ACORD 160 Instructions

ACORD 160 (2009/05) 1 of 64

Universal wording updates to improve clarity and intent were made to all FIG text for this form on 06/30/2009.
Section Name Field Name Field and/or Section Description
TITLE ACORD 160 (2009/05) Business Owners Application The title of the form. ACORD 160, Business Owners Application is designed to be used with most business owners and small business policies. The form is attached to the ACORD 125, Commercial Insurance Application Applicant Information Section, and collects property, liability and additional coverages, such as accounts receivables, boiler and machinery, crime, glass, signs and valuable papers. Space is provided for company-specific additional coverages as well. The form can accommodate specialty programs, such as apartment, condominiums or restaurants. Individual carriers should be contacted for unique underwriting and any other information required by specific companies.
IDENTIFICATION SECTION Agency Customer ID Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage).
IDENTIFICATION SECTION Date Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY)
IDENTIFICATION SECTION Agency Name Enter text: The full name of the producer/agency.
IDENTIFICATION SECTION Carrier 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.
IDENTIFICATION SECTION NAIC Code Enter code: The identification code assigned to the insurer by the NAIC.
IDENTIFICATION SECTION Policy # 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.
IDENTIFICATION SECTION Effective Date Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence.
IDENTIFICATION SECTION First Named Insured Enter text: The named insured(s) as it/they will appear on the policy declarations page.
IDENTIFICATION SECTION Policy Type - Standard Check the box (if applicable): Indicates the type of policy/perils insured is standard.
IDENTIFICATION SECTION Policy Type - Special Check the box (if applicable): Indicates the type of policy/perils insured is special.

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Section Name Field Name Field and/or Section Description
IDENTIFICATION SECTION Policy Type - Other Check the box (if applicable): Indicates the type of policy/perils insured is other than those listed.
IDENTIFICATION SECTION Policy Type - Other Description Enter text: The description of the type of policy issued to the insured.
PREMIUM Building Enter amount: The total premium amount for the building coverages.
PREMIUM Personal Property Enter amount: The total premium amount for personal property coverages.
PREMIUM Liability Enter amount: The total premium amount for liability coverages.
PREMIUM Optional Coverages Enter amount: The total premium amount for optional coverages.
PREMIUM Other Description Enter text: The description of coverages associated with the total premium amount.
PREMIUM Other Amount Enter amount: The total premium amount for the coverages.
PREMIUM Schedule Credits Enter amount: The total premium amount for schedule credits.
PREMIUM Deductible Credits Enter amount: The total premium amount for deductible credits.
PREMIUM Taxes Surcharge Enter amount: The total premium amount for taxes surcharge.
PREMIUM Other Description Enter text: The description of coverages associated with the total premium amount.
PREMIUM Other Amount Enter amount: The total premium amount for the coverages.
PREMIUM Other Description Enter text: The description of coverages associated with the total premium amount.
PREMIUM Other Amount Enter amount: The total premium amount for the coverages.
PREMIUM Minimum Premium Enter amount: The minimum premium amount for the business owners (BOP) line of business.
PREMIUM Total Premium Enter amount: The premium amount for the business owners (BOP) line of business.
GENERAL INFORMATION 1. Do/have past, present or discontinued operations involving storing, treating, discharging, applying, disposing, or transporting of hazardous material? Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do/have past, present or discontinued operations involve(d) storing, treating, discharging, applying, disposing, or transporting of hazardous material?".
GENERAL INFORMATION 1. Remarks Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION 2. Are athletic teams sponsored? Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are athletic teams sponsored?".
GENERAL INFORMATION Type of Sport Enter text: The description of the type of sport in which the sponsored athletic team is involved.
GENERAL INFORMATION Contact Sport (Y / N) Enter Y for a “Yes” response. Input N for “No” response. Indicates if the sponsored athletic is involved in a contact sport.
GENERAL INFORMATION Age Group - 12 & Under Check the box (if applicable): Indicates the sport participants are 12 years old or under.

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Section Name Field Name Field and/or Section Description
GENERAL INFORMATION Age Group - 13 - 18 Check the box (if applicable): Indicates the sport participants are 13 through 18 years old.
GENERAL INFORMATION Age Group - Over 18 Check the box (if applicable): Indicates the sport participate are over 18 years old.
GENERAL INFORMATION Extent of Sponsorship Enter text: The description of the extent of sponsorship the named insured provides for the athletic team.
GENERAL INFORMATION Type of Sport Enter text: The description of the type of sport in which the sponsored athletic team is involved.
GENERAL INFORMATION Contact Sport (Y / N) Enter Y for a “Yes” response. Input N for “No” response. Indicates if the sponsored athletic is involved in a contact sport.
GENERAL INFORMATION Age Group - 12 & Under Check the box (if applicable): Indicates the sport participants are 12 years old or under.
GENERAL INFORMATION Age Group - 13 - 18 Check the box (if applicable): Indicates the sport participants are 13 through 18 years old.
GENERAL INFORMATION Age Group - Over 18 Check the box (if applicable): Indicates the sport participate are over 18 years old.
GENERAL INFORMATION Extent of Sponsorship Enter text: The description of the extent of sponsorship the named insured provides for the athletic team.
GENERAL INFORMATION 3. Do you obtain and verify certificates of insurance obtained from subcontractors, manufacturers and / or suppliers? Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do you obtain and verify certificates of insurance from subcontractors, manufacturers and / or suppliers?".
GENERAL INFORMATION 3. Remarks Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION 4. Do you lease employees to or from other employers? Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do you lease employees to or from other employers?".
GENERAL INFORMATION Lease To Enter text: The additional interest's full name. As used here, this is the company that employees are leased to.
GENERAL INFORMATION Workers Compensation Coverage Carried (Y / N) Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is workers compensation coverage carried?".
GENERAL INFORMATION Lease To Enter text: The additional interest's full name. As used here, this is the company that employees are leased to.
GENERAL INFORMATION Workers Compensation Coverage Carried (Y / N) Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is workers compensation coverage carried?".
GENERAL INFORMATION Lease From Enter text: The additional interest's full name. As used here, this is the company that employees are leased from.

ACORD 160 (2009/05) 4 of 64

Section Name Field Name Field and/or Section Description
GENERAL INFORMATION Workers Compensation Coverage Carried (Y / N) Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is workers compensation coverage carried?".
GENERAL INFORMATION Lease From Enter text: The additional interest's full name. As used here, this is the company that employees are leased from.
GENERAL INFORMATION Workers Compensation Coverage Carried (Y / N) Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is workers compensation coverage carried?".
GENERAL INFORMATION 5. Do you own or operate any other business? Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do you own or operate any other business?".
GENERAL INFORMATION Street, City, State, Zip Enter text: The first address line of the physical location.
GENERAL INFORMATION Enter text: The city of the physical location.
GENERAL INFORMATION Enter code: The state or province of the physical location.
GENERAL INFORMATION Enter code: The postal code of the physical location.
GENERAL INFORMATION Type of Business or Loc - Service Check the box (if applicable): Indicates the nature of business is service.
GENERAL INFORMATION Type of Business or Loc - Office Check the box (if applicable): Indicates the nature of business is an office.
GENERAL INFORMATION Type of Business or Loc - Retail Check the box (if applicable): Indicates the nature of business is retail.
GENERAL INFORMATION Type of Business or Loc -Wholesale Check the box (if applicable): Indicates the nature of business is wholesale.
GENERAL INFORMATION Type of Business or Loc - Other Check the box (if applicable): Indicates the nature of business is other than those listed.
GENERAL INFORMATION Type of Business or Loc - Other Description Enter text: The description of the nature/type of business.
GENERAL INFORMATION Building Interest - Own Check the box (if applicable): Indicates the named insured's interest in the building is as its owner.
GENERAL INFORMATION Building Interest - Lease Check the box (if applicable): Indicates the named insured leases the building.
GENERAL INFORMATION Building Interest - Rent Check the box (if applicable): Indicates the named insured rents the building.
GENERAL INFORMATION Building Interest - Other Check the box (if applicable): Indicates the named insured's interest is the building is other than as its owner or tenant.
GENERAL INFORMATION Building Interest - Other Description Enter text: The description of the insured's interest is the building when it is other than as its owner or tenant.
GENERAL INFORMATION Operations Enter text: The description of the operations of this risk. A restatement of the products classification wording is often not sufficient (e.g., "Metal Goods Manufacturing NOC" could include anything from paper clips to bridge girders).
GENERAL INFORMATION Street, City, State, Zip Enter text: The first address line of the physical location.
GENERAL INFORMATION Enter text: The city of the physical location.
GENERAL INFORMATION Enter code: The state or province of the physical location.

