check the box (if applicable): Indicates flood coverage does not exist. <br />ACORD 28 (2006/07) 9 of 10 <br /> Section Name Field Name Field and/or Section Description <br />COVERAGE INFORMATION Flood N/A Check the box (if applicable): Indicates flood coverage is not applicable. <br />COVERAGE INFORMATION Wind/Hail (If subject to different provisions) YES Check the box (if applicable): Indicates wind/hail coverage exists. As used here, if yes, indicate the limit for this coverage and the applicable deductible. <br />COVERAGE INFORMATION Wind/Hail If Different Provisions Limit Enter limit: The limit applicable to wind/hail coverage. <br />COVERAGE INFORMATION Wind/Hail If Different Provisions Deductible Enter deductible: The deductible applicable to wind/hail coverage. <br />COVERAGE INFORMATION Wind/Hail If Different Provisions No Check the box (if applicable): Indicates wind/hail coverage does not exist. <br />COVERAGE INFORMATION Wind/Hail If Different Provisions N/A Check the box (if applicable): Indicates wind/hail coverage is not applicable. <br />COVERAGE INFORMATION Permission to waive subrogation in favor of mortgage holder prior to loss Yes Check the box (if applicable): Indicates the permission to waive subrogation in favor of mortgage holder prior to loss is granted <br />COVERAGE INFORMATION Permission to waive subrogation in favor of mortgage holder prior to loss No Check the box (if applicable): Indicates the permission to waive subrogation in favor of mortgage holder prior to loss is not granted. <br />COVERAGE INFORMATION Permission to waive subrogation in favor of mortgage holder prior to loss N/A Check the box (if applicable): Indicates the permission to waive subrogation in favor of mortgage holder prior to loss is not applicable. <br />COVERAGE INFORMATION Coverage Other Description Enter text: The description of the coverage. <br />COVERAGE INFORMATION Coverage Other Yes Check the box (if applicable): Indicates the coverage described exists. <br />COVERAGE INFORMATION Coverage Other No Check the box (if applicable): Indicates the coverage described does not exist. <br />COVERAGE INFORMATION Coverage Other N/A Check the box (if applicable): Indicates the coverage described is not applicable. <br />COVERAGE INFORMATION Coverage Other Limit and/or Deductible Text Enter text: The additional information required for the coverage. This may include limits and deductibles. <br />ACORD 28 (2006/07) 10 of 10 <br /> Section Name Field Name Field and/or Section Description <br />CANCELLATION Number of Days Enter number: The number of days before cancellation that the issuing insurer will endeavor to notify the additional interest prior to termination of the policy (e.g., 10 days). <br />ADDITIONAL INTEREST Mortgagee Checkbox Check the box (if applicable): Indicates the additional interest type is a mortgagee. <br />ADDITIONAL INTEREST Lender Loss Payable Checkbox Check the box (if applicable): Indicates the additional interest type is a lenders loss payable. <br />ADDITIONAL INTEREST Contract of Sale Checkbox Check the box (if applicable): Indicates the additional interest type is a contract of sale. <br />ADDITIONAL INTEREST Other Checkbox Check the box (if applicable): Indicates the additional interest is not any of the types listed on the form. <br />ADDITIONAL INTEREST Other Description Enter text: The description of the type of interest in the item. <br />ADDITIONAL INTEREST Name and Address Enter text: The additional interest's full name. <br />ADDITIONAL INTEREST Enter text: The additional interest's mailing address line one. <br />ADDITIONAL INTEREST Enter text: The additional interest's mailing address line two. <br />ADDITIONAL INTEREST Enter text: The additional interest's mailing address city name. <br />ADDITIONAL INTEREST Enter code: The additional interest's mailing address state or province code. <br />ADDITIONAL INTEREST Enter code: The additional interest's mailing address postal code. <br />ADDITIONAL INTEREST Lender Servicing Agent Name and Address Enter text: The additional interest's full name. As used here, this is the lender servicing agent. <br />ADDITIONAL INTEREST Enter text: The additional interest's mailing address line one. As used here, this is the lender servicing agent. <br />ADDITIONAL INTEREST Enter text: The additional interest's mailing address line two. As used here, this is the lender servicing agent. <br />ADDITIONAL INTEREST Enter text: The additional interest's mailing address city name. As used here, this is the lender servicing agent. <br />ADDITIONAL INTEREST Enter code: The additional interest's mailing address state or province code. As used here, this is the lender servicing agent. <br />ADDITIONAL INTEREST Enter code: The additional interest's mailing address postal code. As used here, this is the lender servicing agent. <br />ADDITIONAL INTEREST Authorized Representative Sign here: Accommodates the signature of the authorized representative (e.g. producer, agent, broker, etc.). by all companies to issue Certificates. This is required in most states. <br />REMARKS REMARKS Enter text: The Evidence Of Commercial Property Insurance general remarks. <br />Edition Date The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM).<br /><br />Click here to view my web site <a href="http://www.formsboss.com">ACORD Forms</a>.Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.comtag:blogger.com,1999:blog-24194515.post-85132104647158544262010-07-12T12:59:00.003-04:002011-06-08T14:16:15.771-04:00ACORD Forms: How to complete a Cancellation Request/Policy Release 35This guide provides basic instructions for completing the ACORD Cancellation Request/Policy Release form. It explains information the company needs to process the transaction.<br /><br />This form is used as tangible evidence of the insured's instruction to cancel a contract. It can be used for either Personal or Commercial Lines, or as an enclosure to the returned original contract, when available.<br /><br />* Method of cancellation and all calculations should be confirmed with the company before final settlement of the account with the insured. Caution should be exercised to ensure proper signature specifications are followed, as required by the company.<br /><br />Insured entities must have an authorized signature and title where applicable. Individual companies may have specific requirements for additional information particularly in situations of "Policy Rewritten" or "Pro Rata" cancellations.<br /><br />Verify that cancellation notice rights have not been extended to additional parties.<br /><br />Premium financed policies should be discreetly handled to ensure proper transmittal of premium and information.<br /><br /><br />IDENTIFICATION SECTION<br /><br />Date<br />Month/day/year on which the form was completed.<br /><br />Producer<br /><br />Name and address of the producer of record whose policy is being cancelled or released.<br /><br />Phone (A/C, No, Ext)<br /><br />Producer's telephone number.<br /><br />Code<br /><br />Identifying code assigned to your agency or brokerage firm by the insurance company receiving this form.<br /><br />Subcode<br /><br />If your agency uses a subcode identification system with the company, enter the appropriate code.<br /><br />Agency Customer ID<br /><br />Customer's identification number assigned by the agency.<br /><br />Company Name and Address<br /><br />Issuing company's name, NAIC code, and address shown on the policy being cancelled or released. Do not use group or trade name.<br /><br />Policy Type<br /><br />Specific type of insurance (e.g., Automobile Policy, Workers Compensation, Homeowners, etc.).<br /><br />Insured Name and Address<br /><br />Name, mailing address and ZIP code of the insured as it appears on the policy. If the policy is issued to multiple named insureds, and the space is not adequate to list them all, enter only the first named insured followed by "et al."<br /><br /><br />CANCELED POLICY INFORMATION<br /><br />Policy Number<br /><br />Policy Number exactly as it appears on the policy, including both prefix and suffix symbols.<br /><br /><br />Effective Date and Hour of Cancellation<br /><br />List the effective date of the policy cancellation in month/day/year format. Enter the time including, AM or PM, that the policy cancellation takes effect.<br /><br /> <br />Policy Term<br /><br />List the full term effective and expiration dates as listed on the policy.<br /><br /> <br />CANCELLATION REQUEST (Policy Attached)<br /> <br /><br />If this form is being used to notify the carrier of policy cancellation and the insured's original copy of the policy is attached, check this box and return both this form and original policy to the company.<br /><br /> <br /><br />POLICY RELEASE (Complete Statement Section below)<br /><br /><br />Policy Release<br /><br />Mark "X" in this block only if this document is used as a Policy Release (policy not attached).<br /><br /> <br /><br />Witness<br /><br />When this document is used as a Policy Release, an insured should have a witness sign and date the form before returning it to the agent.<br /><br /> <br /><br />Signature of Named Insured<br /><br />First named insured must sign and date this form when used as either a Cancellation Request or Policy Release.<br /><br /> <br /><br />Additional Interest<br /><br />Provide the name and address of any Lien Holder, Mortgagee or Loss Payee. Identify this entity by marking "X" in the appropriate box.<br /><br /> <br /><br />The signature and title of an authorized representative of any additional interest indicated in the contract must be obtained if the document is used as a Policy Release. Space is provided for the corresponding signature date.<br /><br /> <br /><br />FOR AGENCY/COMPANY USE<br /><br /> <br /><br />Reason for Cancellation<br /><br />Mark "X" in the appropriate block to indicate the reason for cancellation of the policy. Available options are:<br /><br />Not Taken <br />Request of Insured <br />Rewritten (complete below) <br />Other (Identify)<br /> <br /><br />If Rewritten is indicated, enter the new Company, Policy Number, and Inception Date in the spaces provided. If Other is indicated, identify the reason in the space provided.<br /><br /> <br /><br />Company<br /><br />The name of the company that the rewritten policy has been placed with.<br /><br /> <br /><br />Policy Number<br /><br />The new policy number for the rewritten policy.<br /><br /> <br /><br />Effective Date<br /><br />The effective date of the rewritten policy.<br /><br /> <br /><br />Remarks<br /><br /> <br /><br />Method of Cancellation<br /><br />Mark "X" in the appropriate box indicating method of cancellation. Available options are:<br /><br />Flat <br />Short Rate <br />Pro Rata<br /> <br /><br />Note: Individual companies may have specific requirements for additional information, particularly in situations of rewritten or pro-rata cancellations. The method of cancellation and all calculations should be confirmed with the company before final settlement of the account with the insured.<br /><br />Full Term Premium<br /><br />Premium for the full term (six months, annual, etc.) of the policy, including endorsements.<br /><br /> <br /><br />Unearned Factor<br /><br />Unearned factor from either the short rate or pro-rata tables for the unearned period of time; from date of cancellation to date of policy expiration.<br /><br /> <br /><br />Return Premium<br /><br />Gross return premium equals the unearned factor multiplied by the full term premium.<br /><br /> <br /><br />REMARKS<br /><br /> <br /><br />List any additional comments regarding the cancellation. Explanations should be made regarding back-dated cancellations or why premium is listed as being pro-rated instead of short-rated.<br /><br />NAME AND ADDRESS - Request/ Release Distribution<br /><br /><br />Use these sections to list any additional distributions for this form, including the new agent of record, if any. Check the appropriate box for the corresponding address. The line within the name and address field is a margin setting used for window envelopes.<br /> <br />PRODUCER'S SIGNATURE<br />This form should be signed by the agent completing it. <br /><br />Click here to view my web site <a href="http://www.formsboss.com">ACORD Forms</a>.Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.comtag:blogger.com,1999:blog-24194515.post-30049054848631407262009-12-15T11:35:00.001-05:002009-12-15T11:37:13.128-05:00ACORD Forms: How to complete an Evidence of Commercial Property 28ACORD 28 Instructions<br /> <br /> ACORD 28 (2006/07) 1 of 10 Universal wording updates to improve clarity and intent were made to all FIG text for this form on 05/29/2009. <br />Section Name Field Name Field and/or Section Description <br />TITLE ACORD 28 (2006/07) Evidence of Commercial Property Insurance The title of the form. ACORD 28, Evidence of Commercial Property Insurance, provides a coverage statement for mortgagees, additional insureds and loss payees who provide mortgages or loans on real property or business personal property insured under a Commercial Lines policy, and are named in the policy. Insurance coverage on large commercial property can have many variables. Coverages, coinsurance percentages, deductibles and other details can vary widely and are important considerations to mortgagees and other lenders. In addition, The Terrorism Risk Insurance Act and the recent increase in exposure to mold and fungus losses have resulted in a greater need to know more about the specific terms of the insurance contract. ACORD 28 provides check boxes and pre-printed text to communicate important insurance details. The intent is to minimize follow-up conversations and correspondence with respect to information that is required in most cases involving large commercial real estate. ACORD 28 provides information about coverages currently in force on a policy. IMPORTANT <br />TITLE Use ACORD 27, Evidence of Property Insurance, to provide information to mortgagees and loss payees who provide mortgages or loans on residential property, personal property or small commercial properties where less detail is required by the mortgagee or loss payee. IMPORTANT Kansas, Kentucky, Minnesota, Missouri, North Carolina, Oklahoma and Wisconsin require the filing of certificate of insurance forms. ACORD has filed all of its certificates in these states. In these states, the text of ACORD's certificates cannot be modified, unless the modified form is filed for approval by the respective state Department of Insurance. <br />IDENTIFICATION SECTION Date <br />IDENTIFICATION SECTION Producer Name, Contact Person and Address Additionally, virtually every other state will not allow any change in a certificate of insurance that would attempt to modify a policy unless the revised certificate is filed and <br />IDENTIFICATION SECTION Producer Name, Contact Person and Address Enter text: The name of the individual at the producer's establishment that is the primary contact. <br />ACORD 28 (2006/07) 2 of 10 <br /> Section Name Field Name Field and/or Section Description <br />IDENTIFICATION SECTION Producer Name, Contact Person and Address Enter text: The mailing address line one of the producer/agency. <br />IDENTIFICATION SECTION Producer Name, Contact Person and Address Enter text: The mailing address line two of the producer/agency. <br />IDENTIFICATION SECTION Producer Name, Contact Person and Address Enter text: The mailing address city name of the producer/agency. <br />IDENTIFICATION SECTION Producer Name, Contact Person and Address Enter code: The mailing address state or province code of the producer/agency. <br />IDENTIFICATION SECTION Producer Name, Contact Person and Address Enter code: The mailing address postal code of the producer/agency. <br />IDENTIFICATION SECTION Phone (A/C, No, Ext) Enter number: The producer's contact person's phone number. If applicable, include the area code and extension. <br />IDENTIFICATION SECTION Fax (A/C, No) Enter number: The fax number of the producer/agency. <br />IDENTIFICATION SECTION E-Mail Address Enter text: The producer's contact person e-mail address. <br />IDENTIFICATION SECTION Code Enter code: The identification code assigned to the producer (e.g. agency or brokerage firm) by the insurer. <br />IDENTIFICATION SECTION Subcode Enter code: The identification code assigned by the insurer to the sub-producer (e.g. person) within a producer's office (e.g. agency or brokerage). <br />IDENTIFICATION SECTION Agency Customer ID Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage). <br />IDENTIFICATION SECTION Named Insured and Address Enter text: The named insured(s) as it/they will appear on the policy declarations page. <br />IDENTIFICATION SECTION Enter text: The named insured's mailing address line one. <br />IDENTIFICATION SECTION Enter text: The named insured's mailing address line two. <br />IDENTIFICATION SECTION Enter text: The named insured's mailing address city name. <br />IDENTIFICATION SECTION Enter code: The named insured's mailing address state or province code. <br />IDENTIFICATION SECTION Enter code: The named insured's mailing address postal code. <br />IDENTIFICATION SECTION Additional Named Insured(s) Enter text: The named insured(s) as it/they will appear on the policy declarations page. <br />ACORD 28 (2006/07) 3 of 10 <br /> Section Name Field Name Field and/or Section Description <br />IDENTIFICATION SECTION Company Name and Address Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. <br />IDENTIFICATION SECTION Enter text: The first line of the insurer's mailing address. <br />IDENTIFICATION SECTION Enter text: The second line of the insurer's mailing address. <br />IDENTIFICATION SECTION Enter text: The city of the insurer's mailing address. <br />IDENTIFICATION SECTION Enter code: The state or province of the insurer's mailing address. <br />IDENTIFICATION SECTION Enter code: The postal code of the insurer's mailing address. <br />IDENTIFICATION SECTION NAIC No. Enter code: The identification code assigned to the insurer by the NAIC. <br />IDENTIFICATION SECTION Policy Type Enter text: The type of policy issued to the insured (e. g., personal auto, truckers, garage liability, commercial property, builders risk, etc.). <br />IDENTIFICATION SECTION Loan Number Enter identifier: The loan number, account number or other controlling number that the additional interest may have assigned the insured. <br />IDENTIFICATION SECTION Policy Number Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. <br />IDENTIFICATION SECTION Effective Date Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. <br />IDENTIFICATION SECTION Expiration Date Enter date: The date on which the terms and conditions of the policy will expire. <br />IDENTIFICATION SECTION Continued Until Terminated if Checked Check the box (if applicable): Indicates the policy was issued on a continuous basis. <br />IDENTIFICATION SECTION This Replaces Prior Evidence Dated Enter date: The date the prior Evidence of Property Insurance, which this form replaces, was issued to this additional interest. <br />PROPERTY INFORMATION Building (checkbox) Check the box (if applicable): Indicates that Building Coverage applies. <br />PROPERTY INFORMATION Business Personal Property Check the box (if applicable): Indicates that Business Personal Property Coverage applies. <br />PROPERTY INFORMATION Location/Description Enter text: The first address line of the physical location. <br />ACORD 28 (2006/07) 4 of 10 <br /> Section Name Field Name Field and/or Section Description <br />PROPERTY INFORMATION Enter text: The second address line of the physical location. <br />PROPERTY INFORMATION Enter text: The city of the physical location. <br />PROPERTY INFORMATION Enter code: The state or province of the physical location. <br />PROPERTY INFORMATION Enter code: The postal code of the physical location. <br />PROPERTY INFORMATION Enter text: The description of the location used to differentiate locations such as vacant land, apartment buildings, townhouses, single family dwellings, farms. Provide the number of acres if farm land. <br />COVERAGE INFORMATION Basic Check the box (if applicable): Indicates the type of policy/perils insured is basic. <br />COVERAGE INFORMATION Broad Check the box (if applicable): Indicates the type of policy/perils insured is broad. <br />COVERAGE INFORMATION Special Check the box (if applicable): Indicates the type of policy/perils insured is special. <br />COVERAGE INFORMATION Other Peril Check the box (if applicable): Indicates the type of policy/perils insured is other than those listed. <br />COVERAGE INFORMATION Describe Other Peril Enter text: The description of the type of policy issued to the insured. <br />COVERAGE INFORMATION Commercial Property Coverage Amount of Insurance Enter limit: The limit applicable to the commercial property coverage. <br />COVERAGE INFORMATION Deductible Enter deductible: The deductible applicable to the commercial property coverage. <br />COVERAGE INFORMATION Business Income Check the box (if applicable): Indicates business income coverage applies. As used here, if the mortgage or loan requires Business Income coverage, indicate the applicable limit, or the number of months of coverage if coverage is provided on an actual loss sustained basis. <br />COVERAGE INFORMATION Rental Value Check the box (if applicable): Indicates rental value coverage applies. As used here, if the mortgage or loan requires either Rental Value coverage, indicate the applicable limit, or the number of months of coverage if coverage is provided on an actual loss sustained basis. <br />COVERAGE INFORMATION Business Income Or Rental Value -Yes Check the box (if applicable): Indicates business income or rental value coverage exists. <br />ACORD 28 (2006/07) 5 of 10 <br /> Section Name Field Name Field and/or Section Description <br />COVERAGE INFORMATION Business Income Or Rental Value Limit Enter limit: The limit applicable to the business income or rental value coverage. <br />COVERAGE INFORMATION Actual Loss Sustained Checkbox Check the box (if applicable): Indicates the coverage is on an actual loss sustained basis. <br />COVERAGE INFORMATION Actual Loss Sustained Number Of Months Enter number: The number of months of coverage. <br />COVERAGE INFORMATION Business Income Or Rental Value -No Check the box (if applicable): Indicates business income or rental value coverage does not exists. <br />COVERAGE INFORMATION Business Income Or Rental Value -NA Check the box (if applicable): Indicates business income or rental value coverage is not applicable. <br />COVERAGE INFORMATION Blanket Coverage YES Check the box (if applicable): Indicates blanket coverage exists. As used here, if yes, indicate value(s) reported on properties identified in the Property Information section. <br />COVERAGE INFORMATION If YES, Indicate value(s) reported on property identified above Enter amount: The value for each property in accordance with the valuation method and the subject of insurance. <br />COVERAGE INFORMATION Blanket Coverage No Check the box (if applicable): Indicates blanket coverage does not exist. <br />COVERAGE INFORMATION Blanket Coverage N/A Check the box (if applicable): Indicates blanket coverage is not applicable. <br />COVERAGE INFORMATION Terrorism Coverage YES Check the box (if applicable): Indicates terrorism coverage exists. As used here, if yes, attach Disclosure Notice / DEC. <br />COVERAGE INFORMATION Terrorism Coverage No Check the box (if applicable): Indicates terrorism coverage does not exist. <br />COVERAGE INFORMATION Terrorism Coverage N/A Check the box (if applicable): Indicates terrorism coverage is not applicable. <br />COVERAGE INFORMATION Is there a terrorism-specific exclusion? Yes Check the box (if applicable): Indicates a terrorism exclusion applies. <br />COVERAGE INFORMATION Is there a terrorism-specific exclusion? No Check the box (if applicable): Indicates a terrorism exclusion does not exist. <br />COVERAGE INFORMATION Is there a terrorism-specific exclusion? N/A Check the box (if applicable): Indicates a terrorism exclusion is not applicable. <br />COVERAGE INFORMATION Is domestic terrorism excluded? Yes Check the box (if applicable): Indicates a domestic terrorism exclusion applies. <br />COVERAGE INFORMATION Is domestic terrorism excluded? No Check the box (if applicable): Indicates a domestic terrorism exclusion does not exist. <br />ACORD 28 (2006/07) 6 of 10 <br /> Section Name Field Name Field and/or Section Description <br />COVERAGE INFORMATION Is domestic terrorism excluded? N/A Check the box (if applicable): Indicates a domestic terrorism exclusion is not applicable. <br />COVERAGE INFORMATION Limited Fungus Coverage YES Check the box (if applicable): Indicates limited fungus coverage applies. As used here, if yes, indicate the limit for this coverage and the applicable deducible. <br />COVERAGE INFORMATION Limited Fungus Coverage Limit Enter limit: The limit applicable to limited fungus coverage. <br />COVERAGE INFORMATION Limited Fungus Coverage Deductible Enter deductible: The deductible applicable to limited fungus coverage. <br />COVERAGE INFORMATION Limited Fungus Coverage No Check the box (if applicable): Indicates limited fungus coverage does not exist. <br />COVERAGE INFORMATION Limited Fungus Coverage N/A Check the box (if applicable): Indicates limited fungus coverage is not applicable. <br />COVERAGE INFORMATION Fungus Exclusion YES Check the box (if applicable): Indicates a fungus exclusion applies. As used here, if yes, indicate the form number, the form date and the owner (name of organization) of the form. <br />COVERAGE INFORMATION Form Number Enter identifier: The number used by the insurer for this form. <br />COVERAGE INFORMATION Form Date Enter date: The edition date of the form. <br />COVERAGE INFORMATION Name of Organization Enter code: Indicates the entity that has copyright ownership of the form. <br />COVERAGE INFORMATION Fungus Exclusion No Check the box (if applicable): Indicates a fungus exclusion does not exist. <br />COVERAGE INFORMATION Fungus Exclusion N/A Check the box (if applicable): Indicates a fungus exclusion is not applicable. <br />COVERAGE INFORMATION Replacement Cost YES Check the box (if applicable): Indicates replacement cost coverage exists. <br />COVERAGE INFORMATION Replacement Cost No Check the box (if applicable): Indicates replacement cost coverage does not exist. <br />COVERAGE INFORMATION Replacement Cost N/A Check the box (if applicable): Indicates replacement cost coverage is not applicable. <br />COVERAGE INFORMATION Agreed Value YES Check the box (if applicable): Indicates a valuation type of agreed amount exists. <br />COVERAGE INFORMATION Agreed Value No Check the box (if applicable): Indicates a valuation type of agreed amount does not exist. <br />ACORD 28 (2006/07) 7 of 10 <br /> Section Name Field Name Field and/or Section Description <br />COVERAGE INFORMATION Agreed Value N/A Check the box (if applicable): Indicates a valuation type of agreed amount is not applicable. <br />COVERAGE INFORMATION Co-insurance YES Check the box (if applicable): Indicates a coinsurance percentage exists. As used here, if yes, indicate percent. <br />COVERAGE INFORMATION Co-insurance Percent Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage. <br />COVERAGE INFORMATION Co-insurance No Check the box (if applicable): Indicates a coinsurance percentage does not exist. <br />COVERAGE INFORMATION Co-insurance N/A Check the box (if applicable): Indicates a coinsurance percentage is not applicable. <br />COVERAGE INFORMATION Equipment Breakdown (If applicable) YES Check the box (if applicable): Indicates equipment breakdown coverage exists. As used here, if yes, indicate the limit for this coverage and the applicable deductible. <br />COVERAGE INFORMATION Equipment Breakdown Limit Enter limit: The limit applicable to equipment breakdown coverage. <br />COVERAGE INFORMATION Equipment Breakdown Deductible Enter deductible: The deductible applicable to equipment breakdown coverage. <br />COVERAGE INFORMATION Equipment Breakdown No Check the box (if applicable): Indicates equipment breakdown coverage does not exist. <br />COVERAGE INFORMATION Equipment Breakdown N/A Check the box (if applicable): Indicates equipment breakdown coverage is not applicable. <br />COVERAGE INFORMATION Ordinance or Law - Coverage for loss to undamaged portion of building YES Check the box (if applicable): Indicates building ordinance or law undamaged portion of building coverage exists. <br />COVERAGE INFORMATION Ordinance or Law Coverage to undamaged portion of building No Check the box (if applicable): Indicates building ordinance or law undamaged portion of building coverage does not exist. <br />COVERAGE INFORMATION Ordinance or Law Coverage to undamaged portion of building N/A Check the box (if applicable): Indicates building ordinance or law undamaged portion of building coverage is not applicable. <br />COVERAGE INFORMATION Ordinance or Law Demolition Costs Yes Check the box (if applicable): Indicates building ordinance or law demolition costs coverage exists. As used here, if yes, indicate the limit for this coverage and the applicable deductible. <br />COVERAGE INFORMATION Ordinance or Law Demolition Costs Limit Enter limit: The limit applicable to building ordinance or law demolition costs coverage. <br />ACORD 28 (2006/07) 8 of 10 <br /> Section Name Field Name Field and/or Section Description <br />COVERAGE INFORMATION Ordinance or Law Demolition Costs Deductible Enter deductible: The deductible applicable to building ordinance or law demolition costs coverage. <br />COVERAGE INFORMATION Ordinance or Law Demolition Costs No Check the box (if applicable): Indicates building ordinance or law demolition costs coverage does not exist. <br />COVERAGE INFORMATION Ordinance or Law Demolition Costs N/A Check the box (if applicable): Indicates building ordinance or law demolition costs coverage is not applicable. <br />COVERAGE INFORMATION Ordinance or Law Increase Cost of Construction Yes Check the box (if applicable): Indicates building ordinance or law increased cost of construction coverage exists. As used here, if yes, indicate the limit for this coverage and the applicable deductible. <br />COVERAGE INFORMATION Ordinance or Law Increase Cost of Construction Limit Enter limit: The limit applicable to building ordinance or law increased cost of construction coverage. <br />COVERAGE INFORMATION Ordinance or Law Increase Cost of Construction Deductible Enter deductible: The deductible applicable to building ordinance or law increased cost of construction coverage. <br />COVERAGE INFORMATION Ordinance or Law Increase Cost of Construction No Check the box (if applicable): Indicates building ordinance or law increased cost of construction coverage does not exist. <br />COVERAGE INFORMATION Ordinance or Law Increase Cost of Construction N/A Check the box (if applicable): Indicates building ordinance or law increased cost of construction coverage is not applicable. <br />COVERAGE INFORMATION Earth Movement Yes Check the box (if applicable): Indicates earth movement coverage exists. As used here, if yes, indicate the limit for this coverage and the applicable deductible. <br />COVERAGE INFORMATION Earth Movement Limit Enter limit: The limit applicable to earth movement coverage. <br />COVERAGE INFORMATION Earth Movement Deductible Enter deductible: The deductible applicable to earth movement coverage. <br />COVERAGE INFORMATION Earth Movement No Check the box (if applicable): Indicates earth movement coverage does not exist. <br />COVERAGE INFORMATION Earth Movement N/A Check the box (if applicable): Indicates earth movement coverage is not applicable. <br />COVERAGE INFORMATION Flood Yes Check the box (if applicable): Indicates flood coverage exists. As used here, if yes, indicate the limit for this coverage and the applicable deductible. <br />COVERAGE INFORMATION Flood Limit Enter limit: The limit applicable to flood coverage. <br />COVERAGE INFORMATION Flood Deductible Enter deductible: The deductible applicable to flood coverage. <br />COVERAGE INFORMATION Flood No Check the box (if applicable): Indicates flood coverage does not exist. <br />ACORD 28 (2006/07) 9 of 10 <br /> Section Name Field Name Field and/or Section Description <br />COVERAGE INFORMATION Flood N/A Check the box (if applicable): Indicates flood coverage is not applicable. <br />COVERAGE INFORMATION Wind/Hail (If subject to different provisions) YES Check the box (if applicable): Indicates wind/hail coverage exists. As used here, if yes, indicate the limit for this coverage and the applicable deductible. <br />COVERAGE INFORMATION Wind/Hail If Different Provisions Limit Enter limit: The limit applicable to wind/hail coverage. <br />COVERAGE INFORMATION Wind/Hail If Different Provisions Deductible Enter deductible: The deductible applicable to wind/hail coverage. <br />COVERAGE INFORMATION Wind/Hail If Different Provisions No Check the box (if applicable): Indicates wind/hail coverage does not exist. <br />COVERAGE INFORMATION Wind/Hail If Different Provisions N/A Check the box (if applicable): Indicates wind/hail coverage is not applicable. <br />COVERAGE INFORMATION Permission to waive subrogation in favor of mortgage holder prior to loss Yes Check the box (if applicable): Indicates the permission to waive subrogation in favor of mortgage holder prior to loss is granted <br />COVERAGE INFORMATION Permission to waive subrogation in favor of mortgage holder prior to loss No Check the box (if applicable): Indicates the permission to waive subrogation in favor of mortgage holder prior to loss is not granted. <br />COVERAGE INFORMATION Permission to waive subrogation in favor of mortgage holder prior to loss N/A Check the box (if applicable): Indicates the permission to waive subrogation in favor of mortgage holder prior to loss is not applicable. <br />COVERAGE INFORMATION Coverage Other Description Enter text: The description of the coverage. <br />COVERAGE INFORMATION Coverage Other Yes Check the box (if applicable): Indicates the coverage described exists. <br />COVERAGE INFORMATION Coverage Other No Check the box (if applicable): Indicates the coverage described does not exist. <br />COVERAGE INFORMATION Coverage Other N/A Check the box (if applicable): Indicates the coverage described is not applicable. <br />COVERAGE INFORMATION Coverage Other Limit and/or Deductible Text Enter text: The additional information required for the coverage. This may include limits and deductibles. <br />ACORD 28 (2006/07) 10 of 10 <br /> Section Name Field Name Field and/or Section Description <br />CANCELLATION Number of Days Enter number: The number of days before cancellation that the issuing insurer will endeavor to notify the additional interest prior to termination of the policy (e.g., 10 days). <br />ADDITIONAL INTEREST Mortgagee Checkbox Check the box (if applicable): Indicates the additional interest type is a mortgagee. <br />ADDITIONAL INTEREST Lender Loss Payable Checkbox Check the box (if applicable): Indicates the additional interest type is a lenders loss payable. <br />ADDITIONAL INTEREST Contract of Sale Checkbox Check the box (if applicable): Indicates the additional interest type is a contract of sale. <br />ADDITIONAL INTEREST Other Checkbox Check the box (if applicable): Indicates the additional interest is not any of the types listed on the form. <br />ADDITIONAL INTEREST Other Description Enter text: The description of the type of interest in the item. <br />ADDITIONAL INTEREST Name and Address Enter text: The additional interest's full name. <br />ADDITIONAL INTEREST Enter text: The additional interest's mailing address line one. <br />ADDITIONAL INTEREST Enter text: The additional interest's mailing address line two. <br />ADDITIONAL INTEREST Enter text: The additional interest's mailing address city name. <br />ADDITIONAL INTEREST Enter code: The additional interest's mailing address state or province code. <br />ADDITIONAL INTEREST Enter code: The additional interest's mailing address postal code. <br />ADDITIONAL INTEREST Lender Servicing Agent Name and Address Enter text: The additional interest's full name. As used here, this is the lender servicing agent. <br />ADDITIONAL INTEREST Enter text: The additional interest's mailing address line one. As used here, this is the lender servicing agent. <br />ADDITIONAL INTEREST Enter text: The additional interest's mailing address line two. As used here, this is the lender servicing agent. <br />ADDITIONAL INTEREST Enter text: The additional interest's mailing address city name. As used here, this is the lender servicing agent. <br />ADDITIONAL INTEREST Enter code: The additional interest's mailing address state or province code. As used here, this is the lender servicing agent. <br />ADDITIONAL INTEREST Enter code: The additional interest's mailing address postal code. As used here, this is the lender servicing agent. <br />ADDITIONAL INTEREST Authorized Representative Sign here: Accommodates the signature of the authorized representative (e.g. producer, agent, broker, etc.). by all companies to issue Certificates. This is required in most states. <br />REMARKS REMARKS Enter text: The Evidence Of Commercial Property Insurance general remarks. <br />Edition Date The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM). <br /><br />Click here to view my web site <a href="http://www.formsboss.com/">ACORD Forms</a>.Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.comtag:blogger.com,1999:blog-24194515.post-88243016611037736852009-05-13T10:35:00.002-04:002009-05-13T10:37:22.948-04:00ACORD Forms: How to Complete a Garage and Dealers Section 128Garage and Dealers Section 128<br /><br />This guide provides the user with basic instructions for completing the<br />ACORD Garage & Dealers Section. This form has been designed to<br />handle the basic underwriting needs for automobile service operations<br />and automobile dealers.<br /><br />Space is provided to enter driver information for up to eight drivers. For<br />additional drivers, ACORD 163, Driver Information Schedule, can be<br />attached.<br /><br />Insurance coverage, "no fault" and uninsured/underinsured motorists<br />coverages in particular, varies widely from state to state. In addition,<br />there are numerous state-specific requirements that apply to Garage and<br />Dealers applications. ACORD 128 cannot address these various unique<br />specifications. Therefore, state specific forms, ACORD 138, have been<br />developed to respond to these requirements. Use the ACORD 138 for<br />your state to provide coverages/limits information, as well as the<br />required disclosure and other data unique to the state. See the State<br />Forms section of this Guide for more information.<br /><br />This form was alsodesigned to be used in conjunction with the<br />Commercial Insurance Application - Applicant Information Section<br />(ACORD 125) and the Vehicle Schedule (ACORD 129). Please turn to<br />the chapters on these forms for specific information on completing<br />them.<br /><br />Many states require supplements to all auto applications, to provide<br />specific coverage explanations or to allow applicants to accept or reject<br />certain coverages. In some cases, the applicant must be allowed to select<br />among various options. In others, laws or regulations require disclosure<br />of information pertinent to auto insurance.<br /><br />ACORD has provided the necessary supplements in most states. Refer<br />to the State Forms section of this Guide.<br /><br />IDENTIFICATION SECTION<br /><br />Much of the information for the Identification Section should match the data found within the<br />Applicant Information Section of ACORD 125. Nevertheless, it is still important to complete it.<br />Many companies separate the applications by line of business for rating purposes. Not completing<br />this portion of the application makes it difficult to keep track of the full account.<br /><br />Date<br />Month/day/year on which the form is completed.<br /><br />Agency<br />Agency's name, address and telephone number.<br /><br />Applicant (First Named Insured)<br />First Named Insured as it appears on the ACORD 125.<br /><br />Proposed Eff. Date<br />Enter the Effective date on which the terms and conditions of the policy will commence.<br /><br />Proposed Exp. Date<br />Enter the Expiration date on which the terms and conditions of the policy will terminate<br />unless renewed.<br /><br />Billing Plan<br />Indicate whether the agency or the company (direct) will bill the insured or other payor for<br />the policy.<br /><br />Payment Plan<br />Indicate the plan to be used to pay the company for the policy. Use the company's specific<br />designation for the plan where possible (e.g., Prepaid, Annual, Semi-annual, Bi-monthly,<br />40-30-30).<br /><br />Audit<br />Use this field to indicate the audit term for policies that are subject to periodic audit. If the<br />audit period is known, enter the code:<br />A . . . . . . . . . . . . . . . . . . . . . . . . . . . . annual<br />S . . . . . . . . . . . . . . . . . . . . . . . . . . . . semi-annual<br />Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . quarterly<br />M. . . . . . . . . . . . . . . . . . . . . . . . . . . . monthly<br />O . . . . . . . . . . . . . . . . . . . . . . . . . . . . other<br /><br />BUSINESS/VEHICLE STORAGE INFORMATION<br />This section is used to identify the type of insurance necessary for the applicant.<br /><br />Auto Service Operations or Trailer Sales<br />Place an "X" in all applicable boxes to identify the type of operations in which the applicant<br />is involved.<br /><br />Auto Dealers<br />Indicate if the dealership is franchised, deals in one or more specific lines of cars such as<br />Ford or GM, or if it is a non-franchised dealer. Indicate the percentage of vehicle style in<br />relation to total inventory.<br /><br />Vehicle Storage<br />Indicate where the applicant's vehicles are stored.<br /><br />Location Number<br />Enter the location number as it relates to the numbers found on the ACORD 25. For each<br />location, identify where the vehicles are stored.<br /><br />Building<br />Vehicles are stored within a building.<br /><br />Standard Open Lot<br />The lot is enclosed by walls or fences at least six feet in height, with openings securely<br />locked when unattended.<br /><br />Non-Standard Open Lot<br />The lot is either an open lot or an unroofed space and the building is not securely enclosed<br />or locked when unattended.<br /><br />COVERAGES/LIMITS<br /><br />Covered Auto Symbols<br />Garage or Dealers policies use numeric symbols on the policy declarations to indicate the<br />type(s) of vehicles for which coverage is in effect. Be sure to place an X in the appropriate<br />box for each type of coverage. Only those symbols specified for a coverage may be used.<br />Symbols 21 through 26 provide fleet automatic coverage. Symbol 21 includes Hired and<br />Non-Owned auto coverage. If symbol 21 is not used and Hired Auto (symbol 28) or Non-Owned<br />Auto (symbol 29) coverage is desired, those symbols must be checked.<br />The symbols indicate the automobiles to which each coverage applies. The symbol<br />"triggers" the coverage. For exact policy definitions of the symbols, please refer to the<br />company's policy declarations page.<br /><br />Symbol 21 - Any Auto<br />Can only be used for Liability insurance and/or Medical Payments insurance. Its use<br />provides coverage for any auto the insured will have contact with, including owned & non-owned<br />& hired vehicles. It includes coverage for non-owned autos, no-fault, uninsured<br />motorists or physical damage insurance. Damage to customers' autos is provided by using<br />Symbol 30, Garage Keepers Insurance.