ACORD 128 Instructions


ACORD 128 Instructions
Section Name Field Name Field and/or Section Description
TITLEACORD 128 (2004/3) Garage and Dealers Section The following provides the user with basic instructions for completing ACORD 128, Garage & Dealers Section. This form has been designed to handle the basic underwriting needs for automobile service operations and automobile dealers.Space is provided to enter driver information for up to eight drivers. For additional drivers, ACORD 163, Driver Information Schedule, can be attached.Insurance coverage, “no fault” and uninsured/underinsured motorists coverages in particular, varies widely from state to state. In addition, there are numerous state-specific requirements that apply to Garage and Dealers applications. ACORD 128 cannot address these various unique specifications. Therefore, state specific forms, ACORD 138, have been developed to respond to these requirements. Use the ACORD 138 for your state to provide coverages/limits information, as well as the required disclosure and other data unique to the state.
This form was also designed to be used in conjunction with the Commercial Insurance Application – Applicant Information Section (ACORD 125) and the Vehicle Schedule (ACORD 129). Please turn to the chapters on these forms for specific information on completing them.Many states require supplements to all auto applications, to provide specific coverage explanations 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 disclosureof information pertinent toauto insurance.ACORD has provided the necessary supplements in most states.
IDENTIFICATION SECTION 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 this portion of theapplication makes it difficult to keep track of the full account.
IDENTIFICATION SECTION Date Month/day/year (MM/DD/YYYY on which the form is completed.
IDENTIFICATION SECTION Agency Agency’s name and address.
IDENTIFICATION SECTION Phone (A/C, No, Ext) Producer’s telephone number.
IDENTIFICATION SECTION Fax (A/C, No, Ext) Producer’s fax number.
IDENTIFICATION SECTION Code Identification code assigned to the agency or brokerage firm by the insurance company receiving this form.
IDENTIFICATION SECTION Sub Code If the agency uses a sub-code identification system with the company, enter the appropriate code.
IDENTIFICATION SECTION Agency Customer ID Customer’s identification number assigned by the agency.
IDENTIFICATION SECTION Applicant (First Named Insured) First Named Insured as it appears on the ACORD 125.
IDENTIFICATION SECTION Proposed Eff. Date Enter the Effective date on which the terms and conditions of the policy will commence.
IDENTIFICATION SECTION Proposed Exp. Date Enter the Expiration date on which the terms and conditions of the policy will terminateunless renewed.
IDENTIFICATION SECTION Billing Plan Indicate whether the agency or the company (direct) will bill the insured or other payor for the policy.
IDENTIFICATION SECTION Payment Plan Indicate 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).
IDENTIFICATION SECTION Audit Use this field to indicate the audit term for policies that are subject to periodic audit. If the audit period is known, enter the code:A . . . . . . . . . . . . . . . . . . . . . . . . . . . . annualS . . . . . . . . . . . . . . . . . . . . . . . . . . . . semi-annualQ . . . . . . . . . . . . . . . . . . . . . . . . . . . . quarterlyM. . . . . . . . . . . . . . . . . . . . . . . . . . . . monthlyO . . . . . . . . . . . . . . . . . . . . . . . . . . . . other
BUSINESS/VEHICLE STORAGE INFORMATION This section is used to identify the type of insurance necessary for the applicant.
BUSINESS/VEHICLE STORAGE INFORMATION Auto Service Operations or Trailer Sales Place an “X” in all applicable boxes to identify the type of operations in which the applicant is involved.
BUSINESS/VEHICLE STORAGE INFORMATION Auto Dealers Indicate if the dealership is franchised, deals in one or more specific lines of cars such as Ford or GM, or if it is a non-franchised dealer. Indicate the percentage of vehicle style in relation to total inventory.
BUSINESS/VEHICLE STORAGE INFORMATION Vehicle Storage Indicate where the applicant’s vehicles are stored.
BUSINESS/VEHICLE STORAGE INFORMATION Location Number Enter the location number as it relates to the numbers found on the ACORD 125. For each location, identify where the vehicles are stored.
BUSINESS/VEHICLE STORAGE INFORMATION Building Vehicles are stored within a building.