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Section Name Field Name Field and/or Section Description
GENERAL INFORMATION Enter code: The postal code of the physical location.
GENERAL INFORMATION Type of Business or Loc - Service Check the box (if applicable): Indicates the nature of business is service.
GENERAL INFORMATION Type of Business or Loc - Office Check the box (if applicable): Indicates the nature of business is an office.
GENERAL INFORMATION Type of Business or Loc - Retail Check the box (if applicable): Indicates the nature of business is retail.
GENERAL INFORMATION Type of Business or Loc -Wholesale Check the box (if applicable): Indicates the nature of business is wholesale.
GENERAL INFORMATION Type of Business or Loc - Other Check the box (if applicable): Indicates the nature of business is other than those listed.
GENERAL INFORMATION Type of Business or Loc - Other Description Enter text: The description of the nature/type of business.
GENERAL INFORMATION Building Interest - Own Check the box (if applicable): Indicates the named insured's interest in the building is as its owner.
GENERAL INFORMATION Building Interest - Lease Check the box (if applicable): Indicates the named insured leases the building.
GENERAL INFORMATION Building Interest - Rent Check the box (if applicable): Indicates the named insured rents the building.
GENERAL INFORMATION Building Interest - Other Check the box (if applicable): Indicates the named insured's interest is the building is other than as its owner or tenant.
GENERAL INFORMATION Building Interest - Other Description Enter text: The description of the insured's interest is the building when it is other than as its owner or tenant.
GENERAL INFORMATION Operations Enter text: The description of the operations of this risk. A restatement of the products classification wording is often not sufficient (e.g., "Metal Goods Manufacturing NOC" could include anything from paper clips to bridge girders).
GENERAL INFORMATION 6. In addition to your primary nature of business are you also involved in manufacture, relabeling or repackaging of others products? Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "In addition to your primary nature of business are you also involved in the manufacture, relabeling or repackaging of others products?".
GENERAL INFORMATION 6. Remarks Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION 7. In addition to your primary nature of business are you also involved in the mixing of others products? Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "In addition to your primary nature of business are you also involved in the mixing of others products?".
GENERAL INFORMATION 7. Remarks Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.

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Section Name Field Name Field and/or Section Description
GENERAL INFORMATION 8. Do you rent or loan equipment to others? Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do you rent or loan equipment to others?".
GENERAL INFORMATION Equipment Enter text: The description of the item.
GENERAL INFORMATION Type of Equipment - Small Tools Check the box (if applicable): Indicates the subclass / grouping of property into which the item falls is small tools.
GENERAL INFORMATION Type of Equipment - Large Equipment Check the box (if applicable): Indicates the subclass / grouping of property into which the item falls is large equipment.
GENERAL INFORMATION Instruction Given (Y / N) Enter Y for a “Yes” response. Input N for “No” response. Indicates instructions are given on how to use the item when it is rented or loaned to others.
GENERAL INFORMATION Equipment Enter text: The description of the item.
GENERAL INFORMATION Type of Equipment - Small Tools Check the box (if applicable): Indicates the subclass / grouping of property into which the item falls is small tools.
GENERAL INFORMATION Type of Equipment - Large Equipment Check the box (if applicable): Indicates the subclass / grouping of property into which the item falls is large equipment.
GENERAL INFORMATION Instruction Given (Y / N) Enter Y for a “Yes” response. Input N for “No” response. Indicates instructions are given on how to use the item when it is rented or loaned to others.
GENERAL INFORMATION 9. Does the operation have hours after 9:00 PM and / or 24 hour operations? Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the operation have hours after 9:00 PM and / or 24 hour operations?".
GENERAL INFORMATION Start Time Enter time: The starting time for the normal business day.
GENERAL INFORMATION End Time Enter time: The closing time for the normal business day.
GENERAL INFORMATION 24 Hour Operations Check the box (if applicable): Indicates the business is open 24 hours a day.
REMARKS Remarks Enter text: The description of any additional information required for underwriting or rating. Attach ACORD 101, Additional Remarks Schedule, if more space is required.
IDENTIFICATION SECTION Agency Customer ID Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage).
LIABILITY COVERAGES -POLICY LEVEL Bodily Injury and Property Damage - Occurrence Enter limit: The bodily injury each occurrence limit amount.
LIABILITY COVERAGES -POLICY LEVEL Bodily Injury and Property Damage - Aggregate Enter limit: The commercial general liability policy, bodily injury aggregate limit amount.
LIABILITY COVERAGES -POLICY LEVEL Bodily Injury and Property Damage - Deductible Enter amount: The deductible applicable to the Bodily Injury coverage.
LIABILITY COVERAGES -POLICY LEVEL Bodily Injury and Property Damage - Included Check the box (if applicable): Indicates bodily injury coverage is included in the policy.

ACORD 160 (2009/05) 7 of 64

Section Name Field Name Field and/or Section Description
LIABILITY COVERAGES -POLICY LEVEL Bodily Injury and Property Damage - Form Number Enter identifier: The form number used by the company for bodily injury coverage.
LIABILITY COVERAGES -POLICY LEVEL Bodily Injury and Property Damage - Form Date Enter date: The edition date of the form used by the company for bodily injury coverage.
LIABILITY COVERAGES -POLICY LEVEL Bodily Injury and Property Damage - Premium Enter amount: The premium amount for bodily injury coverage.
LIABILITY COVERAGES -POLICY LEVEL Medical Expense (per person) -Total Amount 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).
LIABILITY COVERAGES -POLICY LEVEL Medical Expense (per person) -Deductible Enter deductible: The deductible amount for medical expense coverage.
LIABILITY COVERAGES -POLICY LEVEL Medical Expense (per person) -Included Check the box (if applicable): Indicates medical expense coverage is included in the policy.
LIABILITY COVERAGES -POLICY LEVEL Medical Expense (per person) -Form Number Enter identifier: The form number used by the company for medical expense coverage.
LIABILITY COVERAGES -POLICY LEVEL Medical Expense (per person) -Form Date Enter date: The edition date of the form used by the company for medical expense coverage.
LIABILITY COVERAGES -POLICY LEVEL Medical Expense (per person) -Premium Enter amount: The premium amount for medical expense coverage.
LIABILITY COVERAGES -POLICY LEVEL Personal & Advertising Injury -Total Amount 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).
LIABILITY COVERAGES -POLICY LEVEL Personal & Advertising Injury -Deductible Enter deductible: The deductible amount for personal and advertising injury coverage.
LIABILITY COVERAGES -POLICY LEVEL Personal & Advertising Injury -Included Check the box (if applicable): Indicates personal and advertising injury coverage is included in the policy.
LIABILITY COVERAGES -POLICY LEVEL Personal & Advertising Injury -Form Number Enter identifier: The form number used by the company for personal and advertising injury coverage.
LIABILITY COVERAGES -POLICY LEVEL Personal & Advertising Injury -Form Date Enter date: The edition date of the form used by the company for personal and advertising injury coverage.
LIABILITY COVERAGES -POLICY LEVEL Personal & Advertising Injury -Premium Enter amount: The premium amount for personal and advertising injury coverage.
LIABILITY COVERAGES -POLICY LEVEL Products & Completed Operations Total Amount 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).