<br /><br />Symbol 22 - All Owned Autos<br />Provides coverage for owned autos only and includes automatic coverage for autos you<br />newly acquire. This symbol cannot be used to provide liability coverage for dealers, but can<br />be used to provide liability for non-dealers. It can also be used for dealers and non-dealers to<br />provide any of the physical damage coverages or uninsured motorist's insurance.<br /><br />Symbol 23 - Owned Private Passenger Autos Only<br />Provides coverage for owned private passenger autos only and includes automatic coverage<br />for private passenger autos you newly acquire. It can be used for dealers and non-dealers to<br />provide uninsured motorist's insurance and physical damage coverages. It may also be used<br />to provide medical payments insurance for non-dealers.<br /><br />Symbol 24 - Owned Autos Other Than Private Passenger<br />Provides coverage for owned autos other than private passenger autos and includes<br />automatic coverage for autos you newly acquire, other than private passenger autos. It is not<br />limited to trucks or truck tractors, but also includes taxis, motorcycles, emergency vehicles,<br />trailers and buses. Any vehicle which is not a private passenger auto fits within this symbol.<br /><br />Symbol 25 - Owned Autos Subject to No-Fault Laws<br />Applies to owned autos where no-fault is required by law including automatic coverage for<br />autos you newly acquire.<br /><br />Symbol 26 - Owned Autos Subject to Uninsured Motorist Laws<br />Applies to owned autos where there is a compulsory uninsured motorist's law including<br />automatic coverage for autos you newly acquire where rejection of UM is not permitted by<br />law.<br /><br />Symbol 27 - Specifically Described Autos<br />Provides coverage for scheduled autos only with no automatic coverage for autos you newly<br />acquire. Use Vehicle Schedule, ACORD 129, to provide information on individual<br />vehicles.<br /><br />Symbol 28 - Hired Autos Only<br />Provides coverage only for autos leased, hired, rented or borrowed by the named insured.<br />This does not include autos owned by employees or members of their families.<br /><br />Symbol 29 - Non-Owned Autos Used in Garage Business<br />Provides liability coverage for autos not owned by the named insured but used in<br />connection with the garage business. This includes autos owned by employees.<br /><br />Symbol 30 - Autos Left for Service/Repairs/Storage<br />Provides coverage for customer's autos which are in the care, custody, and control of the<br />named insured. It provides garage keepers insurance for dealers and non-dealers when autos<br />are left for service, repair or storage.<br /><br />Symbol 31 - Autos On Consignment and Dealer Autos<br />Provides physical damage coverages for autos consigned to dealer or held for sale in<br />possession of non-dealer.<br /><br />Symbol 32 - Company Use<br />This is a company specific code. It can be used to provide coverage when no other symbol<br />applies (e.g., to provide coverage for Long Term Leased Vehicles). It will be necessary to<br />write in this symbol if used.<br /><br />Coverages & Limits - Use ACORD 138<br /><br />AUTO DEALERS OPERATORS<br /><br />The Insurance Services Office developed the Dealers Class Plan to rate liability and collision<br />coverages. The basis for rating involves assigning rating factors and rating units for employees and<br />non-employees.<br /><br />Record by location the number of persons within each category. If rating the policy, refer to the<br />Commercial Lines Manual for additional information.<br /><br />DEALERS PHYSICAL DAMAGE<br /><br />Indicate if the autos to be covered are New or Used for each coverage and check the interest to be<br />insured.<br /><br />SERVICE OR REPAIR SHOPS<br /><br />Indicate Annual Gross Sales and the number of gallons of gasoline pumped per year.<br /><br />NON-DEALERS PREMISES & OPERATIONS<br /><br />Payroll is the basis for rating this coverage. Enter the location number as it appears on the ACORD<br />125, the estimated annual remuneration and number of employees at each location. See the<br />appropriate manual for the payroll limitations that apply.<br /><br />DRIVER INFORMATION<br /><br />This section is used to collect information on all the drivers that will be covered under this<br />account. The driver list should include any family member who will be driving company vehicles<br />and employees who regularly drive their own vehicles for company business.<br /><br />Name<br />Enter the driver's full name. If the company requires the address, enter it as well.<br /><br />Sex<br />Enter F for female, M for male.<br /><br />Marital Stat<br />Enter the marital status for each driver. Examples:<br /><br />S . . . . . . . . . . . . . . . . . . . . . . . . . . . . Single<br />M. . . . . . . . . . . . . . . . . . . . . . . . . . . . Married<br />D . . . . . . . . . . . . . . . . . . . . . . . . . . . . Divorced<br />SP . . . . . . . . . . . . . . . . . . . . . . . . . . . Separated<br />W. . . . . . . . . . . . . . . . . . . . . . . . . . . . Widowed<br /><br />Date of Birth<br />Enter the driver's birth date.<br /><br />Yrs Exp<br />Enter the number of years of driving experience for each driver.<br /><br />Year Licensed<br />Enter the year in which the driver was first licensed.<br /><br />Driver's License Number/Soc. Sec. #<br />Enter the complete driver's license number. If a license number is unavailable, enter the<br />driver's social security number.<br /><br />State Lic.<br />Enter the state in which the license was issued.<br />Date Hire<br />Enter the date of hire for each driver.<br />Use Vehicle and %<br />Enter the vehicle number that this driver primarily uses and the percentage of driving done<br />by this driver in this vehicle.<br /><br />GENERAL INFORMATION<br />Use the Remarks section to provide additional information for any questions answered with a "Yes"<br />response. The overview below lists the expected information that should be added to the remarks<br />section for "Yes" responses.<br /><br />1. Does applicant rent, lease or loan vehicles to others?<br />List the frequency, who receives the vehicles and if this is part of the normal business<br />operations. Indicate if insurance is provided.<br />2. Does applicant pick-up or deliver customer's cars?<br />Indicate how many cars per day, and how the employee commutes to the location.<br /><br />3. Does pick-up or delivery exceed 50 miles?<br />Indicate the radius of this operation if it exceeds 50 miles, and how often.<br /><br />4. Is tire recapping or retreading performed?<br />List the percentage of gross sales this operation represents. Indicate if the applicant sends<br />out for retreads, or if the applicant performs the operation.<br /><br />5. Does applicant own or sponsor a car for racing?<br />Provide a description of the car. Indicate how frequently the car is raced, who drives the car<br />and how the car is transported.<br /><br />6. Does applicant handle butane, propane or other gases?<br />State what type of storage facilities are used, what gases are involved and if they are for sale<br />to the general public.<br /><br />7. Are any vehicles furnished for groups or organizations?<br />Identify the group (school, hospital, church, or civic organization) to which the vehicle is<br />loaned. Indicate if there is a charge.<br /><br />8. Does applicant perform spray painting or welding?<br />Indicate how frequently this type of operation is performed, and if the applicant has<br />approved booths or ventilated spray areas. Describe the type of welding or painting job<br />handled and where in the building each job is located.<br /><br />9. Does applicant drive away or haul away vehicles from factory distributing<br />point or other dealers?<br />Describe circumstances causing drive-aways. Indicate if this is a regular operation, how<br />many cars are involved, and give the radius of operation.<br /><br />10. Does applicant dismantle autos or have salvage operation?<br />Describe this type of operation completely. If there is a salvage operation on premises, so<br />indicate.<br /><br />11. Does applicant use tow trucks?<br />Indicate how many trucks are owned or used by the applicant and describe towing<br />operations. These trucks may be listed on ACORD 129 Vehicle Schedule and attached to<br />the Garage Section.<br /><br />12. Do employees regularly use their own autos on company business?<br />List who, what vehicle and for what operations.<br /><br />13. Does applicant park customers' vehicles on public streets or off<br />premises?<br />Describe any type of off-premises parking of vehicles.<br /><br />14. Is a charge made for parking?<br />Indicate how much is charged, how many attendants are on duty, and the hours of<br />operation. Indicate if employees drive vehicles or if customers self-park.<br /><br />15. Any private protection systems?<br />Describe all such systems in detail.<br /><br />16. Is applicant involved in any "non-garage" operations?<br />If a retail operation, mini-mart, liquor store, or other operation is run on the premises, list<br />the operation and annual gross sales from this portion of the business. Indicate if there is<br />any insurance for this operation.<br /><br />17. Does applicant perform any road emergency services?<br />Indicate if the applicant is on call for any highway or other emergencies, and if towing<br />operations are available around the clock.<br /><br />18. Any drivers with convictions for moving traffic violations?<br />Give driver name and number, date, type and place for each conviction. Enter the number<br />of years reviewed, in accordance with the company's and state's requirements.<br /><br />ADDITIONAL INTEREST<br /><br />Use this section to collect information on any additional interest or receiver of Certificates of<br />Insurance.<br /><br />Interest<br />Check all appropriate boxes that apply to the additional interest. If the interest is other<br />than the listed options, check the last box and list the interest type after it.<br /><br />Name and Address<br />List the additional interest's name and mailing address.<br /><br />Interest in Item<br />Use this section to indicate what the additional interest has an interest in. Examples:<br />For a Mortgagee, list the location and building number. <br />For an automobile lienholder, list the vehicle number.<br /><br />If the additional interest has an interest in multiple items, such as a lienholder on multiple<br />vehicles, list all of the numbers associated with the additional interest.<br /><br />Certificate Holder<br />If a Certificate of Insurance is required, check this box.<br /><br />Reference Number<br />List any reference number, such as a loan number, that may be beneficial in tying the<br />additional interest to item.<br /><br />REMARKS<br />Use this section to provide any additional information required for underwriting or rating.<br /><br />Click here to view my web site <a href="http://www.formsboss.com/">ACORD Forms</a>.Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.comtag:blogger.com,1999:blog-24194515.post-77577195891041678852009-01-20T10:57:00.003-05:002009-01-20T11:00:31.674-05:00ACORD Forms: How to Complete a Business Auto Section 127Business Auto Section 127<br /><br />The Business Auto Section of the ACORD Commercial Insurance Application series contains basic policy information as well as essential underwriting information for commercial auto accounts. Through the effective use of the Business Auto Section, specific needs of an individual account can be addressed. Space is provided to enter driver information for up to ten drivers. For additional drivers, ACORD 163, Driver Information Schedule, can be attached. Space is also provided to enter descriptions of up to eight vehicles. If the fleet should exceed this number, the ACORD Vehicle Schedule (ACORD 129), which contains space for 7 additional vehicles, can be attached.<br /><br />Insurance coverages,"no fault" and uninsured/underinsured motorists coverages in particular, vary widely from state to state. In addition, there are numerous state-specific requirements that apply to Business Auto applications. ACORD 127 cannot address these various unique specifications. Therefore, state-specific forms, ACORD 137, have been developed to respond to these requirements. Use the ACORD 137 for your state to provide coverages/ limits information, as well as the required disclosure and other data unique to the state. See the State Forms section of this Guide for more information.<br /><br />This form was also designed to be used in conjunction with the Commercial Insurance Application - Applicant Information Section (ACORD 125). Please turn to the chapter on the ACORD 125 for<br />information on that form.<br /><br />Many states require supplements to all auto applications, to provide specific coverage explanation or to allow applicants to accept or reject certain coverages. In some cases, the applicant must be allowed to select among various options. In others, laws or regulations require disclosure of information pertinent to auto insurance. ACORD has provided the necessary supplements in all states. Refer to the State Forms section of this Guide.<br /><br /><br />IDENTIFICATION SECTION<br /><br />Much of the information for the Identification Section should match the data found within the Applicant Information Section of ACORD 125. Nevertheless, it is still important to complete it. Many companies separate the applications by line of business for rating purposes. Not completing<br />this portion of the application makes it difficult to keep track of the full account.<br /><br />Date<br />Month/day/year on which the form is completed.<br /><br />Agency<br />Agency's name, address and telephone number.<br /><br />Phone (A/C, No, Ext)/FAX No<br />Producer's telephone and fax numbers.<br /><br />Code<br />Identification code assigned to the agency or brokerage firm by the insurance company receiving this form.<br /><br />Subcode<br />If the agency uses a subcode identification system with the company, enter the appropriate code.<br /><br />Agency Customer ID<br />Customer's identification number assigned by the agency.<br /><br />Applicant (First Named Insured)<br />First Named Insured as it appears on the ACORD 125.<br /><br />Effective Date<br />Month/day/year on which the terms and conditions of the policy will commence.<br /><br />Expiration Date<br />Month/day/year on which the terms and conditions of the policy will terminate unless renewed.<br /><br />Billing Plan<br />Indicate whether the agency or the company (direct) will bill the insured or other payor for the policy.<br /><br />Payment Plan<br />Plan used to pay the company for the policy. Use the company's specific designation for the plan where possible (e.g., Prepaid, Annual, Semi-annual, Bi-monthly, 40-30-30).<br /><br />Audit<br />The audit term for policies that are subject to periodic audit. If the audit period is known, enter the code:<br /><br />A . . . . . . . . . . . . . . . . . . . . . . . . . . . . annual<br />S . . . . . . . . . . . . . . . . . . . . . . . . . . . . semi-annual<br />Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . quarterly<br />M. . . . . . . . . . . . . . . . . . . . . . . . . . . . . monthly<br />O . . . . . . . . . . . . . . . . . . . . . . . . . . . . .other<br /><br />COVERAGES/LIMITS<br /><br />Covered Auto Symbols<br />The Business Auto Policy uses numeric symbols on the policy declarations to indicate the type(s) of vehicles for which coverage is in effect. Be sure to place an "X" in the appropriate box for each type of coverage. Only those symbols specified for a coverage may be used.<br />Symbols 1 through 6 provide fleet automatic coverage. Symbol 1 includes Hired and Non-Owned auto coverage. If symbol 1 is not used and Hired auto (symbol 8) or Non-Owned auto (symbol 9) coverage is desired, those symbols must be checked.<br /><br />The symbols indicate coverage for each applicable automobile. The symbols "trigger" coverage. Please refer to the company's policy declarations page for exact policy definitions of the symbols.<br /><br />Symbol 1 - Any Auto<br />Symbol 1 can only be used for liability insurance. This includes coverage for owned, non-owned, and hired autos. Provides automatic coverage for autos the insured newly acquires. Not to be used for No-Fault, Medical Payments, Uninsured or Underinsured Motorists, or<br />Physical Damage coverages.<br /><br />Symbol 2 - All Owned Autos<br />Applies only to autos owned by the insured, and for liability coverage on any non-owned trailers while attached to power units the insured owns. This provides automatic coverage for autos the insured newly acquires. Used for Liability, Medical Payments, Uninsured and Underinsured Motorists, or Physical Damage coverages, except Towing and Labor.<br /><br />Symbol 3 - Owned Private Passenger Autos<br />Provides automatic coverage for private passenger autos the insured newly acquires. Used for Liability, Medical Payments, Uninsured and Underinsured Motorists, Physical Damage, or Towing.<br /><br />Symbol 4 - Owned Autos Other Than Private Passenger<br />Provides automatic coverage for autos other than private passenger the insured newly acquires. Used for Liability, Medical Payments, Uninsured and Underinsured Motorists, and Physical Damage except Towing.<br /><br />Symbol 5 - All Owned Autos Which Require No-Fault Coverage<br />Provides automatic coverage for autos the insured newly acquires where no-fault is required by law. Used only for P.I.P. and Additional P.I.P.<br /><br />Symbol 6 - Owned Autos Subject To Compulsory U.M. Law<br />Provides automatic coverage for autos the insured newly acquires where rejection of U.M. is not permitted by law.<br /><br />Symbol 7 - Autos Specified On Schedule<br />Applies only to those autos described on the schedule for which a premium charge is shown, and for liability coverage on any non-owned trailers while attached to power units the insured owns. Provides no automatic coverage for autos the insured newly acquires. The<br />company must be notified of newly acquired autos within 30 days. Used for all coverages.<br /><br />Symbol 8 - Hired Autos<br />Applies only to those autos leased, hired, rented or borrowed by the insured. This does not include any auto leased, hired, rented or borrowed from any of the insured's employees or members of their households. Can be used for all coverages except no-fault, towing, and labor. For medical payments, this symbol applies only to funeral directors.<br /><br />Symbol 9 - Non-Owned Autos<br />Applies only to those autos not owned, leased, or hired by the insured which are used in connection with the insured's business. Used only for liability coverage. Coverages / Limits - Use ACORD 137 for your state.<br /><br />DRIVER INFORMATION<br /><br />This section is used to collect information on all the drivers that will be covered under this account. The driver list should include any family member that will be driving company vehicles and employees who regularly drive their own vehicles for company business.<br /><br />Driver #<br />Indicate the driver number assigned by the agency/agency-vendor system used for tracking purposes.<br /><br />Name<br />Enter driver's full name. If the company requires the address, enter it as well.<br /><br />Sex<br />Enter F for female, M for male.<br /><br />Marital Stat<br /><br />Enter the marital status for each driver. Examples:<br /><br />S . . . . . . . . . . . . . . . . . . . . . . . . . . . . Single<br />M. . . . . . . . . . . . . . . . . . . . . . . . . . . . Married<br />D . . . . . . . . . . . . . . . . . . . . . . . . . . . ..Divorced<br />SP . . . . . . . . . . . . . . . . . . . . . . . . . . Separated<br />W. . . . . . . . . . . . . . . . . . . . . . . . . . . . Widowed<br /><br />Date of Birth<br />Enter the driver's birth date.<br /><br />Yrs Exp<br />Enter the number of years of driving experience for each driver.<br /><br />Year Licensed<br />Enter the year in which the driver was first licensed.<br /><br />Driver's License Number/Soc. Sec. #<br />Enter the complete driver's license number. If a license number is unavailable, enter the driver's social security number.<br /><br />State Lic.<br />Enter the state in which the license was issued.<br /><br />Date Hire<br />Enter the date of hire for each driver.<br /><br />Broadened No Fault<br />Certain states "no fault" liability laws permit broadened no fault coverage to be written for specific drivers. If such specific coverage is to apply, indicate "yes" here for each driver that is to be covered.<br /><br />DOC<br />Enter Y in this column for any driver specifically covered by Drive Other Car coverage.<br /><br />Use Vehicle #<br />Enter the vehicle number that this driver primarily uses.<br /><br />% Use<br />Indicate the percentage of driving done by this driver in the primary vehicle that this driver uses.<br /><br />GENERAL INFORMATION<br /><br />Use the Remarks section to provide additional information for any questions answered with a "Yes" response. The overview below lists the expected information that should be added to the remarks section for "Yes" responses.<br /><br />1. With the exception of encumbrances, are any vehicles not solely owned by and registered to the applicant?<br />Indicate if any of the vehicles described in the application are not owned by or registered to the applicant.<br /><br />2. Do over 50% of the employees use their autos in the business?<br />Indicate if more than 50% of applicant's employees use their vehicles in the applicant's business.<br /><br />3. Is there a vehicle maintenance program in operation?<br />Explain the type of program and if there are maintenance records kept on file.<br /><br />4. Are any vehicles leased to others?<br />Indicate if autos are leased on a short term or long term basis. Are certificates of insurance required from lessees? List who the vehicles are leased to.<br /><br />5. Are any vehicles customized, altered or have special equipment?<br />Provide the details on such alterations/customizations. List customized item and estimated value of customization.<br /><br />6. Are ICC, PUC or other filings required?<br />If Interstate Commerce Commission or Public Utilities Commission filings are required, describe the insured operations and trip frequency.<br /><br />7. Do operations involve transporting hazardous material?<br />List the materials hauled, safety measures taken and if the applicant is subject to the Federal Motor Carrier Act Requirements.<br /><br />8. Any Hold Harmless Agreements?<br />If any hold harmless agreements are in force, describe any in which the applicant indemnifies others. Attach a copy of the agreement.<br /><br />9. Any vehicles used by family members?<br />Provide details regarding which vehicles are used and how often. Make sure the driver is included in the Driver Information section.<br /><br />10. Does the applicant obtain MVR verifications?<br />Indicate if applicant reviews MVRs on all assigned drivers. How often? Upon hiring only? If No, provide explanation of why MVRs are not reviewed.<br /><br />11. Does the applicant have a specific driver recruiting method?<br />Describe the recruiting method. Are written and/or road tests conducted?<br /><br />12. Are any drivers not covered by Workers Compensation?<br />Provide the names of all drivers not covered.<br /><br />13. Any vehicles owned but not scheduled on this application?<br />List vehicles not to be covered and explain why. Indicate where coverage is placed for these vehicles.<br /><br />14. Any drivers with convictions for moving traffic violations?<br />Give driver name and number, date, type and place for each conviction. Enter the number of years reviewed, in accordance with the company's and state's requirements.<br /><br />15. Has agent inspected vehicles?<br />Describe any damage to vehicles, including any missing safety devices.<br /><br />Maximum Dollar Value Subject to Loss<br />List the highest value that the insurer would be subject to if a major automobile loss occurred on the insured premises.<br /><br />Description of Garage/Storage Locations<br />Provide a brief description of all garage or storage locations for the vehicles (e.g., Fenced in secured lot or Closed secured garage).<br /><br />ADDITIONAL INTERESTS/CERTIFICATE RECIPIENTS<br /><br />Use this section for information on any additional interests, employees who should be listed as additional insureds, and others who require Certificates of Insurance on the automobile portion of this policy. For additional names attach an ACORD 45.<br /><br />Interest<br />Indicate all appropriate options for the individual named.<br /><br />Rank<br />Primarily used for Mortgagees. Indicate the ranking such as 1st, 2nd or 3rd mortgagee.<br /><br />Name and Address<br />List the additional interest's name and address.<br /><br />Reference #<br />Indicate the additional interest's reference number for this applicant such as the loan or mortgage number.<br /><br />Certificate Required<br />If a Certificate of Insurance is required, check this box.<br /><br />Interest in Item Number<br />List the item number corresponding with the application for the item of interest for this additional insured.<br /><br />Item Description<br />If needed, further clarify the item of interest in this field. For a vehicle, list the make, model and VIN number. For a scheduled item, list the description, such as three carat diamond in six point setting.<br /><br />Cert<br />Indicate by "yes" or "no" whether a Certificate of Insurance needs to be issued to the additional interest.<br /><br />VEHICLE DESCRIPTION<br /><br />This section is used to collect pertinent information on the vehicles that are to be insured, what they are, how they are used and what coverage applies to them. If there are more than eight vehicles associated with this risk, place additional vehicles on the ACORD 129 Vehicle Schedule.<br /><br />Veh #<br />Number assigned by the agent to this vehicle for purposes of tracking in the application process.<br /><br />Year<br />Vehicle's model year.<br /><br />Make<br />Vehicle's manufacturer (e.g., Buick).<br /><br />Model<br />Manufacturer's model name (e.g., Regal).<br /><br />Body Type<br />Vehicle's body type (e.g., 4 door sedan).<br /><br />V.I.N.<br />Full vehicle identification number assigned by the manufacturer.<br /><br />City, State, Zip where garaged<br />List the location where this vehicle is normally garaged.<br /><br />Lic State<br />Enter the state where the vehicle is licensed.<br /><br />Terr<br />Enter the rating territory in which the vehicle is principally garaged.<br /><br />GVW/GCW<br />These terms identify the size class of commercial vehicles. The weights must be indicated to classify the vehicle correctly.<br /><br />GVW<br />Gross Vehicle Weight. The maximum loaded weight for which a single vehicle is designed by the manufacturer.<br /><br />GCW<br />Gross Combined Weight. The maximum loaded weight for a combination truck-tractor and semi-trailer or trailer for which the truck-tractor is designed as specified by the manufacturer.<br /><br />Class<br />This is the primary industry classification code found in rating manuals for commercial vehicles as determined by:<br />If this is a fleet or non-fleet policy <br />Commercial autos by size, business use, radius of operation and whether truck or trailer type <br />Public autos by type of vehicle, radius or seating capacity<br /><br />S.I.C.<br />This is the secondary Special Industry Class code which applies to commercial vehicles as determined by industry rating manuals.<br /><br />Factor<br />This is the sum of the rating factors from the primary and secondary classification tables. This field may be left blank if you are not rating this application.<br /><br />Seating Capacity<br />Used for public vehicles and livery vehicles. Enter the number of passenger seats available.<br /><br />Sym/Age<br />Enter the age of the vehicle in years, as follows:<br />1-Current model year <br />2-First preceding model year <br />3-Second preceding model year <br />4-Third preceding model year <br />5-Fourth preceding model year <br />6-All other autos<br /><br />Cost New<br />If actual cash value coverage is desired, indicate the original retail cost the original purchaser paid for the vehicle and equipment.<br /><br />Radius<br />Enter the appropriate radius code as follows:<br /><br />L - Local<br />Up to 50 miles. Not frequently operated beyond a 50-mile radius from the point of principal garaging.<br /><br />I -Intermediate<br />Operation beyond 50 miles, but not regularly operated beyond a 200-mile radius from the point of principal garaging.<br /><br />LD - Long Distance<br />Regularly and frequently operated beyond a radius of 200 miles.<br /><br />Farthest Term<br />For zone-rated vehicles, enter the town name and state of the terminal farthest away from the normal garaging location of this vehicle, that this vehicle travels to.<br /><br />Drive to Work/School<br />If this vehicle is used for commuting purposes to work or school, check the box that applies. Options are:<br />Drive to Work or School under 15 miles one way <br />Drive to Work or School 15 miles or over one way<br /><br />Use<br />Check the appropriate box for the primary use of this vehicle. Options are:<br />Pleasure - Private passenger vehicles or pickups/vans not used for business purposes <br />Farm - Private passenger vehicles or pickups/vans principally garaged and used on a farm or ranch <br />Retail - Pick up or delivery of property to individual households <br />Service - Transportation of personnel, tools, equipment or supplies to or from a job site <br />Commercial - The transportation of property in vehicles other than those defined as retail or service<br /><br />Check Coverages<br />Use this section to indicate the coverages applicable to this individual vehicle. These coverages should correspond to the symbols indicated in the coverage section of ACORD 137.<br />Abbreviations are:<br /><br />Liab . . . . . . . . . . . . . . . . . . . . .Liability<br />No-Fault . . . . . . . . . . . . . . . . "No-Fault" coverage, if applicable<br />Add'l No-Fault . . . . . . . . . . . Additional "No-Fault" Protection, if applicable<br />Med Pay . . . . . . . . . . . . . . . . Medical Payments<br />Unins. Mot . . . . . . . . . . . . . . . Uninsured Motorist<br />Underins Mot . . . . . . . . . . . . Underinsured Motorist<br />Towing & Labor . . . . . . . . . .Towing and Labor<br />Spec C of L . . . . . . . . . . . . . . Specified Cause of Loss<br />F. . . . . . . . . . . . . . . . . . . . . . . . .Specified Cause of Loss by Fire<br />F & T. . . . . . . . . . . . . . . . . . . . .Specified Causes of Loss by Fire and Theft<br />F, T, & W . . . . . . . . . . . . . . . . .Specified Causes of Loss by Fire, Theft and Windstorm<br />LSP . . . . . . . . . . . . . . . . . . . . . . Limited Specified Perils<br />Comp. . . . . . . . . . . . . . . . . . . . .Comprehensive Coverage<br />Coll. . . . . . . . . . . . . . . . . . . . . . .Collision Coverage<br />Rent. Reimb. . . . . . . . . . . . . . Rental Reimbursement Coverage<br />FG. . . . . . . . . . . . . . . . . . . . . . . .Full Glass Coverage<br />Blank space . . . . . . . . . . . . . .Specify Other Coverage<br /><br />Deductibles<br />Indicate if the deductible is based on an ACV - Actual Cash Value, AA - Agreed Amount, or ST Amt - Stated Amount basis by checking the appropriate box. For Agreed Amount or Stated Amount basis enter the applicable limit.<br /><br />Indicate if the other than collision deductible is for comprehensive or some sort of specified cause of loss. Enter the collision deductible in the space provided.<br /><br />Net Veh Dr/Cr<br />Enter the net rating factor that applies to this vehicle. Do not include debits or credits that apply on a policy level. Provide under Remarks a description of each debit or credit used in the calculation of the net rating factor.<br /><br />Tot Prem<br />Enter the total premium for the vehicle.<br /><br />REMARKS<br /><br />Use this section to provide any additional information required for underwriting or rating. Also indicate if any attachments such as hold harmless agreements, or pictures of vehicles are being sent.<br /><br />Click here to view my web site <a href="http://www.formsboss.com/">ACORD Forms</a>.Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.comtag:blogger.com,1999:blog-24194515.post-4851902936074976572008-10-10T10:57:00.001-04:002008-10-10T11:02:26.947-04:00ACORD Forms : How to Complete a Commercial General Liability Section 126-SCommercial General Liability Section 126-S<br /><br />Commercial General Liability is a form of insurance designed to protect owners and operators of businesses from a wide variety of liability exposures. These exposures include liability for accidents resulting from the insured's operations or premises, products sold or operations completed by the insured, and contractual liability.<br /><br />The Coverage and Limits Section of the ACORD 126 was designed to follow the ISO Policy Simplification Program first initiated in 1986.<br /><br />The ACORD 126 was designed to be used in conjunction with the Commercial Insurance Application - Applicant Information Section (ACORD 125). Please refer to the chapter on the ACORD 125 for information on that form.<br /><br />IDENTIFICATION SECTION<br /><br />Much of the information for the Identification Section should match that found within the Applicant Information Section of ACORD 125. Even so, it is still important to complete this section. Many companies separate the applications by line of business for rating purposes. Not completing this portion of the application makes it difficult to keep track of the full account.<br /><br />Date<br />Month/day/year (MM/DD/YYYY) on which the form is completed.<br /><br />Agency<br />Agency's name and address.<br /><br />Phone (A/C, No, Ext)<br />Producer's telephone number.<br /><br />Code<br />Identification code assigned to the agency or brokerage firm by the insurance company receiving this form.<br /><br />Subcode<br />If the agency uses a subcode identification system with the company, enter the appropriate code.<br /><br />Agency Customer ID<br />Customer's identification number assigned by the agency.<br /><br />Applicant (First Named Insured)<br />First Named Insured as it appears on the ACORD 125.<br /><br />Effective Date<br />Month/day/year on which the terms and conditions of the policy will commence.<br /><br />Expiration Date<br />Month/day/year on which the terms and conditions of the policy will terminate unless renewed.<br /><br />Billing Plan<br />Indicate whether the agency or the company (direct) will bill the insured or other payor for the policy.<br /><br />Payment Plan<br />Plan used to pay the company for the policy. Use the company's specific designation for the plan where possible, (e.g., Prepaid, Annual, Semi-annual, Bi-monthly, 40-30-30).<br /><br />Audit<br />The term for policies that are subject to periodic audit. If the audit period is known, enter the code:<br /><br />A . . . . . . . . . . . . . . . . . . . . . . . . . . . . annual<br />S . . . . . . . . . . . . . . . . . . . . . . . . . . . . semi-annual<br />Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . quarterly<br />M. . . . . . . . . . . . . . . . . . . . . . . . . . . . monthly<br />O . . . . . . . . . . . . . . . . . . . . . . . . . . . . other<br /><br />COVERAGES<br /><br />Commercial General Liability<br />Indicate if commercial general liability coverage is required.<br /><br />Claims Made<br />Check to request that the Commercial General Liability policy be issued on a claims made basis. For Claims Made policies, be sure to complete the Claims Made section of the application.<br /><br />Occurrence<br />Check to request the Commercial General Liability policy be issued on an occurrence basis.<br /><br />Owner's & Contractors Protective<br />Check only when separate Owner's & Contractors Protective Liability coverage is being requested.<br /><br />* Use the blank area to request other coverage forms such as Railroad Protective Liability, Liquor Liability, Pollution Liability, or a separate Products/Completed Operations Liability Only policy.<br /><br />Deductibles<br />If a deductible is requested, indicate the amount and type of deductible, and whether it is to apply per claim or per occurrence. Use the blank line to indicate options other than Property Damage or Bodily Injury Deductible.<br /><br />Per Claim<br />A per claim deductible applies to individual claims even if the claims are all related to the same occurrence or event.<br /><br />Per Occurrence<br />A per occurrence deductible applies once to each occurrence no matter how many individual claims result from the occurrence or event.<br /><br />Other Coverages, Restrictions, and/or Endorsements<br />Use this area to request any other coverages, endorsements, or special conditions. Examples:<br />Include the Vendors Endorsement<br />Exclude Damage To Rented Premises coverage<br />Exclude Medical Expense coverage<br />Exclude Personal and Advertising Injury coverage<br />LIMITS<br /><br />Enter the policy limits as they are to appear on the policy declarations page. Available limits following the ISO Policy Simplification Program are: (All limits are in whole dollars.)<br />General Aggregate<br />Each Occurrence<br />Products & Completed Operations Aggregate<br />Damage to Rented Premises (each occurence)<br />Personal & Advertising Injury<br />Medical Expense (Any One Person)<br />Employee Benefits<br />Premiums<br />Not all companies require that the producer rate the policy prior to submission of the application. If you have done so, enter the coverage premiums here.<br /><br />SCHEDULE OF HAZARDS<br /><br />Location #<br />For each classification, enter the location number of the risk's location as it appears on the Applicant Information Section of ACORD 125. All classifications should be grouped by location number.<br /><br />Classification<br />Classify the applicant's liability exposures by location, using the ISO Classification Table or other industry organization rules. Enter the appropriate class description from the table in this field.<br /><br />Class Code<br />Provide the general liability class code that corresponds to the class description shown in the previous field.<br /><br />Premium Basis<br />Enter the premium basis code followed by the estimated premium basis (exposure) for each class code. This amount should be listed as a whole number (actual basis) and not as the fraction that will be used in rating. (e.g., "S456,500" means that the premium basis is gross sales, the estimated amount of gross sales for the coming policy period is $456,500.) When rated, the rate will be multiplied by 456.5 because gross sales are rated per thousands of estimated sales.<br /><br />Exposure<br />Enter Exposure information as required.<br /><br />Terr.<br />For each discribed exposure, enter the rating territory code based on location from the appropriate state exception page.<br /><br />Rate - Prem/Ops & Products<br />If the policy has been rated prior to submitting the application, enter the separate Premises Operations and Products manual rates applicable to each classification.<br /><br />Premium - Prem/Ops & Products<br />If the policy has been rated prior to submitting the application, enter the separate Premises Operations and Products premiums applicable to each classification.<br /><br />CLAIMS MADE (Explain All "Yes " Responses)<br /><br />If a Claims Made coverage is requested, this section needs to be completed. Use this section to explain the status of previous Claims Made coverage. Because a Claims Made policy uses a different coverage "triggering" mechanism, this additional information is needed to properly process the application.<br /><br />* It is very important that the information in this section be accurate to ensure uninterrupted general liability coverage for the applicant. Use the Comments area to provide additional information.<br /><br />1. Proposed Retroactive Date<br />The Retroactive Date you are requesting for the policy being applied for. This is the proposed earliest date for which an occurrence could "trigger" coverage under a Claims Made policy.<br /><br />2. Entry date into uninterrupted claims made coverage<br />The retroactive date shown on the applicant's first Claims Made policy. If this is the first such policy, the date will be the same as the proposed retroactive date shown on the preceding field. If this is a renewal, it is the effective date of the first policy issued in the sequence of uninterrepted Claims Made policies.<br /><br />3. Has any product, work, accident or location been excluded, uninsured or self-insured from any previous coverage?<br />For yes responses, describe the situations of the above occurrences in the Comment section.<br /><br />4. Was tail coverage purchased under any previous policy?<br />For yes responses, describe terms and limits of tail coverage purchased under any previous policy. Tail coverage extends the reporting period on a Claims Made policy to cover claims arising from occurrences that were not known by the date the policy was cancelled, non-renewed or replaced.<br /><br />EMPLOYEE BENEFITS LIABILITY<br /><br />Use this section when Employee Benefits Liability is to be provided, to collect information about deductibles, number of employees, number of employees covered by Employee Benefits plans, and retroactive date, if applicable.<br /><br />CONTRACTORS<br /><br />The information requested is for any past or present operations. his is important because the contractor applicant continues to be held responsible for injury or damage that results from completed work done by the contractor, or for it by subcontractors. Use the Remarks area to<br />provide additional information.<br /><br />1. Does applicant draw plans, designs, or specifications for others?<br />If the applicant draws plans, designs or specifications, explain. Indicate whether qualified professionals are employed by the applicant for preparation.<br /><br />2. Do any operations include blasting or utilize or store explosive material?<br />Describe any operation that includes any of these activities.<br /><br />3. Do any operations include evacuation, tunneling, underground work or earth moving?<br />Describe any operation that requires any of these activities and the safety measures taken.<br /><br />4. Do your subcontractors carry coverages or limits less than yours?<br />State the limits of coverages carried by subcontractors if less than the applicant's. Identify the subcontractors and the amount of coverage.<br /><br />5. Are subcontractors allowed to work without providing you with Certificates of Insurance?<br />Explain why certificates are not requested from subcontractors.<br /><br />6. Does applicant lease equipment to others with or without operators?<br />If applicant leases equipment describe the type of equipment, number of operators, frequency, and lease arrangement.<br /><br />Remarks/Describe the type of work & percentage subcontracted<br />Describe in detail the type of work the applicant subcontracts. Also include leased equipment activities. (e.g., An excavation contractor may subcontract the blasting required. This may account for 10% of the contracts it undertakes.) List any other remarks that may be pertinent to the contractors work.<br /><br />$ Paid to Subcontractors<br />Show the total annual dollars paid.<br /><br />% of Work Subcontracted<br />List the total percentage of work that the contractor subcontracts.