BUSINESS/VEHICLE STORAGE INFORMATION Standard Open Lot The lot is enclosed by walls or fences at least six feet in height, with openings securely locked when unattended.
BUSINESS/VEHICLE STORAGE INFORMATION Non-Standard Open Lot The lot is either an open lot or an unroofed space and the building is not securely enclosedor locked when unattended.
COVERAGES/LIMITS Covered Auto Symbols Garage or Dealers policies use 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. Symbols 21 through 26 provide fleet automatic coverage. Symbol 21 includes Hired and Non-Owned auto coverage. If symbol 21 is not used and Hired Auto (symbol 28) or Non-Owned Auto (symbol 29) coverage is desired, those symbols must be checked. The symbols indicate the automobiles to which each coverage applies. The symbol “triggers” the coverage. For exact policy definitions of the symbols, please refer to the company’s policy declarations page.
COVERAGES/LIMITS Symbol 21 – Any Auto Can only be used for Liability insurance and/or Medical Payments insurance. Its use provides coverage for any auto the insured will have contact with, including owned & non-owned & hired vehicles. It includes coverage for non-owned autos, no-fault, uninsured motorists or physical damage insurance. Damage to customers’ autos is provided by using Symbol 30, Garage Keepers Insurance.
COVERAGES/LIMITS Symbol 22 – All Owned Autos Provides coverage for owned autos only and includes automatic coverage for autos you newly acquire. This symbol cannot be used to provide liability coverage for dealers, but can be used to provide liability for non-dealers. It can also be used for dealers and non-dealers to provide any of the physical damage coverages or uninsured motorist’s insurance.
COVERAGES/LIMITS Symbol 23 – Owned Private Passenger Autos Only Provides coverage for owned private passenger autos only and includes automatic coverage for private passenger autos you newly acquire. It can be used for dealers and non-dealers to provide uninsured motorist’s insurance and physical damage coverages. It may also be used to provide medical payments insurance for non-dealers.
COVERAGES/LIMITS Symbol 24 – Owned Autos Other Than Private Passenger Provides coverage for owned autos other than private passenger autos and includes automatic coverage for autos you newly acquire, other than private passenger autos. It is not limited to trucks or truck tractors, but also includes taxis, motorcycles, emergency vehicles, trailers and buses. Any vehicle which is not a private passenger auto fits within this symbol.
COVERAGES/LIMITS Symbol 25 – Owned Autos Subject to No-Fault Laws Applies to owned autos where no-fault is required by law including automatic coverage for autos you newly acquire.
COVERAGES/LIMITS Symbol 26 – Owned Autos Subject to Uninsured Motorist Laws Applies to owned autos where there is a compulsory uninsured motorist’s law including automatic coverage for autos you newly acquire where rejection of UM is not permitted by law.
COVERAGES/LIMITS Symbol 27 – Specifically Described Autos Provides coverage for scheduled autos only with no automatic coverage for autos you newly acquire. Use Vehicle Schedule, ACORD 129, to provide information on individual vehicles.
COVERAGES/LIMITS Symbol 28 – Hired Autos Only Provides coverage only for autos leased, hired, rented or borrowed by the named insured. This does not include autos owned by employees or members of their families.
COVERAGES/LIMITS Symbol 29 – Non-Owned Autos Used in Garage Business Provides liability coverage for autos not owned by the named insured but used in connection with the garage business. This includes autos owned by employees.
COVERAGES/LIMITS Symbol 30 – Autos Left for Service/Repairs/Storage Provides coverage for customer’s autos which are in the care, custody, and control of the named insured. It provides garage keepers insurance for dealers and non-dealers when autos are left for service, repair or storage.
COVERAGES/LIMITS Symbol 31 – Autos On Consignment and Dealer Autos Provides physical damage coverages for autos consigned to dealer or held for sale in possession of non-dealer.
COVERAGES/LIMITS Symbol 32 – Company Use This is a company specific code. It can be used to provide coverage when no other symbol applies (e.g., to provide coverage for Long Term Leased Vehicles). It will be necessary to write in this symbol if used.Coverages & Limits – Use ACORD 138
AUTO DEALERS OPERATORS The Insurance Services Office developed the Dealers Class Plan to rate liability and collision coverages. The basis for rating involves assigning rating factors and rating units for employees and non-employees.Record by location the number of persons within each category. If rating the policy, refer tothe Commercial Lines Manual for additional information
DEALERS PHYSICAL DAMAGE Indicate if the autos to be covered are New or Used for each coverage and check the interest to be insured.
