This form was designed to be used in conjunction with the Commercial
Insurance Application - Applicant Information Section (ACORD 125). Refer to
the chapter on the ACORD 125 for information on that form.
Most information for the Identification Section should match
the data found within the Applicant Information Section (ACORD 125). However,
it is still important to complete the section. Many companies, for rating purposes,
separate the applications by line of business. Not completing this part of the
application makes it difficult to keep track of the full account.
Month/day/year on which the form is completed.
Producer's name, address and telephone number.
Applicant (First Named Insured)
First Named Insured as it appears on the ACORD 125.
Proposed Eff. Date
Effective date on which the terms and conditions of the policy will commence.
Proposed Exp. Date
Expiration date on which the terms and conditions of the policy will terminate
Indicate whether the agency or the company (direct) will bill the insured or
other payor for the policy.
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,
Indicate the audit term for policies that are periodically audited. If the audit
period is known, enter the code:
A . . . . . . . . . . . . . . . . . . . . . . . . . . . . annual
S . . . . . . . . . . . . . . . . . . . . . . . . . . . . semi-annual
Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . quarterly
M. . . . . . . . . . . . . . . . . . . . . . . . . . . . monthly
O . . . . . . . . . . . . . . . . . . . . . . . . . . . . other.
TERRITORY OF OPERATION
Specifiy exactly where the equipment or schedule of items is
normally located. For a specific location, give the address, or information
such as the construction site name and address, city, county or state.
TYPE OF OPERATION
Describe the type of work performed by the applicant and nature
of this business. This information may also appear on the Application Section
(ACORD 125). If so, enter "see ACORD 125."
List the form of coverage desired and all apporopriate deductibles
in the space provided. Indicate if the Floater is to be written on a Scheduled
or Blanket basis. If scheduled, list all the items. Specify if All Risk or Named
Perils. Enter any other options chosen as Replacement Cost or Actual Cash Value
and the desired deductible. Deductibles may be written on a "dollar amount"
or "percentage" basis. Specify how the deductible is to be applied
if not familiar with each company's policy (e.g., Contractors' Equipment, Commercial
Articles Floater or Musical Instrument Dealers).
Collect limit information applicable to contractor's equipment.
If other limits for coverages as Commercial Article Floaters fit, enter them
here. Limits that don't fit within these section headings should be listed within
the Coverage and Deductible section.
Months in Storage
Number of months the equipment is kept in storage. (If less than one month,
enter one. All partial months should be rounded up).
Maximum Value in Building
Indicate the maximum value of the scheduled items stored inside a building.
Maximum Value Outside
Indicate the maximum value of all scheduled items stored outside.
Type of Security
Briefly describe the kind of securiy employed by the applicant at each location.
Specify guards, alarms, fences, dogs, etc.
It may be necessary to individually schedule all items owned
by the applicant. This section should be used to group similar items together
for unscheduled coverage.
Describe the unscheduled grouping (e.g., Miscellaneous Hand Tools or Camera
Maximum value of any single item within this grouping.
Amount of Insurance
The total value of all of the unscheduled items. Values can be either on a Replacement
Cost or Actual Cash Value basis.
Coinsurance percentage contemplated by the amount of insurance required. Most
insurers require 100 percent coinsurance.
ADDITIONAL INTEREST/CERTIFICATE RECIPIENTS
Collect information on any additional interest or receiver
of Certificates of Insurance.
Name and Address
List the additional Interest's name and mailing address.
List the scheduled item's item number and the interest in the item. Examples:
Item 15, Loss Payee
Item 2, Additional Insured
Item 1, Additional Insured/Lessor
If a Certificate of Insurance is required, check this box.
The underwriting questions have been designed for applicants
dealing in contractors' eqipment. The Remarks section provides additional information
for any questions answered "Yes" and for applicants not associated
with contractors' equipment.
The following overview lists information that should be added
to the Remarks section for "Yes" responses.
1. Equipment rented, loaned to or from others with
or without operators?
If the applicant is involved in any sort of rental or loan agreement, explain
the circumstances and the nature of the agreement, including who is carrying
the insurance for the equipment.
2. Is applicant operating equipment that is not listed
Indicate if applicant owns, leases, or hires equipment not to be insured by
this policy. Identify equipment and nature of operations.
3. Property used underground?
Indicate if any work is done underground and if equipment is left underground.
Explain all circumstances of undergorund operations.
4. Any work done afloat?
Indicate if any work is done on bodies of water and if equipment is left afloat
unattended for extended periods. Explain circumstances and indicate which bodies
of water are involved.
Provide any additional information required for underwriting
Individually schedule items.
Assign an individual item number to each item scheduled.
Model Year of each item scheduled, or the specific year in which the equipment
was manufactured, if applicable.
Descibe the type of equipment to be insured.
Indicate the manufacturer for each item listed.
Indicate the model number for each item listed.
Indicate the capacity for each item listed.
Describe any other important information to identify the equipment.
Item's identification or serial number or any other identifying symbol.
Date when each piece of equipment was purchase by the applicant.
Indicate if the item scheduled was purchased new or used by the applicant.
Amount of Insurance
Amount of insurance representing the liability limit for the particular described
equipment. The limit should reflect the required coinsurance percentage and
the requested basis of valuation (ACV or Replacement Cost).