<br /><br /># Full Time Staff<br />Indicate the total number of full time staff.<br /><br /># Part Time Staff<br />Indicate the total number of part time staff.<br /><br />PRODUCTS/COMPLETED OPERATIONS<br /><br />This section should be completed whenever Products/Completed Operations coverage is being requested by the applicant. While it may seem to be designed with manufacturers in mind, it is also intended to be completed for retail stores, distributors, and contractors.<br /><br />Products<br />Use this field to describe the products for which product liability coverage is being requested. The description should be detailed enough so that the underwriter can fully understand the nature of each product. If there are too many products to describe individually, those which share certain characteristics should be grouped under a single generic description and the characteristics of each group should be described. Attach any literature or brochures available. (E.g., All of the furniture manufacturer's office desks can be described as "office desks", because each one is very similar to the other, even though there are several sizes and shapes and they are designed for home or office use. On the other hand, dining tables and medical office patient examination tables should not be grouped as "tables" because they are dissimilar in design and function.)<br /><br />Annual Gross Sales<br />Estimated dollar amount the applicant expects to sell in the coming year for each product or product group described. Remember the application is for the next policy year, not the current or past policy year.<br /><br />An amount should be shown for each product or product group described. This breakdown of sales is primarily needed to figure the premium, especially when there are two or more products and each one is subject to a different rating classification.<br /><br /># of Units<br />Number of units the applicant expects to sell and/or manufacture in the coming year. An amount should be shown for each product or product group described. The breakdown of units is primarily needed to estimate the product's claims frequency potential.<br /><br />Time in Market<br />Number of years or months that each described product or product group has been sold by the applicant.<br /><br />Expected Life<br />Average length of time, (days, weeks, months, or years) that the applicant expects each described product or group of products to last until it is worn out, used up, or consumed. This may be the shelf life for products consumed or useful life for other products.<br /><br />Intended Use<br />Describe the use or uses of each product or product group contemplated by the applicant. The following information should be provided:<br />What the product is designed to be or do<br />How the product is designed to work or function<br />How, when and where the product is designed to be used or consumed<br /><br />Example: If the product is food, its use is apparent. If it is a chemical or a machine part, there may be a variety of uses. In these instances, the specific use becomes an important consideration for both coverage and pricing.<br /><br />This information is necessary for the underwriter to identify and evaluate the hazards associated with the use or potential misuse of a product.<br /><br />Principal Components<br />Major components of the product. If additional space is needed to complete the information required for a particular product, attach a separate sheet. Use the Remarks section or a separate sheet of paper to explain any "Yes" responses to the following questions, for any past or present operation or product.<br /><br />1. Does applicant install, service or demonstrate products?<br />The explanation of a "Yes" response to this question should include:<br />What, how and where it is done<br />Who does it, employees or independent contractors<br />Whether a maintenance or repair service is sold<br /><br />When the work is done by independent contractors, the explanation should also include information on the cost of the work done for the applicant by the independent contractors.<br /><br />2. Foreign products sold, distributed, or used as components?<br />Each foreign-made product or product group bought, sold or distributed by the applicant should be described. In addition, the following information should be provided on each described product or group of products:<br />Intended use<br />Expected use life<br />Time in the market<br />Principal components<br />Estimated annual gross sales<br />Major source, such as U.S.-based importer or foreign-based exporter or manufacturer<br />Relationship with manufacturer or exporter<br /><br />The explanation should also indicate, for each major source, whether or not that source has U.S. products liability insurance, the limits of that insurance, and the name of the domestic insurer. Indicate whether the applicant markets products abroad.<br /><br />3. Research and development conducted or new products planned?<br />Describe the nature and extent of R&D work. Example: Indicate if it is solely directed at the development of new products or if some effort is directed to improving or changing existing products.<br /><br />Describe any new products to be marketed within the next 12 months and the potential market. Provide an estimate of anticipated sales.<br /><br />4. Guarantees, warranties, hold harmless agreements?<br />A guarantee is a promise made by the seller that the product can be returned for repair, replacement or a refund if the buyer is unsatisfied with it for some reason. A warranty is a positive statement that the product is as represented or will be as promised by the seller. If the applicant issues written guarantees or warranties with its products, copies should be<br />attached. Indicate whether they have been reviewed by an attorney.<br /><br />The presence of a Hold Harmless agreement means that the applicant has assumed certain obligations or liabilities of another person or firm. Remember, the contractual liability coverage contained in the Commercial General Liability coverage form applies only to covered bodily injury and property damage for which the indemnitee (the person or firm<br />being held harmless) is liable in tort. Coverage does not apply to any other obligation or liability that the applicant may have assumed in the Hold Harmless agreement. Attach copies of any Hold Harmless agreements the applicant may have signed.<br /><br />5. Products related to aircraft/space industry?<br />Describe any aircraft or space industry products sold or installed by the applicant and explain how and by whom they are used. Many insurers have underwriting restrictions on aerospace related products. (e.g., electronic equipment, aircraft frames, guided missile systems.)<br /><br />6. Products recalled, discontinued, changed?<br />The applicant's current products liability exposure includes products that are still in use but may not have been found and fixed by a recall, products no longer made, and products made prior to a product change. These exposures must be separately underwritten when such products are known to exist.<br /><br />A product recall usually indicates that the products subject to the recall were considered to be unreasonably dangerous. Consequently, any product recall should be fully explained. The explanation provided for recalled products should include the following:<br />A description of the products including their intended use and expected life<br />The reason for the recall, including a description of the product defects, if any,<br />which made the recall necessary<br />Who initiated the recall, the applicant or a government agency<br />The purpose of the recall, modification, repair or replacement of the defective products, and the effectiveness of the recall<br />A description of the recall method<br />The total number of the defective products subject to the recall<br />The result of the recall, including the percentage of recalled products found<br /><br />The explanation provided for discontinued products should indicate when and why manufacturing ended and how many items are estimated to be in current use.<br /><br />A changed product may forecast a start of or increase in claims or suits from the products made before the change. The explanation should indicate when the change was made and the reason for the change.<br /><br />7. Products of others sold or repackaged under applicant's label?<br /><br />When the applicant sells products under its name or label that are made by someone else, the applicant should be considered as the manufacturer of those products. Indicate whether products are repackaged, modified, or further processed by applicant. The explanation should include information on who supplies the products and the contractual relationship between the applicant and the actual manufacturer.<br /><br />8. Products under label of others?<br />When the applicant makes products that are sold with someone else's name or label on them, the explanation should provide the following information:<br />Who has contracted for the products and who is selling them?<br />Are the products processed further by others before reaching the ultimate consumer?<br /><br />9. Vendor's coverage required?<br />The explanation should identify the vendor, explain why the vendor wants to be included as an additional insured, and indicate the extent of coverage required by the vendor. Provide the gross sales to each vendor.<br /><br />10. Does any named insured sell to any other named insured?<br />Provide the product(s) name. All sales of products between multiple named insureds must be included when determining the total gross sales used for premium computations.<br /><br />Please attach literature, brochures, labels, warnings, etc.<br /><br />Use this space to comment on any of the above questions. Make sure the items listed in the caption are attached to help the underwriter analyze the risk.<br /><br />ADDITIONAL INTERESTS/CERTIFICATE RECIPIENTS<br /><br />Use this section for information on any additional interests, employees who should be listed as additional insureds, and others who require Certificates of Insurance on the general liability portion of this policy. For additional names attach an ACORD 45, and check the box in the title line of this section.<br /><br />Interest<br />Indicate all appropriate options for the individual named.<br /><br />Rank<br />Primarily used for Mortgagees - indicate the ranking such as 1st, 2nd or 3rd mortgagee.<br /><br />Name and Address<br />List the additional interests name and address.<br /><br />Reference #<br />Indicate the additional interests reference number for this applicant such as the loan or mortgage number.<br /><br />Certificate Required<br />If a Certificate of Insurance is required check this box.<br /><br />Interest in Item Number<br />List the item number corresponding with the application for the item of interest for this additional insured.<br /><br />Item Description<br />If needed, further clarify the item of interest in this field. For a vehicle list the make, model and VIN number. For a scheduled item list the description, such as 3 carat diamond in six point setting.<br /><br />GENERAL INFORMATION<br /><br />Use the Remarks section to provide additional information for any questions answered with a "Yes" response. The overview below lists the expected information that should be added to the Remarks section for "Yes" responses.<br /><br />1. Any medical facilities provided or medical professionals employed or contracted?<br />Describe the medical or first aid facilities provided on the premises. Indicate if any physicians or other health care personnel are employed or contracted.<br /><br />2. Any exposure to radioactive/nuclear materials?<br />Indicate if the applicant's operating/manufacturing process involves the use of or deals with these materials. Is a Nuclear Regulatory (Atomic Energy) Commission license required?<br /><br />3. Do operations involve storing, treating, discharging, applying, disposing or transporting hazardous material?<br />Indicate whether the applicant's operations involve any discharge of fumes, acids, caustics, or wastes. List any harmful by-products generated and how they are controlled, stored or disposed of. Indicate whether the applicant owns or operates any landfills or fuel tanks.<br /><br />4. Any listed operations sold, acquired, or discontinued in the last five years?<br />Explain and describe all such operations.<br /><br />5. Is any machinery or equipment loaned or rented to others?<br />Describe the types of equipment the applicant loans, rents, or leases to others.<br /><br />6. Any watercraft, docks, floats owned, hired, or leased?<br />Describe any watercraft or waterfront exposures. Indicate if the facilities are for private use or available to the public.<br /><br />7. Any parking facilities owned/ rented?<br />Describe if the facilities are for the use of employees, customers, visitors, etc. Give the area in square feet.<br /><br />8. Is a fee charged for parking?<br />If a fee is charged for parking, indicate whether the parking is available to the public or used primarily by employees. List the number of locations involved, and how many parking facilities are at each location.<br /><br />9. Are any recreational facilities provided?<br />Describe any recreational facilities provided for both employees or non-employees. This should include gymnasiums, grandstands, bleachers, parks, playgrounds, exercise rooms, or swimming pools owned or maintained by the applicant.<br /><br />10. Is there a swimming pool on the premises?<br />State size, maximum depth, and whether or not the pool is equipped with a diving board or water slide. Also note if a lifeguard is on duty when the pool is open.<br /><br />11. Any sporting or social events sponsored?<br />Describe the nature of such events and include the location and number of spectators and participants. If the applicant sponsors athletic teams, indicate whether the teams are composed of employees or others, such as Little League.<br /><br />12. Any structural alterations contemplated?<br />List any anticipated new construction for any locations included in the insurance being requested. Explain who will do the work: employees or subcontractors. Provide the payroll of employees or the cost of the work if subcontracted.<br /><br />13. Any demolition exposure contemplated?<br />Describe any demolition work contemplated by the applicant. Identify the structure and who will be performing the work.<br /><br />14. Has applicant been active in or is currently active in joint ventures?<br />List venture's name and address along with the role of the applicant.<br /><br />15. Do you lease employees to or from others?<br />List the companies involved, whether you are the lessor or lessee and attach a copy of the lease agreement.<br /><br />16. Is there a labor interchange with any other business or subsidiaries?<br />List the companies involved and outline the agreement.<br /><br />17. Are daycare facilities operated or controlled?<br />Indicate if facilities are for employees children only or open to the public. List number of children watched on a daily basis. If off premises give location of operation.<br /><br />18. Have any crimes occurred or been attempted on your premises within the last three years?<br />Describe any crimes or attempted crimes (e.g., burglaries, robberies, etc.).<br /><br />19. Is there a formal, written safety and security policy in effect?<br />If yes, provide a copy of the written safety or security policy in cases where your company requires this information. Indicate if these policies are practiced on a regular basis. Describe activities and precautions that are taken with respect to safety and security, including use of outside security firms.<br /><br />20. Does the businesses' promotional literature make any representations about the safety or security of the premises?<br />If yes, provide copes of such literature.<br /><br />REMARKS<br /><br />Use this section to provide any additional information required for underwriting or rating. Also indicate if any attachments such as Hold Harmless agreements, literature, brochures, labels, warnings or product surveys are being sent.<br /><br />Click here to view my web site <a href="http://www.formsboss.com/">ACORD Forms</a>.Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.comtag:blogger.com,1999:blog-24194515.post-43457722569124511672008-05-28T10:26:00.000-04:002008-05-28T10:28:48.725-04:00ACORD Forms : How to Complete a Commercial Insurance Application 125The underwriting process for any commercial account begins with the submission of a completed application. This guide will provide assistance in completing the ACORD Commercial Insurance Applicant Information Section.<br /><br />The Applicant Information Section is the foundation on which the ACORD commercial application program is built. This form contains information that is not duplicated on other ACORD commercial<br />application forms. The Applicant Information Section is a required part of every commercial submission except Workers Compensation, and no commercial application is complete without it.<br /><br />IDENTIFICATION SECTION<br /><br />Date<br />Month/day/year on which the form is completed.<br /><br />Phone (A/C, No, Ext), Fax No.<br />Producer's telephone and fax numbers.<br /><br />Agency<br />Producer's name, address and telephone number. In Florida and Nebraska, also include the producers state license number, and in Nebraska, add the agency state license number.<br /><br />Code<br />Identification code assigned to the agency or brokerage firm by the insurance company receiving this form.<br /><br />Subcode<br />If the agency uses a sub-code identification system with the company, enter the appropriate code.<br /><br />Agency Customer ID<br />Customer's identification number assigned by the agency.<br /><br />Carrier<br />Name of the applicable insurance company. Do not use group names; use the actual name of the company within the group in which you wish to have the policy issued.<br /><br />NAIC Code<br />Individual company code assigned by the NAIC.<br /><br />Underwriter/Und. Off<br />Use these fields to direct the application to a specific company underwriter and company office.<br /><br />Policies or Program Requested<br />Use this field to request an independently filed policy or program that may be optionally available from the insurance company. It may also be used to name the subsidiary company in which the line of business will be placed.<br /><br />Policy Number<br />Use this field to provide the policy number if a policy has already been issued.<br /><br />Sections Attached<br />A checklist indicating the other ACORD application sections that are attached to complete the submission. If there are any other additional forms attached enter the form name on the blank line. The form numbers associated with the listed section names are:<br />Property - ACORD 140 <br />Glass & Sign - ACORD 144 <br />Accounts Receivable/Valuable Papers - ACORD 145 <br />Crime - ACORD 141 <br />Miscellaneous Crime - ACORD 151 <br />Transportation/Motor truck Cargo - ACORD 143 <br />Equipment Floater - ACORD 146 <br />Installation/Builders Risk - ACORD 147 <br />Electronic Data Processing - ACORD 148 <br />Commercial General Liability - ACORD 126 <br />Business Auto - ACORD 127, and ACORD 137 for the state where the<br />insurance will be written <br />Truckers/Motor Carriers - ACORD 132, and ACORD 137 for the state where<br />the insurance will be written <br />Garage - ACORD 128 <br />Vehicle Schedule - ACORD 129 <br />Boiler & Machinery - ACORD 155 <br />Workers Compensation - ACORD 130 <br />Umbrella - ACORD 131<br /><br />Additional ACORD forms, such as state-specific forms, may also be filled in.<br /><br />STATUS OF TRANSACTION<br /><br />Indicate which company response to this application is expected. If the risk is bound, list the date and the time coverage began and attach a copy of the binder. If more than one option applies, check multiple boxes.<br /><br />PACKAGE POLICY INFORMATION<br /><br />Use this section to indicate common effective and expiration dates or common billing and payment plans for package policies.<br /><br />Proposed Eff. Date<br />Month/day/year on which the terms and conditions of the policy will commence.<br /><br />Proposed Exp. Date<br />Month/day/year on which the terms and conditions of the policy will terminate unless renewed.<br /><br />Billing Plan<br />Indicate whether the agency or the company (direct) will bill the insured or other payor for the policy.<br /><br />Payment Plan<br />The plan to be used to pay the company for the policy. Use the company's specific designation for the plan where possible. (e.g., Prepaid, Annual, Semi-annual, Bi-monthly, 40-30-30.)<br /><br />Audit<br />The audit term for policies that are subject to periodic audit. If the audit period is known, enter the code:<br />A . . . . . . . . . . . . . . . . . . . . . . . . . . . . annual<br />S . . . . . . . . . . . . . . . . . . . . . . . . . . . . semi-annual<br />Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . quarterly<br />M. . . . . . . . . . . . . . . . . . . . . . . . . . . . monthly<br />O . . . . . . . . . . . . . . . . . . . . . . . . . . . . other<br />APPLICANT INFORMATION<br /><br />Name (First Named Insured & Other Named Insureds)<br />Full name of the applicant as it should appear on the policy. (The first named Insured is given certain rights and responsibilities by the policy contract language. If more than one insured is named, be sure the one intended to receive these rights and responsibilities is named first.) If joint ownership, the name used may include both names (e.g., John and Mary Smith). Wording such as "et al" or "As their interests may appear" is not acceptable as the name of the insured. These phrases do not designate legal entities. Show the federal employment identification number (FEIN) or social security number, if the first named insured is an individual. Also include the phone number and email address (if applicable.)<br /><br />Mailing Address (of First Named Insured)<br />The address at which the first named Insured is to receive all correspondence regarding the insurance.Also include the business's website address(es), if applicable.<br />Form of Business Organization<br />Identify the applicant as an Individual, Partnership, Corporation,Joint Venture, Subchapter "S" Corporation, LLC or Other. If other, provide a description such as Professional Association.<br />If there is more than one named insured, provide the form of business organization for each. In the Remarks section list each named insured along with its form of organization. (e.g., The Green Thumb Co., a corporation; John Jones and Bill Smith, a partnership or a joint<br />venture composed of ABC Contracting Inc. and XYZ Contracting Inc.)<br />Not For Profit Organization<br />Check this box if the company is registered as a "Not for Profit Organization". This status affects some rating classifications.<br /><br />Date Business Started<br />Provide the date the applicant began in business. This is important because it helps the underwriter determine the expertise and business success of the applicant.<br /><br />Inspection Contact-Phone<br />Name and telephone number of the person to contact to arrange for a premises inspection. This should be an individual under the insured's employment, not the insurance agent's name and number.<br /><br />Accounting Records Contact-Phone<br />Name and telephone number of the person to contact to arrange for review of the accounting records. This should be an individual under the insured's employment or their accountant, not the insurance agent's name and number.<br /><br />PREMISES INFORMATION<br /><br />Loc #<br />Location number for this premesis.<br /><br />Bld #<br />Building number for this location. Used when more than one building exists at an individual location.<br /><br />Street, City, County, State, Zip Code<br />For each location number, enter the complete physical address (not P.O. Box) including both county and ZIP Code for each location. If there are more than three locations, attach a separate list.<br /><br />Address should include:<br /><br />Street number, if any<br />Pre-direction, if any (e.g., 150 N Central Ave) <br />Street name, if any <br />Street type (e.g., st, rd, ave) <br />Post-direction, if any (e.g., 150 Central Ave N) <br />City <br />County <br />State <br />ZIP code<br /><br />If the address does not have a street number and name, provide sufficient information and directions so that the property can be physically located. Provide legal description if required by mortgage holders.<br /><br />City Limits<br />For rating purposes indicate if this location is situated within the city limits.<br /><br />Interest<br />Indicate the applicant's interest in each location.<br /><br />Yr Built<br />Year the building at each location was originally constructed. Specify in the Remarks section any significant additions or renovations and the year they were completed.<br /><br /># Employees<br />List the total number of employees in each building at each location.<br /><br />Part Occupied<br />Identify the portion of the premises or building occupied by the applicant, such as "entire", "first floor" or "800 sq. ft. on the 10th floor."<br /><br />NATURE OF BUSINESS/DESCRIPTION OF OPERATIONS<br /><br />This section is designed to inform the underwriter of what business each applicant performs and the way it is conducted by premises. Operations which may not be apparent in a general description of operations may be segmented by location (e.g., location #1 is the general offices, location #2 is the warehouse).<br /><br />The section should be completed in enough detail to enable the underwriter to understand and classify each operation. Do not use the classification wording from the Commercial Lines Manual or Workers Compensation Manual. They do not provide adequate detail. Example: a manufacturer of pulley wheels used in sewing machines should be described as such and not as"Metal Goods Mfg. N.O.C."<br /><br />If the applicant is a manufacturer, describe the:<br />Raw materials used <br />Processes or work performed <br />Products manufactured, who uses them and how they are used<br />If the applicant is a contractor, describe the:<br />Type of contractor <br />Work performed <br />Specialized equipment used <br />Nature of sub-contracts<br /><br />If the applicant is a merchant, describe the:<br />Type of operation, wholesale or retail (if both, give the percentage of each) <br />Merchandise sold, indicate if domestic or foreign manufacture <br />Services provided, whether or not the applicant delivers<br /><br />If the applicant is a service organization, describe the:<br />Type of service performed <br />Location where services are performed <br />Applicant's clients (e.g., general public, dentists, banks)<br />GENERAL INFORMATION<br /><br />Use the Remarks section to provide additional information for any questions answered with a "Yes" response. The overview below lists the expected information that should be added to the Remarks section for "Yes" responses.<br /><br />1a. Is the applicant a subsidiary of another entity?<br />If the applicant is a subsidiary of another organization, identify the parent company and describe the relationship including the percentage owned by the parent.<br /><br />1b. Does the applicant have any subsidiaries?<br />If the applicant has any subsidiaries, provide a list and describe each relationship and the percentage owned by the applicant.<br /><br />2. Is a formal safety program in operation?<br />Some larger applicants may have formal safety programs. If this applicant does, be sure to provide an explanation of the program activities. This could have a positive impact on the underwriter's acceptance and pricing decisions.<br /><br />3. Any exposure to flammables, explosives, chemicals?<br />Provide a description of the exposure, identify the substances involved, explain any hazardous processes, and describe any precautions taken to reduce or control the hazard. If hazardous waste is generated, describe it and explain how it is disposed of.<br /><br />4. Any catastrophe exposure?<br />Describe any known exposures of this nature such as: "located on an earthquake fault," "located in a flood plain," or "next to a rocket fuel factory."<br /><br />5. Any other insurance with this company or being submitted?<br />Indicate if other insurance is currently written for this applicant by the company. If a submission was mailed to another department recently, note it in the Remarks section along with any policy numbers available.<br /><br />6. Any policy or coverage declined, cancelled or non-renewed during the prior 3 years?<br />Provide an explanation of how this situation occurred.<br /><br />7. Any past losses or claims relating to sexual abuse or molestation allegations, discrimination or negligent hiring?<br />Provide an explanation if any of the above exposures occurred.<br /><br />8. During the last five years (ten in RI,) has any applicant been convicted of any degree of the crime of arson? (In Rhode Island, failure to disclose the existence of an arson conviction is a misdemeanor punishable by a sentence of up to one year of imprisonment.)<br />Rhode Island law requires that all applicants for property insurance must answer this question.<br /><br />9. Any uncorrected Fire Code Violations?<br />Describe any violations of applicable building codes that have not been corrected.<br /><br />10. Any bankruptcies, tax or credit liens against the applicant in the past five years?<br />If yes, Describe in detail.<br /><br />11. Has business been placed in a trust?<br />If yes, provide the name of the trust.<br /><br />REMARKS/PROCESSING INSTRUCTIONS<br /><br />Use this space to provide detailed answers to the General Information underwriting questions outlined above. This space should also be used to provide additional information as required from other sections of the application. If additional space is needed attach a separate list.<br /><br />SIGNATURE SECTION<br /><br />Applicant's Signature<br />Upon completion of the full commercial lines application series, the insured should review the applications and sign this form in the available space.<br /><br />Producer's Signature<br />Upon completion of the full commercial lines application series, the producer should review the applications and sign this form in the available space.The National Producer Number should also be provided.<br /><br />PRIOR CARRIER INFORMATION<br /><br />Space is provided to enter up to five years of information for each line of business. This information, along with the loss history below, is required to experience rate the risk. The completeness and accuracy of this information can affect the underwriter's pricing decisions.<br /><br />COMMON TO ALL LINES<br /><br />Carrier<br />Name of the insurance company that wrote the policy.<br /><br />Policy Number<br />Reference identification assigned by the insurance company to identify the policy.<br /><br />Eff.- Exp. Date<br />Show the effective and expiration date of the policy.<br /><br />Modification Factor<br />The reciprocal of the percentage by which the premium shown differs from the manual. Example: if the General Liability insurance manual premium is $1,000, but the actual premium charged was reduced to $680 because of a combination of package, experience and schedule credits, the Modification Factor is .68.<br /><br />This factor is used by the insurance company to convert premium charged back to manual premium for application of experience rating plans.<br /><br />Total Premium<br />The annual modified premium charged (not including taxes or service charges) for the specified line of business.<br /><br />COMMERCIAL GENERAL LIABILITY<br /><br />Policy Type<br />Indicate whether the policy was issued on a Claims Made or Occurrence basis.<br /><br />Retro Date<br />If the policy was issued on a Claims Made basis and there was a retroactive date, list the date. If there was no date enter "none".<br /><br />Limits<br />List the limits as they appeared on the policy declarations page. Limits can be listed following either the ISO simplified Policy Format or the non-simplified policy format.<br /><br />AUTOMOBILE LIABILITY<br /><br />Policy Type<br />List the policy type that the previous policy was issued on. (e.g., Business Automobile, Truckers policy.)<br /><br />Limits<br />List the limits as they appear on the policy declarations page.<br /><br />PROPERTY<br /><br />Policy Type<br />The coverage form that the previous policy was issued on. (e.g., Special excluding Theft.)<br /><br />Bldg./Pers Prop Amount<br />Indicate if the amount listed is the Building Limit or the Personal Property Limit.<br /><br />OTHER<br /><br />Complete this section for policy history on other lines of business.<br /><br />LOSS HISTORY<br /><br />Whenever possible, attach a copy of the previous carrier's loss run for each line of business. Loss reports should cover the previous five years of loss history, except in Kansas and New York, which limit the recording of loss history to three years. If loss reports are attached check the "See<br />Attached Loss Summary" box instead of completing this section.<br /><br />Check Here if None<br />Check this box if there are no known losses and no occurrences that may lead to losses over the past five years for all lines of business being submitted.<br /><br />See Attached Loss Summary<br />Check this box if a loss summary report is being sent with the application.<br /><br />Date of Occurrence<br />Date when the accident or incident occurred that resulted in the filing of a claim.<br /><br />Line<br />Line of business involved in the loss (e.g., Automobile Liability, Property, General Liability).<br /><br />Type/Description of Occurrence or Claim<br />A brief description of the loss.<br /><br />Date of Claim<br />The date on which the loss or occurrence occurred.<br /><br />Amount Paid<br />If the previous carrier has made any payments on this claim, enter the total amount paid to date.<br /><br />Amount Reserved<br />If the claim is still open, list the reserve amount the previous carrier is holding open for this claim.<br /><br />Claim Status<br />Indicate if this claim is open or closed.<br /><br />REMARKS<br /><br />Use this section to list any additional, pertinent information that the underwriter should know about the overall exposures of this risk.<br /><br />Click here to view my web site <a href="http://www.formsboss.com/">ACORD Forms</a>.Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.comtag:blogger.com,1999:blog-24194515.post-17006416496905480642008-02-27T14:17:00.000-05:002008-02-27T14:21:15.759-05:00ACORD Forms : How to Complete Personal Automobile Application 90The underwriting process for any personal lines policy begins with the submission of a completed application. This guide provides assistance in completing the ACORD Personal Auto Application. The generic sections of each personal lines form are explained in the Personal Lines Generic Section at the beginning of the Personal Lines Section of the Forms Instruction Guide.<br /><br />There are three additional, optional forms in the personal auto series: <a href="file:///C:/Temp/FBP/goodstudentdrivertraining.229.htm">Good Student/Driver Training (ACORD 91)</a>, <a href="file:///C:/Temp/FBP/medicalstatement.236.htm">Medical Statement (ACORD 92)</a>, and <a href="file:///C:/Temp/FBP/youngdriverquestionnaire.255.htm">Young Driver Questionnaire (ACORD 93)</a>.<br /><br />IMPORTANT - State-specific personal auto applications, together with all necessary required supplements and notices, have been provided for all states. All comply with current state statutes and regulations, and all will be revised as necessary to comply with future changes in state requirements. The original ACORD 90, Personal Auto Application, was withdrawn July 1, 1996, two years after the introduction of all of the state-specific forms. The original ACORD 90 was not acceptable because of laws or regulations in thirty-three states. However, the state-specific applications developed by ACORD to replace the original ACORD 90 are acceptable in each respective state.<br /><br />The unique sections of the state applications are the Coverages/Premium section on the front of the form, and the Fair Credit, Fraud, coverage acceptance/rejection, and other disclosure requirements on the bottom of the back of the form. The balance of each state form is identical to all the others. The following pages include a depiction of the common sections, and instructions relating to the completion of these sections. Refer to the State Forms section of this Guide, and your company rating manual, for information about the state-unique coverage and requirements.<br /><br />RESIDENCE<br />Number of Years at Address Current and Previous<br />Number of years present at both the applicant's current and previous addresses.<br /><br />Previous Address<br />Physical address of the first named insured if the applicant has been at the current address for less than three years.<br /><br />GARAGE LOCATION<br />Indicate vehicle number and complete address including ZIP code for any vehicle not kept at the mailing address. Also, provide this information if the mailing address is a post office box or rural route address, or when a driver is at school with a vehicle.<br /><br />VEHICLE DESCRIPTION/USE<br />Total # Vehicles In Household<br />All owned, leased, or regularly used vehicles in household, including non-registered and non-insured vehicles.<br /><br />Year<br />Model year of the vehicle.<br /><br />Make, Model and Body Type<br />Manufacturer's trade name for the vehicle, including number of doors (e.g., Ford Taurus, 4 door sedan).<br /><br />VIN/Registered State<br />Vehicle identification number as it appears on the title certificate or registration. Also enter the state where the vehicle is registered. If the vehicle is registered in a state different from where it is garaged, provide an explanation in the Remarks section.<br /><br />HP/CC<br />Horsepower, or the number of cubic centimeters of displacement.<br /><br />Date Purch<br />Year the applicant acquired the vehicle in YYYY format.<br /><br />New/Used<br />Enter "N" if the applicant bought the vehicle new, "U" if the vehicle was used.<br /><br />Cost New<br />Original cost of the vehicle.<br /><br />Symbol Age Grp<br />If the vehicle requires physical damage coverage, enter the symbol group code. Refer to rating manual.<br /><br />Terr<br />Rating territory code where the vehicle is principally garaged. Refer to rating manual.<br /><br />Miles 1 Way Wk/Schl<br />Number of miles from the garage location to school or work.<br /><br /># Days Week<br />Number of days per week the vehicle is used to commute from the garage location to work or school. This includes driving to and from a commuter lot or transit station.<br /><br /># Weeks/ Mo.<br />Number of weeks per month the vehicle is used to commute from the garage location to work or school. This includes driving to and from a commuter lot or transit station.<br /><br />Usage<br />Enter pleasure (P), business (B) or farm (F). Use business (except for farming) if the vehicle is involved in the occupation, profession or business of the applicant or any other operator of the vehicle. Going to or from the principal place of occupation, profession or business is considered pleasure.<br /><br />Perform<br />Vehicle's performance level. Indicate High (H), Intermediate (I) or Sport (S).<br /><br />Multi-Car<br />Check box only if multi-car credit applies.<br /><br />Carpool<br />Indicate if any vehicle is used in a car pool for travel to work or school.<br /><br />Garaged<br />Indicate if the vehicle is parked in a garage at night. If the vehicle is left on the street, at school or some other equally exposed place, provide this information in Remarks. Examples of exposures are:<br /><br />Off street (driveway)<br />Off street (school)<br />On street (at residence)<br />On street (at school)<br /><br />Odometer Reading<br />Current number of miles on the odometer.<br /><br />Annual Mileage<br />Total estimated annual mileage for each vehicle.<br /><br />Govern Driver<br />Driver to be assigned to each vehicle for rating purposes.<br /><br />Driver Use %<br />Percentage that each driver uses each vehicle. Each vehicle should total 100 percent. If any driver has 0 percent use for all vehicles, indicate why in the Remarks section.<br /><br />Class<br />Rate classification for each vehicle. Refer to manual; some companies determine class automatically from information provided in Vehicle Use and Driver Information sections.<br /><br />Seat Belt<br />Check the box if the vehicle is equipped with automatic seat belts.<br /><br />Air Bag<br />Indicate D for driver side air bag, B for vehicle equipped with air bag for both front driver and passenger.<br /><br />Anti-Lock Brakes 2/4<br />For vehicles with anti-lock brakes, indicate whether the car is equipped with a 2-wheel or 4-wheel anti-lock braking system.<br /><br />Anti-Theft Devices<br />If vehicle is equipped with an anti-theft device, indicate type.<br /><br />Credits and Surcharges<br />Enter any other credits and/or surcharges that are to apply to any or all vehicles.<br /><br />COVERAGES/PREMIUMS<br />For information relating to each state's unique coverages, refer to the State Forms section in this guide, and your company's rating manual.<br /><br />DRIVER INFORMATION<br />Name<br />Name of each licensed operator (resident or not) as it appears on their drivers licenses, and every resident of the household regardless of age. Enter the surname only if different from the applicant's. Show the applicant as driver #1, even if not an operator.<br /><br />Sex<br />Enter F for female, M for male.<br /><br />Mar Stat<br />Enter the marital status of each listed driver. Examples:<br /><br />S=Single<br />M=Married<br />D=Divorced<br />SP=Separated<br />W=Widowed<br /><br />Relation to Applicant<br />Driver's relationship to the applicant. Examples:<br /><br />I=Insured<br />Sp=Spouse<br />C=Child<br />Sib=Brother/Sister<br />P=Parent<br />E=Employee<br /><br />Date of Birth<br />Date of birth of each driver and household resident (MM/DD/YY) (e.g., March 7, 1944 should be 03/07/44).<br /><br />Occupation<br />Occupation of each operator.<br /><br />Date Lic<br />Date (MM/YY) each driver was permanently licensed.<br /><br />Stdt >> 100<br />Indicate if any youthful driver is residing at a school over 100 road miles from the principal place of garaging. Show name of institution and address in the Remarks section.<br /><br />Good Stdt<br />Indicate if any driver qualifies for a good student credit (verify that company offers this credit). Complete and attach a Good Student Certificate (ACORD 91) for each operator who qualifies.<br /><br />Drv Train<br />Indicate if driver training credit applies to the driver, if required by the company. Refer to the company's manual to verify if a credit or surcharge should be applied. Attach a Driver Training Certificate for any operator under age 21 who has successfully completed this training and qualifies for the credit.<br /><br />Acc Prev Cse<br />Date on which the driver successfully completed an approved motor vehicle accident prevention course (or a similarly recognized defensive driving course). Attach a completion certificate for each driver who qualifies.<br /><br />Drivers License #/ Licensed State<br />Complete drivers license number and licensed state for each licensed operator. Copy directly from license if possible.<br /><br />Social Security #<br />Social security number for each named driver and household resident.