NON-DEALERS PREMISES & OPERATIONS Payroll is the basis for rating this coverage. Enter the location number as it appears on the ACORD 125, the estimated annual remuneration and number of employees at each location. See the appropriate manual for the payroll limitations that apply.
NON-DEALERS PREMISES & OPERATIONS LOC # Enter the location number as it relates to the numbers found on the ACORD 125.
NON-DEALERS PREMISES & OPERATIONS Estimated Annual Remuneration Total annual payroll for the class. Payroll means money or substitutes for money, such as the value of meals or lodging if provided. Accurate payroll estimates help avoid additional premium requirements being discovered during an audit. Do not include overtime premium.
NON-DEALERS PREMISES & OPERATIONS # Employees Indicate the number of employees at this location.
SERVICE OR REPAIR SHOPS Annual Gross Sales $ Indicate Annual Gross Sales.
SERVICE OR REPAIR SHOPS Number of Gallons Of Gas Pumped Per Year Indicate the number of gallons of gasoline pumped per year.
DRIVER INFORMATION 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 who will be driving company vehicles and employees who regularly drive their own vehicles for company business.
DRIVER INFORMATION Driver # Assign a number to each driver.
DRIVER INFORMATION Name Enter the driver’s full name. If the company requires the address, enter it as well.
DRIVER INFORMATION Sex Enter F for female, M for male.
DRIVER INFORMATION Marital Stat Enter the marital status for each driver. Examples:S . . . . . . . . . . . . . . . . . . . . . . . . . . . . SingleM. . . . . . . . . . . . . . . . . . . . . . . . . . . . MarriedD . . . . . . . . . . . . . . . . . . . . . . . . . . . . DivorcedSP . . . . . . . . . . . . . . . . . . . . . . . . . . . SeparatedW. . . . . . . . . . . . . . . . . . . . . . . . . . . . Widowed
DRIVER INFORMATION Date of Birth Enter the driver’s birth date.
DRIVER INFORMATION Yrs Exp Enter the number of years of driving experience for each driver.
DRIVER INFORMATION Year Licensed Enter the year in which the driver was first licensed.
DRIVER INFORMATION Driver’s License Number/Soc. Sec. # Enter the complete driver’s license number. If a license number is unavailable, enter the driver’s social security number.
DRIVER INFORMATION State Lic. Enter the state in which the license was issued.
DRIVER INFORMATION Date Hire Enter the date of hire for each driver.
DRIVER INFORMATION Use Vehicle # Enter the vehicle number that this driver primarily uses.
DRIVER INFORMATION % Use Enter the percentage of driving done by this driver in this vehicle.
GENERAL INFORMATION 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.
GENERAL INFORMATION 1. Does applicant rent, lease or loan vehicles to others? List the frequency, who receives the vehicles and if this is part of the normal business operations. Indicate if insurance is provided.
GENERAL INFORMATION 2. Does applicant pick-up or deliver customer’s cars? Indicate how many cars per day, and how the employee commutes to the location.
GENERAL INFORMATION 3. Does pick-up or delivery exceed 50 miles? Indicate the radius of this operation if it exceeds 50 miles, and how often.
GENERAL INFORMATION 4. Is tire recapping or retreading performed? List the percentage of gross sales this operation represents. Indicate if the applicant sends out for retreads, or if the applicant performs the operation.
GENERAL INFORMATION 5. Does applicant own or sponsor a car for racing? Provide a description of the car. Indicate how frequently the car is raced, who drives the car and how the car is transported.
GENERAL INFORMATION 6. Does applicant handle butane, propane or other gases? State what type of storage facilities are used, what gases are involved and if they are for sale to the general public.
GENERAL INFORMATION 7. Are any vehicles furnished for groups or organizations? Identify the group (school, hospital, church, or civic organization) to which the vehicle is loaned. Indicate if there is a charge.
GENERAL INFORMATION 8. Does applicant perform spray painting or welding? Indicate how frequently this type of operation is performed, and if the applicant has approved booths or ventilated spray areas. Describe the type of welding or painting job handled and where in the building each job is located.