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Section Name Field Name Field and/or Section Description
LIABILITY COVERAGES -POLICY LEVEL Products & Completed Operations Deductible Enter deductible: The deductible amount for products and completed operations coverage.
LIABILITY COVERAGES -POLICY LEVEL Products & Completed Operations Included Check the box (if applicable): Indicates products and completed operations coverage is included in the policy.
LIABILITY COVERAGES -POLICY LEVEL Products & Completed Operations Form Number Enter identifier: The form number used by the company for products and completed operations coverage.
LIABILITY COVERAGES -POLICY LEVEL Products & Completed Operations Form Date Enter date: The edition date of the form used by the company for products and completed operations coverage.
LIABILITY COVERAGES -POLICY LEVEL Products & Completed Operations Premium Enter amount: The premium amount for products and completed operations coverage.
LIABILITY COVERAGES -POLICY LEVEL Professional Liability -Employment Practices Liability (EPLI) - Total Amount Enter limit: The limit amount for employment practices liability (EPLI) coverage.
LIABILITY COVERAGES -POLICY LEVEL Professional Liability -Employment Practices Liability (EPLI) - Retroactive Date Enter date: The retroactive date for employment practices liability (EPLI) coverage.
LIABILITY COVERAGES -POLICY LEVEL Professional Liability -Employment Practices Liability (EPLI) - Deductible Enter deductible: The deductible amount for employment practices liability (EPLI) coverage.
LIABILITY COVERAGES -POLICY LEVEL Professional Liability -Employment Practices Liability (EPLI) - Included Check the box (if applicable): Indicates employment practices liability (EPLI) coverage is included in the policy.
LIABILITY COVERAGES -POLICY LEVEL Professional Liability -Employment Practices Liability (EPLI) - Form Number Enter identifier: The form number used by the company for employment practices liability (EPLI) coverage.
LIABILITY COVERAGES -POLICY LEVEL Professional Liability -Employment Practices Liability (EPLI) - Form Date Enter date: The edition date of the form used by the company for employment practices liability (EPLI) coverage.
LIABILITY COVERAGES -POLICY LEVEL Professional Liability -Employment Practices Liability (EPLI) - Premium Enter amount: The premium amount for employment practices liability (EPLI) coverage.
LIABILITY COVERAGES -POLICY LEVEL Professional Liability - Directors & Officers - Total Amount Enter limit: The limit amount for directors and officers (D&O) coverage.
LIABILITY COVERAGES -POLICY LEVEL Professional Liability - Directors & Officers - Retroactive Date Enter date: The retroactive date for Directors & Officers (D&O) coverage.

ACORD 160 (2009/05) 9 of 64

Section Name Field Name Field and/or Section Description
LIABILITY COVERAGES -POLICY LEVEL Professional Liability - Directors & Officers - Deductible Enter deductible: The deductible amount for directors and officers (D&O) coverage.
LIABILITY COVERAGES -POLICY LEVEL Professional Liability - Directors & Officers - Included Check the box (if applicable): Indicates directors and officers (D&O) coverage is included in the policy.
LIABILITY COVERAGES -POLICY LEVEL Professional Liability - Directors & Officers - Form Number Enter identifier: The form number used by the company for directors and officers (D&O) coverage.
LIABILITY COVERAGES -POLICY LEVEL Professional Liability - Directors & Officers - Form Date Enter date: The edition date of the form used by the company for directors and officers (D&O) coverage.
LIABILITY COVERAGES -POLICY LEVEL Professional Liability - Directors & Officers - Premium Enter amount: The premium amount for directors and officers (D&O) coverage.
LIABILITY COVERAGES -POLICY LEVEL Tenants Legal Liability - Total Amount Enter limit: The limit amount for tenants legal liability coverage.
LIABILITY COVERAGES -POLICY LEVEL Tenants Legal Liability -Deductible Enter deductible: The deductible amount for tenants legal liability coverage.
LIABILITY COVERAGES -POLICY LEVEL Tenants Legal Liability - Included Check the box (if applicable): Indicates tenants legal liability coverage is included in the policy.
LIABILITY COVERAGES -POLICY LEVEL Tenants Legal Liability - Form Number Enter identifier: The form number used by the company for tenants legal liability coverage.
LIABILITY COVERAGES -POLICY LEVEL Tenants Legal Liability - Form Date Enter date: The edition date of the form used by the company for tenants legal liability coverage.
LIABILITY COVERAGES -POLICY LEVEL Tenants Legal Liability - Premium Enter amount: The premium amount for tenants legal liability coverage.
LIABILITY COVERAGES -POLICY LEVEL Auto - Hired Physical Damage -Total Amount Enter limit: The limit amount for hired auto physical damage coverage.
LIABILITY COVERAGES -POLICY LEVEL Auto - Hired Physical Damage -Deductible Enter deductible: The deductible amount for hired auto physical damage coverage.
LIABILITY COVERAGES -POLICY LEVEL Auto - Hired Physical Damage -Included Check the box (if applicable): Indicates hired auto physical damage coverage is included in the policy.
LIABILITY COVERAGES -POLICY LEVEL Auto - Hired Physical Damage -Form Number Enter identifier: The form number used by the company for hired auto physical damage coverage.
LIABILITY COVERAGES -POLICY LEVEL Auto - Hired Physical Damage -Form Date Enter date: The edition date of the form used by the company for hired auto physical damage coverage.
LIABILITY COVERAGES -POLICY LEVEL Auto - Hired Physical Damage -Premium Enter amount: The premium amount for hired auto physical damage coverage.
LIABILITY COVERAGES -POLICY LEVEL Auto - Hired Liability - Bodily Injury - Total Amount Enter limit: The limit amount for hired auto bodily injury coverage.

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Section Name Field Name Field and/or Section Description
LIABILITY COVERAGES -POLICY LEVEL Auto - Hired Liability - Bodily Injury - Deductible Enter deductible: The deductible amount for hired auto bodily injury coverage.
LIABILITY COVERAGES -POLICY LEVEL Auto - Hired Liability - Bodily Injury - Included Check the box (if applicable): Indicates hired auto bodily injury coverage is included in the policy.
LIABILITY COVERAGES -POLICY LEVEL Auto - Hired Liability - Bodily Injury - Form Number Enter identifier: The form number used by the company for hired auto bodily injury coverage.
LIABILITY COVERAGES -POLICY LEVEL Auto - Hired Liability - Bodily Injury - Form Date Enter date: The edition date of the form used by the company for hired auto bodily injury coverage.
LIABILITY COVERAGES -POLICY LEVEL Auto - Hired Liability - Bodily Injury - Premium Enter amount: The premium amount for hired auto bodily injury coverage.
LIABILITY COVERAGES -POLICY LEVEL Auto - Hired Liability - Property Damage - Total Amount Enter limit: The limit amount for hired auto property damage coverage.
LIABILITY COVERAGES -POLICY LEVEL Auto - Hired Liability - Property Damage - Deductible Enter deductible: The deductible amount for hired auto property damage coverage.
LIABILITY COVERAGES -POLICY LEVEL Auto - Hired Liability - Property Damage - Included Check the box (if applicable): Indicates hired auto property damage coverage is included in the policy.
LIABILITY COVERAGES -POLICY LEVEL Auto - Hired Liability - Property Damage - Form Number Enter identifier: The form number used by the company for hired auto property damage coverage.
LIABILITY COVERAGES -POLICY LEVEL Auto - Hired Liability - Property Damage - Form Date Enter date: The edition date of the form used by the company for hired auto property damage coverage.
LIABILITY COVERAGES -POLICY LEVEL Auto - Hired Liability - Property Damage - Premium Enter amount: The premium amount for hired auto property damage coverage.
LIABILITY COVERAGES -POLICY LEVEL Auto - Non-Owned - Total Amount Enter limit: The limit amount for non-owned auto coverage.
LIABILITY COVERAGES -POLICY LEVEL Auto - Non-Owned - Deductible Enter deductible: The deductible amount for non-owned auto coverage.
LIABILITY COVERAGES -POLICY LEVEL Auto - Non-Owned - Included Check the box (if applicable): Indicates non-owned auto coverage is included in the policy.
LIABILITY COVERAGES -POLICY LEVEL Auto - Non-Owned - Form Number Enter identifier: The form number used by the company for non-owned auto coverage.
LIABILITY COVERAGES -POLICY LEVEL Auto - Non-Owned - Form Date Enter date: The edition date of the form used by the company for non-owned auto coverage.
LIABILITY COVERAGES -POLICY LEVEL Auto - Non-Owned - Premium Enter amount: The premium amount for non-owned auto coverage.
LIABILITY COVERAGES -POLICY LEVEL Employee Benefits Liability - Total Amount Enter limit: The general liability employee benefits limit amount.