<br /><br />ACCIDENTS/CONVICTIONS<br />It is important that this section be completed fully and accurately. Many companies verify driving records with state motor vehicle departments. Discrepancies between the application and the report may result in processing delays and unnecessary correspondence with the company. If there have not been any accidents, convictions or comprehensive losses during the indicated time period, enter "None". Be sure to enter the number of years reviewed, in accordance with the company's and state's requirements, as the experience period.<br /><br />Drv #<br />Driver number as found in the driver information section.<br /><br />Date of Accident/Conviction<br />Date the accident or conviction occurred.<br /><br />Description of Accident or Conviction<br />A complete description of the accident or conviction. This would include the number of vehicles involved and the type of vehicles (private passenger or commercial). Convictions constitute a judgement of guilty, plea of nolo contendere or forfeiture of bail. Use the Remarks section or an additional piece of paper if necessary.<br /><br />Place of Accident/Conviction<br />City and state of the accident or conviction.<br /><br />BI or Death<br />Indicate whether bodily injury or death occurred. Include details in the description of accident.<br /><br />Amount of Property Damage<br />Total amount of property damage, both the applicant's and all claimant's combined damages. Refer to company manual.<br /><br />ADDITIONAL INTEREST<br />Indicate if additional interest is an additional insured-lessor, certificate holder or a loss payee. Show complete name and mailing address. Provide the following information for each entity having an interest in the personal automobile(s) to be insured. The interest number or rank (1st, 2nd), whether additional interest or loss payee, the name and address of the interest (e.g., Loans Are Us Bank, 123 Main St, Anytown, NY 10010) and loan number.<br /><br />EMPLOYMENT INFORMATION<br />Applicant's/Co-Applicant's Employer<br />Name of the organization that employs the applicant(s) named in the identification section.<br /><br />Applicant's Employment Location<br />Applicant's employment location. This may differ from where the main office/plant is situated.<br /><br />Work Phone Number<br />Work phone number at which the applicant/co-applicant may be reached.<br /><br />Yrs Empl<br />The number of years the applicant(s) have been with the employer indicated above. If less than 2 years, provide the number of years previous employment. Provide the name of the previous employer and previous occupantion in the remarks section.<br /><br />PRIOR COVERAGE<br />Provide the prior insurance company's name, producer, number of years with the company, policy number and the date the prior policy expired.<br /><br />GENERAL INFORMATION<br />If there are any Yes responses, provide a complete explanation in the Remarks section. Use an additional sheet of paper if the room in the Remarks section is not adequate.<br /><br />1. Vehicle not registered to applicant?<br />Provide the vehicle number and the name of any vehicle not owned by or registered to the applicant.<br /><br />2. Any car modified/special equipment?<br />Indicate which vehicles have been altered, customized or equipped with special equipment or racing items. Include any customized painting such as murals or pin striping, any equipment installed to overcome a physical handicap. Indicate vehicle number, a description of the modifications and the cost of the special equipment.<br /><br />3. Any existing damage?<br />Indicate if any vehicle has been damaged and not repaired as of the date of application. Indicate the vehicle number and a complete description of the damage.<br /><br />4. Any other losses incurred?<br />Any other losses, such as glass damage, vandalism, fire or theft, not shown in the Accident/Conviction section, incurred within the last three years. Provide description and amount of loss.<br /><br />5. Any car kept at school?<br />Identify the household member and the name and location of the school. Provide the distance between the school and the residence garage location.<br /><br />6. Any car parked on street?<br />Determine if any vehicle is parked on the street or kept in other than an enclosed garage when not in use. Indicate vehicle number from vehicle description area and where the vehicle is parked.<br /><br />7. Any other automobile insurance?<br />Provide the insured's name, vehicle description, insurance company, type of coverage and policy number for any other household resident's automobile insurance.<br /><br />8. Any other insurance with company?<br />Indicate the type and policy number of any other insurance the applicant has with the company.<br /><br />9. Any household member in military service?<br />Provide details on branch of service, rank, and location of base for any household member in active military service. Determine if any vehicle is at the military location.<br /><br />10. Any license suspended/revoked?<br />Indicate the driver number, the period of suspension, the reason for suspension, and the date the license was reinstated.<br /><br />11. Any physical/mental impairments?<br />List any operator with a physical or medical impairment which could hinder the safe operation of a vehicle ( amputation, epilepsy). If impaired, enter the name of the driver, a description of any special equipment installed, and treatment or medication being administered. This question cannot be asked in some states. In those states, the question does not appear on the application.<br /><br />12. Any financial responsibility filing?<br />Indicate the driver's name, the reason for the filing, and the date of original filing.<br /><br />13. Has insurance been transferred within agency?<br />Indicate if prior carrier and previous policy number information shown on the front of the application represents a policy being transferred within the agency. If Yes, give reason for transfer.<br /><br />14. Any insurance declined/cancelled?<br />Indicate if any resident in the household has been declined, cancelled or non-renewed through a previous carrier within the last three years. List the person's name and why the action was taken. This question cannot be asked in some states. n those states, the question does not appear on the application.<br /><br />15. Is this brokered business to the agent?<br />Indicate if the application came through a broker not part of the agency.<br /><br />Alabama Personal Auto Application ACORD 90 AL (2/2001)<br />Following are the differences from ACORD 90, the generic Personal Auto Application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverage is not available; this is not a "no-fault" state. Uninsured Motorists Bodily Injury coverage includes Underinsured Motorists Bodily Injury coverage; Uninsured or Underinsured Motorists Property Damage coverage is not available. Statement added to the back of the form referencing the explanation and offer of Uninsured Motorists Bodily Injury coverage up to the policy's Bodily Injury Liability limits, and the right of the applicant to reject this coverage. The statement must be initialed by the applicant.<br /><br />Alaska Personal Auto Application ACORD 90 AK (2/2001)<br />Following are the differences from ACORD 90, the generic Personal Auto Application. For instructions on completing the balance of this form, refer to ACORD 90, the generic Personal Auto Application, on this website.<br />Personal Injury Protection coverage does not apply; this is not a "no-fault"state.<br />A required statement has been added to the back of the form with respect to the offer of Rental Vehicle Damage coverage if Comprehensive and/or Collision coverage has been rejected by the applicant.<br /><br />Arizona Personal Auto Application ACORD 90 AZ (3/97)<br />Following are the differences from ACORD 90, the generic Personal Auto Application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverage is not available; this is not a "no-fault" state. Uninsured and Underinsured Motorists Property Damage coverages are not available. Reference to the Privacy Act notice is added. This notice must be given to the applicant in this state. Statement added to the back of the form, referencing the Arizona Supplement, ACORD 61 AZ, which must be signed by the applicant.<br /><br />Arkansas Personal Auto Application ACORD 90 AR (10/2000)<br />Following are the differences from ACORD 90, the generic Personal Auto Application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide.<br /><br />Personal Injury Protection coverages are revised to reflect unique Arkansas coverages and options. Refer to your state manual.<br />Provision made for Uninsured Motorists Property Damage deductible; Underinsured Motorists Property Damage is not available.<br />Statement added to the back of the form, referencing the Arkansas Supplement, ACORD 61 AR, which must be used if the applicant chooses Uninsured or Underinsured Motorists Bodily Injury coverages less than the limits of the policy's basic Bodily Injury Liability limits.<br /><br />California Personal Auto Application ACORD 90 CA (1/2000)<br />Following are the differences from ACORD 90, the generic Personal Auto Application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverage does not apply. This is not a "no-fault" state. Underinsured Motorists coverage is included in Uninsured Motorists coverage. Reference to "Waiver of Collision Deductible" is added. Statement added referring to the offer of Uninsured Motorists coverage up to the Bodily Injury Liability coverage in the policy, and the applicant's right to select lower limits, reject coverage for certain drivers, or reject UM coverage entirely. If the applicant chooses any option other than limits equal to the policy's BI limits, the California Auto Supplement, ACORD 61 CA, must be signed. Statement added referring to the offering of a Waiver of the Collision deductible. A column titled "Good DRV" is added to the Resident and Driver Information section, to recognize "Good Drivers" as required by California Law. The column titled "Defensive Driving Date" is retitled "ACC Prev CSE Date" (Accident Prevention Course Date). A General Information question (No. 15) is added, relating to brokered business. The Fair Credit Reporting Act on the back of the form is editorially revised. The generic fraud statement is replaced by a fraud statement now mandated by California law. A statement is added to the back of the form as required by California law, advising the applicant of his or her rights with respect to "good driver" policies.<br /><br />Provision is made in the Applicants section to record the name of the registered owner if different from the applicant. A field to record date leased, if applicable, is added to the Vehicle Description/Use section. An instruction is added to General Information question 2 requiring that the cost of special equipment be provided. An instruction to list driver numbers is added to General Information question 11 (regarding physical/mental impairments). A new General Information question 17 is added to capture the years licensed to drive motorcycles, when such vehicles are to be insured. This complies with a new California requirement.<br /><br />Colorado Personal Auto Application ACORD 90 CO (1/99)<br />Following are the differences from ACORD 90, the generic Personal Auto Application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverages are replaced with Colorado's unique coverages and options. Refer to your state manual. Underinsured Motorists coverage is included in Uninsured Motorists coverage. Statements added referring to the explanation and offer to the applicant of Uninsured Motorists coverage, and the right of the applicant to select/reject coverage. If Uninsured Motorists Bodily Injury coverage is rejected entirely, the applicant must initial the statement.<br /><br />Connecticut Personal Auto Application ACORD 90 CT (10/96)<br />Following are the differences from ACORD 90, the generic Personal Auto Application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Although the Connecticut legislature revised the state's no-fault law January 1, 1994, so that these coverages are no longer mandatory, coverage can still be made available. Many companies are continuing to offer Basic Reparations Benefits and/or Added Basic Reparations Benefits (no-fault coverages). Consequently, these items are included in to the Coverages/Premium section. Uninsured Motorists and Underinsured Motorists coverages are combined. Uninsured Motorists Conversion coverage is added to the Coverages/Premiums section. This coverage can be purchased instead of Uninsured/Underinsured Motorists coverage. Full Glass Optional coverage added to Comprehensive. Reference to the Privacy Act notice is added. This notice must be given to the applicant in this state.<br /><br />Delaware Personal Auto Application ACORD 90 DE (8/98)<br />Reference to the mailing of the policy to the agent or to the applicant is added to the Payment Plan section. A new field is added to the Vehicle Description/Use section to record the date the vehicle was leased, if applicable. Reference to "Policy Fee" is added in the Additional Coverages section, to accommodate those companies or agents that charge policy fees. Added instruction in the Resident and Driver Information section to show name as it appears on drivers license. At the request of the Delaware Department of Insurance, "3 years" is printed in the sentence in the Accidents/Convictions section relating to information about accidents and traffic violations. A note is added to the Employment Information section requiring that self-employed applicants state the nature of their business. An instruction is added to General Information question 2 requiring that the cost of special equipment be provided. An instruction to list driver numbers is added to General Information question 11 (regarding physical/mental impairments). Reference to "no-fault application" is removed from the Attachments section. Such forms are no longer necessary. The "Applicants Statement" on the back of the form is editorially revised. These revisions will be made to all state-specific ACORD 90 forms, but only when other specific changes must be made in the individual states.<br /><br />District of Columbia Personal Auto Application ACORD 90 DC (9/2000)<br />Following are the differences from ACORD 90, the generic Personal Auto Application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverages are revised to reflect D.C.'s unique coverages and options. Refer to your state manual. Statement added referencing the offer of Uninsured and Underinsured Motorists coverages, and the applicant's right to select coverage limits, and reject Underinsured Motorists coverage. Statement added allowing the applicant to reject Personal Injury Protection coverages. Applicant must signify rejection by initialing the form. Question relating to cancellation or declination of coverage is deleted; this question cannot<br />be asked in D.C.<br /><br />Florida Personal Auto Application ACORD 90 FL (7/2000)<br />Following are the differences from ACORD 90, the generic Personal Auto Application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverages are revised to reflect Florida's unique coverages and options. Refer to your state manual. Underinsured Motorists/Bodily Injury coverage is included in Uninsured Motorists/Bodily Injury coverage; Uninsured and Underinsured Motorists Property Damage coverages are not available. References to "stacked" and "non stacked" options are added to Uninsured Motorists coverage. Statement added to the back of the form referencing the various Uninsured Motorists coverage options, and the use of the state supplement, ACORD 61 FL, if Uninsured Motorists, or non-stacked coverage, is rejected. The fraud statement is revised to comply with a new Florida law.<br /><br />Georgia Personal Auto Application ACORD 90 GA (10/96)<br />Following are the differences from ACORD 90, the generic Personal Auto Application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverage does not apply; this is not a "no-fault" state. Uninsured Motorists coverage includes Underinsured Motorists coverage; provision is made for per-accident deductibles under Uninsured Motorists coverage. Required statements have been added to the back of the form:<br /><br />1. Noting if copies of the Privacy Act and Fair Credit Reporting notices have been given to the applicant<br />2. Referring to the state supplement containing explanation and selection options for Uninsured Motorists and Medical Payments coverages<br />3. Providing a statement regarding the advance payment of the first sixty days of coverage by the applicant, unless the policy is a continuation of another policy, and there has been no lapse in coverage<br /><br />Hawaii Personal Auto Application ACORD 90 HI (9/2000)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverages and options available. Refer to your state manual. The applicant can select "stacked" or "non-stacked" Uninsured and Underinsured Motorists BI coverage; however, there is no UM or UIM PD coverage available.<br /><br />Idaho Personal Auto Application ACORD 90 ID (11/96)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverages are not available; this is not a "no-fault" state. Uninsured and Underinsured Motorists Property Damage coverages are not available. Statement added to the back of the form, referencing the offer of Uninsured and Underinsured Motorists Bodily Injury coverages up to the policy's basic Bodily Injury Liability limits, and the applicant's right to select other limits, or to reject coverage entirely.<br /><br />Illinois Personal Auto Application ACORD 90 IL (8/2000)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverages deleted; this is not a "no-fault" state. Uninsured and Underinsured Motorists Bodily Injury coverages are combined; Underinsured Motorists Property Damage coverage does not apply; Uninsured Motorists Property Damage coverage is shown separately. Reference to the Privacy Act notice is added. This notice must be given to the applicant in this state. Statement added referring to the state supplement, ACORD 61 IL, with respect to the selection of Uninsured/Underinsured Motorists Bodily Injury Liability coverage lower than the Bodily Injury Liability coverage in the policy, or the selection of Uninsured Motorists Property Damage coverage for vehicles not covered by collision insurance.<br /><br />Indiana Personal Auto Application ACORD 90 IN (8/2000)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverages are not available; this is not a "no-fault" state. Statement added to the back of the form, referencing the offer of Uninsured and Underinsured Motorists Bodily Injury and Property Damage coverages. The applicant must initial the statement if any coverage is rejected.<br /><br />Iowa Personal Auto Application ACORD 90 IA (10/96)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverages are not available; this is not a "no-fault" state. Uninsured Motorists and Underinsured Motorists coverage sections include reference to "stacked" and "non-stacked" coverages; Uninsured and Underinsured Motorists Property Damage coverages are not available. Statement added to the back of the form, referencing the state supplement, ACORD 61 IA, the offer of various Uninsured and Underinsured Motorists Bodily Injury coverage options, and the applicant's right to select or to reject coverage entirely. If the insured decides to select "stacked" UM or UIM, or to reject either UM or UIM coverage, the state supplement must be signed.<br /><br />Kansas Personal Auto Application ACORD 90 KS (9/2000)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverages have been revised to allow for Kansas options. Refer to your state manual. Uninsured Motorists coverage includes Underinsured Motorists coverage; however, there is no Property Damage coverage available. Information relating to accidents or convictions on the front of the form is limited to the last 3 years, as is information regarding license suspension/revocation on the back of the form. Reference to the Privacy Act notice is added. This notice must be given to the applicant in this state. A required statement has been added to the back of the form, advising the applicant that auto liability insurance may be available through the Kansas Automobile Insurance Plan. In addition, a statement has been added to the back of the form requiring the applicant to acknowledge available Uninsured Motorists coverage options, including the option of rejecting UM limits higher than the mandatory minimum limits.<br /><br />Kentucky Personal Auto Application ACORD 90 KY (9/2000)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Provision is made to report the "Tax Territory" as required by Kentucky Law. Personal Injury Protection coverages are revised to reflect Kentucky's unique coverages and options. Refer to your state manual. Uninsured and Underinsured Motorists Property Damage coverages are not available. Added section to the back of the form to allow descriptions of motorcycles, and named individuals to be covered, as required under PIP options. Provided statement referencing the explanation to the applicant of Uninsured and Underinsured Motorists coverages and available options; provided space to allow the applicant to reject UM and/or UIM. The fraud statement on the back of the form is revised to reflect a new Kentucky law.<br /><br />Louisiana Personal Auto Application ACORD 90 LA (6/98)<br />Reference to the mailing of the policy to the agent or to the applicant is added to the Payment Plan section. A new field is added to the Vehicle Description/Use section to record the date the vehicle was leased, if applicable. Provision is made to select "Economic & Non Economic" Loss coverage or "Economic Loss only" coverage in the Uninsured Motorists coverage item. Reference to "Policy Fee" is added in the Additional Coverages section, to accommodate those companies or agent sthat charge policy fees. Added instruction in the Resident and Driver Information section to show name as it appears on drivers license. A note is added to the Employment Information section requiring that self-employed applicants state the nature of their business. An instruction is added to General Information question 2 requiring that the cost of special equipment be provided. An instruction to list driver numbers is added to General Information question 11 (regarding physical/mental impairments). The "Applicants Statement" on the back of the form is editorially revised. The statement relating to Uninsured Motorists BI and PD coverage selection and rejection is revised to refer to the new Louisiana Auto Supplement. The new supplement must be used if UMBI or UMPD coverage is rejected, or if the applicant selects UMBI coverage lower than the policy's liability limits. These revisions will be made to all state-specific ACORD 90 forms, but only when other specific changes must be made in the individual states.<br /><br />Maine Personal Auto Application ACORD 90 ME (9/2000)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverages are not available; this is not a "no-fault" state. Uninsured and Underinsured Motorists Bodily Injury coverages are combined.<br />Uninsured and Underinsured Motorists Property Damage coverages are not available. Statement added to the back of the form, referencing the offer of Uninsured/ Underinsured Motorists Bodily Injury coverages up to the policy's basic Bodily Injury Liability limits and the applicant's right to select lower limits, or to reject coverage entirely.<br /><br />Maryland Personal Auto Application ACORD 90 MD (1/98)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverages are revised to reflect Maryland's unique coverages and options. Refer to your state manual. Underinsured Motorists coverage is included in Uninsured Motorists coverage. A limit of three years is added to the question relating to accidents and convictions on the front of the form, as required by the Maryland Insurance Department. Statement added to the back of the form, referencing the state supplement, ACORD 61 MD, which must be given to the applicant if Personal Injury Protection coverage is rejected, or if Uninsured Motorists' Bodily Injury coverage less than the limits of the policy's Bodily Injury Liability limits is selected.<br /><br />Application For Massachusetts Motor Vehicle Insurance ACORD 90 MA (1/2000)<br />This application is entirely different than applications in other states. Therefore, all the instructions for completing the form are provided.<br /><br />The state of Massachusetts requires personal automobile, new business and renewals, to be submitted on forms that are prescribed by the Massachusetts Commissioner of Insurance. The ACORD 90 MA, Application for Massachusetts Motor Vehicle Insurance, meets the<br />prescribed requirements. Questions or comments regarding this form should be directed to the Massachusetts Automobile Insurance Bureau.<br /><br />This application is designed for up to two vehicles and six operators. If these limits are insufficient, attach an additional ACORD 90 MA.<br /><br />Company/Producer<br />Name of the insurance company that will receive the application or name of the producer submitting the application. Use the actual name of the company within the group in which you wish to have the policy issued. Do not use group names.<br /><br />Code<br />Identification code assigned to the agency or brokerage firm by the insurance company receiving this form.<br /><br />Binder/Policy<br />Number assigned by the agent, if a binder is used, or the company, if the policy number is known.<br /><br />Effective Date<br />Month, day and year on which the terms and conditions of the policy will commence.<br /><br />Expiration Date<br />Month, day and year on which the terms and conditions will terminate unless renewed.<br /><br />Applicant's Name and Residential Address<br />Full name of the applicant as it should appear on the policy. The first named insured is given certain rights and responsibilities by the policy contract language. If more than one insured is named, be sure the one intended to receive these rights and responsibilities is named first and the additional insured identified as such. If joint ownership, the name used may include both names (e.g., John and Mary Smith).<br /><br />Provide the physical address (not a P.O. Box) at which the first named insured is to receive all correspondence.<br /><br />Phone<br />Telephone number at which the applicant may be reached, including area code and extension, if applicable.<br /><br />Mail Address (if different)<br />Address at which the applicant is to receive mail; this may be a P.O. Box.<br /><br />Direct Bill/Agency Bill<br />Indicate whether the agency or the company (direct) will bill the insured or other payor for the policy.<br /><br />Payment Plan<br />Indicate the plan to be used to pay the company for the policy. Use the company's specific designation for the plan where possible.<br /><br />Deposit Premium<br />Deposit submitted with the application.<br /><br />COVERAGES<br /><br />Space is provided for two vehicles. Coverages 1-4 are compulsory and must be provided for each vehicle. Coverages 5-12 are optional. The applicant may choose all, none or any number of these optional coverages. Refer to the Massachusetts Personal Automobile Manual for descriptions of coverages.<br /><br />Est. Total Premium<br />Aggregate dollar amount owed to the company for all vehicles on this policy.<br /><br />VEHICLE INFORMATION<br /><br />Principal Garaging - City or Town and /Zip<br />City or town in which vehicle number one is primarily located.<br /><br />Year<br />Model year of the vehicle.<br /><br />Make<br />Vehicle manufacturer.<br /><br />Model<br />Manufacturer's trade name for the vehicle.<br /><br />Motorcycle CC<br />Number of cubic centimeters of displacement for motorcycles.<br /><br />Vehicle Identification Number<br />Full vehicle identification number appearing on the title certificate or registration.<br /><br />Registration Plate Number<br />Number on the license plate for the vehicle.<br /><br />Date of Purchase<br />Year the applicant acquired the vehicle.<br /><br />Cost New<br />Original cost of the vehicle.<br /><br />Estimated Annual Mileage<br />Total estimated annual mileage for each vehicle.<br /><br />Odometer Reading<br />Current number of miles on the odometer.<br /><br />Air Bag/Passive Seat Belt<br />Answer "Yes" if the vehicle is equipped with an air bag or automatic shoulder harness seat belt.<br /><br />Anti-Theft Device<br />Answer "Yes" if the vehicle is equipped with an anti-theft device.<br /><br />Vehicle Recovery System<br />Answer "Yes" if the vehicle is equipped with a vehicle recovery system.<br /><br />Leased Auto<br />Answer "Yes" if the vehicle is currently provided through a leasing program.<br /><br />Secured Lender/Lessor<br />Provide complete name and mailing address of the lending institution holding the loan on the vehicle.<br /><br />Date of Final Payment<br />Date on which the vehicle's loan payments will be completed.<br /><br />DRIVER INFORMATION<br /><br />Operator Name<br />Name of each licensed operator (resident or not). Show the applicant as driver #1, even if not an operator.<br /><br />Date of Birth<br />Birth date of each driver and household resident (MM/DD/YY). (e.g., March 7, 1944 should be 03/07/44).<br /><br />Driver's License #/Licensed State<br />The complete driver's license number for each licensed operator. Copy directly from license if possible. List the licensed state for each operator.<br /><br />Date First Licensed<br />Month and year in which each operator became licensed. Enter both dates if applicable.<br /><br />Approved Driver Training<br />Answer "Yes" if the operator has completed an approved driver training course.<br /><br />% of Use<br />Indicate how much each vehicle is driven by each operator. Usage for each operator should total to 100%.<br /><br />Driver Information Questions<br />Answer questions A through F with respect to all listed operators. Explain "Yes" responses in the Description of Incident section.<br /><br />Fully describe accidents or convictions, including the number of vehicles involved and the type of vehicles (private passenger or commercial). Convictions constitute a judgment of guilty, plea of nolo contendere or forfeiture of bail. Use Remarks section or an additional piece of paper if necessary.<br /><br />Location<br />City and state of the accident or conviction.<br /><br />Date<br />Date of the incident.<br /><br />GENERAL INFORMATION<br /><br />Provide a complete explanation in the Remarks section for any "Yes" responses for questions 1-7. Use additional paper if space in the Remarks section is inadequate. Respond to questions 8-12 in the spaces provided.<br /><br /><br />Michigan Personal Auto Application ACORD 90 MI (10/96)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Additional Property Damage Liability coverage in the amount of $500.00 is a basic liability coverage. Personal Injury Protection coverages have been revised to allow for unique Michigan coverages and options. Refer to your state manual. No property damage coverage is available under Uninsured or Underinsured Motorists. Several collision options are shown. Refer to your state manual. The "Good Student" box in the Resident and Driver Information section is deleted, as required by the Michigan Insurance Bureau. Information relating to accidents is limited to the last 5 years, and information relating to coverage cancellation or declination is limited to the last 3 years. Reference to Young Driver Questionnaire, Good Student Certificate and Medical Statement are deleted from the Attachments section. The Fair Credit Reporting Account Statement, Fraud Statement and Applicants Statement on the back of the form have been revised to comply with Michigan law and regulations. The question "How long have you known the applicant?" is deleted, to comply with regulations. Provision is made to allow individuals covered under the policy who are 60 years of age or older, and who have no expectation of actual income loss in the event of an accident, to reject coverage for work loss under Personal Injury Protection coverage. Each individual eligible must sign the application. A statement is added referencing the Michigan Collision Insurance Options Notice (ACORD 62 MI) which must be given to every applicant for auto insurance in Michigan. A statement is added that provides the address and phone number of the Michigan Insurance Bureau.<br /><br />Minnesota Personal Auto Application ACORD 90 MN (1/2000)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverage reflects Minnesota's unique coverages. Uninsured and Underinsured Bodily Injury coverage is combined; there is no Property Damage coverage. Comprehensive coverage can include "Full Glass" coverage; refer to your rating manual. Information relating to accidents is limited to the last 5 years, and information relating to suspension or revocation of drivers licenses is limited to l0 years. Reference to the Privacy Act notice is added. This notice must be given to the applicant in this state. A statement is added requiring the applicant to acknowledge receipt of a copy of the Minnesota Guaranty Association Notice (ACORD 65 MN). A statement is added requiring the applicant to acknowledge the offering of Uninsured/Underinsured Motorists coverage up to the limits of BI Liability. A statement is added referencing the company's right to cancel coverage during the forty-nine days following the issuance of coverage, for any reason not prohibited by law. The fraud statement on the back of the form is revised to reflect a new Minnesota law.<br /><br />Mississippi Personal Auto Application ACORD 90 MS (1/97)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverages are not available; this is not a "no-fault" state. Uninsured and Underinsured Motorists coverage's are combined. Statement added to the back of the form, referencing the offer of Uninsured/Underinsured Motorists coverage's up to the limits of the policy's Liability limits, and the applicant's right to select lower limits, or to reject coverage entirely. The applicant must initial the option selected.<br /><br />Missouri Personal Auto Application ACORD 90 MO (10/96)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverage does not apply; this is not a "no-fault" state. Uninsured and Underinsured Motorist Property Damage coverage's are not available. A required statement has been added to the back of the form, indicating that the premium quoted is an estimate only, and that premium charged will be in accordance with the company's filed rates. A statement has been added to the back of the form, referencing the offer of Uninsured and Underinsured Motorists coverage.<br /><br />Montana Personal Auto Application ACORD 90 MT (1/97)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverage is not available; this is not a "no-fault" state. Uninsured Motorists Property Damage and Underinsured Motorists coverage's are not available. A statement has been added to the back of the form, indicating that a copy of the Privacy Act notice has been given to the applicant. A statement has been added to the back of the form, referencing the offering of Uninsured Motorists coverage up to the limits of Bodily Injury liability coverage.<br /><br />Nebraska Personal Auto Application ACORD 90 NE (8/2000)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Fields are added to the Producer section, to identify "Producer ID" and "Agency ID," as required by Nebraska regulation. Personal Injury Protection coverages are not available; this is not a "no-fault" state. Uninsured and Underinsured Motorists Property Damage coverages are not available. Statement added to the back of the form, referencing the offer of Uninsured and Underinsured Motorists Bodily Injury coverages up to the limits of the policy's Bodily Injury Liability limits and the applicant's right to select lower limits. The fraud statement is removed. It does not apply in Nebraska.<br /><br />Nevada Personal Auto Application ACORD 90 NV (1/97)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverage's are not available; this is not a "no-fault" state. Underinsured Motorists Bodily Injury coverage is included in Uninsured Motorists Bodily Injury coverage. Uninsured and Underinsured Motorists Property Damage coverage's are not available. Reference to the Privacy Act notice is added. This notice must be given to the applicant in this state. Statement added to the back of the form, referencing the state supplement, ACORD 61 NV, which must be given to the applicant to explain the available options under Medical Payments and Uninsured Motorists coverage.<br /><br />New Hampshire Personal Auto Application ACORD 90 NH (1/97)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverage's are not available; this is not a "no-fault" state. Underinsured Motorists coverage is included in Uninsured Motorists coverage.<br /><br />New Jersey Personal Auto Application ACORD 90 NJ (9/2000)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverages have been revised to provide for unique New Jersey coverages. Refer to your State Manual. Uninsured and Underinsured Motorists coverages are combined. Comprehensive is changed to "other than collision coverage". Reference to the Privacy Act notice is added. This notice must be given to the applicant in this state. The fraud statement on the back of the form is revised to comply with New Jersey law. A statement has been added referencing the offer of Uninsured/Underinsured Motorists coverage up to the policy's BI limits. A statement has been added referencing the Insurance Inspection Report, ACORD 94. The producer will indicate if a vehicle inspection has been requested or waived, according to individual company procedures.<br /><br />New Mexico Personal Auto Application ACORD 90 NM (11/96)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverages are not available; this is not a "no-fault" state. Underinsured Motorists coverage is included in Uninsured Motorists coverage. Statement added to the back of the form, referencing the offer of Uninsured Motorists Bodily Injury and Property Damage coverages up to the limits of the policy's Liability limits and the applicants right to select lower limits, or to reject coverage entirely. The applicant must initial the option selected.<br /><br />New York Personal Auto Application ACORD 90 NY (9/2000)<br />Reference to "Registered Owner if different from above" in the Applicants section is deleted. This item is covered by General Information question 1. Reference to "Supplementary Uninsured Motorists Coverage" is revised to "Supplementary Uninsured/Underinsured Motorists Coverage" in the Coverages/Premium section on the front of the form, and in the last statement on the bottom of the back of the form. These changes are required by a recent change in NY law.<br /><br />North Carolina Personal Auto Application ACORD 90 NC (9/2000)<br />Reference to the mailing of the policy to the agent or to the applicant is added to the Payment Plan section. A new field is added to the Vehicle Description/Use section to record the date the vehicle was leased, if applicable. A field is added in the Coverages/Premiums section to record information about a new option, "Alternative Economic Loss Coverage." Reference to "Policy Fee" is added in the Additional Coverages section, to accommodate those companies or agent sthat charge policy fees. Added instruction in the Resident and Driver Information section to show name as it appears on drivers license. A note is added to the Employment Information section requiring that self-employed applicants state the nature of their business. An instruction is added to General Information question 2 requiring that the cost of special equipment be provided. An instruction to list driver numbers is added to General Information question 11 (regarding physical/mental impairments). These revisions will be made to all state-specific ACORD 90 forms, but only when other specific changes must be made in the individual states.<br /><br />North Dakota Personal Auto Application ACORD 90 ND (10/2000)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverages revised to reflect North Dakota's unique coverages and options. Refer to your State Manual. Uninsured and Underinsured Motorists Bodily Injury coverages are combined; Uninsured/Underinsured Motorists Property Damage coverages are not available. Statement is added to the back of the form to allow the applicant to reject Additional Personal Injury Protection coverage. The applicant must initial the form.<br /><br />Ohio Personal Auto Application 90 OH (4/98)<br />The statement on the back of the form relating to Uninsured Motorists coverage is revised to include reference to UMPD, in addition to UMBI.<br /><br />Oklahoma Personal Auto Application ACORD 90 OK (10/96)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverage is not available; this is not a "no-fault" state. Underinsured Motorists BI coverage is included in Uninsured Motorists coverage; Property Damage coverage is not available. The fraud statement is revised to comply with Oklahoma law.<br /><br />Oregon Personal Auto Application ACORD 90 OR (2/98)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverages are revised to reflect Oregon's unique coverages and options. Refer to your State Manual. Underinsured Motorists coverage is included in Uninsured Motorists coverage. Reference to the Privacy Act notice is added. This notice must be given to the applicant in this state. Statement added to the back of the form, referring to the state supplement, ACORD 61 OR, which must be given to the applicant to explain Uninsured Motorists coverage, and the options available.<br /><br />Pennsylvania Personal Auto Application ACORD 90 PA (9/2000)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverage sections have been revised in accordance with unique Pennsylvania coverages and options. Refer to your state Manual. Provided for the selection of "stacked" or "non-stacked" coverage under Uninsured and Underinsured Motorists BI coverages. Property Damage coverage is not available. The Fraud Statement is revised to comply with Pennsylvania law.<br /><br />Puerto Rico Personal Auto Application ACORD 90 PR (3/97)<br />Following are the differences from ACORD 90, the generic Personal Auto Application. In the "Vehicle Description/Use" section, reference to "car pool," "odometer reading," "annual mileage," "governing driver" and "anti-lock brakes" were deleted. Reference to vehicle registration and plate number were added. The "Coverages/Premiums" section is revised to reflect only coverages offered in Puerto Rico. In the "Resident and Driver Information" section, reference to driver training and student discounts were deleted.<br /><br />Rhode Island Personal Auto Application ACORD 90 RI (1/97)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverages are not available; this is not a "no-fault" state. Uninsured and Underinsured Motorists coverages are combined. Statements are added to the back of the form that:<br /><br />1. Allow the applicant to acknowledge the offer of Medical Payments coverage, and the options selected;<br />2. Reference the state supplement, ACORD 61 RI, which must be signed by the applicant if Uninsured/Underinsured Motorists Bodily Injury coverage is rejected;<br />3. Allow the applicant to acknowledge the offer of Uninsured/Underinsured Motorists Property Damage coverage, and the options selected. The applicant must initial the options selected.