GENERAL INFORMATION 9. Does applicant drive away or haul away vehicles from factory distributingpoint or other dealers? Describe circumstances causing drive-aways. Indicate if this is a regular operation, how many cars are involved, and give the radius of operation.
GENERAL INFORMATION 10. Does applicant dismantle autos or have salvage operation? Describe this type of operation completely. If there is a salvage operation on premises, so indicate.
GENERAL INFORMATION 11. Does applicant use tow trucks? Indicate how many trucks are owned or used by the applicant and describe towing operations. These trucks may be listed on ACORD 129 Vehicle Schedule and attached to the Garage Section.
GENERAL INFORMATION 12. Do employees regularly use their own autos on company business? List who, what vehicle and for what operations.
GENERAL INFORMATION 13. Does applicant park customers’ vehicles on public streets or offpremises? Describe any type of off-premises parking of vehicles.
GENERAL INFORMATION 14. Is a charge made for parking? Indicate how much is charged, how many attendants are on duty, and the hours of operation. Indicate if employees drive vehicles or if customers self-park.
GENERAL INFORMATION 15. Any private protection systems? Describe all such systems in detail.
GENERAL INFORMATION 16. Is applicant involved in any “non-garage” operations? If a retail operation, mini-mart, liquor store, or other operation is run on the premises, list the operation and annual gross sales from this portion of the business. Indicate if there is any insurance for this operation.
GENERAL INFORMATION 17. Does applicant perform any road emergency services? Indicate if the applicant is on call for any highway or other emergencies, and if towing operations are available around the clock.
GENERAL INFORMATION 18. Any drivers with convictions for moving traffic violations? 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.
ADDITIONAL INTEREST/CERTIFICATE RECIPIENT Use this section to collect information on any additional interest or receiver of Certificates of Insurance.
ADDITIONAL INTEREST/CERTIFICATE RECIPIENT Interest Check all appropriate boxes that apply to the additional interest. If the interest is other than the listed options, check the last box and list the interest type after it.
ADDITIONAL INTEREST/CERTIFICATE RECIPIENT Rank Primarily used for Mortgagees. Indicate the ranking such as 1st, 2nd or 3rd mortgagee.
ADDITIONAL INTEREST/CERTIFICATE RECIPIENT Name and Address List the additional interest’s name and mailing address.
ADDITIONAL INTEREST/CERTIFICATE RECIPIENT Reference # List any reference number, such as a loan number, that may be beneficial in tying the additional interest to item.
ADDITIONAL INTEREST/CERTIFICATE RECIPIENT Certificate Required If a Certificate of Insurance is required, check this box.
ADDITIONAL INTEREST/CERTIFICATE RECIPIENT Interest in Item Use this section to indicate what the additional interest has an interest in. Examples: *For a Mortgagee, list the location and building number. *For an automobile lienholder, list the vehicle number.If the additional interest has an interest in multiple items, such as a lienholder on multiple vehicles, list all of the numbers associated with the additional interest.
ADDITIONAL INTEREST/CERTIFICATE RECIPIENT Item Description 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.
ADDITIONAL INTEREST/CERTIFICATE RECIPIENT Interest Indicate all appropriate options for the individual named.
ADDITIONAL INTEREST/CERTIFICATE RECIPIENT Rank Primarily used for Mortgagees. Indicate the ranking such as 1st, 2nd or 3rd mortgagee.
ADDITIONAL INTEREST/CERTIFICATE RECIPIENT Name and Address List the additional interest’s name and address.
ADDITIONAL INTEREST/CERTIFICATE RECIPIENT Reference # Indicate the additional interest’s reference number for this applicant such as the loan or mortgage number.
ADDITIONAL INTEREST/CERTIFICATE RECIPIENT Certificate Required If a Certificate of Insurance is required, check this box.
ADDITIONAL INTEREST/CERTIFICATE RECIPIENT Interest in Item Number List the item number corresponding with the application for the item of interest for this additional insured.
ADDITIONAL INTEREST/CERTIFICATE RECIPIENT Item Description 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.
REMARKS Use this section to provide any additional information required for underwriting or rating.