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Section Name Field Name Field and/or Section Description
LIABILITY COVERAGES -POLICY LEVEL Employee Benefits Liability -Retroactive Date Enter date: The retroactive date that is the earliest date for which an occurrence could "trigger" coverage under Employee Benefits coverage.
LIABILITY COVERAGES -POLICY LEVEL Employee Benefits Liability -Deductible Enter deductible: The deductible per claim applicable to Employee Benefits Liability coverage.
LIABILITY COVERAGES -POLICY LEVEL Employee Benefits Liability -Included Check the box (if applicable): Indicates employee benefits coverage is included in the policy.
LIABILITY COVERAGES -POLICY LEVEL Employee Benefits Liability - Form Number Enter identifier: The form number used by the company for employee benefits coverage.
LIABILITY COVERAGES -POLICY LEVEL Employee Benefits Liability - Form Date Enter date: The edition date of the form used by the company for employee benefits coverage.
LIABILITY COVERAGES -POLICY LEVEL Employee Benefits Liability -Premium Enter amount: The premium amount for employee benefits coverage.
LIABILITY COVERAGES -POLICY LEVEL Extended Employee Dishonesty -Total Amount Enter limit: The limit amount for extended employee dishonesty coverage.
LIABILITY COVERAGES -POLICY LEVEL Extended Employee Dishonesty -Deductible Enter deductible: The deductible amount for extended employee dishonesty coverage.
LIABILITY COVERAGES -POLICY LEVEL Extended Employee Dishonesty -Included Check the box (if applicable): Indicates extended employee dishonesty coverage is included in the policy.
LIABILITY COVERAGES -POLICY LEVEL Extended Employee Dishonesty -Form Number Enter identifier: The form number used by the company for extended employee dishonesty coverage.
LIABILITY COVERAGES -POLICY LEVEL Extended Employee Dishonesty -Form Date Enter date: The edition date of the form used by the company for extended employee dishonesty coverage.
LIABILITY COVERAGES -POLICY LEVEL Extended Employee Dishonesty -Premium Enter amount: The premium amount for extended employee dishonesty coverage.
LIABILITY COVERAGES -POLICY LEVEL Freight or Passenger Elevators Inspection Fee - Total Amount Enter limit: The limit amount for freight or passenger elevators inspection fee coverage.
LIABILITY COVERAGES -POLICY LEVEL Freight or Passenger Elevators Inspection Fee - Deductible Enter deductible: The deductible amount for freight or passenger elevators inspection fee coverage.
LIABILITY COVERAGES -POLICY LEVEL Freight or Passenger Elevators Inspection Fee - Included Check the box (if applicable): Indicates freight or passenger elevators inspection fee coverage is included in the policy.
LIABILITY COVERAGES -POLICY LEVEL Freight or Passenger Elevators Inspection Fee - Form Number Enter identifier: The form number used by the company for freight or passenger elevators inspection fee coverage.
LIABILITY COVERAGES -POLICY LEVEL Freight or Passenger Elevators Inspection Fee - Form Date Enter date: The edition date of the form used by the company for freight or passenger elevators inspection fee coverage.
LIABILITY COVERAGES -POLICY LEVEL Freight or Passenger Elevators Inspection Fee - Premium Enter amount: The premium amount for freight or passenger elevators inspection fee coverage.

ACORD 160 (2009/05) 12 of 64

Section Name Field Name Field and/or Section Description
LIABILITY COVERAGES -POLICY LEVEL Garage - Collision - Total Amount Enter limit: The limit amount for garage collision coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage - Collision - Deductible Enter deductible: The deductible amount for garage collision coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage - Collision - Included Check the box (if applicable): Indicates garage collision coverage is included in the policy.
LIABILITY COVERAGES -POLICY LEVEL Garage - Collision - Form Number Enter identifier: The form number used by the company for garage collision coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage - Collision - Form Date Enter date: The edition date of the form used by the company for garage collision coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage - Collision - Premium Enter amount: The premium amount for garage collision coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage - Comprehensive / OTC -Total Amount Enter limit: The limit amount for garage comprehensive coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage - Comprehensive / OTC -Deductible Enter deductible: The deductible amount for garage comprehensive coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage - Comprehensive / OTC -Included Check the box (if applicable): Indicates garage comprehensive coverage is included in the policy.
LIABILITY COVERAGES -POLICY LEVEL Garage - Comprehensive / OTC -Form Number Enter identifier: The form number used by the company for garage comprehensive coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage - Comprehensive / OTC -Form Date Enter date: The edition date of the form used by the company for garage comprehensive coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage - Comprehensive / OTC -Premium Enter amount: The premium amount for garage comprehensive coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Loc 1 - Loc # Enter number: The producer assigned location number for the premises.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Loc 1 - Total Amount Enter limit: The limit amount for garage keepers coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Loc 1 -Deductible Enter deductible: The deductible amount for garage keepers coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Loc 1 - Included Check the box (if applicable): Indicates the garage keepers coverage is included in the policy.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Loc 1 - Form Number Enter identifier: The form number used by the company for garage keepers coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Loc 1 - Form Date Enter date: The edition date of the form used by the company for garage keepers coverage.

ACORD 160 (2009/05) 13 of 64

Section Name Field Name Field and/or Section Description
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Loc 1 - Premium Enter amount: The premium amount for garage keepers coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Loc 2 - Loc # Enter number: The producer assigned location number for the premises.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Loc 2 - Total Amount Enter limit: The limit amount for garage keepers coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Loc 2 -Deductible Enter deductible: The deductible amount for garage keepers coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Loc 2 - Included Check the box (if applicable): Indicates the garage keepers coverage is included in the policy.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Loc 2 - Form Number Enter identifier: The form number used by the company for garage keepers coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Loc 2 - Form Date Enter date: The edition date of the form used by the company for garage keepers coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Loc 2 - Premium Enter amount: The premium amount for garage keepers coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Loc 3 - Loc # Enter number: The producer assigned location number for the premises.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Loc 3 - Total Amount Enter limit: The limit amount for garage keepers coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Loc 3 -Deductible Enter deductible: The deductible amount for garage keepers coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Loc 3 - Included Check the box (if applicable): Indicates the garage keepers coverage is included in the policy.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Loc 3 - Form Number Enter identifier: The form number used by the company for garage keepers coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Loc 3 - Form Date Enter date: The edition date of the form used by the company for garage keepers coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Loc 3 - Premium Enter amount: The premium amount for garage keepers coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Legal or Direct -Legal Check the box (if applicable): Indicates the policy is to be written on a legal liability basis.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Legal or Direct -Direct Check the box (if applicable): Indicates the policy is to be written on a direct basis.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Legal or Direct -Total Amount Enter limit: The limit amount for garage keepers coverage.