<br /><br />South Carolina Personal Auto Application ACORD 90 SC (1/2000)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. A box relating to "Facility Code" is added to the front of the form, to provide information relating to the re-insurance facility. Provision is made to record the Fire District (required when Physical Damage coverage is written). Medical Payments coverage is deleted; Medical expenses are included under Personal Injury Protection coverage. A mandatory $200.00 deductible is shown for both Uninsured and Underinsured Motorists Property Damage coverages.<br /><br />South Dakota Personal Auto Application ACORD 90 SD (9/98)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverages are revised to reflect South Dakota's unique coverages and options. Refer to your state Manual. Uninsured and Underinsured Motorists Property Damage coverages are not available. Statement added to the back of the form to allow the applicant to select or reject supplemental auto coverage. The applicant must initial the form.<br /><br />Tennessee Personal Auto Application ACORD 90 TN (11/2000)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverages are not available; this is not a "no-fault" state. Underinsured Motorists coverage is included in Uninsured Motorists coverage. A mandatory $200.00 deductible is shown for Uninsured Motorists Property Damage coverage. Statement added to the back of the form, referencing the offer of Uninsured Motorists Bodily Injury and Property Damage coverages up to the limits of the policy's Liability limits and the applicant's right to select lower limits, or to reject coverage entirely. The applicant must initial the option(s) selected.<br /><br />Texas Personal Auto Application ACORD 90 TX (11/96)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverages are revised to provide for various Texas coverages and options. Refer to your state Manual. Uninsured and Underinsured Motorists coverages are combined. The Property Damage deductible is $250.00. Comprehensive coverage is replaced by "Other than Collision"; refer to your State Manual for options. Statements are added to the back of the form requiring the applicant to acknowledge the explanation of Uninsured/Underinsured Motorists coverage and Personal Injury Protection, and to acknowledge selection/rejection decisions by initialing the statements.<br /><br />Utah Personal Auto Application ACORD 90 UT (1/2001)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverages reflect the unique coverages available in this state. Underinsured Motorists Property Damage coverage is not available. A statement is added to the back of the form explaining arbitration as an alternative to court action. This statement is required by Utah law. A statement is added requiring the insured to initial the selection/rejection of various Uninsured and/or Underinsured Motorists coverage options.<br /><br />ACORD 90 VI (2001/03)<br />Following are the differences specific to the Virgin Islands.<br />Checkboxes are provided to record NEW or RENEWAL in the APPLICANTS section.<br />Personal Injury Protection, Uninsured and Underinsured Motorists coverage fields reflect the territory's unique coverages.<br /><br />Vermont Personal Auto Application ACORD 90 VT (1/97)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverage is not available; this is not a "no-fault" state. Underinsured Motorists coverage is included in Uninsured Motorists coverage. The Fair Credit Reporting Act Statement is replaced with Vermont's Fair Credit law requirements. A statement is added to the back of the form, referencing the explanation of Uninsured Motorists coverage to the applicant, and the applicants selection of coverage.<br /><br />Virginia Personal Auto Application ACORD 90 VA (10/98)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverage is revised to reflect the coverages and options available in Virginia. Refer to your state Manual. Underinsured Motorists coverage is included in Uninsured Motorists coverage. A required statement is added referring to the Company's right to cancel the policy for any reason within the first 60 days it is in effect, and thereafter for reasons stated in the policy. Reference to the Privacy Act notice is added. This notice must be given to the applicant in this state. A statement is added referencing the offering of Uninsured Motorists coverage. Dual lines are provided for the initials of more than one named insured at the end of the statement on the back of the form relating to Uninsured Motorists coverage selection. A recent court decision determined that each named insured must acknowledge the offer of UM coverage.<br /><br />Washington Personal Auto Application ACORD 90 WA (8/2000)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverage is revised to reflect Washington's unique coverages and options. Refer to your state Manual. Added "Auto Loan" coverage in the coverages/Premium section. Reference to the Privacy Act notice is added. This notice must be given to the applicant in this state. Statement added to the back of the form referring to the options available under Underinsured Motorists and Personal Injury Protection coverages and the applicant's right to reject these coverages.<br /><br />West Virginia Personal Auto Application ACORD 90 WV (11/97)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverages are not available; this is not a "no-fault" state. Statement added to the back of the form, referencing the state supplements, ACORD 60 WV, 61 WV, and 62 WV, with respect to the offering and selection of Uninsured and Underinsured Motorists coverages.<br /><br />Wisconsin Personal Auto Application ACORD 90 WI (7/97)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection coverages are not available; this is not a "no-fault" state. Uninsured and Underinsured Motorists Property Damage coverages are not available. Statements added to the back of the form:<br /><br />1. Acknowledging the offer of Medical Payments coverage, and allowing the applicant to reject this coverage; the applicant must initial the form of coverage that is rejected.<br />2. Acknowledging the offer of Uninsured and Underinsured Motorists Bodily Injury coverages, and the options available.<br /><br />Wyoming Personal Auto Application ACORD 90 WY (1/97)<br />Following are the differences from ACORD 90, the generic Personal Auto application. For instructions on completing the balance of this form, refer to ACORD 90 in the Personal Lines section of this guide. Personal Injury Protection is not available; this is not a "no-fault" state. Uninsured and Underinsured Motorists Property Damage coverage is not available. A statement is added to the back of the form referencing the offering of Uninsured and Underinsured Motorists coverage.<br />Click here to view my web site <a href="http://www.formsboss.com/">ACORD Forms</a>.Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.comtag:blogger.com,1999:blog-24194515.post-65611525351070393832008-01-15T12:21:00.000-05:002008-01-15T12:24:36.879-05:00ACORD Forms : How to Complete a Personal Lines Package Application , Watercraft Inland Marine Supplement 87The underwriting process for any personal lines policy begins with the submission of a completed application. This guide will provide assistance in completing the ACORD Personal Lines Package Application, Watercraft/Inland Marine Supplement.<br /><br />For property, liability and umbrella coverages, use ACORD 86.<br /><br />The generic sections of personal lines forms are explained in the Personal Lines Generic Section at the beginning of the Personal Lines Section of the Forms Instruction Guide. On the ACORD website (www.acord.org), this information appears under the title PERSONAL LINES GENERIC SECTIONS.<br /><br />INSTRUCTIONS<br /><br />WATERCRAFT COVERAGES/LIMITS OF LIABILITY<br /><br />Indicate the limit of insurance, deductible and coverage premium for each applicable coverage. List any additional coverages, including their limit and premium in the other coverage section.<br /><br />Hull Coverage<br />Provide the limit, premium and deductible for boat damage; this may include collision liability.<br /><br />Outboard Motor<br />Provide the limit and premium for damage to the outboard motor. Limits may be entered for rwo motors.<br />(Coverage for inboard motors is included in the hull coverage.)<br /><br />Portable Accessories<br />Provide the limit and premium for those items not permanently attached to the boat. Examples:<br />Oars<br />Anchors<br />Life Preservers<br />Fire Extinguishers<br /><br />Trailer<br />Provide the limit and premium for damage to the trailer.<br /><br />Liability<br />Provide the limit and premium for bodily injury and property damage. May be called protection and indemnity.<br /><br />Medical Payments<br />Provide the limit and premium for medical expenses for bodily injury to occupants of the boat.<br /><br /><br />WATERCRAFT BOAT INFORMATION<br /><br />Power<br />Indicate the method of propulsion. Examples:<br />IB = inboard<br />OB = outboard<br />IO = inboard/outdrive<br />WTRJET = water jet propulsion<br /><br />Sailboats can be powered by an auxiliary engine, therefore, please check SAIL in addition to the auxiliary type of propulsion for sailboats.<br /><br />Hull Type<br />Indicate the type of watercraft to be insured.<br /><br />Hull Material<br />Indicate the construction material of the hull.<br /><br />Fuel Tank<br />Indicate whether the fuel tank is made of fiberglass or metal.<br /><br />Registration Number<br />Show the state or federal license number for the watercraft.<br /><br />Hull ID#<br />Show the serial number of the watercraft.<br /><br />Year<br />Model year of the unit in YYYY format. If built at home, enter the year built.<br /><br />Make/Model<br />Name of the manufacturer and the model (e.g., Chris Craft Tournament Fisherman, Pacemaker Runabout).<br /><br />Cost New<br />Cost of the boat when it was purchased new, in whole dollar amounts.<br /><br />Length<br />Overall length measured in feet from bow to stern.<br /><br />Max Speed<br />Enter the maximum speed of the craft. State if measured in knots or miles per hour.<br /><br />Date Purchased<br />Date the watercraft was purchased by the insured in MMYY format.<br /><br />Present Value<br />Boat's present value, stated or agreed, in whole dollar amounts.<br /><br />Name of Boat<br />Name in which the watercraft is registered.<br /><br />Waters Navigated<br />Identify the primary area of operation (e.g., San Francisco Bay Area, Hudson River). Be very specific for yacht coverage because this description will determine the navigation warranty. (e.g., Atlantic, Pacific, Great Lakes, Inland Waterways, Rivers.)<br /><br />Territory<br />This is typically the navigation territory. However, use company manuals to determine territory.<br /><br />Berth/Storage Location<br />Physical address where the boat is stored; no P.O. boxes.<br /><br />Lay-Up Period<br />Specify the period when the boat is not in operation (e.g., from October to March). Also, state if the boat is stored afloat or in a dry dock. If the boat is stored afloat, indicate the devices used to prevent ice damage (e.g., bubble system).<br /><br />WATERCRAFT ENGINE/OUTBOARD MOTOR<br /><br />Use this section to provide information about all engines and motors used to propel the boat.<br /><br />Year<br />Model year of the engine/outboard motor in YYYY format.<br /><br />Make/Model<br />Enter the name of the manufacturer and the model (e.g., Mercury Mark 50, Evinrude 200).<br /><br />Serial Number<br />The serial number provided by the manufacturer.<br /><br />Horsepower<br />Enter the horsepower. There is a method for determining the maximum safe horsepower for a specific boat based on length and width. If the company employs this formula, it may be helpful to make note of the width in the space labeled "other". Also indicate the fuel used to power the engine.<br /><br />Date Purchased/ Cost New / Present Value<br />For outboard motors only, provide the date purchased, cost when new and present value.<br /><br />WATERCRAFT TRAILER INFORMATION<br /><br />If boat trailer insurance is to be included on the policy (usually only available for stand-alone watercraft policies), enter all pertinent information regarding the boat trailer: year, manufacturer, serial number, number of axles, capacity.<br /><br />WATERCRAFT EQUIPMENT INFORMATION<br /><br />Indicate the number present on the boat and an appropriate description of each piece of equipment.<br /><br />Bilge Pumps<br />A bilge pump is a manually operated or automatically activated device used for pumping water from the inner part of the ship's hull. Using the same principle as the manual pump, the automatic pump is activated by the rise of water within the hull. Specify the manufacturer and the model (e.g., Dynaflow Pump 304).<br /><br />Cooking Stove<br />Indicate the manufacturer, model and fuel type. Also indicate if there is more than one stove.<br /><br />CO2/Chemical System<br />A built-in fire extinguishing device. Indicate if it is manual or automatic and identify the spaces protected. Include the manufacturer and model. Use the Remarks section if necessary.<br /><br />Fire Extinguishers<br />Indicate the number of fire extinguishers on the boat. Specify the type, size, and the date last weighed, if available.<br /><br />Depth Sounder<br />An electronic device for determining the depth of the water beneath the boat. Indicate the manufacturer and model (e.g., Moran 6"- 150/SV-300).<br /><br />Ship to Shore Radio<br />Indicate the type of radio. Examples:<br />SSB-Single Side Band<br />VHF-FM-Very High Frequency- Frequency Modulation<br />CB- Citizens Band<br />Cellular Phones<br />Marine Radio<br /><br />HULL INFORMATION<br /><br />Use the Remarks section to provide additional information for any questions answered with a "Yes" response.<br /><br />1. Is the boat chartered to others?<br />If the vessel is chartered, describe the type of arrangements, destination, length of time and frequency. Indicate if it is a bare boat charter where no crew or supervision is furnished, a voyage charter, a time charter, etc. Include the purpose of the charter (sight-seeing, fishing) and whether alcohol is served.<br /><br />2. Is the boat used commercially or for business purposes?<br />Describe the commercial or business use of the vessel. Indicate if the vessel is used for demonstrations, promotions, fishing, sight-seeing trips, etc.<br /><br />3. Is the boat used for racing?<br />If the vessel is used for racing, indicate the frequency of such races during the year, the extent of the race, the waters navigated, etc.<br /><br />4. Is the boat used for waterskiing?<br />Indicate how frequently the vessel is used for waterskiing.<br /><br />5. Does the applicant employ a paid crew?<br />Specify the number of crew members, and whether they are full or part time. Be sure to list the crew members in the Operator section of the application.<br /><br />6. Any sleeping facilities?<br />Provide the number of beds.<br /><br />7. Any existing damage to the boat?<br />Describe any damage in detail.<br /><br />GENERAL INFORMATION<br /><br />Use the Remarks section to provide additional information for any questions answered with a "yes" response.<br /><br />1. Any operator have a physical/mental impairment<br />Answer "Yes" only if the impairment impedes the use of the watercraft. Indicate the impairment and any applicable medical treatment being used by the applicant. This question may not be asked in Wisconsin.<br /><br />2. Any drivers license suspended/revoked during the last three years?<br />Indicate the driver number, period of suspension, reason for suspension, and date license was reinstated.<br /><br />3. Any operator had an accident/conviction in the last three years?<br />Provide the date of each occurrence and describe in detail<br /><br /><br />INLAND MARINE COVERAGE INFORMATION<br /><br />COVERAGES<br />Enter the amounts of insurance, the rate (carried to three decimal places), and premium (rounded to the nearest whole dollar) for each applicable coverage. If objects are stored at different locations, include information for each additional location.<br /><br />Jewelry<br />Total amount for all jewelry.<br /><br />Furs<br />Total amount for all furs. If more than one category of furs is to be covered, use the blank space provided (No. 11-14).<br /><br />Fine Arts<br />Total amount for all fine arts. Include paintings, pictures, etchings, sculptures or other objects of art. Note general information question 2.<br /><br />Cameras<br />Includes photographic equipment and supplies; note general information question 5.<br /><br />Musical Instruments<br />Includes musical instruments, instrument cases, sound and amplifying equipment; note general information question 5.<br /><br />Silverware<br />Includes flatware and other silverware and goldware.<br /><br />Stamps and Coins<br />Stamps and coins may either be scheduled individually or blanket coverage may be provided. Check the box below No. 7 if unattended car coverage is to be included.<br /><br />Golfer's Equipment<br />Total amount for golfer's equipment.<br /><br />Personal Computers<br />Includes printers, modems and other peripheral equipment.<br /><br />INLAND MARINE GENERAL INFORMATION<br /><br />Use the Remarks section to provide additional information for any questions answered with a "Yes" response.<br /><br />1. Any protective devices/systems in use?<br />Provide the details for the system; include the type of system, whether it is local, central, or directly connected to a central station, and whether it was professionally installed. For scheduled jewelry kept at home, a copy of the alarm specifications sheet must be submitted to qualify for a credit.<br /><br />2. Will any property be exhibited?<br />This question refers to exhibition away from the insured's premises. Provide information regarding exhibition of the property. Include what type of property, the location where the property will be exhibited, type of exhibition, type of security, or security devices that may be used, and the duration of the exhibition.<br /><br />3. Will any special restriction/endorsements apply?<br />List the endorsements and/or describe the restrictions. If the endorsements/restrictions do not apply to all property classes or items, designate the classes or items to which they apply.<br /><br />4. Will any type of deductible apply?<br />Provide the amount and type of deductible. Designate which classes or items should have the deductible applied.<br /><br />5. Is any property used professionally/commercially?<br />List those items used in this capacity. Also, provide an explanation of how the property is used. Include cameras and musical instruments.<br /><br />SCHEDULE OF PROPERTY<br /><br />List those items that are to be covered on the policy in this section. Designate which items should receive additional coverage or rating consideration. Since a total value for each property class must be provided, group together all items of the same property class and with the same rating characteristics. When working with a long list of items, you may attach a list of the items rather than completing this section of the application. When listing items, provide a full description including serial numbers, if applicable. Appraisals or sales receipts must be included where required.<br /><br />Click here to view my web site <a href="http://www.formsboss.com/">ACORD Forms</a>.Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.comtag:blogger.com,1999:blog-24194515.post-49681014725377361682007-08-28T10:24:00.000-04:002007-08-28T10:29:41.792-04:00ACORD Forms : How to Complete a Mobile Home Application 85<p>The underwriting process for any personal lines policy begins with the<br />submission of a completed application. This guide will provide assistance in completing the ACORD Mobile Home Application.<br /><br />APPLICANT INFORMATION<br /><br />Previous Address<br />Enter previous physical address of the first named insured if the applicant has been at the current address for less than three years. Also indicate the number of years at the previous address.<br /><br />Location of Property if Diff From Above<br />Enter the physical address of the property to be insured only if it is different from the mailing address listed above.<br /><br />Applicant's/Co-Applicant's Occupation<br />Briefly describe the occupation for the applicant(s) named in the identification section. State the nature of the business if self employed.<br /><br />Applicant's/Co-Applicant's Employer Name and Address<br />Name and address of the organization that employs the applicant(s) named in the identification section.<br /><br />Yrs in Curr. Occ.<br />Number of years in current occupation or business.<br /><br />Yrs w/Curr. Empl.<br />Number of years with the present employer. If less than 3 years, provide the number of years in career field or industry in the Remarks section.<br /><br />Yrs w/Prior Empl.<br />Number of years with the prior employer.<br /><br />Mar Stat<br />Marital status of each named applicant. Codes:<br /><br />S . . . . . . . . . . . . . . . . . . . . . . . . . . . . Single<br />M. . . . . . . . . . . . . . . . . . . . . . . . . . . . Married<br />D . . . . . . . . . . . . . . . . . . . . . . . . . . . . Divorced<br />SP . . . . . . . . . . . . . . . . . . . . . . . . . . . Separated<br />W. . . . . . . . . . . . . . . . . . . . . . . . . . . . Widowed<br /><br />Date of Birth<br />Birth date of each named applicant (MM/DD/YYYY). (E.g., March 7, 1944 should be 03/07/1944.)<br /><br />Social Security #<br />Social security number for each named applicant.<br /><br />Questions relating to agent's knowledge of applicant and when property was inspected<br />Indicate how long the agent has known the applicant, and the date when the property was last inspected.<br /><br />ADDITIONAL INTEREST<br /><br />Provide the following information for each entity having an interest in the mobile home(s) to be insured: the interest number or rank (1st, 2nd), whether the additional interest is the mortgage holder (e.g., bank in which the mortgage is held), or other interest, the name and address of the interest (e.g., Loans Are Us Bank, 123 Main St, Anytown, NY 10010) and loan number.<br /><br />COVERAGES/LIMITS OF LIABILITY<br /><br />List the anticipated dollar limit amounts for each applicable coverage.<br /><br />Deductible & Type<br />Enter the deductible amount and the type (Flat, Percentage,) The deductibles may vary from one amount for all perils to different deductibles for various coverages..<br /><br />Endorsements<br />Enter the name of each applicable endorsement, and the applicable limit of coverage, if any.<br /><br />Premium<br />Enter the estimated total premium, the deposit paid by the applicant, and the balance due later.<br /><br />Payment Plan<br /><br />Indicate whether the agency or the company (direct) will bill the insured or other payee for the policy. If direct bill, also indicate who is to be billed, and the plan to be used for payment.<br /><br />RATING UNDERWRITING INFORMATION<br /><br />Year<br />The model year for the mobile home, not necessarily the year the unit was manufactured.<br /><br />Make and Model<br />The name of the manufacturer.<br /><br />ID Number<br />The unique identification number for this mobile home.<br /><br />Length/Width<br />Mobile home's exterior length and width, expressed in feet.<br /><br />Purchase Date/Price<br />Year the applicant acquired the dwelling and the purchase price. The year should be expressed in YYYY format.<br /><br />New/Used<br />Check the box to indicate if the mobile home was purchased new by the applicant, or if it was purchased from a previous owner.<br /><br />Cooking Location<br />Check the appropriate box to show the location of the cooking equipment within the mobile home.<br /><br />Tie Down<br />Check the appropriate box to indicate the type of tie down, if any, used to secure the mobile home from wind damage.<br /><br />Terr Code<br />Location of the mobile home based on individual state bureau or company manual pages.<br /><br />Fire Prem Group<br />The applicable premium group based upon the mobile home's location, construction and fire protection code. Some companies require this data; others generate it.<br /><br />EC Prem Group<br />Extended coverage, broad form and special form premium group number determined from the territory.<br /><br />Pers Liab Terr Code<br />Provide the territory code determined by the dwelling's location if the company's rate structure requires separate rating information for personal liability.<br /><br />Protect Class<br />Four character fire protection class found in individual state manuals.<br /><br />Distance to Hydrant<br />Distance (in ft.) from the nearest hydrant that supports the protection class used.<br /><br />NOTE: Where the distane to the nearest hydrant is over 1000 feet, or there is no public hydrant, describe in Remarks any additional water source such as cisterns or water tanks.<br /><br />Distance to Fire Station<br />Distance in miles from the nearest fire station that supports the protection class used.<br /><br />Fire District/Code Number<br />Fire district name and corresponding code number which can be found in the individual state manual pages.<br /><br />Protection Device Type<br />For alarms to qualify for credit, a copy of the manufacturer's specification sheet must be submitted with the application.<br /><br />Heat Type<br />Type of heating device for the residence. If the residence has no heat, check the box.<br /><br />If more than one type exists, indicate the primary and secondary types. Use the Remarks section if necessary. If fuel storage tanks are located on the premises, describe the type and indicate the location. Possible types include:<br />Electric - Permanent/Portable<br />Natural Gas<br />Liquid Propane - Permanent/Portable<br />Oil - Permanent/Portable<br />Kerosene - Permanent/Portable<br />Solar<br />Coal - Professionally/Non-Professionally Installed<br />Wood<br />Other - Explain the heating system in Remarks section<br />Central Heating<br /><br /><br />Occupancy<br />Indicate by whom the mobile home is currently occupied: owner, tenant, no occupants, or the mobile home is vacant.<br /><br />Use<br />Indicate if the mobile home is the applicant's primary or secondary residence, or if the use is seasonal, or rented to others.<br /><br />Housekeeping Condition<br />An evaluation of the interior upkeep of the mobile home.<br /><br /><br />Exterior Construction<br />Check the appropriate box.<br /><br />Foundation Construction<br />Check the box that most closely describes the type of foundation.<br /><br />Utilities<br />Check the appropriate boxes to indicate which utilities are permanently connected to the structure.<br /><br />Wiring<br />Check the appropriate box to indicate copper or aluminum wiring, and show the date the wiring was las inspected.<br /><br />OTHER STRUCTURES<br /><br />Describe any other structure(s) to be included in Coverage B - Other Structures.<br /><br />LOCATION INFORMATION<br />If the mobile home is located in a mobile home park, give Yes or No answers to the questions relating to park management and access to the park.<br />If the mobile home is not located in a mobile home park, give Yes or No answers to the question relating to visibility from the road.<br />In either case, answer the question regarding road paving.<br /><br />GENERAL INFORMATION QUESTIONS<br /><br />Use the remarks section to provide additional information for any questions answered with a "Yes" response.<br /><br />1. Any business conducted on premises?<br />Describe the business as well as where the business is conducted on the premises.<br /><br />2.Any residence employees?<br />Describe the number and type of full and part time employes.<br /><br />3. Any flooding, brush hazard, fire hazard, landslide, etc.<br />Use the Remarks section to describe the type of hazard and the distance between the residence and the hazard. Some companies may require a photograph.<br /><br />4. Any other residence owned, occupied or rented?<br />Use the Remarks section to detail the occupancy or use of the other residence. If no liability coverage is requested for this residence, detail where the coverage is provided if liability coverage is to be included in the policy for any property.<br /><br />5. Any other insurance with this company?<br />Indicate whether other insurance is currently written for this applicant by the company.,If a submission was mailed to another department recently, note it in the Remarks section along with any policy numbers available.<br /><br />6. Has insurance been transferred within the agency?<br />Indicate why the insurance has been moved from the last company.<br /><br />7. Any coverage declined, cancelled or non-renewed?<br />Explain the circumstances surrounding the situation. This question cannot be asked in certain states.<br /><br />8. Has applicant had a foreclosure, repossession or bankruptcy during the past five years?<br />Use the Remarks section to provide information regarding any real estate foreclosure, personal property repossession, or bankruptcy filing during the specified time period.<br /><br />9. Are there any animals or exotic pets kept on the premises?<br />Use the remarks section to give the age, breed, or other information about livestock or pets that may be vicious or dangerous to human beings. Also give any history of biting or causing injury to others.<br /><br />10. Is property located within two miles of tidal water?<br />Use the Remarks section to describe the coastal hazard, if applicable.<br /><br />11; Is property situated on more than five acres?<br />Ust the Remarks section to indicate if any part of the property is farmed, or used to grow crops or animals for sale, or used for any other non-residential purpose.<br /><br />12. Does applicant own any recreational vehicles (snowmobiles, dune buggys, ATVs, mini-bikes, etc.)?<br />Use the Remarks section to describe the recreational vehicle. Include the year, type, make, model, and any other information necessary to provide a complete description.<br /><br />13. During the last five years (ten in RI), has any applicant been convicted of any degree of the crime of arson? (In Rhode Island, failure to disclose the existence of an arson conviction is a misdemeanor punishable by a sentence of up to one year of imprisonment.)<br />Rhode Island law requires that all applicants for property insurance must answer this question.<br /><br />14. Any uncorrected fire or building code violations?<br />Describe any violations of applicable codes that have not been corrected.<br /><br />15. Is mobile home for sale?<br />Provide the length of time the mobile home has been for sale, and the expected sale date, if known.<br /><br />16. Is property within 300 feet of a commercial or non-residential property?<br />Describe the occupancy of any commercial or non-residential property.<br /><br />17. Is there a trampoline on the premises?<br />Describe the device.<br /><br />18. Any lead paint hazard?<br />Describe the location and the extent of the hazard.<br /><br />19.If a fuel oil tank is on the premises, has other insurance been obtained for the tank?<br />Give the First Party to the insurance and the applicable limit, and the Third Party and the applicable limit.<br />20. Is home doublewide construction?<br />Indicate if the mobile home is doublewide construction.<br /><br />LOSS HISTORY<br /><br />This section shows the losses this applicant has had in the past. List losses for the last three years unless the company requires a different period of time.<br /><br />PRIOR COVERAGE<br /><br />Prior Carrier<br />Provide the prior insurance company's name.<br /><br />Prior Policy Number<br />List the complete policy number including prefix and suffix.<br /><br />Expiration Date<br />Provide the expiration date of the prior insurance policy. </p>Click here to view my web site <a href="http://www.formsboss.com/">ACORD Forms</a>.Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.comtag:blogger.com,1999:blog-24194515.post-12144505446401707592007-04-26T13:50:00.000-04:002007-04-26T13:52:30.236-04:00ACORD Forms : How to Complete a Dwelling Fire Application 84The underwriting process for any personal lines policy begins with the submission of a completed application. This guide will provide assistance in completing the ACORD Dwelling Fire Application.<br /><br />The generic section of personal lines form are explained in the Personal Lines Generic Section at the beginning of the Personal Lines Section of the Forms Instruction Guide. On the ACORD website (www.acord.org), this information appears under the title PERSONAL LINES GENERIC SECTIONS.<br /><br />APPLICANT INFORMATION<br /><br />Previous Address<br />Enter previous physical address of the first named insured if the applicant has been at the current address for less than three years. Also indicate the number of years at the previous address.<br /><br />Location of Property if Diff From Above<br />Enter the physical address of the property to be insured only if it is different from the address listed above.<br /><br />Applicant's/Co-applicant's Occupation<br />Briefly describe the occupation for the applicant(s) named in the identification section. State the nature of business if self-employed.<br /><br />Applicant's/Co-Applicant's Employer Name and Address<br />Name and address of the organization that employs the applicant(s) named in the identification section.<br /><br />Yrs in Curr. Occ.<br />Number of years in current occupation or business.<br /><br />Yrs w/Curr. Empl.<br />Number of years with present employer. If less than 3 years, provide the number of years in career field or industry in the Remarks section.<br /><br />Yrs w/Prior Empl.<br />Number of years with the prior employer.<br /><br />Mar Stat<br />Marital status of each named applicant. Codes:<br /><br />S . . . . . . . . . . . . . . . . . . . . . . . . . . . . Single<br />M. . . . . . . . . . . . . . . . . . . . . . . . . . . . .Married<br />D . . . . . . . . . . . . . . . . . . . . . . . . . . . . Divorced<br />SP . . . . . . . . . . . . . . . . . . . . . . . . . . . Separated<br />W. . . . . . . . . . . . . . . . . . . . . . . . . . . . Widowed<br /><br />Date of Birth<br />Birth date of each named applicant (MM/DD/YYYY). (e.g., March 7, 1944 should be 03/07/1944.)<br /><br />Social Security #<br />Social security number for each named applicant.<br /><br />Questions Relating to Knowledge of Applicant and Date Property Was Inspected<br />Indicate how long the applicant is known to the agent, and when the property was last inspected by the agent.<br /><br />COVERAGES/LIMITS OF LIABILITY/ ENDORSEMENTS<br /><br />Enter the anticipated dollar limit amounts for each applicable coverage. List any optional endorsement(s), corresponding limit(s) and any endorsement information that is to be included in this policy.<br /><br />Policy Type<br />Show the policy form, form number or company form designation for the type of policy/coverage desired.<br /><br />Deductibles<br />Several deductible fields are shown. One or more may be selected, depending on the company, the jurisdiction for the policy and the property coverage. Enter the appropriate deductible amount in each field. (Note: Deductibles may be the same amount or they may differ by coverage.)<br /><br />Premium<br />Enter the estimated total premium calculated by the insurance agency, as well as the applicant's deposit.<br /><br />Payment Plan<br />Indicate whether the agency or the company (direct) will bill the insured or other payee for the policy. If direct bill, also indicate who is to be billed, and the plan to be used for payment.<br /><br />RATING/UNDERWRITING<br /><br />Provide the information below for each dwelling.<br /><br />Construction Type<br />Check the primary type of building material used to construct the dwelling. Also indicate the siding type.<br /><br />Examples of siding types not shown on the form include stucco, log, asbestos, and synthetic stucco/ EIFS (Exterior Insulation Finishing System).<br /><br />Synthetic stucco is an artificial stucco used for exterior insulation and finishing systems (EIFS). It is created by affixing a styrofoam panel to the wall sheathing. The styrofoam is covered with reinforcing mesh, followed by a base coat and a finish coat. Both the base coat and the finish coats include an acrylic resin. The resin is water soluble in its liquid form, but once applied and dried, it becomes waterproof. Typically, this type of surface is less than a half-inch thick. It is relatively light, and sounds hollow when tapped. Real stucco is relatively heavy and feels and sounds solid when tapped. It is a much harder material than synthetic stucco, and is more resistant to injury by a blow or impact.<br /><br />NOTE: you must advise the insurer if synthetic stucco (EIFS) siding is present.<br /><br />Yr Built<br />Year the dwelling was built. Use four digits (e.g., 1952). If significant alterations were made, indicate the year and describe the alternations in the Remarks section. Also complete the Renovation Update section.<br /><br />Sq Ft<br />Dwelling's total square footage of living area.<br /><br /># Rooms<br />Total number of rooms in a residence, including full and half rooms (bath).<br /><br /># Apts<br />Complete only for tenant or condominium policies. Enter the number of apartments (residences) in the building.<br /><br />Market Value<br />Estimated total dollar amount for which the dwelling could be sold under current market conditions.<br /><br />Replacement Cost<br />Estimated total dollar amount required to rebuild the dwelling without depreciation.<br /><br />Structure Type<br />Indicate the residence type. The full meaning of each abbreviation is:<br /><br />DWELLING Dwelling, intended to be a free standing, up to 4 family building.<br /><br />APART Apartment.<br /><br />CONDO Condominium.<br /><br />TOWNHOUSE Townhouse<br /><br />ROWHOUSE Rowhouse<br /><br />CO-OP Co-operative.<br /><br />Usage Type<br />Applicant's use for the dwelling within the guidelines listed. ("COC" refers to dwellings in the "course of construction.")<br /><br /># Families<br />Number of separate family units in the dwelling. Not required for HO-4 or HO-6.<br /><br /># Hsehold Res<br />Number of residents in the household.<br /><br />Purchase Date/Price<br />Year the applicant acquired the dwelling and the purchase price. The year should be expressed in YYYY format.<br /><br /># of Fire Div/ # of Units in Fire Div<br />Complete only for apartments, townhouses, rowhouses and condominiums. Enter the number of residences that are in the same fire division with the insured residence (including the insured's residence). A fire division is the number of units within the building or within approved firewalls.<br /><br />Terr Code<br />Dwelling location based on individual state bureau or company homeowners manual pages.<br /><br />Prem Group<br />Premium group codes are found in individual state homeowner manuals. Some companies may require this data, others will generate it. Premium Group is a combination of Protection Class, Territory Code and Construction Type Code used to determine the applicable rate<br />based upon the dwelling's location, construction and fire protection code.<br /><br />Protect Class<br />Dwelling's four-character fire protection grade found in individual state homeowners manuals.<br /><br />Distance to Hydrant<br />Distance in feet from the nearest hydrant to support the protection class used.<br /><br />Distance to Fire Station<br />Distance in miles from the nearest fire station to support the protection class used.<br /><br />Fire/EC Rate<br />Complete if residence is specifically rated. Refer to thecompany rate manual.<br /><br />Fire District/Code Number<br />Residence's fire district name and correspoding code number, which can be found in the idividual state manual pages.<br /><br />Protection Device Type<br />For temperature, smoke and burglar alarms to qualify for credit, a copy of the manufacturer's specification sheet must be submitted with the application. The combination of dead bolt, smoke detector and fire extinguisher qualifies for a separate credit with some companies.<br /><br />Heat Type<br />Type of heating device for the residence. If there is more than one type, indicate the primary and secondary types. Use the Remarks section if necessary. Some possible types are:<br /><br />Electric - Permanent/Portable<br />Liquid Propane - Permanent/Portable<br />Natural Gas<br />Kerosene - Permanent/Portable<br />Coal -Professionally/Non-Professionally Installed<br />Oil<br />Wood<br />Solar<br />Other - Explain the heating system in Remarks<br /><br />Housekeeping Condition<br />Enter the evaluation of the interior upkeep of the dwelling.<br /><br />Renovation Type<br />If wiring, plumbing, heating or roofing have been partially or completely replaced, provide the year updated. If the exterior has been repainted, provide the year.<br /><br />Date Heating System Last Serviced<br />Indicate the date (mm/dd/yyyy) heating system was last serviced.<br /><br />Num of Amps (Elec. Syst)<br />Indicate the number of amps in the electrical system.<br /><br />Circuit Breakers<br />Check the applicable box.<br /><br />Fuses<br />Check the applicable box.<br /><br />Knob & Tube or Aluminum Wiring<br />Check the appropriate box.<br /><br />Plumbing System Condition<br />Indicate condition of the plumbing system.<br /><br />Plumbing System - Any Known Leaks<br />Indicate if there are any known leaks in the plumbing system.<br /><br />Foundation<br />Check the applicable box.<br /><br />Dwelling Location<br />Location of the dwelling within the guidelines listed. Complete only if applicable.<br /><br />Occupancy<br />Indicate if the dwelling is occupied by the owner or a tenant, unoccupied or vacant.<br /><br />Deadbolt<br />If all entry (exterior) doors are fitted with deadbolt locks, check the box.<br /><br />Fire Extinguisher<br />If the dwelling is equipped with fire extinguisher(s), check the box. Indicate the number of fire extinguishers and their locations in the blank space.<br /><br />Visible to Neighbors<br />If the residence is visible from a road, or from another residence usually occupied by an adult during the day, check the box.<br /><br />Oil Storage Tank Location<br />If the fuel type is oil, provide the location of the fuel oil storage tank. Options are:<br /><br />Indoors above ground on masonry floor<br />Indoors above ground not on a masonry floor<br />Outdoors above ground<br />Outdoors below ground<br /><br />Also show the distance from the dwelling, if the storage tank is outdoors.<br /><br />Swimming Pool<br />If a swimming pool is on the residence property, check the appropriate boxes to indicate the existence of the pool, whether the pool is above ground, in ground, has a diving board, slide or approved fence.<br /><br />Storm Shutters<br />Check the applicable boxes.<br /><br />Hurricane Resistant Glass<br />Check the applicable box.<br /><br />Bldg Code Grade<br />Enter the ISO Building Code Grade, if applicable. Also check the appropriate box to indicate whether or not the building was inspected.<br /><br />Tax Code<br />Enter the city, county or state tax code, if required.<br /><br />Rating<br />Check the applicable box.<br /><br />Occupied Daily<br />Check the applicable box.<br /><br /># Weeks Rented<br />Number of weeks the dwelling is rented by the insured to others.<br /><br />Wind Class<br />Check the applicable box.<br /><br />Roof Material<br />Enter the material used to construct the roof. Examples:<br /><br />Composition (fiberglass, asphalt, etc.)