ACORD 138 InstructionsACORD 138 - Garage and Dealers, Coverages/Limits Section Use this form to collect the coverage, limits and premium information necessary to write Garage and Dealers insurance in this state. Required disclosure and coverage acceptance or rejection information is also included.
IDENTIFICATION SECTION Date Month/day/year (MM/DD/YYYY) on which the form is completed.
Agency's name. Applicant (First Named Insured) 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 any additional insureds identified as such. If joint ownership, the name used may include both names (e.g., John and Mary Smith). 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 format for the Limit section is designed primarily for one limit per coverage. If a coverage requires more than one limit, and multiple limits will not fit within the allotted space, enter "See Below" and use either the optional other coverage area or endorsements area to enter the multiple limits. Split limits should be listed in the format of: BI - Each Person / BI - Each occurrence / PD - Each Occurrence. Example: 100,000/300,000/200,000 would represent: BI = each person of $100,000, BI = each occurrence of $300,000 and PD = each occurrence of $200,000. Liability For garage operations enter the limits in the following fashion:
Medical Payments Enter the appropriate medical payments limits. Indicate if this limit is for Automobile coverage, Premises (Prem.) Operations coverage or both. Uninsured Motorists Enter any applicable uninsured motorist limit(s) as required by state law. PHYSICAL DAMAGE For Physical Damage or Comprehensive Coverage, complete this section.
Indicate if the other than collision coverage is to be Comprehensive or Specified Perils. For Specified Perils coverage, list under the option box which perils are to be covered. Codes are:
LOC # The location Number for the Physical Damage coverages should correspond to a location number documented on the ACORD 125. Enter the Limits for Each Location Enter the liability limit (sum of all autos being covered) per each location. Deductible Per Auto Enter the deductible that applies on a per auto basis. Maximum Deductible Per Loss Enter the maximum deductible that will apply on a per loss basis. Collision Enter the collision deductible amount. Other Write in any additional coverages, along with their coverage auto symbols, limits and deductibles that may be desired. Examples of coverages include: Personal Injury Liability Coverage, Elevator Collision Coverage, Fire, Legal Liability. GARAGE KEEPERS Complete this section if coverage is being requested for vehicles left in the applicant's care, custody or control for service, repairs or storage.
Indicate the Garage Keepers policy type by checking the appropriate box. Legal Liability If the Garage Keepers is to be written on a Legal Liability basis, check this box. Direct Basis If the Garage Keepers is to be written on a Legal Liability basis, check this box and indicate if this is Primary or Excess insurance. Comp/(OTC) or Specified Perils Indicate if the other than collision coverage is to be Comprehensive or Specified Perils. For Specified Perils coverage, list under the option box which perils are to be covered. Codes are:
LOC # The location number for the Physical Damage coverages should correspond to a location number documented on the ACORD 125. Enter the Limits for Each Location Enter the liability limit (sum of all autos being covered) per each location. # of Autos Enter the number of autos located on the premises. Deductible Per Auto Enter the deductible that applies on a per auto basis. Maximum Deductible Per Loss Enter the maximum deductible that will apply on a per loss basis. Collision Enter the collision deductible amount. LOC # The location number for the Garage Keepers coverages should correspond to a location number documented on the ACORD 125. Enter the Limits for Each Location Enter the liability limit (sum of all autos being covered) per each location. # of Autos Enter the number of autos located on the premises. Deductible Per Auto Enter the deductible that applies on a per auto basis. Maximum Deductible Per Loss Enter the maximum deductible that will apply on a per loss basis. Other Write in any additional coverages, along with their coverage auto symbols, limits and deductibles that may be desired. Examples of coverages include: Personal Injury Liability Coverage, Elevator Collision Coverage, Fire, Legal Liability. Physical Damage Reporting Period If the policy will be on a Reporting basis, enter the timing of the reporting period. Examples: Monthly, Quarterly, Semi-Annual. For Non-Reporting policies, check the appropriate box. # Dealer Plates/Repairer Plates Enter the total number of sets of plates issued to the applicant. # Transportation Plates Enter the total number of sets of plates issued to the applicant. # Hoists Enter the number of hoists located on the premises. Temporary Location Limit Enter the limit for covered autos stored temporarily off premises. Transit Limit Enter the limit for covered autos in transit. Endorsements Enter any endorsements that apply. Be sure to include the form numbers and the required information for attaching the endorsement. UM/BI Selection/Rejection The applicant must initial his selection of UMBI coverage. If the applicant rejects UMBI coverage, his signature is required. Applicant's Signature The applicant should read and understand the Fair Credit Reporting Act, the Privacy Act (where applicable), the Applicant's Statement, and any other disclosure information on the form before personally signing the application. Date Date the form was signed. Producer's Signature The producer should sign the application. This is required in most states. National Producer Number The National Producer Number assigned by the NAIC should be shown.
Sign up for Free Access to all ACORD forms. Get the extra benefits of Fill In On Screen ACORD forms for only $99.95 a year. Return to Simply Easier ACORD Forms home page from ACORD 138 Instructions page.
|