ACORD 160 (2009/05) 14 of 64

Section Name Field Name Field and/or Section Description
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Legal or Direct -Deductible Enter deductible: The deductible amount for garage keepers coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Legal or Direct -Included Check the box (if applicable): Indicates the garage keepers coverage is included in the policy.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Legal or Direct -Form Number Enter identifier: The form number used by the company for garage keepers coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Legal or Direct -Form Date Enter date: The edition date of the form used by the company for garage keepers coverage.
LIABILITY COVERAGES -POLICY LEVEL Garage Keepers - Legal or Direct -Premium Enter amount: The premium amount for garage keepers coverage.
LIABILITY COVERAGES -POLICY LEVEL Liquor Liability - General Aggregate Enter limit: The limit amount for liquor liability coverage.
LIABILITY COVERAGES -POLICY LEVEL Liquor Liability - Per Person Enter limit: The limit amount for liquor liability coverage.
LIABILITY COVERAGES -POLICY LEVEL Liquor Liability - Other Description Enter text: The description of the liquor liability limit.
LIABILITY COVERAGES -POLICY LEVEL Liquor Liability - Other Total Limit Enter limit: The limit amount for liquor liability coverage.
LIABILITY COVERAGES -POLICY LEVEL Liquor Liability - Deductible Enter deductible: The deductible amount for liquor liability coverage.
LIABILITY COVERAGES -POLICY LEVEL Liquor Liability - Included Check the box (if applicable): Indicates liquor liability coverage is included in the policy.
LIABILITY COVERAGES -POLICY LEVEL Liquor Liability - Form Number Enter identifier: The form number used by the company for liquor liability coverage.
LIABILITY COVERAGES -POLICY LEVEL Liquor Liability - Form Date Enter date: The edition date of the form used by the company for liquor liability coverage.
LIABILITY COVERAGES -POLICY LEVEL Liquor Liability - Premium Enter amount: The premium amount for liquor liability coverage.
LIABILITY COVERAGES -POLICY LEVEL Medical Payments - Total Amount Enter limit: The limit amount for medical payments coverage.
LIABILITY COVERAGES -POLICY LEVEL Medical Payments - Deductible Enter deductible: The deductible amount for medical payments coverage.
LIABILITY COVERAGES -POLICY LEVEL Medical Payments - Included Check the box (if applicable): Indicates medical payments coverage is included in the policy.
LIABILITY COVERAGES -POLICY LEVEL Medical Payments - Form Number Enter identifier: The form number used by the company for medical payments coverage.

ACORD 160 (2009/05) 15 of 64

Section Name Field Name Field and/or Section Description
LIABILITY COVERAGES -POLICY LEVEL Medical Payments - Form Date Enter date: The edition date of the form used by the company for medical payments coverage.
LIABILITY COVERAGES -POLICY LEVEL Medical Payments - Premium Enter amount: The premium amount for medical payments coverage.
LIABILITY COVERAGES -POLICY LEVEL Mobile Equipment Subject to Motor Vehicle Laws - Total Amount Enter limit: The limit amount for mobile equipment subject to motor vehicle laws coverage.
LIABILITY COVERAGES -POLICY LEVEL Mobile Equipment Subject to Motor Vehicle Laws - Deductible Enter deductible: The deductible amount for mobile equipment subject to motor vehicle laws coverage.
LIABILITY COVERAGES -POLICY LEVEL Mobile Equipment Subject to Motor Vehicle Laws - Included Check the box (if applicable): Indicates mobile equipment subject to motor vehicle laws coverage is included in the policy.
LIABILITY COVERAGES -POLICY LEVEL Mobile Equipment Subject to Motor Vehicle Laws - Form Number Enter identifier: The form number used by the company for mobile equipment subject to motor vehicle laws coverage.
LIABILITY COVERAGES -POLICY LEVEL Mobile Equipment Subject to Motor Vehicle Laws - Form Date Enter date: The edition date of the form used by the company for mobile equipment subject to motor vehicle laws coverage.
LIABILITY COVERAGES -POLICY LEVEL Mobile Equipment Subject to Motor Vehicle Laws - Premium Enter amount: The premium amount for mobile equipment subject to motor vehicle laws coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Coverages Schedule Attached Check the box (if applicable): Indicates a coverages schedule is attached.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Coverage Code Enter code: The code for the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Description 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).

ACORD 160 (2009/05) 16 of 64

Section Name Field Name Field and/or Section Description
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Deductible Enter amount: The deductible applicable to the Other Coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Deductible Type Enter code: The type of deductible (e.g. Flat, Percent, etc.)
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Options Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Options Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Terr Enter code: The rating territory code applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Y / N Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to a question associated with the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Description of Credit / Surcharge Amount Enter text: The description of credits and / or surcharges applicable to the policy.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Premium Enter amount: The premium for other general liability coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Coverage Code Enter code: The code for the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Description 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).

ACORD 160 (2009/05) 17 of 64

Section Name Field Name Field and/or Section Description
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Deductible Enter amount: The deductible applicable to the Other Coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Deductible Type Enter code: The type of deductible (e.g. Flat, Percent, etc.)
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Options Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Options Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Terr Enter code: The rating territory code applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Y / N Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to a question associated with the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Description of Credit / Surcharge Amount Enter text: The description of credits and / or surcharges applicable to the policy.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Premium Enter amount: The premium for other general liability coverage.

ACORD 160 (2009/05) 18 of 64

Section Name Field Name Field and/or Section Description
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Coverage Code Enter code: The code for the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Description 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Deductible Enter amount: The deductible applicable to the Other Coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Deductible Type Enter code: The type of deductible (e.g. Flat, Percent, etc.)
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Options Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Options Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Terr Enter code: The rating territory code applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Y / N Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to a question associated with the coverage.

ACORD 160 (2009/05) 19 of 64

Section Name Field Name Field and/or Section Description
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Description of Credit / Surcharge Amount Enter text: The description of credits and / or surcharges applicable to the policy.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Premium Enter amount: The premium for other general liability coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Coverage Code Enter code: The code for the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Description 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Deductible Enter amount: The deductible applicable to the Other Coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Deductible Type Enter code: The type of deductible (e.g. Flat, Percent, etc.)
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Options Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Options Enter code: The code for an option applicable to the coverage.

ACORD 160 (2009/05) 20 of 64

Section Name Field Name Field and/or Section Description
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Terr Enter code: The rating territory code applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Y / N Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to a question associated with the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Description of Credit / Surcharge Amount Enter text: The description of credits and / or surcharges applicable to the policy.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Premium Enter amount: The premium for other general liability coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Coverage Code Enter code: The code for the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Description 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Deductible Enter amount: The deductible applicable to the Other Coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Deductible Type Enter code: The type of deductible (e.g. Flat, Percent, etc.)

ACORD 160 (2009/05) 21 of 64

Section Name Field Name Field and/or Section Description
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Options Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Options Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Terr Enter code: The rating territory code applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Y / N Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to a question associated with the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Description of Credit / Surcharge Amount Enter text: The description of credits and / or surcharges applicable to the policy.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Premium Enter amount: The premium for other general liability coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Coverage Code Enter code: The code for the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Description 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).

ACORD 160 (2009/05) 22 of 64

Section Name Field Name Field and/or Section Description
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Deductible Enter amount: The deductible applicable to the Other Coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Deductible Type Enter code: The type of deductible (e.g. Flat, Percent, etc.)
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Options Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Options Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Terr Enter code: The rating territory code applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Y / N Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to a question associated with the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Description of Credit / Surcharge Amount Enter text: The description of credits and / or surcharges applicable to the policy.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Premium Enter amount: The premium for other general liability coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Coverage Code Enter code: The code for the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Description 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).