<br />Metal<br />Poured<br />Slate<br />Tile<br />Wood Shake/Shingle<br />Other If used, explain in Remarks<br /><br />Condition of Roof<br />Indicate the condition of the roof.<br /><br />If Replacement Cost coverage applies, check the appropriate box if an ACORD replacement cost worksheet has been used (i. e., ACORD 40, 41, or 42.)<br /><br />Basement<br />Indicate the number of square feet in the basement. Leave this field blank if there is no basement.<br /><br />Garage<br />Indicate the number of square feet in the garage. Leave this field blank if there is no garage.<br /><br />Breezeway<br />Indicate the number of square feet in the breezeway. Leave this field blank if there is no breezeway.<br /><br />Rating Credits<br />Check the applicable box(es) if any rating credits apply.<br /><br />Sprinkler<br />If the dwelling is equipped with a fire sprinkler system, indicate whether it is full or partial. Leave this field blank if there is no sprinkler system.<br /><br />Fireplaces<br />Enter the number in the applicable box(es) to describe the fireplace(s.)<br /><br />GENERAL INFORMATION QUESTIONS<br /><br />Use the Remarks section to provide additional information for any questions answered with a "Yes" response. (Except questions 15, 16 and 17.)<br /><br />1. Any farming or other business conducted on premises?<br />Describe the business, where the business is conducted on the premises, and if applicable, whether corporal punishment coverage is to be provided.<br /><br />2. Any residence employees?<br />Describe the number and type of full and part time employees.<br /><br />3. Any flooding, brush, forest fire hazard, landslide, etc.?<br />Use the Remarks section to describe the type of hazard and the distance between the residence and the hazard. Some companies may require a photograph.<br /><br />4. Any other residence owned, occupied or rented?<br />Use the Remarks section to describe the occupancy or use of the other residence. If no liability coverage is requested for this residence and this policy will provide liability coverage, detail where the coverage for the other residence is provided.<br /><br />5. Any other insurance with this company?<br />Indicate whether other insurance is currently written for this applicant by the company. If a submission was mailed to another department recently, note it in the Remarks section along with any policy numbers available.<br /><br />6. Has insurance been transferred within agency?<br />Indicate why this insurance has been moved from the last company.<br /><br />7. Any coverage declined, cancelled, or non-renewed?<br />Explain the circumstances surrounding this situation. Indicate the reason for the cancellation, etc. This question cannot be asked in Missouri.<br /><br />8. Has applicant had a foreclosure, repossession, bankruptcy, judgement or lien during the past five years?<br />Use the Remarks section to provide information regarding any real estate foreclosure, personal property repossession, bankruptcy filing, judgement or lien during the specified time period.<br /><br />9. Are there any animals or exotic pets kept on the premises?<br />Use the remarks section to give the age, breed, or other information about livestock or pets that may be vicious or dangerous to human beings. Also, give any history of biting or causing injury to others or to other animals.<br /><br />10. Is property located within two miles of tidal water?<br />Use the Remarks section to describe the coastal hazard, if applicable.<br /><br />11. Is property situated on more than five acres?<br />Use the Remarks section to indicate if any part of the property is farmed, or used to grow crops or animals for sale, or used for any other non-residential purpose.<br /><br />12. Does applicant own any recreational vehicles (snowmobiles, dune buggys, ATVs, mini-bikes, etc.)?<br />Use the Remarks section to describe the recreational vehicle. Include the year, type, make, model, and any other information necessary to provide a complete description.<br /><br />13. Is Building retrofitted for earthquake?<br />Answer this question only in those earthquake zones where existing buildings may be retrofitted to comply with the latest "earthquake resistant" technology and building codes.<br /><br />14. During the last ten years, has any applicant been convicted of any degree of the crime of arson? (In Rhode Island, failure to disclose the existence of an arson conviction is a misdemeanor punishable by a sentence of up to one year of imprisonment.)<br />Rhode Island law requires that all applicants for property insurance must answer this question.<br /><br />15-17. Renters and Condos Only<br />Indicate if:<br /><br />15. There is a manager on the premises.<br /><br />16. A security attendant.<br /><br />17. The building entrance is locked.<br /><br />18. Any uncorrected code violations?<br />Describe any violations of applicable building codes that have not been corrected.<br /><br />19. Is building undergoing renovation or reconstruction?<br />Describe the type and scope of renovation or reconstruction of any part of the building.<br /><br />20. Is the house for sale?<br />Provide the length of time the house has been for sale, and the expected sale date if known.<br /><br />21. Is property within 300 ft. of a commercial or non-residential property?<br />Describe the occupancy of any commercial or non-residential property.<br /><br />22. Is there a trampoline on the premises?<br />Describe the device.<br /><br />23. Was the structure originally built for other than a private residence and then converted?<br />Describe what the structure was originally built for.<br /><br />24. Any lead paint hazard?<br />Describe the location and extent of the hazard.<br /><br />25. If a fuel oil tank is on premises, has other insurance been obtained for the tank?<br />Give the First Party to the insurance and the applicable limit, and the Third Party and the applicable limit.<br /><br />26. If building is under construction, is the applicant the general contractor?<br /><br /><br />LOSS HISTORY<br /><br />This section shows the losses this applicant has had in the past. List losses for the time period specified by the company.<br /><br />OTHER STRUCTURES<br /><br />Describe the other structure(s) and its coverage limit to be included under Coverage B - Other Structures.<br /><br />PRIOR COVERAGE<br /><br />Prior Carrier<br />Provide the prior insurance company's name.<br /><br />Prior Policy Number /Expiration Date<br />List the complete policy number including prefix and suffix, and the policy's expiration date.<br /><br />ADDITIONAL INTEREST<br /><br />Provide the following information for each entity having an interest in the dwelling(s) to be insured: the interest number or rank (1st, 2nd), whether the additional interest is the mortgage holder (i.e., bank in which the mortgage is held), or other interest, the name and address of the interest (e.g., Loans Are Us Bank, 123 Main St, Anytown, NY 10010) and loan number.<br /><br />Click here to view my web site <a href="http://www.formsboss.com/">ACORD Forms</a>.Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.com0tag:blogger.com,1999:blog-24194515.post-17554672588725688132007-04-16T13:55:00.000-04:002007-04-16T13:57:50.603-04:00ACORD Forms : How to Complete a Personal Umbrella Application 83Personal Umbrella or Personal Excess insurance policies are personal lines insurance contracts that provide for indemnification of third parties as a result of damages and/or injuries sustained due to the insured's negligence with respect to personal acts. Coverage for negligence arising out of any professional activities and nearly all business pursuits conducted by the insured is normally excluded. It is important to note that personal umbrellas normally provide personal injury in addition to bodily injury coverage. While the latter coverage deals solely with physical injuries, the former includes "injuries" sustained as a result of libel, slander, defamation of character, false arrest and other "non-physical" perils.<br /><br />Personal umbrellas typically operate in excess of or "overlay" the primary<br />liability coverage contained in other personal lines insurance contracts such as private passenger auto, homeowners and watercraft. Coverage limits are written on a combined single limit (CSL) basis. In some cases, Personal umbrellas may provide basic or "first dollar" coverage for certain types of negligence for which there is no primary coverage. Personal umbrellas can also overlay coverages afforded under certain commercial insurance contracts such as owners, landlords and tenants liability policies. They also provide that the insurer will pay legal defense costs on a first-dollar basis in addition to the policy limits. The majority of personal umbrellas contain a provision for a retained limit which effectively operates as a per occurrence deductible.<br /><br />Although insurance coverage afforded by a personal umbrella is typically<br />operative "worldwide" and specific units at risk (such as automobiles) may be related to locations in varying geographical locations (rotary territories), premiums are developed on the basis of unique personal umbrella rates applicable at the insured's primary residence. No known requirement for allocating premiums back to other exposure locations exists.<br /><br />The underwriting process for any personal lines policy begins with the<br />submission of a completed application. The generic sections of each personal lines form are explained in the Personal Lines Generic section at the beginning of the Personal Lines Section of the Forms Instruction Guide. On the ACORD website, (www.acord.org), this information appears under the title PERSONAL LINES GENERIC SECTIONS.<br /><br />UMBRELLA INFORMATION<br /><br />Policy Amount<br />Limit of liability.<br /><br />Retention<br />The amount of liability retained by the insured. Retention is generally expressed in whole dollars but can be a percentage.<br /><br />Optional Coverages to Apply<br />Insurance companies often provide options or special coverages. Examples:<br />Professional <br />Business <br />Major medical <br />Uninsured/underinsured motorists<br /><br />Specifically note each option desired and provide all the information necessary for underwriter review and policy issuance.<br /><br />In Florida, Indiana, Louisiana, and Vermont, Uninsured Motorists coverages (and Underinsured Motorist coverages in Indiana) must be offered in umbrella policies up to the liability limit of the policy when auto liability coverage is included. In Florida, auto supplement ACORD 61 FL should be used with umbrella policies. Refer to the instructions for use of this form in the State Forms section of this guide. In the other states mentioned above, no supplement is required, but the insured must initial the appropriate statement at the bottom of the back of this form, indicating selection or rejection of UM (and UIM in IN) coverage.<br /><br />Premiums<br />Methods for calculating the policy premiums differ by company, but usually include a basic amount. Any additional autos, residences, watercraft or special options involve additional premiums based on an established schedule.<br /><br />Calculations<br />The insurance company may require use of specific multipliers or factors which can be shown here.<br /><br />PAYMENT PLAN<br /><br />Indicate whether the agency or the company (direct) will bill the insured or other payee for the policy. If direct bill, also indicate who is to be billed, and the plan for payment.<br /><br />PRIMARY POLICY INFORMATION<br /><br />Type of Policy<br />The most common coverages are pre-printed on the application. Space for additional primary policies in force is provided.<br /><br />Company/Policy Number<br />Provide the name of the insurance company and the full policy number including any alphabetical prefix and/or suffix. Be sure to list all primary policies for all insureds in the household such as children with their own auto policies.<br /><br />Policy Period<br />Effective and expiration dates for each primary policy in force.<br /><br />Limits of Liability<br />Limits for each policy. Some policies may offer different limits for specific hazards (fire, legal liability or waterskiing) which must be identified. Use the blank spaces to provide this information.<br /><br />REAL ESTATE<br /><br />Location<br />Address of all owned, leased, rented or occupied residences, buildings, farms and vacant land.<br /><br />Description<br />Differentiate locations such as vacant land, apartment buildings, townhouses, single family dwellings, farms. Provide the number of acres if farm land.<br /><br />Interest<br />Show the interest of the applicant (owner, lessor, lessee, occupier, etc.) for each described location.<br /><br />Yr Built<br />Year the dwelling was built, use four digits (e.g., 1952).<br /><br />Occupancy<br />Identify the occupants of the premises (self, self and tenant, tenant, three families, doctor's office). Indicate if the occupancy is seasonal.<br /><br />AUTOMOBILES<br /><br />Year and Make and Model<br />List all automobiles owned, leased or furnished for regular use.<br /><br />RECREATIONAL VEHICLES<br /><br />Year and Type, Make and Model<br />Provide the same information as for automobiles; be specific regarding the type of vehicle. Specify if it is a dirt bike, van, scooter, etc. Include size of engine in cubic centimeter displacement and/or horsepower.<br /><br />WATERCRAFT<br /><br />Year<br />Model year of the unit in YYYY format. If built at home, the year built.<br /><br />Motor Type, Manufacturer and Model<br />Indicate type of motor (inboard, outboard, etc.), manufacturer and model.<br /><br />Length<br />Overall length measured in feet from bow to stern.<br /><br />Horsepower<br />Total horsepower of the watercraft.<br /><br />Max Speed<br />Enter the maximum speed of the craft. State if measured in knots or miles per hour.<br /><br />Value<br />Companies may require either one or both dollar amounts. Indicate in the corresponding box whether cost new or current value applies. If two amounts are required, enter the cost new first.<br /><br />Waters Navigated<br />Body of water or geographical area navigated (e.g., Atlantic, Great Lakes, Inland Waterways, Pacific, Rivers). Specific names (Hudson River, San Francisco Bay) can also be provided.<br /><br />OPERATOR INFORMATION<br /><br />Name<br />Names of all household members and all operators of vehicles or watercraft, even if they are not members of the household. The listing should include children at home or relatives/friends who may use a vehicle or watercraft.<br /><br />Sex/Mar Stat<br />Sex and marital status of each driver and household member.<br /><br />Date of Birth<br />Date of birth of each driver and household resident (MM/DD/YYYY). (e.g., March 7, 1944 should be 03/07/1944.)<br /><br />Drivers License #/Licensed State<br />Complete drivers license number and license state for each licensed operator. Copy directly from license if possible.<br /><br />Social Security #<br />Social security number for each driver.<br /><br />Vehicle, % Use<br />The vehicle operated by each of those named above, the percentage of use of the vehicle attributed to that operator, and annual mileage or any other information required by the insurance company.<br /><br />Craft, % Use<br />The watercraft operated by each of those named above, the percentage of use of the craft attributed to that operator, and annual mileage or any other information required by the insurance company.<br /><br />EMPLOYMENT<br /><br />Occupation<br />Some job titles are not very specific (Manager, Analyst). Expand upon the title as necessary (e.g., Department Manager of Plastics Manufacturer).<br /><br />Employer's Name and Address<br />Name of the employer and the address of the location where employed.<br /><br />Yrs Empl<br />Number of years the applicant(s) has been with the employer indicated above. If less than 3 years, provide the number of years in the same or other career field or industry in the Remarks area.<br /><br />PRIOR EXPERIENCE<br /><br />Losses<br />Follow the company guidelines for required information on prior losses.<br /><br />Prior Carrier and Policy Number<br />Provide the prior insurance company's name and the complete policy number, including prefix and suffix.<br /><br />GENERAL INFORMATION<br /><br />Use the Remarks section to provide additional information for any of the questions below answered with a "Yes" response.<br /><br />1. Any aircraft owned, leased, chartered or furnished for regular use?<br />This does not include scheduled commercial airlines. If the applicant is a licensed pilot, the company may require additional information.<br /><br />2. Any operators convicted for any traffic violations?<br />Provide the name of driver involved, the date and nature of the violation and/or conviction.<br /><br />3. Any operator have physical /mental impairment?<br />Provide the name of the driver and the details. Determine if the operator's impairment (e.g., amputation or epilepsy) could hinder the safe operation of a vehicle. Provide a description of any special equipment installed and treatment or medication being administered.<br /><br />4. Any swimming pool, spa or hot tub on premises?<br />Indicate if there is a swimming pool, spa or hot tub on any covered premises. If there is a swimming pool, indicate whether the pool is above/in ground and whether there is an approved fence.<br /><br />5. Any real estate, vehicles, watercraft, aircraft used commercially or for business purposes?<br />Describe all commercial or business use.<br /><br />6. Any real estate, vehicles watercraft, aircraft owned, hired, leased or regularly used, not covered by primary policies?<br />If yes, explain why no primary coverage exists.<br /><br />7. Do you engage in farming operation?<br />Describe all farming operations performed by the applicant including custom farming. Include size of the farm, its acreage and annual sales.<br /><br />8. Do you hold any non-compensated positions?<br />List any unsalaried or other philanthropic position the insured holds. Examples:<br />Corporation's board of directors <br />Master of a lodge <br />Commodore of yacht club<br /><br />9. Any full-time employees?<br />If the applicant employs any full or part time employees, provide information on whether they work inside or outside, number of employees, duties, number of hours worked per week and total payroll (e.g., housekeeper, gardener).<br /><br />10. Any non-owned property exceeding $1,000 in value in your custody?<br />If the applicant is responsible for the property of others, list the type of property. Examples:<br />Firearms <br />Art <br />Computers<br /><br />11. Any business and/or professional activities included in primary policies?<br />Provide the nature of such professional or commercial activities and whether or not income is produced.<br /><br />12. Any primary policy have reduced limits of liability?<br />Include any primary policy endorsed to limit, restrict, exclude or otherwise modify coverage provided by the basic policy form (e.g., liability may be reduced when the applicant is using watercraft for waterskiing, or for a youthful operator when operating a motor vehicle).<br /><br />13. Any coverage declined, cancelled, non-renewed?<br />If any policy had this action taken, provide the reasons and circumstances. This question cannot be asked in Missouri.<br /><br />14. Does applicant or tenants have any animals or exotic pets?<br />Use the remarks section to give the age, breed, or other information about livestock or pets that may be vicious or dangerous to human beings. Also give any history of biting or causing injury to others or to other animals.<br /><br />15. Has insurance been transferred within agency?<br />Indicate if prior carrier information shown on the front of the application represents a policy being transferred within the agency. Give reason for transfer.<br /><br />16. Any pending litigation, court proceedings or judgment?<br />If yes, describe in detail.<br /><br />17. Is there a trampoline on the premises?<br />Indicate if there is a trampoline on any covered premises.<br /><br />Click here to view my web site <a href="http://www.formsboss.com/">ACORD Forms</a>.Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.com0tag:blogger.com,1999:blog-24194515.post-7181084740822984842007-04-10T13:53:00.000-04:002007-04-10T13:56:01.027-04:00ACORD Forms : How to Complete a Watercraft Application 82The underwriting process for any personal lines policy begins with the<br />submission of a completed application. This guide will provide assistance in completing the ACORD Watercraft Application.<br /><br />This form can be used either as a stand-alone application or as a supplement to the Homeowners Application (ACORD 80) if physical damage on watercraft is being written under the Homeowners policy. Check with the company to determine whether physical damage can be written on the Homeowners policy.<br /><br />If coverage will be provided under a yacht policy, do not use this form. Use ACORD 210, Yacht Section.<br /><br />The generic sections of each personal lines form are explained in the Personal Lines Generic Section at the beginning of the Personal Lines Section of the Forms Instruction Guide. On the ACORD website, this information appears under the title PERSONAL LINES GENERIC SECTIONS.<br /><br />BOAT HULL<br /><br />Provide hull number if more than one hull is to be insured.<br /><br />Power<br />Indicate the method of propulsion. Sailboats can be powered by an auxiliary engine, therefore, please check SAIL in addition to the auxiliary type of propulsion for sailboats.<br /><br />Type of Hull<br />Indicate the type of watercraft to be insured. "Personal WC" refers to "personal watercraft".<br /><br />Hull Material<br />If the hull material is not fiberglass, metal or wood, please indicate the material type in the remarks area.<br /><br />Hull Design<br />Indicate the type of hull to be insured.<br /><br />Fuel Tank<br />Indicate whether the fuel tank is made of fiberglass or metal.<br /><br />Year<br />Model year of the unit in YYYY format. If built at home, enter the year built.<br /><br />Manufacturer/Model<br />Name of the manufacturer and the model (e.g., Chris Craft Tournament Fisherman, Pacemaker Runabout).<br /><br />Length<br />Overall length measured in feet from bow to stern.<br /><br />Max Speed<br />Enter the maximum speed of the craft. State if measured in knots or miles per hour.<br /><br />Date Purchased<br />Date the watercraft was purchased by the insured in MMYY format.<br /><br />Cost New<br />Cost of the boat when it was purchased new, in whole dollar amounts.<br /><br />Present Value<br />Boat's present value, stated or agreed, in whole dollar amounts.<br /><br />Name of Boat<br />Name in which the watercraft is registered.<br /><br />Registration Number/Hull Identification Number<br />Enter the registration number and the serial number of the watercraft.<br /><br />Waters Navigated<br />Identify the primary area of operation (e.g., San Francisco Bay Area, Hudson River).<br /><br />Territory<br />This is typically the navigation territory. However, use company manuals to determine territory.<br /><br />Berth/Storage Location<br />Physical address where the boat is stored; no P.O. boxes.<br /><br />Lay-Up Period<br />Specify the period when the boat is not in operation (e.g., October through March). Also, state if the boat is stored afloat or in a dry dock. If the boat is stored afloat, indicate the devices used to prevent ice damage (e.g., bubble system).<br /><br />ENGINE/MOTOR<br /><br />Use this section to provide information about all engines and motors used to propel the boat.<br /><br />Year<br />Model year of the engine/outboard motor in YYYY format.<br /><br />Manufacturer/Model/Serial Number<br />Enter the name of the manufacturer, the model (e.g., Mercury Mark 50, Evinrude 200), and the serial number.<br /><br />Horsepower<br />Enter the horsepower. There is a method for determining the maximum safe horsepower for a specific boat based on length and width. If the company employs this formula, it may be helpful to make note of the width in the space labeled "other".<br /><br />Fuel<br />Indicate the fuel used to power the engine.<br /><br />For Outboard Motors Only<br />Provide the date purchased, cost when new and present value.<br /><br />TRAILER<br />If boat trailer insurance is to be included on the watercraft policy (usually only available for stand-alone watercraft policies), enter all pertinent information regarding the boat trailer: year, manufacturer, serial number, number of axles, capacity, date purchased, cost.<br /><br />COVERAGES/LIMITS OF LIABILITY<br /><br />Indicate the limit of insurance, deductible and coverage premium for each applicable coverage. List any additional coverages, including their limit and premium in the other coverage section.<br /><br />Hull<br />Amount of coverage for boat damage; this may include collision liability.<br /><br />Outboard Motor<br />Amount of coverage for damage to the outboard motor. Limits may be entered for three motors.<br /><br />* Coverage for inboard motors is included in the hull coverage.<br /><br />Portable Accessories<br />Coverage amount for those items not permanently attached to the boat. Examples:<br />Oars <br />Anchors <br />Life Preservers <br />Fire extinguishers<br /><br />Trailer<br />Amount of coverage for damage to the trailer.<br /><br />Liability<br />Coverage amount for bodily injury and property damage. May be called protection and indemnity.<br /><br />Medical Payments<br />Amount of coverage for medical expenses for bodily injury to occupants of the boat.<br /><br />Uninsured Boaters Liability<br />Coverage amount for bodily injury caused by an uninsured boat operator. Some companies offer this coverage.<br /><br />Total<br />Estimated total premium.<br /><br />Describe all Credits to Apply to each Boat<br />List all credit amounts and names for each boat.<br /><br />Credit<br />Total credit amount for the watercraft portion of the policy.<br /><br /><br />PAYMENT PLAN<br /><br />Indicate whether the agency or the company(direct) will bill the insured or other payee for the policy. If direct bill, also indicate who is to be billed, and the plan to be used for payment.<br /><br />ADDITIONAL INTEREST<br /><br />Provide the following information for each entity having an interest in the motors or the watercraft to be insured: the interest number or rank (1st, 2nd), whether the additional interest is the lienholder (e.g., bank in which the loan is held) or other interest, the name and address of the interest (e.g., Loans Are Us Bank, 123 Main St, Anytown, NY 10010) and loan number.<br /><br />RATING/UNDERWRITING<br /><br />Provide a description of the equipment on the boat that is of particular interest to the underwriter.<br />Indicate the number present on the boat and an appropriate description of each piece of equipment.<br /><br />Bilge Pumps<br />A bilge pump is a manually operated or automatically activated device used for pumping water from the inner part of the ship's hull. Using the same principle as the manual pump, the automatic pump is activated by the rise of water within the hull. Specify the manufacturer and the model (e.g., Dynaflow Pump 304).<br /><br />Cooking Stove<br />Indicate the manufacturer, model and fuel type. Also indicate if there is more than one stove.<br /><br />Fume Detector<br />A device used for detecting the presence of fuel vapors below deck. Specify the manufacturer and model (e.g., Sniffer 203).<br /><br />CO2 / Chemical System<br />A built-in fire extinguishing device. Indicate if it is manual or automatic and identify the spaces protected. Include the manufacturer and model. Use the Remarks section if necessary.<br /><br />Fire Extinguishers<br />Indicate the number of fire extinguishers on the boat. Specify the type, size, and the date last weighed, if available.<br /><br />Depth Sounder<br />An electronic device for determining the depth of the water beneath the boat. Indicate the manufacturer and model (e.g., Moran 6" - 150/SV-300).<br /><br />Radar<br />A device for detecting distant objects and determining their position. Specify the manufacturer and model.<br /><br />Radio Direction Finder<br />A navigational aid employing a radio signal. Enter the manufacturer and model (e.g., Loran, GSP).<br /><br />Ship to Shore Radio<br />Indicate the type of radio. Examples:<br />SSB-Single Side Band <br />VHF-FM-Very High Frequency - Frequency Modulation <br />CB -Citizens Band <br />Cellular Phones <br />Marine Radio<br /><br />Anti-Theft Devices<br />Special locks, burglar alarms or engine cut-out devices may be employed by the applicant. Marina security may be noted as well.<br /><br />Heating<br />Describe heating system, if any.<br /><br />Other<br />Use the blank spaces to list additional equipment. Attach a separate list if necessary.<br /><br />PORTABLE ACCESSORIES<br /><br />List the portable accessories that are to be insured. Include the name of the equipment, year of manufacture, name of manufacturer, and the model and serial number if applicable. Also provide the limit(s) of insurance required.<br /><br />OPERATORS<br /><br />List the name, sex, marital status (S-Single, M-Married, D-Divorced, SEP-Separated, W-Widowed), date of birth (MM/DD/YY), social security #, auto drivers license number and licensed state if applicable, for each household member and any other frequent operators.<br /><br />OPERATORS EXPERIENCE<br /><br />Indicate if any operator completed courses offered by the United States Coast Guard Auxiliary, the Power Squadron or other recognized training. The underwriter will also be interested in the number of years of boating experience and the type of boats operated or owned. Some companies require the percentage of use for each operator. Be sure to cross-reference the operator number.<br /><br />HULL INFORMATION<br /><br />Use the Remarks section to provide additional information for any questions answered with a "Yes" response.<br /><br />1. Is the boat chartered to others?<br />If the vessel is chartered, describe the type of arrangements, destination, length of time and frequency. Indicate if it is a bare boat charter where no crew or supervision is furnished, a voyage charter, a time charter, etc. Include the purpose of the charter (sight-seeing, fishing) and whether alcohol is served.<br /><br />2. Is the boat used commercially or for business purposes?<br />Describe the commercial or business use of the vessel. Indicate if the vessel is used for demonstrations, promotions, fishing, sight-seeing trips, etc.<br /><br />3. Is the boat used for racing?<br />If the vessel is used for racing, indicate the frequency of such races during the year, the extent of the race, the waters navigated, etc.<br /><br />4. Is the boat used for waterskiing?<br />Indicate how frequently the vessel is used for waterskiing.<br /><br />5. Does the applicant employ a paid crew?<br />Specify the number of crew members, and whether they are full or part time. Be sure to list the crew members in the Operator section of the application.<br /><br />6. Any sleeping facilities?<br />Provide number of beds.<br /><br />7. Any existing damage to the boat?<br />If yes, describe in detail.<br /><br />GENERAL INFORMATION<br /><br />Use the Remarks section to provide additional information for any question answered with a "yes" response.<br /><br />1. Has the applicant lived at current address for less than 3 years?<br />Indicate the previous address of the applicant.<br /><br />2. Any operator have physical/mental impairment?<br />Answer "yes" only if the impairment impedes the use of the watercraft. Indicate the impairment and any applicable medical treatment being used.<br /><br />3.Any drivers license suspended/revoked during the last 3 years?<br />Indicate if the drivers license of any operator was suspended or revoked and explain the circumstances.<br /><br />4. Has any operator had an accident/conviction during the last 3 years?<br />Indicate accidents/convictions for both driving and boating records.<br /><br />5. Any other insurance with this company?<br />Indicate if other insurance is currently written for this applicant by the company. If a submission was mailed to another department recently, note it in the remarks section along with any policy numbers available.<br /><br />6. Any losses occur during the last 3 years?<br />Describe in detail, all losses during the last three years. Include data on the operator, the type of loss, the amount of the loss, the date and the disposition.<br /><br />7. Any coverage declined, cancelled, or non-renewed?<br />Provide the circumstances surrounding this situation. This question cannot be asked in Missouri.<br /><br />8. During the last five years(ten in RI), has any applicant been convicted of any degree of the crime of arson?<br />In RI, failure to disclose the existence of an arson conviction is a misdemeanor punishable by a sentence of up to one year of imprisonment.<br /><br />Click here to view my web site <a href="http://www.formsboss.com/">ACORD Forms</a>.Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.com0tag:blogger.com,1999:blog-24194515.post-76778783169866037892007-03-26T11:45:00.000-04:002007-03-26T11:46:49.392-04:00ACORD Forms : How to Complete a Personal Inland Marine Application 81The underwriting process for any personal lines policy begins with the submission of a completed application. This guide provides assistance in completing the ACORD Personal Inland Marine Application.<br /><br />This form can be used as a stand-alone application. It can also be used as a supplement to the Homeowners Application (ACORD 80) if scheduled personal property is being submitted as part of a homeowners transaction.<br /><br />The generic sections of each personal lines form are explained in the Personal Lines Generic Section at the beginning of the Personal Lines Sections of the Forms Instruction Guide. On the ACORD website (www.acord.org), this information appears under the title PERSONAL LINES GENERIC SECTIONS.<br /><br />APPLICANT INFORMATION<br /><br />Birth Date<br />First named applicant's date of birth (MM/DD/YYYY).<br /><br />Marital Status<br />Marital status of the first named applicant. Examples:<br /><br />S . . . . . . . . . . . . . . . . . . . . . . . . . . . . Single<br />M. . . . . . . . . . . . . . . . . . . . . . . . . . . . Married<br />D . . . . . . . . . . . . . . . . . . . . . . . . . . . . Divorced<br />SP . . . . . . . . . . . . . . . . . . . . . . . . . . .Separated<br />W. . . . . . . . . . . . . . . . . . . . . . . . . . . . Widowed<br /><br />Occupation/Spouse's Occupation<br />A brief text description of the occupation of the applicant(s) named in the top identification section.<br /><br />Terr Code<br />Location of the dwelling based on individual state bureau or company homeowner,s manual pages.<br /><br />Protect Class<br />Dwelling,s four-character fire protection grade found in individual state homeowner,s manuals.<br /><br />Fire District/Code Number<br />Dwelling's fire district name and corresponding five-character code number found in individual state homeowner,s manuals,<br /><br />Location of Property<br />Indicate the physical address of the property to be insured only if it is different from the mailing address.<br /><br />Dwelling Type(s)<br />Indicate each residence type. Possible options are:<br />Dwelling, up to four family building <br />Townhouse <br />Rowhouse <br />Apartment <br />Condominium <br />Co-operative.<br /><br />Construction Type(s)<br />Primary type of building material used to construct the dwelling.<br /><br /># Families<br />Number of families in each listed location.<br /><br />Other<br />List any other information that may be required by or helpful to the company receiving this application.<br /><br />COVERAGES<br /><br />Enter the amounts of insurance, the rate (carried to three decimal places), and premium (rounded to the nearest whole dollar) for each applicable coverage.<br /><br />If objects are stored at different locations, include information for each additional location.<br /><br />Jewelry<br />Total amount for all jewelry.<br /><br />Furs<br />Total amount for all furs. If more than one category of furs is to be covered, use the blank space provided (Nos. 10-14).<br /><br />Fine Arts<br />Total amount for all fine arts. Include paintings, pictures, etchings, sculptures or other objects of art. Note general information question 2.<br /><br />Cameras<br />Includes photographic equipment and supplies; note general information question 5.<br /><br />Musical Instruments<br />Includes musical instruments, instrument cases, sound and amplifying equipment; note general information question 5.<br /><br />Silverware<br />Includes flatware and other silverware and goldware.<br /><br />Stamps and Coins<br />Stamps and coins may either be scheduled individually or blanket coverage may be provided. Check the box below No. 7 if unattended car coverage is to be included.<br /><br />Golfer's Equipment<br />Total amount for golfer's equipment.<br /><br />Personal Computers<br />Total amount for personal computers.<br /><br />Unattended Car Coverage (Stamps and Coins)<br />Additional rating information may be required for this coverage. Check with your company.<br /><br />Broad Form Pair and Set Coverage<br />Additional rating information may be required for this coverage. Check with your company.<br /><br />Non-Mobile Organ Coverage<br />Additional rating information may be required for this coverage. Check with your company.<br /><br />Safe Credit<br />Identify any property stored in a safe. If a bank vault is used, provide the name and address of the bank.<br /><br />Breakage Coverage<br />Use an asterisk (*) to identify each item on the Schedule of Property that has breakage coverage.<br /><br />ACV Loss Settlement/Replacement Cost Loss Settlement<br />Indicate if either of these options apply.<br /><br />Blanket Coverage<br />If coverage is to be written blanket, check the box and attach a statement of values.<br /><br />GENERAL INFORMATION<br /><br />Use the Remarks section to provide additional information for any questions answered with a "Yes" response.<br /><br />1. Any protective devices/systems in use?<br />Provide the details for the system; include the type of system, whether it is local, central, or directly connected to a central station, and whether it was professionally installed. For scheduled jewelry kept at home, a copy of the alarm specifications sheet must be submitted to qualify for a credit.<br /><br />2. Will any property be exhibited?<br />This question refers to exhibition away from the insured's premises. Provide information regarding exhibition of the property. Include what type of property, the location where the property will be exhibited, type of exhibition, type of security, or security devices that may be used, and the duration of the exhibition.<br /><br />3. Will any special restriction/endorsements apply?<br />List the endorsements and/or describe the restrictions. If the endorsements/restrictions do not apply to all property classes or items, designate the classes or items to which they apply.<br /><br />4. Will any type of deductible apply?<br />Provide the amount and type of deductible. Designate which classes or items should have the deductible applied.<br /><br />5. Is any property used professionally/commercially?<br />List those items used in this capacity. Also, provide an explanation of how the property is used. Include cameras and musical instruments.<br /><br />6. Any other insurance with this company?<br />Indicate whether other insurance is currently written for this applicant by the company. If a submission was mailed to another department recently, note it in the Remarks section along with any policy numbers available. If other insurance is in force, list types of insurance and provide policy numbers. Indicate whether insurance is commercial or personal.<br /><br />7. Did any loss occur during the last 3 years?<br />Describe in detail all losses during the last three years; use the Remarks section. Include data on the applicant, the type of loss, the amount of the loss, the date and the disposition.<br /><br />8. Any coverage declined/canceled/non renewed?<br />If this situation occurred, provide the circumstances under which it happened. This question may not be asked in Missouri.<br /><br />Prior Insurance & Policy Number<br />Provide the prior insurance company's name and the complete policy number including any prefix or suffix.<br /><br />SCHEDULE OF PROPERTY<br /><br />List those items that are to be covered on the policy in this section. Designate which items should receive additional coverage or rating consideration. Since a total value for each property class must<br />be provided, group together all items of the same property class and with the same rating characteristics. When working with a long list of items, you may attach a list of the items rather than completing this section of the application. When listing items, provide a full description including serial numbers, if applicable. Appraisals or sales receipts must be included where required.<br /><br />Click here to view my web site <a href="http://www.formsboss.com/">ACORD Forms</a>.Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.com0tag:blogger.com,1999:blog-24194515.post-29154061212218368682007-03-23T13:18:00.000-04:002007-03-23T13:35:14.652-04:00ACORD Forms : How to Complete a Homeowner Application 80The underwriting process for any personal lines policy begins with submitting a completed application. This guide assists in completing the ACORD Homeowner Application. The ACORD Personal Inland Marine Application (ACORD 81) should be used for scheduling personal property which is being submitted as part of the Homeowner Application.<br /><br />The Generic sections of each personal lines form are explained in the Personal Lines Generic Section at the beginning of the Personal Lines Section of the Forms Instruction Guide on the ACORD website (www.acord.org), this information appears under the title PERSONAL LINES GENERIC SECTIONS.<br /><br />APPLICANT INFORMATION<br /><br />Previous Address<br />Enter previous physical address of the first named insured if the applicant has been at the current address for less than three years. Also indicate the number of years at the previous address.<br /><br />Location of Property if Different From Above<br />Enter the physical address of the property to be insured only if it is different from the mailing address listed above.<br /><br />Applicant's/Co-Applicant's Occupation<br />Briefly describe the occupation for the applicant(s) named in the identification section. State the nature of the business if self employed.<br /><br />Applicant's/Co-Applicant's Employer Name and Address<br />Name and address of the organization that employs the applicant(s) named in the identification section.<br /><br />Yrs in Curr. Occ.<br />Number of years in current occupation or business.<br /><br />Yrs w/Curr. Empl.<br />Number of years with the present employer. If less than 3 years, provide the number of years in career field or industry in the Remarks section.<br /><br />Yrs w/Prior Empl.<br />Number of years with the prior employer.<br /><br />Mar Stat<br />Marital status of each named applicant. Codes:<br /><br />S . . . . . . . . . . . . . . . . . . . . . . . . . . . . Single<br />M. . . . . . . . . . . . . . . . . . . . . . . . . . . . Married<br />D . . . . . . . . . . . . . . . . . . . . . . . . . . . . Divorced<br />SP . . . . . . . . . . . . . . . . . . . . . . . . . . .Separated<br />W. . . . . . . . . . . . . . . . . . . . . . . . . . . . Widowed<br /><br />Date of Birth<br />Birth date of each named applicant (MM/DD/YYYY). (E.g., March 7, 1944 should be 03/07/1944.)