ACORD 160 (2009/05) 23 of 64

Section Name Field Name Field and/or Section Description
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Deductible Enter amount: The deductible applicable to the Other Coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Deductible Type Enter code: The type of deductible (e.g. Flat, Percent, etc.)
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Options Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Options Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Terr Enter code: The rating territory code applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Y / N Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to a question associated with the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Description of Credit / Surcharge Amount Enter text: The description of credits and / or surcharges applicable to the policy.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Premium Enter amount: The premium for other general liability coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Coverage Code Enter code: The code for the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Description 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).

ACORD 160 (2009/05) 24 of 64

Section Name Field Name Field and/or Section Description
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Deductible Enter amount: The deductible applicable to the Other Coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Deductible Type Enter code: The type of deductible (e.g. Flat, Percent, etc.)
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Options Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Options Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Terr Enter code: The rating territory code applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Y / N Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to a question associated with the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Description of Credit / Surcharge Amount Enter text: The description of credits and / or surcharges applicable to the policy.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Premium Enter amount: The premium for other general liability coverage.

ACORD 160 (2009/05) 25 of 64

Section Name Field Name Field and/or Section Description
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Coverage Code Enter code: The code for the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Description 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit 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).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Limit Applies To Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Deductible Enter amount: The deductible applicable to the Other Coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Deductible Type Enter code: The type of deductible (e.g. Flat, Percent, etc.)
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Options Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Options Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Terr Enter code: The rating territory code applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Y / N Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to a question associated with the coverage.

ACORD 160 (2009/05) 26 of 64

Section Name Field Name Field and/or Section Description
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Description of Credit / Surcharge Amount Enter text: The description of credits and / or surcharges applicable to the policy.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL Premium Enter amount: The premium for other general liability coverage.
IDENTIFICATION SECTION Agency Customer ID Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage).
IDENTIFICATION SECTION Loc # Enter number: The producer assigned number of the location.
IDENTIFICATION SECTION Bldg # Enter number: The building number for the premises. Used when more than one building exists at an individual location.
PREMISES Blanket Rate Enter Y for a “Yes” response. Input N for “No” response. Indicates if a blanket rate is being requested.
PREMISES Building Description Enter text: This describes the particular sublocation in a manner sufficient to distinguish it from other sublocations at a given location. An example might be "3 story blue structure on the left of the main building".
PREMISES Check if Primary Premises Check the box (if applicable): Indicates if the location / building is the primary premises.
PREMISES Description of all occupancies at this premises Enter text: The description of the buildings occupancy.
PREMISES Right Exposure Enter text: The description of the buildings, structures, activities conducted, or use of the adjacent property to the right of the insured premises.
PREMISES Distance Enter number: The distance to the adjacent exposure on the right of the insured premises in linear feet.
PREMISES Left Exposure Enter text: The description of the buildings, structures, activities conducted, or use of the adjacent property to the left of the insured premises.
PREMISES Distance Enter number: The distance to the adjacent exposure on the left of the insured premises in linear feet.
PREMISES Front Exposure Enter text: The description of the buildings, structures, activities conducted, or use of the adjacent property to the front of the insured premises.
PREMISES Distance Enter number: The distance to the adjacent exposure on the front of the insured premises in linear feet.
PREMISES Rear Exposure Enter text: The description of the buildings, structures, activities conducted, or use of the adjacent property to the rear of the insured premises.

ACORD 160 (2009/05) 27 of 64

Section Name Field Name Field and/or Section Description
PREMISES Distance Enter number: The distance to the adjacent exposure on the rear of the insured premises in linear feet.
PREMISES Annual Sales Receipts Enter amount: The total annual gross sales or receipts.
PREMISES Total Payroll Enter amount: The total annual payroll of the business in whole dollars.
PREMISES Class Code Enter code: The industry code that identifies the exposure. This code is derived from Insurance Services Office or a company code list.
PREMISES Rate# Enter number: The rate number for the exposure defined by the insurer.
PREMISES Rate Group Enter code: The rate group for the exposure defined by the insurer.
PREMISES Prot. Class Enter code: The fire rating protection class for this location. Note: some structures may be located too far from the nearest hydrant, or too far from the nearest fire station, for the protection class of the community to apply.
PREMISES Rate Terr. Enter code: Enter the Insurance Services Office (ISO) or company rating territory for this location.
PREMISES Distance to Hydrant Ft. Enter number: The distance in feet from the nearest hydrant that supports the protection class used.
PREMISES Distance to Fire Station Mi. Enter number: The distance in miles from the nearest fire station that supports the protection class used.
PREMISES Fire District - Name Enter text: The property's fire district name.
PREMISES Fire District Code Number Enter code: The property's fire district code number which can be found in the individual states manual pages.
PROPERTY Building Limit Enter limit: The building limit amount.
PROPERTY % Coins 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. As used here, this information is for the building.
PROPERTY Valuation - RC Check the box (if applicable): Indicate the replacement cost will be used to determine the amount paid on a claim. As used here, this information is for the building.
PROPERTY Valuation - FVRC Check the box (if applicable): Indicate the full value replacement cost will be used to determine the amount paid on a claim. As used here, this information is for the building.
PROPERTY Valuation - ACV Check the box (if applicable): Indicate the actual cash value will be used to determine the amount paid on a claim. As used here, this information is for the building.

ACORD 160 (2009/05) 28 of 64

Section Name Field Name Field and/or Section Description
PROPERTY Valuation - Other Check the box (if applicable): Indicate the method used to determine the amount paid on a claim is other than those listed. As used here, this information is for the building.
PROPERTY Valuation - Other Description Enter code: Indicate the method which will be used to determine the amount paid on a claim. Valuation methods are: ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value As used here, this information is for the building.
PROPERTY INFL% Enter percentage: The inflation guard percentage gives an automatic increase in the amount of coverage based on a percentage over time. List both the percentage amount and the period of time during which it applies (e.g., 4% per year). As used here, this information is for the building.
PROPERTY Deductible Type Enter code: The type of deductible (e.g. Flat, Percent, etc.) As used here, this information is for the building.
PROPERTY Deductible Enter deductible: The deductible amount that is to apply to this subject of insurance. As used here, this information is for the building.
PROPERTY Deductible Type Enter code: The type of deductible (e.g. Flat, Percent, etc.) As used here, this information is for the building.
PROPERTY Deductible Enter deductible: The deductible amount that is to apply to this subject of insurance. As used here, this information is for the building.
PROPERTY Personal Property Limit Enter limit: The personal property limit amount.
PROPERTY % Coins 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. As used here, this information is for personal property.
PROPERTY Valuation - RC Check the box (if applicable): Indicate the replacement cost will be used to determine the amount paid on a claim. As used here, this information is for personal property.
PROPERTY Valuation - FVRC Check the box (if applicable): Indicate the full value replacement cost will be used to determine the amount paid on a claim. As used here, this information is for personal property.
Section Name Field Name Field and/or Section Description
PROPERTY Valuation - ACV Check the box (if applicable): Indicate the actual cash value will be used to determine the amount paid on a claim. As used here, this information is for personal property.
PROPERTY Valuation - Other Check the box (if applicable): Indicate the method used to determine the amount paid on a claim is other than those listed. As used here, this information is for personal property.
PROPERTY Valuation - Other Description Enter code: Indicate the method which will be used to determine the amount paid on a claim. Valuation methods are: ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value As used here, this information is for personal property.
PROPERTY INFL% Enter percentage: The inflation guard percentage gives an automatic increase in the amount of coverage based on a percentage over time. List both the percentage amount and the period of time during which it applies (e.g., 4% per year). As used here, this information is for personal property.
PROPERTY Deductible Type Enter code: The type of deductible (e.g. Flat, Percent, etc.) As used here, this information is for personal property.
PROPERTY Deductible Enter deductible: The deductible amount that is to apply to this subject of insurance. As used here, this information is for personal property.
PROPERTY Deductible Type Enter code: The type of deductible (e.g. Flat, Percent, etc.) As used here, this information is for personal property.
PROPERTY Deductible Enter deductible: The deductible amount that is to apply to this subject of insurance. As used here, this information is for personal property.
PROPERTY Year Built Enter year: The 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.