<br /><br />Social Security #<br />Social security number for each named applicant.<br /><br />Questions Relating to Knowledge of Applicant and Inspection of Property<br />Indicate how long the applicant is known to the agent, and the date of the last property inspection.<br /><br />COVERAGES/LIMITS OF LIABILITY/ENDORSEMENTS/PAYMENT PLAN<br /><br />Enter the anticipated dollar limit and premium charge for each applicable coverage. List any optional endorsement(s), corresponding limit(s) and any endorsement information that is to be included in this policy.<br /><br />HO Form<br />Policy form number or company form designation for the type of policy/coverage desired. Some ISO form types are:<br /><br />1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Basic<br />2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Broad<br />3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Special<br />4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tenants Contents<br />4A . . . . . . . . . . . . . . . . . . . . . . . . . . . All Risk Tenants<br />5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Comprehensive<br />6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . Condominium<br />6A . . . . . . . . . . . . . . . . . . . . . . . . . . . All Risk Condominium.<br /><br />Deductibles<br />Several deductible fields are shown. One or more may be selected, depending on the company, the jurisdiction for the policy and the property coverage. Enter the appropriate deductible amount in each field. (Note: Deductibles may be the same amount or they may differ by coverage.)<br /><br />Premium<br />Enter the estimated total premium calculated by the insurance agency, as well as the applicant's deposit.<br /><br />Payment Plan<br />Indicate whether the agency or the company (direct) will bill the insured or other payee for the policy. If direct bill, also indicate who is to be billed, and the plan to be used for payment.<br /><br />RATING/UNDERWRITING<br /><br />Provide the information below for each dwelling.<br /><br />Construction Type<br />Check the primary type of building material used to construct the dwelling. Also indicate the siding type.<br /><br />Examples of siding types not shown on the form include stucco, log, asbestos, and synthetic stucco/ EIFS (Exterior Insulation Finishing System).<br /><br />Synthetic stucco is an artificial stucco used for exterior insulation and finishing systems (EIFS). It is created by affixing a styrofoam panel to the wall sheathing. The styrofoam is covered with reinforcing mesh, followed by a base coat and a finish coat. Both the base coat and the finish coats include an acrylic resin. The resin is water soluble in its liquid form, but once applied and dried, it becomes waterproof. Typically, this type of surface is less than a half-inch thick. It is relatively light, and sounds hollow when tapped. Real stucco is relatively heavy and feels and sounds solid when tapped. It is a much harder material than synthetic stucco, and is more resistant to injury by a blow or impact.<br /><br />NOTE: you must advise the insurer if synthetic stucco (EIFS) siding is present.<br /><br />Yr Built<br />Year the dwelling was built. Use four digits (e.g., 1952). If significant alterations were made, indicate the year and describe the alternations in the Remarks section. Also complete the Renovation Update section.<br /><br />Sq Ft<br />Dwelling's total square footage of living area.<br /><br /># Rooms<br />Total number of rooms in a residence, including full and half rooms (bath).<br /><br /># Apts<br />Complete only for tenant or condominium policies. Enter the number of apartments (residences) in the building.<br /><br />Market Value<br />Estimated total dollar amount for which the dwelling could be sold under current market conditions.<br /><br />Replacement Cost<br />Estimated total dollar amount required to rebuild the dwelling without depreciation.<br /><br />Structure Type<br />Indicate the residence type. The full meaning of each abbreviation is:<br /><br />DWELLING Dwelling, intended to be a free standing, up to 4 family building.<br /><br />APART Apartment.<br /><br />CONDO Condominium.<br /><br />TOWNHOUSE Townhouse<br /><br />ROWHOUSE Rowhouse<br /><br />CO-OP Co-operative.<br /><br />Usage Type<br />Applicant's use for the dwelling within the guidelines listed. ("COC" refers to dwellings in the "course of construction.")<br /><br /># Families<br />Number of separate family units in the dwelling. Not required for HO-4 or HO-6.<br /><br /># Hsehold Res<br />Number of residents in the household.<br /><br />Purchase Date/Price<br />Year the applicant acquired the dwelling and the purchase price. The year should be expressed in YYYY format.<br /><br /># of Fire Div/ # of Units in Fire Div<br />Complete only for apartments, townhouses, rowhouses and condominiums. Enter the number of residences that are in the same fire division with the insured residence (including the insured's residence). A fire division is the number of units within the building or within approved firewalls.<br /><br />Terr Code<br />Dwelling location based on individual state bureau or company homeowners manual pages.<br /><br />Prem Group<br />Premium group codes are found in individual state homeowner manuals. Some companies may require this data, others will generate it. Premium Group is a combination of Protection Class, Territory Code and Construction Type Code used to determine the applicable rate<br />based upon the dwelling's location, construction and fire protection code.<br /><br />Protect Class<br />Dwelling's four-character fire protection grade found in individual state homeowners manuals.<br /><br />Distance to Hydrant<br />Distance in feet from the nearest hydrant to support the protection class used.<br /><br />Distance to Fire Station<br />Distance in miles from the nearest fire station to support the protection class used.<br /><br />Fire/EC Rate<br />Complete if residence is specifically rated. Refer to thecompany rate manual.<br /><br />Fire District/Code Number<br />Residence's fire district name and correspoding code number, which can be found in the idividual state manual pages.<br /><br />Protection Device Type<br />For temperature, smoke and burglar alarms to qualify for credit, a copy of the manufacturer's specification sheet must be submitted with the application. The combination of dead bolt, smoke detector and fire extinguisher qualifies for a separate credit with some companies.<br /><br />Heat Type<br />Type of heating device for the residence. If there is more than one type, indicate the primary and secondary types. Use the Remarks section if necessary. Some possible types are:<br /><br />Electric - Permanent/Portable<br />Liquid Propane - Permanent/Portable<br />Natural Gas<br />Kerosene - Permanent/Portable<br />Coal -Professionally/Non-Professionally Installed<br />Oil<br />Wood<br />Solar<br />Other - Explain the heating system in Remarks<br /><br />Housekeeping Condition<br />Enter the evaluation of the interior upkeep of the dwelling.<br /><br />Renovation Type<br />If wiring, plumbing, heating or roofing have been partially or completely replaced, provide the year updated. If the exterior has been repainted, provide the year.<br /><br />Date Heating System Last Serviced<br />Indicate the date (mm/dd/yyyy) heating system was last serviced.<br /><br />Num of Amps (Elec. Syst)<br />Indicate the number of amps in the electrical system.<br /><br />Circuit Breakers<br />Check the applicable box.<br /><br />Fuses<br />Check the applicable box.<br /><br />Knob & Tube or Aluminum Wiring<br />Check the appropriate box.<br /><br />Plumbing System Condition<br />Indicate condition of the plumbing system.<br /><br />Plumbing System - Any Known Leaks<br />Indicate if there are any known leaks in the plumbing system.<br /><br />Foundation<br />Check the applicable box.<br /><br />Dwelling Location<br />Location of the dwelling within the guidelines listed. Complete only if applicable.<br /><br />Occupancy<br />Indicate if the dwelling is occupied by the owner or a tenant, unoccupied or vacant.<br /><br />Deadbolt<br />If all entry (exterior) doors are fitted with deadbolt locks, check the box.<br /><br />Fire Extinguisher<br />If the dwelling is equipped with fire extinguisher(s), check the box. Indicate the number of fire extinguishers and their locations in the blank space.<br /><br />Visible to Neighbors<br />If the residence is visible from a road, or from another residence usually occupied by an adult during the day, check the box.<br /><br />Oil Storage Tank Location<br />If the fuel type is oil, provide the location of the fuel oil storage tank. Options are:<br /><br />Indoors above ground on masonry floor<br />Indoors above ground not on a masonry floor<br />Outdoors above ground<br />Outdoors below ground<br /><br />Also show the distance from the dwelling, if the storage tank is outdoors.<br /><br />Swimming Pool<br />If a swimming pool is on the residence property, check the appropriate boxes to indicate the existence of the pool, whether the pool is above ground, in ground, has a diving board, slide or approved fence.<br /><br />Storm Shutters<br />Check the applicable boxes.<br /><br />Hurricane Resistant Glass<br />Check the applicable box.<br /><br />Bldg Code Grade<br />Enter the ISO Building Code Grade, if applicable. Also check the appropriate box to indicate whether or not the building was inspected.<br /><br />Tax Code<br />Enter the city, county or state tax code, if required.<br /><br />Rating<br />Check the applicable box.<br /><br />Occupied Daily<br />Check the applicable box.<br /><br /># Weeks Rented<br />Number of weeks the dwelling is rented by the insured to others.<br /><br />Wind Class<br />Check the applicable box.<br /><br />Roof Material<br />Enter the material used to construct the roof. Examples:<br /><br />Composition (fiberglass, asphalt, etc.)<br />Metal<br />Poured<br />Slate<br />Tile<br />Wood Shake/Shingle<br />Other If used, explain in Remarks<br /><br />Condition of Roof<br />Indicate the condition of the roof.<br /><br />If Replacement Cost coverage applies, check the appropriate box if an ACORD replacement cost worksheet has been used (i. e., ACORD 40, 41, or 42.)<br /><br />Basement<br />Indicate the number of square feet in the basement. Leave this field blank if there is no basement.<br /><br />Garage<br />Indicate the number of square feet in the garage. Leave this field blank if there is no garage.<br /><br />Breezeway<br />Indicate the number of square feet in the breezeway. Leave this field blank if there is no breezeway.<br /><br />Rating Credits<br />Check the applicable box(es) if any rating credits apply.<br /><br />Sprinkler<br />If the dwelling is equipped with a fire sprinkler system, indicate whether it is full or partial. Leave this field blank if there is no sprinkler system.<br /><br />Fireplaces<br />Enter the number in the applicable box(es) to describe the fireplace(s.)<br /><br /><br />GENERAL INFORMATION<br /><br />Use the Remarks section to provide additional information for any questions answered with a "Yes" response (Except questions 15, 16 and 17.)<br /><br />1. Any farming or other business conducted on premises?<br />Describe the business, where business is conducted on the premises, and if applicable, whether corporal punishment or day care coverage is to be provided.<br /><br />2. Any residence employees?<br />Use the Remarks section to provide information regarding the number of employees, the nature of their employment, hours worked per week, and whether employed inside (inservants) or outside (outservants).<br /><br />3. Any flooding/brush, forest fire hazard/landslide, etc.?<br />Use the Remarks section to describe the type of hazard and the distance between the residence and the hazard. Some companies may require a photograph.<br /><br />4. Any other residence owned, occupied or rented?<br />Use the Remarks section to detail the occupancy or use of the other residence. If no liability coverage is requested for this residence, detail where the coverage is provided if liability coverage is to be included in the policy for any property.<br /><br />5. Any other insurance with this company?<br />Indicate whether other insurance is currently written for this applicant by the company. If a submission was mailed to another department recently, note it in the Remarks section along with any policy numbers available. If other insurance is in force, list types of insurance and provide policy numbers. Indicate whether insurance is commercial or personal.<br /><br />6. Has insurance been transferred within agency?<br />Indicate why this insurance has been moved from the last company.<br /><br />7. Any coverage declined, cancelled, or non-renewed?<br />Explain the circumstances surrounding this situation, including the reason for the cancellation. This question cannot be asked in Missouri.<br /><br />8. Has applicant had a foreclosure, repossession, bankruptcy, judgement or lien during the past five years?<br />Use the Remarks section to provide information regarding any real estate foreclosure, personal property repossession, or bankruptcy filing, judgement or lien during the specified time period.<br /><br />9. Are there any animals or exotic pets kept on the premises?<br />Use the Remarks section to give the age, breed, or other information about livestock or pets that may be vicious or dangerous to human beings. Also give any history of biting or causing injury to others or to other animals.<br /><br />10. Is property located within two miles of tidal water?<br />Use the Remarks section to describe the coastal hazard, if applicable. Indicate actual distance.<br /><br />11. Is property situated on more than five acres?<br />Use the Remarks section to indicate if any part of the property is farmed, or used to grow crops or animals for sale, or used for any other non-residential purpose.<br /><br />12. Does applicant own any recreational vehicles (snowmobiles, dune buggys, ATVs, mini-bikes, etc.)?<br />Use the Remarks section to describe the recreational vehicle. Include the year, type, make, model, and any other information necessary to provide a complete description.<br /><br />13. Is building retrofitted for earthquake?<br />Answer this question only in those earthquake zones where existing buildings may be retrofitted to comply with the latest "earthquake resistant" technology and building codes.<br /><br />14. During the last ten years, has any applicant been convicted of any degree of the crime of arson? (In Rhode Island, failure to disclose the existence of an arson conviction is a misdemeanor punishable by a sentence of up to one year of imprisonment.)<br />Rhode Island law requires that all applicants for property insurance must answer this question.<br /><br />15-17. Renters and Condos Only.<br />Indicate if:<br /><br />15. There is a manager on the premises.<br /><br />16. A security attendant.<br /><br />17. The building entrance is locked.<br /><br />18. Any uncorrected code violations?<br />Describe any violations of applicable building codes that have not been corrected.<br /><br />19. Is building undergoing renovation or reconstruction?<br />Describe the type and scope of renovation or reconstruction of any part of the building.<br /><br />20. Is the house for sale?<br />Provide the length of time the house has been for sale, and the expected sale date if known.<br /><br />21. Is property within 300 ft. of a commercial or non-residential property?<br />Describe the occupancy of any commercial or non-residential property.<br /><br />22. Is there a trampoline on the premises?<br />Describe the device.<br /><br />23. Was structure originally built & converted for other than private residence?<br />Indicate what the structure was originally built for.<br /><br />24. Any lead paint hazard?<br />Describe the location and the extent of the hazard.<br /><br />25. If a fuel tank is on premises, has other insurance been obtained for the tank?<br />Give the First Party and the applicable limit, and the Third Party and the applicable limit.<br /><br />26. If building is under construction, is the applicant the general contractor?<br /><br />LOSS HISTORY<br /><br />This section shows the losses this applicant has had in the past. List losses for the time period required by the company.<br /><br />CAT# refers to a Catastrophe Number that is assigned by the Insurance Services Office Property Claims Service in cases of multiple losses due to floods, hurricanes, earthquakes, and similar major loss events.<br /><br />Provision is made for the applicant to initial this section.<br /><br />PRIOR COVERAGE<br /><br />Prior Carrier<br />Provide the prior insurance company's name.<br /><br />Prior Policy Number/Expiration Date<br />List the complete policy number including prefix and suffix, and the policy's expiration date.<br /><br />ADDITIONAL INTEREST<br /><br />Provide the following information for each entity having an interest in the dwelling(s) to be insured: the interest number or rank (1st, 2nd), whether the additional interest is the mortgage holder (e.g., bank in which the mortgage is held) or other interest, the name and address of the<br />interest (e.g., Loans Are Us Bank, 123 Main St, Anytown, NY 10010) and loan number.<br /><br />Click here to view my web site <a href="http://www.formsboss.com/">ACORD Forms</a>.Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.comtag:blogger.com,1999:blog-24194515.post-1166206202272561382006-12-15T13:07:00.000-05:002006-12-15T13:10:06.143-05:00ACORD Forms : How to Complete an Evidence of Commercial Property Insurance 28<div align="center"><strong>Evidence of Commercial Property Insurance 28</strong></div><strong><div align="left"><br /></strong>The Evidence of Commercial Property Insurance (ACORD 28) provides a coverage statement for mortgagees, additional insureds and loss payees who provide mortgages or loans on real property or business personal property insured under a Commercial Lines policy. Often, the form replaces the need to send a complete policy to banks, savings and loans and other lenders, as well as other additional insureds named in the policy.<br /><br />Insurance coverage on commercial property can have many variables. Coverages, coinsurance percentages, deductibles and other details can vary widely and are important considerations to mortgages and other lenders. In addition, The Terrorism Risk Insurance Act and the recent increase in exposure to mold losses have resulted in a greater need to know more about the specific terms of the insurance contract.<br /><br />ACORD 28 provides check boxes and pre-printed text to clarify important insurance details. The intent is to reduce ambiguity and eliminate follow-up conversations and correspondence with respect to missing information that is required in most cases involving commercial real estate.<br /><br />The purpose of ACORD 28 is significantly different from the Certificate of Property Insurance (ACORD 24). Like the Certificate of Insurance, ACORD 28 summarizes coverages currently in force on a policy. However, it differs by conveying to the holder of the form all rights that go with the policy, including notice of cancellation. These "rights" apply only to individuals identified on the policy. In creating this form, ACORD received input from the Mortgage Bankers Association of America, the Council of Insurance Agents and Brokers, many insurance companies and several individual agents.<br /><br /><br />IMPORTANT<br /><br />Use ACORD 28 to provide information about physical damage coverage to loss payees in connection with an auto loan when the vehicle is being purchased and coverage is being provided under a Commercial Lines policy. Use ACORD 23, Leased Auto Certificate of Insurance in lieu of ACORD 28 to provide information to the owner of a leased motor vehicle or the lender about both liability and physical damage coverages applying to the vehicle when the coverage is being provided under a leased auto coverage form. Use ACORD 27, Evidence of Personal Property Insurance, to provide information to mortgagees, additional insureds and loss payees who provide mortgages or loans on real property or personal property insured under a Personal Lines policy.<br /><br />IDENTIFICATION SECTION<br /><br />Producer Name, Contact Person and Address<br />Producer's name, name of a contact person at the agency, and the agency's address.<br /><br />Phone (A/C, No, Ext)<br />Producer's telephone number.<br /><br />Fax (A/C, No,)<br />Producer's facsimile number.<br /><br />E-Mail Address<br />Producer's e-mail address.<br /><br />Code<br />Identification code assigned to the agency or brokerage firm by the insurance company providing the policy coverages.<br /><br />Subcode<br />If the agency uses a sub-code identification system with the company, enter the appropriate code.<br /><br />Agency Customer ID<br />Customer's identification number assigned by the agency.<br /><br />Named Insured and Address<br />Insured's name and address as they appear on the policy declarations page.<br /><br />Additional Named Insured(s)<br />Additional Insured(s) name as they appear on the policy declarations page.<br /><br />Company Name and Address<br />Name and address of the applicable insurance company. Use the actual name of the company within the group to which the policy has been issued. Do not use group names.<br /><br />NAIC No.<br />Indicate the insurance company's NAIC number.<br /><br />Loan Number<br />Insured's loan or account number for this additional interest.<br /><br />Policy Number<br />Number exactly as it appears on the policy, including prefix and suffix symbols.<br /><br />Effective Date<br />Date on which the terms and conditions of the policy commence.<br /><br />Expiration Date<br />Date on which the terms and conditions of the policy expires.<br /><br />Continued Until Terminated if Checked<br />If the policy is issued on a Continuous basis, check the available box.<br /><br />This Replaces Prior Evidence Dated<br />If a prior Evidence of Property Insurance was issued to this additional interest and this form replaces the old one, enter the date the old form was issued; otherwise, leave this field blank.<br /><br />PROPERTY INFORMATION<br /><br />Location/Description<br />For buildings, provide the street address and a brief description of the occupancy of the building (e.g., 123 Johnstone Ave, Endicott - Grocery Store with Apartments, or Route 66, five miles south of intersection with I99 - Tobacco Barn).<br /><br />For other property items, such as inland marine equipment (for lessor information), describe the item along with any available vehicle identification number or serial number (e.g., 82 Case Backhoe Model H-15, Ser # G5963a57).<br /><br />COVERAGE INFORMATION<br /><br />Cause of Loss Form<br />Check box to indicate type of Loss Form used, if applicable.<br /><br />Commercial Property Coverage Amount of Insurance<br />Amount of insurance for the associated coverage.<br /><br />Deductible<br />Deductible for the associated coverage.<br /><br />Business Income/Rental Value<br />If the mortgage or loan agreement requires either Business Income or Rental Value coverage, indicate the applicable limit, or the number of months of coverage if coverage is provided on an "actual loss sustained" basis.<br /><br />Blanket Coverage<br />If yes, indicate amount of insurance on properties identified in the Property Information section.<br /><br />Terrorism Coverage<br />Attach signed Disclosure Notice.<br /><br />Terrorism Coverage - Is coverage provided for "Certified Acts" only?<br />If yes, indicate the sub-limit for this coverage and the applicable deductible.<br /><br />Terrorism Coverage - Is coverage a "stand alone" policy?<br />If yes, indicate the limit for this coverage and the applicable deductible.<br /><br />Terrorism Coverage - Does coverage include domestic terrorism?<br />If yes, indicate the sub-limit for this coverage and the applicable deductible.<br /><br />Coverage for Mold<br />If yes, indicate the limit for this coverage and the applicable deducible.<br /><br />Mold Exclusion<br />If yes, specify the organization's form used.<br /><br />Replacement Cost<br />Check the appropriate box.<br /><br />Agreed Amount<br />Check the appropriate box.<br /><br />Co-insurance<br />If yes, indicate percent.<br /><br />Equipment Breakdown (If applicable)<br />If yes, indicate the limit for this coverage and the applicable deductible.<br /><br />Law and Ordinance - Coverage for loss to undamaged portion of building<br />If yes, indicate the limit for this coverage and the applicable deductible.<br /><br />Law and Ordinance - Demolition Costs<br />If yes, indicate the limit for this coverage and the applicable deductible.<br /><br />Law and Ordinance -Incr. Cost of Construction<br />If yes, indicate the limit for this coverage and the applicable deductible.<br /><br />Earthquake (If applicable)<br />If yes, indicate the limit for this coverage and the applicable deductible.<br /><br />Flood (If applicable)<br />If yes, indicate the limit for this coverage and the applicable deductible.<br /><br />Wind/Hail (If separate policy)<br />If yes, indicate the limit for this coverage and the applicable deductible.<br /><br />Permission to waive subrogation prior to loss<br />Check the appropriate box.<br /><br /><br />REMARKS<br /><br />Remarks<br />Space for any additional comments or to list any special conditions that may exist upon the policy.<br /><br />CANCELLATION<br /><br />Unlike the Certificate of Insurance, the Evidence of Commercial Property Insurance gives the additional interest certain rights in accordance with the policy provisions. This includes the right to receive a written notice in case of policy termination.<br /><br />Number of Days<br />Number of days before cancellation that the additional interest will be notified prior to termination of the policy (e.g., 10 days).<br /><br />ADDITIONAL INTEREST<br /><br />Name and Address<br />Name and address of the additional interest.<br /><br />Nature of Interest<br />Indicate the type of interest by checking the appropriate box. Available options are: Mortgagee and Loss Payee. Use the optional spaces to enter any other type of interest.<br /><br />Lender Servicing Agent Name and Address<br />The name and address of the servicing agent for the mortgagee or other lender.<br /><br />Authorized Representative<br />This form should be signed by an authorized representative of the issuing company.</div><div align="left"> </div><div align="left">Click here to view my web site <a href="http://www.formsboss.com/">ACORD Forms</a>.</div>Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.com0tag:blogger.com,1999:blog-24194515.post-1147115344499687662006-05-08T15:04:00.000-04:002006-05-08T15:09:04.923-04:00ACORD Forms : How to Complete an Insurance Binder 75Insurance Binder 75-S<br /><br />This guide provides basic instructions to complete the ACORD Binder forms. The descriptions explain the information needed to properly issue a binder.<br /><br />The ACORD Insurance Binder addresses both Personal Lines and Commercial Lines risks, although most ACORD Personal Lines applications contain a "built-in" binder. For Commercial Lines, the layout format within the General Liability Section of the ACORD 75 is customized to the ISO Policy Simplification program.<br /><br />Before issuing any binder, the following important considerations should be reviewed and considered carefully:<br /><br />A Binder (Cover Note) is a temporary insurance contract which provides coverage and must be underwritten as an insurance policy. <br />The improper use of binders has become a major cause of producer's Errors and Omissions claims. It is imperative that only authorized people prepare them. Preparation must be complete and accurate. <br />All binders must conform to the state insurance code for the state in which the subject of insurance is located. <br />The maximum and/or minimum term of a binder may be governed by state statute and/or company underwriting instructions. <br />At the end of the binder's specified term, all coverage expires unless a new binder has been issued or the expired binder has been replaced with a policy. <br />The language in the binder must be precise. Do not use vague or all-encompassing terms which may imply coverages not intended, such as "All Risk." If possible, use the same language and terminology that will appear on the policy. <br />An agent may only issue binders which comply with the company's<br />underwriting instructions (per company manual, agency agreement,<br />correspondence and/or company underwriter). If the authority is not in writing, the agent should obtain written authority. Most agency agreements contain stated "time frames" within which the company must be notified of any risk bound. <br />Generally, a broker cannot bind insurance. A broker may only exercise the authority extended by the company. It is recommended that individual binders be issued for each company affording coverage. <br />Most agency agreements dealing with surplus lines and specialty market contracts do not allow the agent or broker to bind coverage. Authorization must be secured prior to binding. <br />A binder provides coverage for a specified period. In most jurisdictions, a premium must be charged for this period unless the binder is replaced by a policy or endorsement. A deposit should be obtained when issuing a binder. A deposit premium may be required by some companies.<br />* Most companies prohibit issuing or extending binders where coverage has been refused or cancelled by any carrier.<br /><br />Limits<br />All Limits should be listed as whole dollar amounts. Enter Limits corresponding to those found on the policy declarations page.<br /><br />IDENTIFICATION SECTION<br /><br />Date<br />Month/day/year on which the form is completed.<br /><br />Producer<br />Name and address of the producer or broker issuing this form.<br /><br />Phone (A/C, No, Ext)<br />The producer's telephone number.<br /><br />Code<br />Identification code assigned to your agency or brokerage firm by the insurance company receiving this form.<br /><br />Subcode<br />If your agency uses a subcode identification system with the company, enter the appropriate code.<br /><br />Agency Customer ID<br />Customer's identification number assigned by the agency.<br /><br />Company<br />Name of the applicable insurance company. Use the actual name of the company within the group to which this binder is being issued. Do not use group names.<br /><br />Binder No.<br />Control number assigned to the binder for referencing purposes. If created by the agent, this number should be sequential and tracked within the Binder Log (ACORD 76). It may also be assigned by the company, in which case it might be the actual policy number. For control purposes, the number should be tracked within the Binder Log.<br /><br />Effective Date<br />Date on which the terms and conditions of the binder commenced. This date normally coincides with the effective date of the policy or of an endorsement to the policy.<br /><br />Effective Time<br />Time when the binder commenced. Check the appropriate AM or PM box associated with this time.<br /><br />Expiration Date<br />Date on which the terms and conditions of the policy will or have expired. Certain state laws limit the terms of a binder, so this date may not coincide with the policy expiration date.<br /><br />Expiration Time<br />Check the appropriate time of 12:01 AM or Noon when the binder expires.<br /><br />This Binder is issued to extend coverage in the above named company per expiring policy #<br /><br />Check the available box and enter the policy number of the expiring policy. Use this option to extend coverage on a policy where renewal is not yet available.<br /><br />Insured<br />Name of the insured and mailing address requested or found on the declarations page of the policy. The line within this field is a margin setting used for window envelopes.<br /><br />Description of Operations/Vehicles/Property<br />Outline the operations of the insured, vehicle information and usage, and, for property exposures, location information. Examples:<br />Machine Tool Die Casters <br />91 Chevy H10 Pick Up Truck - VIN C12345P8991, used for delivery <br />Location 1 - 123 North Main St, Hartford, Ct<br /><br />If the location is the same as the mailing address, and this address is properly descriptive, state "same as mailing address," rather than repeat the address.<br /><br />COVERAGES<br />All limits should be listed as dollar amounts.<br /><br />PROPERTY<br />Complete this section when binding property coverages.<br /><br />Causes of Loss<br />Check the appropriate box to indicate the Cause of Loss for which the property coverage is being bound. For options outside of Basic, Broad, or Special (Spec.), such as Spec. Excluding Theft or Homeowners - HO-3, enter the coverage name in the available space.<br /><br />Coverage/Forms<br />Subjects of insurance that are being covered and any necessary location information (e.g., Loc 1 Building Personal Property Dwelling).<br /><br />Coins %<br />Any applicable Coinsurance percentage associated with the corresponding subject(s) of insurance.<br /><br />Deductible<br />Any deductible associated with the corresponding subject(s) of insurance.<br /><br />Amount<br />Corresponding amounts of insurance for the corresponding subject(s) of insurance.<br /><br />GENERAL LIABILITY<br />Complete this section when binding general liability coverages.<br /><br />Commercial General Liability<br />Check this box for Commercial General Liability (CGL) and the corresponding box to designate the type of policy issued ñ Claims Made or Occur. (Occurrence).<br /><br />Other General Liability Coverages<br />Liability coverages not found on the form may be listed in the last three option boxes. The coverage type should be listed next to the available box (e.g., when binding Comprehensive Personal Liability, check the first box and insert "Comprehensive Personal Liability" on the line after the box).<br /><br />Coverage/Forms<br />For Commercial Lines policies, enter the classification code(s) and description of the class(es) for which the binder is being issued. Include any form numbers. For Personal Lines enter the policy form numbers.<br /><br />Retro Date For Claims Made<br />If the Claims Made option box is checked, and there is a retroactive date, enter the date. If there is no retroactive date, enter "none."<br /><br />Limits<br />Complete the appropriate limits to match the policy declarations page. All limits should be listed as whole dollar amounts.<br /><br />Abbreviations<br /><br />Products Comp/Op Agg . . . . . . . . . . Products Completed Operations Aggregate<br />Personal & Adv. Injury. . . . . . . . . . . . .Personal and Advertising Injury<br />Med. Exp. . . . . . . . . . . . . . . . . . . . . . . . . Medical Expense<br /><br />AUTOMOBILE LIABILITY<br />Complete this section when binding automobile liability coverages.<br /><br />Indicate which classes of vehicles are being bound by checking the appropriate boxes. Available options are: Any Auto, All Owned Autos, Scheduled Autos, Hired Autos and Non-Owned Autos. If coverage is for scheduled autos only, attach a list of the vehicles with their appropriate coverages. If other automobile coverages are desired, use the optional box and write the coverage name next to the box.<br /><br />Coverage/Forms<br />List any policy form numbers in this section.<br /><br />Limits<br />Complete the appropriate limits to match the policy declarations page. All limits should be listed as whole dollar amounts. Use the optional limit line to list any coverage not specifically listed, such as Additional Personal Injury Protection (APIP).<br /><br />AUTO PHYSICAL DAMAGE<br /><br />Complete this section when binding automobile physical damage coverages. If physical damage coverage is being bound, use the appropriate box to indicate Collision or Other than Collision coverage. List any deductibles in the available space.<br /><br />All Vehicles/Scheduled Vehicles<br />Indicate if collision coverage applies to all or only scheduled vehicles.<br /><br />Valuation Type<br />Check the appropriate box to indicate what basis is to be used for determining the vehicle's value. Options are: Actual Cash Value, Stated Amount and Other. For "Other," list the valuation type in the space provided.<br /><br />Limit<br />List the combined sum of the vehicle's physical damage valuation.<br /><br />GARAGE LIABILITY<br /><br />Complete this section only if you are binding garage liability. Use the available lines or the "Any Auto" option to indicate coverage specifics.<br /><br />Coverage Forms<br />List any applicable coverage form numbers.<br /><br />Limits<br />Complete the limits found on the Garage declarations page.<br /><br />EXCESS LIABILITY<br /><br />Complete this section when binding some type of excess liability policy. For Umbrella policies, check the appropriate box. If the Other Than Umbrella box is checked, an additional reference should be made in the Coverage/Forms section stating the kind of policy and to which coverages the policy applies (e.g., Excess - Auto section).<br /><br />Retro Date For Claims Made<br />If this is a Claims Made policy and there is a retroactive date, enter the date. If there is no retroactive date, enter "none."<br /><br />Limit<br />Complete the limits in accordance with the policy declarations page.<br /><br />Workers Compensation and Employer's Liability<br />Complete this section when binding workers compensation and/or employer's liability policies. If the policy being bound is written using Statutory Limits, check the appropriate box. If Employers Liability is included, show the limits for "Each Accident," "Disease-Each Employee," and "Disease-Policy Limit."<br /><br />Special Conditions/Other Coverages<br />Provide any additional information pertinent to the bound policies. Include any special endorsements that are not specified in other sections of the binder. The area can also be used to add other coverages, refer to other binders, acknowledge receipt of deposit premium, or show fees, taxes and/or estimated premium.<br /><br />NAME & ADDRESS<br /><br />This section tracks any additional interest to the policy.<br /><br />Name & Address<br />Complete name and address of an additional interest if any have been indicated. The line within this section is a margin setting used for window envelopes.<br /><br />Interest Type<br />Check the additional interest's type in the appropriate box. Options are:<br />Mortgagee <br />Loss Payee <br />Additional Insured <br />Other<br /><br />Loan #<br />List any loan number, account number or other controlling number that the additional interest may have assigned the insured.<br /><br />AUTHORIZED REPRESENTATIVE<br /><br />Binders must be signed by authorized representatives of the issuing company.<br /><br />Click here to view my web site <a href="http://www.formsboss.com/">ACORD Forms</a>.Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.com2tag:blogger.com,1999:blog-24194515.post-1146754010339834072006-05-04T10:45:00.000-04:002006-05-04T10:46:51.476-04:00ACORD Forms : How to Complete an Auto ID Card 50Automobile Insurance ID Card 50<br /><br />The ACORD Automobile Insurance Identification Card (ACORD 50) is<br />accepted in the majority of states that require the insured to carry/produce upon demand proof of insurance.<br /><br />The states where ACORD 50 is not acceptable are:<br />Arkansas <br />Delaware <br />Florida <br />Hawaii <br />Iowa <br />Kentucky <br />Louisiana <br />Michigan <br />Mississippi <br />Missouri <br />New Jersey <br />Nevada <br />New York* <br />Oklahoma <br />Pennsylvania <br />Texas <br />West Virginia<br /><br />* Effective 1/1/02, the New York ID card must be issued by means of an encrypted bar coded software program available only from insurance companies. ACORD does not provide the ID card.<br /><br />For the states listed above, refer to the State Forms section of this manual.<br />Specific ID cards are provided for each of these states except New York, and information about each ID card is provided.<br /><br />Each completed ACORD 50 ID card should include the appropriate state title on the top line before "Insurance Identification Card."<br /><br />The card is available in single sheets and two part sets to correspond with different states' specifications for the number of copies required to be produced.<br /><br />Note that ACORD ID cards are intended to be the PERMANENT means of complying with state ID card requirements. Some states have different rules for TEMPORARY ID cards. Refer to individual state rules to determine if ACORD cards can be used, or if the carrier must issue its' own temporary cards.<br /><br />Some states require additional wording and/or supplemental information when ACORD 50 is issued. Information on these states follows:<br /><br />* ACORD 50 WM may also be used in all states where ACORD 50 is acceptable. This card contains a watermark (the word "ACORD") which is invisible when the form is photocopied. This feature helps to prevent fraudulent reproduction.<br /><br />Special Provisions/State Exceptions to ACORD ID CARD<br />(ACORD 50).<br /><br />Note: Unless otherwise noted below,the COMPANY NUMBER that must be shown on the card in any of the following states is the NAIC number for the individual company issuing the policy.<br /><br />Alabama<br />Add the following wording: "Policy provides the minimum insurance prescribed by law."<br /><br />Arizona<br />The COMPANY NUMBER in this state is the number assigned to the company by the Arizona DOT.<br /><br />California<br />Add the following wording: "The policy meets the requirements of Section 16056 of the California Vehicle Code." The company address must be shown with the company name.<br /><br />Colorado<br />Must display the coverage required by law; BI, PD, PIP (effective 7/1/03, BI and PD only). Limits need not be stated.<br /><br />Connecticut<br />Add the following wording: "Connecticut Insurance Card issued pursuant to Connecticut Law." This text should appear under the pre-printed words Insurance Identification Card. Issue in duplicate. Expiration date must be one year from effective date.<br /><br />Georgia<br />Title should read "Georgia Liability Insurance Information Card" instead of "Insurance Identification Card."<br /><br />Idaho<br />Title should be either Certificate of Liability or Liability Insurance Identification Card. Inclusion of "State of Idaho" is optional.<br /><br />Illinois<br />Add the following wording: "Examine policy exclusions carefully. This form does not constitute any part of your insurance policy."<br /><br />Indiana<br />Financial Responsibility filing only.<br /><br /><br />Either of the following must be shown in the space for AGENCY/COMPANY ISSUING CARD:<br />Name, address and phone number of insurer, or<br />Name of insurer and name, address and phone number of insurance agency.<br /><br />Kansas<br />Cannot be used by those vehicles subject to the State Corporation Commission.<br /><br />Maine<br />Title should be "Maine Motor Vehicle Insurance Identification Card."<br />The following should also be added to the card (may be added to the reverse side): "The policy provides the minimum insurance required by law."<br /><br />Minnesota<br />Plain language summary of sections 169.791, 169.793 and 169.797 of Minnesota law must accompany the card but does not have to be printed on card. The following language is advisory and can be modified:<br /><br />"Every driver shall have in his or her possession while operating a motor vehicle, and shall produce on demand proof of insurance covering the vehicle being operated. Failure to produce the required proof of insurance can result in a misdemeanor conviction.