ACORD 160 (2009/05) 29 of 64

ACORD 160 (2009/05) 30 of 64

Section Name Field Name Field and/or Section Description
PROPERTY Construction Type Enter code: The primary construction type of the premises. Common construction classifications are: * Frame * Joisted Masonry * Non-Combustible * Masonry Non-Combustible * Modified Fire Resistive * Fire Resistive
PROPERTY # Stories Enter number: The number of stories for this building not including any basement.
PROPERTY % Sprink Enter percentage: The percentage of the structure area covered by the sprinkler system.
PROPERTY Basement Present? (Y / N) Enter Y for a “Yes” response. Input N for “No” response. Indicates if there is a basement in the structure.
PROPERTY Is it finished? (Y / N) Enter Y for a “Yes” response. Input N for “No” response. Indicates if the basement is finished.
PROPERTY Wind Class - Resistive Check the box (if applicable): Indicates the wind class is resistive.
PROPERTY Wind Class - Semi-Resistive Check the box (if applicable): Indicates the wind class is semi-resistive.
PROPERTY Wind Class - Other Check the box (if applicable): Indicates the wind class is other than those listed.
PROPERTY Wind Class - Other Description Enter text: The description of the wind class when "other" has been checked.
PROPERTY Building Improvements - Wiring Year Enter year: The year the wiring improvements took place.
PROPERTY Building Improvements - Roofing Year Enter year: The year the roofing improvements took place.
PROPERTY Building Improvements - Plumbing Year Enter year: The year the plumbing improvements took place.
PROPERTY Building Improvements - Heating Year Enter year: The year the heating improvements took place.
PROPERTY Roof Type Enter code: The material used to construct the roof. Examples: * Composition (fiberglass, asphalt, etc.) * Metal * Poured * Slate * Tile * Wood Shake/Shingle

ACORD 160 (2009/05) 31 of 64

Section Name Field Name Field and/or Section Description
PROPERTY Bldg. Code Grade Enter code: The industry code used to collect the building code effectiveness grade code. The source of this code list is public protection classification or individual insurer rating manuals.
PROPERTY Bldg. Code Grade - Inspected (Y / N) Enter Y for a “Yes” response. Input N for “No” response. Indicate if the structure has been inspected specific to its Building Code effectiveness grade.
PROPERTY Bldg. Code Grade - Community Check the box (if applicable): Indicates the building code effectiveness grade was established for the community.
PROPERTY Bldg. Code Grade - Specific Property Check the box (if applicable): Indicates the building code effectiveness grade was established for this specific property.
PROPERTY Tax Code Enter code: The code which normally represents the location for which a surcharge is being applied (city, county or state).
PROPERTY COVERAGES Accounts Receivable - Pol Level Check the box (if applicable): Indicates accounts receivable coverage applies to the policy.
PROPERTY COVERAGES Accounts Receivable - Prem Level Check the box (if applicable): Indicates accounts receivable coverage applies to a specific premises.
PROPERTY COVERAGES Accounts Receivable - Total Amount Enter limit: The total limit amount for accounts receivable coverage amount.
PROPERTY COVERAGES Accounts Receivable - Deductible Enter deductible: The deductible amount for accounts receivable coverage.
PROPERTY COVERAGES Accounts Receivable - Included Check the box (if applicable): Indicates accounts receivable coverage is included in the policy.
PROPERTY COVERAGES Accounts Receivable - Form Number Enter identifier: The form number used by the company for animal coverage.
PROPERTY COVERAGES Accounts Receivable - Form Date Enter date: The edition date of the form used by the company for animal coverage.
PROPERTY COVERAGES Accounts Receivable - Premium Enter amount: The premium amount for accounts receivable coverage.
PROPERTY COVERAGES Animal Coverage - Pol Level Check the box (if applicable): Indicates animal coverage applies to the policy.
PROPERTY COVERAGES Animal Coverage - Prem Level Check the box (if applicable): Indicates animal coverage applies to a specific premises.
PROPERTY COVERAGES Animal Coverage - Total Amount Enter limit: The total limit amount for animal coverage amount.
PROPERTY COVERAGES Animal Coverage - Deductible Enter deductible: The deductible amount for animal coverage.
PROPERTY COVERAGES Animal Coverage - Included Check the box (if applicable): Indicates animal coverage is included in the policy.
PROPERTY COVERAGES Animal Coverage - Form Number Enter identifier: The form number used by the company for animal coverage.
PROPERTY COVERAGES Animal Coverage - Form Date Enter date: The edition date of the form used by the company for animal coverage.

ACORD 160 (2009/05) 32 of 64

Section Name Field Name Field and/or Section Description
PROPERTY COVERAGES Animal Coverage - Premium Enter amount: The premium amount for animal coverage.
PROPERTY COVERAGES Bailees Liability - Pol Level Check the box (if applicable): Indicates bailees coverage applies to the policy.
PROPERTY COVERAGES Bailees Liability - Prem Level Check the box (if applicable): Indicates bailees coverage applies to a specific premises.
PROPERTY COVERAGES Bailees Liability - Total Amount Enter limit: The total limit amount for bailees coverage amount.
PROPERTY COVERAGES Bailees Liability - Deductible Enter deductible: The deductible amount for bailees coverage.
PROPERTY COVERAGES Bailees Liability - Included Check the box (if applicable): Indicates bailees coverage is included in the policy.
PROPERTY COVERAGES Bailees Liability - Form Number Enter identifier: The form number used by the company for bailees liability coverage.
PROPERTY COVERAGES Bailees Liability - Form Date Enter date: The edition date of the form used by the company for bailees liability coverage.
PROPERTY COVERAGES Bailees Liability - Premium Enter amount: The premium amount for bailees coverage.
PROPERTY COVERAGES Builders Risk - Theft of Bldg Materials - Pol Level Check the box (if applicable): Indicates builders risk - theft of building materials coverage applies to the policy.
PROPERTY COVERAGES Builders Risk - Theft of Bldg Materials - Prem Level Check the box (if applicable): Indicates builders risk - theft of building materials coverage applies to a specific premises.
PROPERTY COVERAGES Builders Risk - Theft of Bldg Materials - Total Amount Enter limit: The total limit amount for builders risk - theft of building materials coverage amount.
PROPERTY COVERAGES Builders Risk - Theft of Bldg Materials - Deductible Enter deductible: The deductible amount for builders risk - theft of building materials coverage.
PROPERTY COVERAGES Builders Risk - Theft of Bldg Materials - Included Check the box (if applicable): Indicates builders risk - theft of building materials coverage is included in the policy.
PROPERTY COVERAGES Builders Risk - Theft of Bldg Materials - Form Number Enter identifier: The form number used by the company for builders risk - theft of building materials coverage.
PROPERTY COVERAGES Builders Risk - Theft of Bldg Materials - Form Date Enter date: The edition date of the form used by the company for builders risk - theft of building materials coverage.
PROPERTY COVERAGES Builders Risk - Theft of Bldg Materials - Premium Enter amount: The premium amount for builders risk - theft of building materials coverage.
PROPERTY COVERAGES Builders Risk - Collapse Due to Hydro-Static Pressure - Pol Level Check the box (if applicable): Indicates builders risk - collapse due to hydro-static pressure coverage applies to the policy.
PROPERTY COVERAGES Builders Risk - Collapse Due to Hydro-Static Pressure - Prem Level Check the box (if applicable): Indicates builders risk - collapse due to hydro-static pressure coverage applies to a specific premises.
PROPERTY COVERAGES Builders Risk - Collapse Due to Hydro-Static Pressure - Total Amount Enter limit: The total limit amount for builders risk - collapse due to hydro-static pressure coverage amount.