<br /><br />"It is unlawful for any person to display, cause or permit the display of, or have in possession proof of insurance that is fictitious or fraudulent.<br /><br />In addition to criminal penalties, any person convicted of a misdemeanor because of any of the above is subject to drivers license revocation, and a fine of not less that $200."<br /><br />Nebraska<br />Title: Nebraska Auto Liability.<br /><br /><br />Rhode Island<br />Add the following wording: "Policy meets Rhode Island limits."<br /><br />South Carolina<br />Add the following wording: "Coverage meets SC minimum financial responsibility requirements."<br /><br />South Dakota<br />Issue in duplicate. Title: Add the following wording: "Coverage provided by this policy meets the minimum liability limits prescribed by law."<br /><br />Tennessee<br />Add the following wording: "An insurance policy has been issued that meets requirements of Tennessee Financial Responsibility law of 1977."<br /><br />Vermont<br />Title: "Vermont Automobile." Add the following wording: "Policy provides the minimum insurance prescribed by law."<br /><br />Click here to view my web site <a href="http://www.formsboss.com/">ACORD Forms</a>.Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.com2tag:blogger.com,1999:blog-24194515.post-1145977629180132752006-04-25T11:06:00.000-04:002006-04-25T11:07:09.286-04:00ACORD Forms : How to Complete an Additional Interest 45Additional Interest 45<br /><br />The Additional Interest form is used in multiple situations to expand upon<br />the additional interest sections within line of business applications. This form may be used for both personal and commercial accounts. The form is used to secure information on additional interests and certificate holders.<br /><br />IDENTIFICATION SECTION<br /><br />Date (MM/DD/YYYY)<br />Month/day/year on which the form is completed.<br /><br />Agency<br />Agency's name and address.<br /><br />Phone (A / C, No, Ext)<br />Agency's telephone number.<br /><br />Code<br />Identification code assigned to the agency or brokerage firm by the Insurance Company receiving this form.<br /><br />Agency Customer ID<br />Customer's identification number assigned by the agency.<br /><br />Applicant (First Named Insured)<br />First Named Insured as it appears on the line of business form to which this form will be attached.<br /><br />Phone (A / C, No, Ext)<br />Applicants telephone number.<br /><br />Effective Date<br />Month/day/year on which the terms and conditions of the policy will commence.<br /><br />Expiration Date<br />Month/day/year on which the terms and conditions of the policy will terminate unless renewed.<br /><br />Co/Plan<br />Name of the insurance company that will receive the application. Do not use group names, use the actual name of the company within the group in which you wish to have the policy issued. Also, if applicable, indicate the type of plan or policy program (Preferred) that you wish to use when issuing the policy. Use the specific plan name that is unique to that company.<br /><br />Policy Number<br />Number assigned by the insurance company for the policy.<br /><br />Account Number<br />Account number to be used for billing purposes. This is the Billing Number assigned by the billing entity. If agency bill, the agency assigns; if direct bill the company assigns.<br /><br />ADDITIONAL INTERESTS/CERTIFICATE RECIPIENTS<br /><br />Use this section for information on any additional interests, employees who should be listed as additional insureds, and others who require Certificates of Insurance.<br /><br />Interest<br />Indicate all appropriate options for the individual named.<br /><br />Rank<br />Primarily used for Mortgagees - indicate the ranking such as 1st, 2nd or 3rd mortgagee.<br /><br />Name and Address<br />List the additional interests name and address.<br />If the additional interest is the owner of a motor vehicle, and the owner is different from the Named Insured, show the owner's name here.<br /><br />Reference #<br />Indicate the additional interests reference number for this applicant such as the loan or mortgage number.<br /><br />Certificate Required<br />If a Certificate of Insurance is required check this box.<br /><br />Interest in Item Number<br />List the item number corresponding with the application for the item of interest for this additional insured.<br /><br />Item Description<br />If needed, further clarify the item of interest in this field. For a vehicle list the make, model and VIN number. For a scheduled item list the description, such as 3 carat diamond in six point setting.<br /><br />Click here to view my web site <a href="http://www.formsboss.com/">ACORD Forms</a>.Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.com0tag:blogger.com,1999:blog-24194515.post-1145894157913118232006-04-24T11:55:00.000-04:002006-04-25T11:03:45.433-04:00ACORD Forms : How to Complete a Cancellation Request/Policy Release 35Cancellation Request/Policy Release 35<br /><br />This guide provides basic instructions for completing the ACORD Cancellation Request/Policy Release form. It explains information the company needs to process the transaction.<br /><br />This form is used as tangible evidence of the insured's instruction to cancel a contract. It can be used for either Personal or Commercial Lines, or as an enclosure to the returned original contract, when available.<br /><br />* Method of cancellation and all calculations should be confirmed with the company before final settlement of the account with the insured. Caution should be exercised to ensure proper signature specifications are followed, as required by the company.<br /><br />Insured entities must have an authorized signature and title where applicable. Individual companies may have specific requirements for additional information particularly in situations of "Policy Rewritten" or "Pro Rata" cancellations.<br /><br />Verify that cancellation notice rights have not been extended to additional parties.<br /><br />Premium financed policies should be discreetly handled to ensure proper transmittal of premium and information.<br /><br />IDENTIFICATION SECTION<br /><br />Date<br />Month/day/year on which the form was completed.<br /><br />Producer<br />Name and address of the producer of record whose policy is being cancelled or released.<br /><br />Phone (A/C, No, Ext)<br />Producer's telephone number.<br /><br />Code<br />Identifying code assigned to your agency or brokerage firm by the insurance company receiving this form.<br /><br />Subcode<br />If your agency uses a subcode identification system with the company, enter the appropriate code.<br /><br />Agency Customer ID<br />Customer's identification number assigned by the agency.<br /><br />Company Name and Address<br />Issuing company's name, NAIC code, and address shown on the policy being cancelled or released. Do not use group or trade name.<br /><br />Policy Type<br />Specific type of insurance (e.g., Automobile Policy, Workers Compensation, Homeowners, etc.).<br /><br />Insured Name and Address<br />Name, mailing address and ZIP code of the insured as it appears on the policy. If the policy is issued to multiple named insureds, and the space is not adequate to list them all, enter only the first named insured followed by "et al."<br /><br />CANCELED POLICY INFORMATION<br /><br />Policy Number<br />Policy Number exactly as it appears on the policy, including both prefix and suffix symbols.<br /><br />Effective Date and Hour of Cancellation<br />List the effective date of the policy cancellation in month/day/year format. Enter the time including, AM or PM, that the policy cancellation takes effect.<br /><br />Policy Term<br />List the full term effective and expiration dates as listed on the policy.<br /><br />CANCELLATION REQUEST (Policy Attached)<br /><br />If this form is being used to notify the carrier of policy cancellation and the insured's original copy of the policy is attached, check this box and return both this form and original policy to the company.<br /><br />POLICY RELEASE (Complete Statement Section below)<br /><br />Policy Release<br />Mark "X" in this block only if this document is used as a Policy Release (policy not attached).<br /><br />Witness<br />When this document is used as a Policy Release, an insured should have a witness sign and date the form before returning it to the agent.<br /><br />Signature of Named Insured<br />First named insured must sign and date this form when used as either a Cancellation Request or Policy Release.<br /><br />Additional Interest<br />Provide the name and address of any Lien Holder, Mortgagee or Loss Payee. Identify this entity by marking "X" in the appropriate box.<br /><br />The signature and title of an authorized representative of any additional interest indicated in the contract must be obtained if the document is used as a Policy Release. Space is provided for the corresponding signature date.<br /><br />FOR AGENCY/COMPANY USE<br /><br />Reason for Cancellation<br />Mark "X" in the appropriate block to indicate the reason for cancellation of the policy. Available options are:<br />Not Taken<br />Request of Insured<br />Rewritten (complete below)<br />Other (Identify)<br /><br />If Rewritten is indicated, enter the new Company, Policy Number, and Inception Date in the spaces provided. If Other is indicated, identify the reason in the space provided.<br /><br />Company<br />The name of the company that the rewritten policy has been placed with.<br /><br />Policy Number<br />The new policy number for the rewritten policy.<br /><br />Effective Date<br />The effective date of the rewritten policy.<br /><br />Remarks<br /><br />Method of Cancellation<br />Mark "X" in the appropriate box indicating method of cancellation. Available options are:<br />Flat<br />Short Rate<br />Pro Rata<br /><br />Note: Individual companies may have specific requirements for additional information, particularly in situations of rewritten or pro-rata cancellations. The method of cancellation and all calculations should be confirmed with the company before final settlement of the account with the insured.<br />Full Term Premium<br />Premium for the full term (six months, annual, etc.) of the policy, including endorsements.<br /><br />Unearned Factor<br />Unearned factor from either the short rate or pro-rata tables for the unearned period of time; from date of cancellation to date of policy expiration.<br /><br />Return Premium<br />Gross return premium equals the unearned factor multiplied by the full term premium.<br /><br />REMARKS<br /><br />List any additional comments regarding the cancellation. Explanations should be made regarding back-dated cancellations or why premium is listed as being pro-rated instead of short-rated.<br /><br />NAME AND ADDRESS - Request/ Release Distribution<br /><br />Use these sections to list any additional distributions for this form, including the new agent of record, if any. Check the appropriate box for the corresponding address. The line within the name and address field is a margin setting used for window envelopes.<br /><br />PRODUCER'S SIGNATURE<br /><br />This form should be signed by the agent completing it.<br /><br />Click here to view my web site <a href="http://www.formsboss.com/">ACORD Forms</a>.Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.com2tag:blogger.com,1999:blog-24194515.post-1145284402180510312006-04-17T10:31:00.001-04:002009-12-15T11:35:05.794-05:00ACORD Forms : How to Complete an Evidence of Personal Property Insurance 27ACORD 27 Instructions<br /> <br /> Section Name Field Name Field and/or Section Description <br />TITLE ACORD 27 (2006/07) Evidence of Property Insurance ACORD 27, Evidence of Property Insurance, provides a coverage statement for mortgagees and loss payees who provide mortgages or loans on residential property, personal property or small commercial properties, and are named in the policy. ACORD 27, Evidence of Property Insurance, provides information about coverages currently in force on a policy. <br />TITLE Evidence of Property Insurance Research reveals that information included on the form satisfies requirements of mortgagees in most situations. Discussions with various lenders indicate that inclusion of items such as coinsurance are not important with respect to Personal Lines policies or small commercial policies. The primary concern is that the amount of insurance is sufficient to cover the amount of the loan. Sufficient space is provided in the Coverage and Remarks sections of the form to include any additional information that may be required. Although many lenders pay the premium for certain types of policies such as Homeowners, inclusion of the premium amount is inappropriate on the EPI. This information will be communicated to the payor via an invoice. Furthermore, in the case of continuing coverage, the premium amount would be invalid after the first year. <br />TITLE Evidence of Property Insurance IMPORTANT Use ACORD 28, Evidence of Commercial Property Insurance, to provide information to mortgagees and loss payees who provide mortgages or loans on real property or personal property insured under a Commercial Lines policy and more detail is required by the mortgagee or loss payee. <br /><br /><br />ACORD 27 (2006/07) rev. 09-05-2008 1 of 3 ACORD 27 (2006/07) rev. 09-05-2008 2 of 3 ACORD 27 (2006/07) rev. 09-05-2008 3 of 3 <br /><br />Section Name Field Name Field and/or Section Description <br />TITLE Evidence of Property Insurance IMPORTANT Kansas, Kentucky, Minnesota, Missouri, North Carolina, Oklahoma and Wisconsin require the filing of certificate of insurance forms. ACORD has filed all of its certificates in these states. In these states, the text of ACORD's certificates cannot be modified, unless the modified form is filed for approval by the respective state Department of Insurance. Additionally, virtually every other state will not allow any change in a certificate of insurance that would attempt to modify a policy unless the revised certificate is filed and approved. In these states, this form can only be changed to reflect the terms and conditions of the policy on which it is reporting. Such change(s) must be approved in advance by the insurance carrier that issued such policy. <br />IDENTIFICATION SECTION Date Month/day/year on which the form is completed. (MM/DD/YYYY) <br />IDENTIFICATION SECTION Agency Agency's name and address <br />IDENTIFICATION SECTION Phone (A/C, No, Ext) Agency's telephone number. <br />IDENTIFICATION SECTION Fax (A/C, No) Agency's facsimile number. <br />IDENTIFICATION SECTION E-Mail Address Agency's e-mail address. <br />IDENTIFICATION SECTION Code Identification code assigned to the agency or brokerage firm by the insurance company providing the policy coverages <br />IDENTIFICATION SECTION Subcode If the agency uses a sub-code identification system with the company, enter the appropriate code. <br />IDENTIFICATION SECTION Agency Customer ID Customer’s identification number assigned by the agency. <br />IDENTIFICATION SECTION Company Name and address of the applicable insurance company. Use the actual name of the company within the group to which the policy has been issued. Do not use group names. <br />IDENTIFICATION SECTION Insured Insured’s name and address as they appear on the policy declarations page. <br />IDENTIFICATION SECTION Loan Number Insured’s loan or account number for this additional interest. <br />Section Name Field Name Field and/or Section Description <br />IDENTIFICATION SECTION Policy Number Number exactly as it appears on the policy, including prefix and suffix symbols. <br />IDENTIFICATION SECTION Effective Date Date on which the terms and conditions of the policy commence. <br />IDENTIFICATION SECTION Expiration Date Date on which the terms and conditions of the policy expires. <br />IDENTIFICATION SECTION Continued Until Terminated if Checked If the policy is issued on a Continuous basis, check the available box. <br />IDENTIFICATION SECTION This Replaces Prior Evidence Dated If a prior Evidence of Property Insurance was issued to this additional interest and this form replaces the old one, enter the date the old form was issued; otherwise, leave this field blank. <br />PROPERTY INFORMATION Location/Description For buildings, provide the street address and a brief description of the occupancy of the building (e.g., 123 Johnstone Ave, Endicott - one-family dwelling with detached two car garage, or Route 66, five miles south of intersection with I99 - 12 X 12 Storage Building). For other property items, such as inland marine scheduled property (for lessor information), describe the item specifically. <br />COVERAGE INFORMATION Coverage/Perils/Forms Narrative description of the coverages provided, causes of loss (perils), and the forms attached (e.g., Homeowner - HO3 0792). <br />COVERAGE INFORMATION Amount of Insurance Amount of insurance for the associated coverage. <br />COVERAGE INFORMATION Deductible Deductible for the associated coverage. <br />REMARKS Remarks Space for any additional comments or to list any special conditions that may exist upon the policy. <br />CANCELLATION Number of Days Number of days before cancellation that the issuing insurer will endeavor to notify the additional interest prior to termination of the policy (e.g., 10 days). <br />ADDITIONAL INTEREST Name and Address Name and address of the additional interest. <br />ADDITIONAL INTEREST Nature of Interest Indicate the type of interest by checking the appropriate box. Available options are: Mortgagee, Additional Insured, Loss Payee. Use the optional space to enter any other type of interest. Note: Additional Insured status generally does not apply to property insurance. Exceptions should be discussed with the company underwriter. <br />ADDITIONAL INTEREST Loan # List any loan number, account number or other controlling number that the additional interest may have assigned the insureds. <br />ADDITIONAL INTEREST Authorized Representative This form should be signed by an authorized representative of the issuing company. <br /> <br />Click here to view my web site <a href="http://www.formsboss.com/">ACORD Forms</a>.Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.com1tag:blogger.com,1999:blog-24194515.post-1144856390549435242006-04-12T11:37:00.002-04:002009-12-15T11:32:41.230-05:00ACORD Forms : How to Complete a Certificate of Liability Insurance 25ACORD 25 Instructions<br /> <br /> Section Name Field Name Field and/or Section Description <br /> The title of the form. ACORD 25, Certificate of Liability Insurance, is "issued as a matter of information only, and confers no rights upon the certificate holder. This certificate does not affirmatively or negatively amend, extend, or alter the coverage afforded by policies". <br /> The above information is included in the opening statement of the form. <br /> If the receiver of the form wants to verify that liability coverage exists on a policy and has no direct interest in the policy, use the certificate of insurance. However, if the receiver of the form does have a verifiable interest in the policy, such as an additional insured, the liability policy must be amended by endorsement, to provide the appropriate coverage for the interested party prior to issuing a certificate of insurance (since the certificate confers no rights upon the holder and does not amend the policy). <br />TITLE ACORD 25 (2009/09) Certificate of Liability Insurance ACORD 25 was designed to collect policy limit information based on the ISO commercial lines program. It addresses both Claims Made and Occurrence policies. <br /><br />ACORD 25 (2009/09) rev. 10-30-2009 1 of 13 ACORD 25 (2009/09) rev. 10-30-2009 2 of 13 <br /><br />Section Name Field Name Field and/or Section Description <br /> The purpose of the Certificate of Insurance has been the topic of frequent discussions throughout the industry. Attention centers around the true purpose of a certificate and the rights, if any, it conveys to a certificate holder. <br /> In a 1974 court decision (United States Pipe & Foundry Co. v United States Fidelity & Guar. Co, 505 F. 2d 88 (5th Cir. 1974), the court ruled that a certificate is not a contract between the holder and the insurer. It only provides information to an interested third party that insurance is in force at the time of issuance. The court also stated: "The provision regarding notification in the event of cancellation is a mere promise, unsupported by any consideration." Although many companies provide notice of cancellation to certificate holders, they are not obliged to do so, since the holder is not a party to the contract. <br />TITLE The Certificate of Liability Insurance is used for most casualty situations in which the insured has requested certification to a third party of issued casualty coverages. The uses of the Certificate can include large and small contracting or manufacturing risks, lessor/lessee agreements, or other areas of liability certification. <br />ACORD 25 (2009/09) rev. 10-30-2009 3 of 13 <br /> Section Name Field Name Field and/or Section Description <br />TITLE The ACORD Certificate should be issued only in compliance with company instructions. ACORD recommends that the Certificate NOT be used in the following situations: * To waive rights * To provide information to the owner of a leased motor vehicle or the lender about both liability and physical damage coverages applying to the vehicle (ACORD 23, Automobile Certificate of Insurance, should be used for this) * To quote wording from a contract * To attach to an endorsement * To quote any wording which amends a policy unless the policy itself has been amended IMPORTANT Kansas, Kentucky, Minnesota, Missouri, North Carolina, Oklahoma and Wisconsin require the filing of certificate of insurance forms. ACORD has filed all of its certificates in these states. In these states, the text of ACORD's certificates cannot be modified, unless the modified form is filed for approval by the respective state Department of Insurance. <br />TITLE Additionally, virtually every other state will not allow any change in a certificate of insurance that would attempt to modify a policy unless the revised certificate is filed and approved. In these states, this form can only be changed to reflect the terms and conditions of the policy on which it is reporting. Such change(s) must be approved in advance by the insurance carrier that issued such policy. <br />IDENTIFICATION SECTION Date Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY) <br />IDENTIFICATION SECTION Producer Enter text: The full name of the producer/agency. <br />IDENTIFICATION SECTION Enter text: The mailing address line one of the producer/agency. <br />ACORD 25 (2009/09) rev. 10-30-2009 4 of 13 <br /> Section Name Field Name Field and/or Section Description <br />IDENTIFICATION SECTION Enter text: The mailing address line two of the producer/agency. <br />IDENTIFICATION SECTION Enter text: The mailing address city name of the producer/agency. <br />IDENTIFICATION SECTION Enter code: The mailing address state or province code of the producer/agency. <br />IDENTIFICATION SECTION Enter code: The mailing address postal code of the producer/agency. <br />IDENTIFICATION SECTION Contact Name Enter text: The name of the individual at the producer's establishment that is the primary contact. <br />IDENTIFICATION SECTION Phone (A/C, No, Ext) Enter number: The producer's contact person's phone number. If applicable, include the area code and extension. <br />IDENTIFICATION SECTION Fax No. (A/C, No, Ext) Enter number: The fax number of the producer/agency. <br />IDENTIFICATION SECTION E-Mail Address Enter text: The producer's contact person e-mail address. <br />IDENTIFICATION SECTION Producer Customer ID Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage). <br />IDENTIFICATION SECTION Insured Enter text: The named insured(s) as it/they will appear on the policy declarations page. <br />IDENTIFICATION SECTION Enter text: The named insured's mailing address line one. <br />IDENTIFICATION SECTION Enter text: The named insured's mailing address line two. <br />IDENTIFICATION SECTION Enter text: The named insured's mailing address city name. <br />IDENTIFICATION SECTION Enter code: The named insured's mailing address state or province code. <br />IDENTIFICATION SECTION Enter code: The named insured's mailing address postal code. <br />INSURERS AFFORDING COVERAGE Insurer A Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. As used here, this is Insurer A. <br />INSURERS AFFORDING COVERAGE NAIC # Enter code: The identification code assigned to the insurer by the NAIC. As used here, this is Insurer A. <br />ACORD 25 (2009/09) rev. 10-30-2009 5 of 13 <br /> Section Name Field Name Field and/or Section Description <br />INSURERS AFFORDING COVERAGE Insurer B Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. As used here, this is Insurer B. <br />INSURERS AFFORDING COVERAGE NAIC # Enter code: The identification code assigned to the insurer by the NAIC. As used here, this is Insurer B. <br />INSURERS AFFORDING COVERAGE Insurer C Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. As used here, this is Insurer C. <br />INSURERS AFFORDING COVERAGE NAIC # Enter code: The identification code assigned to the insurer by the NAIC. As used here, this is Insurer C. <br />INSURERS AFFORDING COVERAGE Insurer D Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. As used here, this is Insurer D. <br />INSURERS AFFORDING COVERAGE NAIC # Enter code: The identification code assigned to the insurer by the NAIC. As used here, this is Insurer D. <br />INSURERS AFFORDING COVERAGE Insurer E Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. As used here, this is Insurer E. <br />INSURERS AFFORDING COVERAGE NAIC # Enter code: The identification code assigned to the insurer by the NAIC. As used here, this is Insurer E. <br />INSURERS AFFORDING COVERAGE Insurer F Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. <br />INSURERS AFFORDING COVERAGE NAIC # Enter code: The identification code assigned to the insurer by the NAIC. <br />COVERAGES Certificate Number Enter identifier: The producer assigned number for the certificate. <br />COVERAGES Revision Number Enter number: The producer assigned revision number for the certificate. <br />COVERAGE INFORMATION Insr Ltr Enter code: The Company Letter of the insurer, as identified in the "Insurers Affording Coverage" form section, associated with the commercial general liability policy. <br />COVERAGE INFORMATION Commercial General Liability Check the box (if applicable): Indicates the claims made or occurrence option applies for the general liability policy. <br />ACORD 25 (2009/09) rev. 10-30-2009 6 of 13 <br /> Section Name Field Name Field and/or Section Description <br />COVERAGE INFORMATION Other General Liability Coverages -Claims-Made Check the box (if applicable): Indicates the "claims made" option applies on the general liability policy. <br />COVERAGE INFORMATION Occur Check the box (if applicable): Indicates the general liability policy, occurrence basis applies. <br />COVERAGE INFORMATION Check Box Check the box (if applicable): Indicates other coverage not found on the form exists for the general liability policy. <br />COVERAGE INFORMATION Field Box Enter text: The description of other coverage (not the limit) on the general liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). <br />COVERAGE INFORMATION Check Box Check the box (if applicable): Indicates other coverage not found on the form exists for the general liability policy. <br />COVERAGE INFORMATION Field Box Enter text: The description of other coverage (not the limit) on the general liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). <br />COVERAGE INFORMATION General Aggregate Limit Applies Per: - Policy Check the box (if applicable): Indicates the general liability policy, general aggregate limit applies per policy. <br />COVERAGE INFORMATION Project Check the box (if applicable): Indicates the general liability policy, general aggregate limit applies per project. <br />COVERAGE INFORMATION Loc Check the box (if applicable): Indicates the general liability policy, general aggregate limit applies per location. <br />COVERAGE INFORMATION Addl Insr Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured on the policy. As used here, place a check mark next to each coverage where an additional insured endorsement has been issued. <br />COVERAGE INFORMATION Subr Wvd Enter Y for a “Yes” response. Input N for “No” response. Indicates subrogation has been waived on the policy. <br />COVERAGE INFORMATION Policy Number Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. As used here, the general liability policy number exactly as it appears on the policy, including prefix and suffix symbols. <br />COVERAGE INFORMATION Policy Eff (MM/DD/YYYY) Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. As used here, the general liability policy effective date. <br />COVERAGE INFORMATION Policy Exp (MM/DD/YYYY) Enter date: The date on which the terms and conditions of the policy will expire. As used here, the general liability policy expiration date. <br />ACORD 25 (2009/09) rev. 10-30-2009 7 of 13 <br /> Section Name Field Name Field and/or Section Description <br />COVERAGE INFORMATION Limits - Each Occurrence $ Enter limit: The general liability, each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page. <br />COVERAGE INFORMATION Damage to Rented Premises $ Enter limit: The general liability, damage to rented premises each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page. <br />COVERAGE INFORMATION Med Exp $ Enter limit: The general liability, medical expense each person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page. <br />COVERAGE INFORMATION Personal & Adv Injury Enter limit: The general liability, personal and advertising injury limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page. <br />COVERAGE INFORMATION General Aggregate $ Enter limit: The general liability, general aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page. <br />COVERAGE INFORMATION Products- Comp/Op Agg $ Enter limit: The general liability, products and completed operations aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page. <br />COVERAGE INFORMATION Other Limits Enter text: The description of other coverage (not the limit). Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). <br />COVERAGE INFORMATION Other Occurrence $ Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). <br />COVERAGE INFORMATION Insr Ltr Enter code: The Company Letter of the insurer, as identified in the "Insurers Affording Coverage" form section, associated with the commercial vehicle policy. <br />ACORD 25 (2009/09) rev. 10-30-2009 8 of 13 <br /> Section Name Field Name Field and/or Section Description <br />COVERAGE INFORMATION Automobile Liability - Any Auto Check the box (if applicable): Indicates the commercial vehicle policy covers any auto. As used here, complete this section only if you are certifying automobile liability. Check all appropriate boxes to correspond with the covered auto symbols found on the policy declarations page. If the certificate is being issued to the owner of a leased vehicle, DO NOT USE THIS FORM. Use ACORD 23, Automobile Certificate of Insurance. <br />COVERAGE INFORMATION All Owned Autos Check the box (if applicable): Indicates the commercial vehicle policy covers all owned autos. <br />COVERAGE INFORMATION Scheduled Autos Check the box (if applicable): Indicates the vehicle policy covers scheduled autos. <br />COVERAGE INFORMATION Hired Autos Check the box (if applicable): Indicates the vehicle policy covers hired autos. <br />COVERAGE INFORMATION Non- Owned Autos Check the box (if applicable): Indicates the vehicle policy covers non-owned autos. <br />COVERAGE INFORMATION Check Box Check the box (if applicable): Indicates other coverage not found on the form exists for the vehicle policy. <br />COVERAGE INFORMATION Field Box Enter text: The description of other coverage (not the limit) on the vehicle policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). <br />COVERAGE INFORMATION Addl Insr Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured on the policy. As used here, place a check mark next to each coverage where an additional insured endorsement has been issued. <br />COVERAGE INFORMATION Subr Wvd Enter Y for a “Yes” response. Input N for “No” response. Indicates subrogation has been waived on the policy. <br />COVERAGE INFORMATION Policy Number Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. As used here, the automobile liability policy number. <br />COVERAGE INFORMATION Policy Eff (MM/DD/YYYY) Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. As used here, the automobile policy effective date. <br />COVERAGE INFORMATION Policy Exp (MM/DD/YYYY) Enter date: The date on which the terms and conditions of the policy will expire. As used here, the automobile policy expiration date. <br />ACORD 25 (2009/09) rev. 10-30-2009 9 of 13 <br /> Section Name Field Name Field and/or Section Description <br />COVERAGE INFORMATION Combined Single Limit $ Enter limit: The vehicle combined single limit liability each accident amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page. <br />COVERAGE INFORMATION Bodily Injury (Per Person) $ Enter limit: The vehicle policy, bodily injury per person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page. <br />COVERAGE INFORMATION Bodily Injury (Per Accident) $ Enter limit: The vehicle policy, bodily injury per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). <br />COVERAGE INFORMATION Property Damage Enter limit: The vehicle policy, property damage per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page. <br />COVERAGE INFORMATION Other Description Enter text: The description of the coverage. <br />COVERAGE INFORMATION Other Limit Enter limit: The limit amount of the other coverage. <br />COVERAGE INFORMATION Other Description Enter text: The description of the coverage. <br />COVERAGE INFORMATION Other Limit Enter limit: The limit amount of the other coverage. <br />COVERAGE INFORMATION Insr Ltr Enter code: The Company Letter of the insurer, as identified in the "Insurers Affording Coverage" form section, associated with the commercial excess umbrella liability policy. <br />COVERAGE INFORMATION Umbrella Liab Check the box (if applicable): Indicates the type of policy is umbrella. <br />COVERAGE INFORMATION Excess Liab Check the box (if applicable): Indicates the type of policy is excess. <br />COVERAGE INFORMATION Type of Insurance -Excess/Umbrella Liability - Occur Check the box (if applicable): Indicates "coverage trigger" is on an occurrence basis on an excess or umbrella liability policy. <br />COVERAGE INFORMATION Claims-Made Check the box (if applicable): Indicates the "coverage trigger" is on a claims-made basis on an excess or umbrella liability policy. <br />ACORD 25 (2009/09) rev. 10-30-2009 10 of 13 <br /> Section Name Field Name Field and/or Section Description <br />COVERAGE INFORMATION Deductible Check the box (if applicable): This indicates whether a deductible or retention amount applies to the excess or umbrella liability policy. <br />COVERAGE INFORMATION Retention Check the box (if applicable): Indicates the excess or umbrella liability policy has an applicable deductible or retention amount. <br />COVERAGE INFORMATION $ Field Box Enter deductible: The excess or umbrella liability deductible or retention amount. <br />COVERAGE INFORMATION Addl Insr Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured on the policy. As used here, place a check mark next to each coverage where an additional insured endorsement has been issued. <br />COVERAGE INFORMATION Subr Wvd Enter Y for a “Yes” response. Input N for “No” response. Indicates subrogation has been waived on the policy. <br />COVERAGE INFORMATION Policy Number Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. As used here, the excess / umbrella policy number. <br />COVERAGE INFORMATION Policy Eff (MM/DD/YYYY) Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. As used here, the excess / umbrella policy effective date. <br />COVERAGE INFORMATION Policy Exp (MM/DD/YYYY) Enter date: The date on which the terms and conditions of the policy will expire. As used here, the excess / umbrella policy expiration date. <br />COVERAGE INFORMATION Limits - Each Occurrence $ Enter limit: The excess umbrella liability limit each occurrence limit. As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). <br />COVERAGE INFORMATION Aggregate $ Enter limit: The excess/umbrella liability aggregate limit should be listed as whole dollar amount, as found on the policy declarations page. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as whole dollar amount, as found on the policy declarations page. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). <br />COVERAGE INFORMATION Field Box Enter text: The description of other coverage (not the limit) on the excess umbrella liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the description of Other Excess / Umbrella Liability Limit as found on the policy declarations page. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). <br />ACORD 25 (2009/09) rev. 10-30-2009 11 of 13 <br /> Section Name Field Name Field and/or Section Description <br />COVERAGE INFORMATION $ Field Box Enter limit: The excess umbrella liability limit other coverage limit. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as whole dollar amount, as found on the policy declarations page. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). <br />COVERAGE INFORMATION Field Box Enter text: The description of other coverage (not the limit) on the excess umbrella liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). <br />COVERAGE INFORMATION $ Field Box Enter limit: The excess umbrella liability limit other coverage limit. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as whole dollar amount, as found on the policy declarations page. <br />COVERAGE INFORMATION Insr Ltr Enter code: The Company Letter of the insurer, as identified in the "Insurers Affording Coverage" form section, associated with the commercial workers compensation and employers liability policy. <br />COVERAGE INFORMATION Type of Insurance -Workers Compensation and Employers' Liability - Any Proprietor/Partner/Executive/Offic er/Member Excluded? Enter Y for a “Yes” response. Input N for “No” response. Indicates whether the workers compensation and employers liability policy excludes any proprietor, partner, executive officer, or member. As used here, this question is mandatory in New Hampshire. <br />COVERAGE INFORMATION Subr Wvd Enter Y for a “Yes” response. Input N for “No” response. Indicates subrogation has been waived on the policy. <br />COVERAGE INFORMATION Policy Number Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. As used here, the workers compensation policy number. <br />COVERAGE INFORMATION Policy Eff (MM/DD/YYYY) Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. As used here, the workers compensation policy effective date. <br />COVERAGE INFORMATION Policy Exp (MM/DD/YYYY) Enter date: The date on which the terms and conditions of the policy will expire. As used here, the workers compensation policy expiration date. <br />COVERAGE INFORMATION Limits - WC Statutory Limits Check the box (if applicable): Indicates that workers compensation statutory limits apply. <br />COVERAGE INFORMATION Limits - Other Check the box (if applicable): Indicates that additional coverage above the workers compensation statutory limits applies (permitted in some states). Describe the additional coverage in the Special Provisions section. <br />ACORD 25 (2009/09) rev. 10-30-2009 12 of 13 <br /> Section Name Field Name Field and/or Section Description <br />COVERAGE INFORMATION Field Box Enter text: The description of other coverage (not the limit) on the workers compensation and employers liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). <br />COVERAGE INFORMATION E.L. Each Accident $ Enter limit: The workers compensation and employers liability policy, employers liability each accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). <br />COVERAGE INFORMATION E.L. Disease- EA Employee $ Enter limit: The workers compensation and employers liability policy, employers liability disease each employee limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page. <br />COVERAGE INFORMATION E.L. Disease- Policy Limit $ Enter limit: The workers compensation and employers liability policy, employers liability disease policy limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). <br />COVERAGE INFORMATION Insr Ltr Enter code: The Company Letter of the insurer, as identified in the "Insurers Affording Coverage" form section, associated with the other policy. <br />COVERAGE INFORMATION Type of Insurance - Other Enter text: The description of the other policy not listed on the form. <br />COVERAGE INFORMATION Addl Insr Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured on the policy. As used here, place a check mark next to each coverage where an additional insured endorsement has been issued. <br />COVERAGE INFORMATION Subr Wvd Enter Y for a “Yes” response. Input N for “No” response. Indicates subrogation has been waived on the policy. <br />COVERAGE INFORMATION Policy Number Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. As used here, the policy number of the other policy. <br />COVERAGE INFORMATION Policy Eff (MM/DD/YYYY) Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. As used here, the effective date of the other policy, <br />COVERAGE INFORMATION Policy Exp (MM/DD/YYYY) Enter date: The date on which the terms and conditions of the policy will expire. As used here, the expiration date of the other policy. <br />COVERAGE INFORMATION Limits Enter limit: The other policy, coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as found on the policy declarations page. <br />Section Name Field Name Field and/or Section Description <br />COVERAGE INFORMATION Description of Operations / Locations / Vehicles / Exclusions Added by Endorsement / Special Provisions Enter text: The Certificate Of Liability Insurance general remarks. As used here, records information necessary to identify the operations, locations, vehicles, exclusions added by endorsement, and/or special provisions for which the certificate was issued. <br />CERTIFICATE HOLDER Certificate Holder Name & Address Enter text: The certificate holder's full name. <br />CERTIFICATE HOLDER Enter text: The certificate holder's mailing address line one. <br />CERTIFICATE HOLDER Enter text: The certificate holder's mailing address line two. <br />CERTIFICATE HOLDER Enter text: The certificate holder's mailing address city name. <br />CERTIFICATE HOLDER Enter code: The certificate holder's mailing address state or province code. <br />CERTIFICATE HOLDER Enter code: The certificate holder's mailing address postal code. <br />CANCELLATION Authorized Representative Sign here: Accommodates the signature of the authorized representative (e.g. producer, agent, broker, etc.). by all companies to issue Certificates. This is required in most states. As used here, the authorized representative by all companies to issue Certificates. <br />Edition Date The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM). <br /><br />ACORD 25 (2009/09) rev. 10-30-2009 13 of 13<br /><br />Click here to view my web site <a href="http://www.formsboss.com/">ACORD Forms</a>.Waynehttp://www.blogger.com/profile/01646146918947450865noreply@blogger.com1