ACORD 160 (2009/05) 33 of 64

Section Name Field Name Field and/or Section Description
PROPERTY COVERAGES Builders Risk - Collapse Due to Hydro-Static Pressure - Deductible Enter deductible: The deductible amount for builders risk - collapse due to hydro-static pressure coverage.
PROPERTY COVERAGES Builders Risk - Collapse Due to Hydro-Static Pressure - Included Check the box (if applicable): Indicates builders risk - collapse due to hydro-static pressure coverage is included in the policy.
PROPERTY COVERAGES Builders Risk - Collapse Due to Hydro-Static Pressure - Form Number Enter identifier: The form number used by the company for builders risk - collapse due to hydro-static pressure coverage.
PROPERTY COVERAGES Builders Risk - Collapse Due to Hydro-Static Pressure - Form Date Enter date: The edition date of the form used by the company for builders risk - collapse due to hydro-static pressure coverage.
PROPERTY COVERAGES Builders Risk - Collapse Due to Hydro-Static Pressure - Premium Enter amount: The premium amount for builders risk - collapse due to hydro-static pressure coverage.
PROPERTY COVERAGES Business Income - Pol Level Check the box (if applicable): Indicates business income coverage applies to the policy.
PROPERTY COVERAGES Business Income - Prem Level Check the box (if applicable): Indicates business income coverage applies to a specific premises.
PROPERTY COVERAGES Business Income - Actual Loss Sustained Check the box (if applicable): Indicates the coverage is on an actual loss sustained basis.
PROPERTY COVERAGES Business Income - Actual Loss Sustained No. of Months Enter number: The number of months of coverage.
PROPERTY COVERAGES Business Income - Business Income Changes - Time Period Check the box (if applicable): Indicates business income changes - time period applies.
PROPERTY COVERAGES Business Income - Total Amount Enter limit: The total limit amount for business income coverage amount.
PROPERTY COVERAGES Business Income - Deductible Enter deductible: The deductible amount for business income coverage.
PROPERTY COVERAGES Business Income - Included Check the box (if applicable): Indicates business income coverage is included in the policy.
PROPERTY COVERAGES Business Income - Form Number Enter identifier: The form number used by the company for business income coverage.
PROPERTY COVERAGES Business Income - Form Date Enter date: The edition date of the form used by the company for business income coverage.
PROPERTY COVERAGES Business Income - Premium Enter amount: The premium amount for business income coverage.
PROPERTY COVERAGES Business Increase From Dependent Properties - Pol Level Check the box (if applicable): Indicates business income from dependent properties coverage applies to the policy.

ACORD 160 (2009/05) 34 of 64

Section Name Field Name Field and/or Section Description
PROPERTY COVERAGES Business Increase From Dependent Properties - Prem Level Check the box (if applicable): Indicates business income from dependent properties coverage applies to a specific premises.
PROPERTY COVERAGES Business Increase From Dependent Properties - Total Amount Enter limit: The total limit amount for business income from dependent properties coverage amount.
PROPERTY COVERAGES Business Increase From Dependent Properties - Deductible Enter deductible: The deductible amount for business income from dependent properties coverage.
PROPERTY COVERAGES Business Increase From Dependent Properties - Included Check the box (if applicable): Indicates business income from dependent properties coverage is included in the policy.
PROPERTY COVERAGES Business Increase From Dependent Properties - Form Number Enter identifier: The form number used by the company for business income from dependent properties coverage.
PROPERTY COVERAGES Business Increase From Dependent Properties - Form Date Enter date: The edition date of the form used by the company for business income from dependent properties coverage.
PROPERTY COVERAGES Business Increase From Dependent Properties - Premium Enter amount: The premium amount for business income from dependent properties coverage.
PROPERTY COVERAGES Business Income With Extra Expense - Pol Level Check the box (if applicable): Indicates business income with extra expense coverage applies to the policy.
PROPERTY COVERAGES Business Income With Extra Expense - Prem Level Check the box (if applicable): Indicates business income with extra expense coverage applies to a specific premises.
PROPERTY COVERAGES Business Income With Extra Expense - Total Amount Enter limit: The total limit amount for business income with extra expense coverage amount.
PROPERTY COVERAGES Business Income With Extra Expense - Deductible Enter deductible: The deductible amount for business income with extra expense coverage.
PROPERTY COVERAGES Business Income With Extra Expense - Included Check the box (if applicable): Indicates business income with extra expense coverage is included in the policy.
PROPERTY COVERAGES Business Income With Extra Expense - Form Number Enter identifier: The form number used by the company for business income with extra expense coverage.
PROPERTY COVERAGES Business Income With Extra Expense - Form Date Enter date: The edition date of the form used by the company for business income with extra expense coverage.

ACORD 160 (2009/05) 35 of 64

Section Name Field Name Field and/or Section Description
PROPERTY COVERAGES Business Income With Extra Expense - Premium Enter amount: The premium amount for business income with extra expense coverage.
PROPERTY COVERAGES Combined Demolition Cost and Increased Construction Cost - Pol Level Check the box (if applicable): Indicates combined demolition cost and increased construction cost coverage applies to the policy.
PROPERTY COVERAGES Combined Demolition Cost and Increased Construction Cost -Prem Level Check the box (if applicable): Indicates combined demolition cost and increased construction cost coverage applies to a specific premises.
PROPERTY COVERAGES Combined Demolition Cost and Increased Construction Cost -Total Amount Enter limit: The total limit amount for combined demolition cost and increased construction cost coverage amount.
PROPERTY COVERAGES Combined Demolition Cost and Increased Construction Cost -Deductible Enter deductible: The deductible amount for combined demolition cost and increased construction cost coverage.
PROPERTY COVERAGES Combined Demolition Cost and Increased Construction Cost -Included Check the box (if applicable): Indicates combined demolition cost and increased construction cost coverage is included in the policy.
PROPERTY COVERAGES Combined Demolition Cost and Increased Construction Cost -Form Number Enter identifier: The form number used by the company for combined demolition cost and increased construction cost coverage.
PROPERTY COVERAGES Combined Demolition Cost and Increased Construction Cost -Form Date Enter date: The edition date of the form used by the company for combined demolition cost and increased construction cost coverage.
PROPERTY COVERAGES Combined Demolition Cost and Increased Construction Cost -Premium Enter amount: The premium amount for combined demolition cost and increased construction cost coverage.
PROPERTY COVERAGES Debris Removal - Pol Level Check the box (if applicable): Indicates debris removal coverage applies to the policy.
PROPERTY COVERAGES Debris Removal - Prem Level Check the box (if applicable): Indicates debris removal coverage applies to a specific premises.
PROPERTY COVERAGES Debris Removal - Total Amount Enter limit: The total limit amount for debris removal coverage amount.
PROPERTY COVERAGES Debris Removal - Deductible Enter deductible: The deductible amount for debris removal coverage.
PROPERTY COVERAGES Debris Removal - Included Check the box (if applicable): Indicates debris removal coverage is included in the policy.
PROPERTY COVERAGES Debris Removal - Form Number Enter identifier: The form number used by the company for debris removal coverage.

ACORD 160 (2009/05) 36 of 64

Section Name Field Name Field and/or Section Description
PROPERTY COVERAGES Debris Removal - Form Date Enter date: The edition date of the form used by the company for debris removal coverage.
PROPERTY COVERAGES Debris Removal - Premium Enter amount: The premium amount for debris removal coverage.
PROPERTY COVERAGES Condo Unit Owners - Owners Loss Assessment - Pol Level Check the box (if applicable): Indicates condo unit owners - owners loss assessment coverage applies to the policy.
PROPERTY COVERAGES Condo Unit Owners - Owners Loss Assessment - Prem Level Check the box (if applicable): Indicates condo unit owners - owners loss assessment coverage applies to a specific premises.
PROPERTY COVERAGES Condo Unit Owners - Owners Loss Assessment - Total Amount Enter limit: The total limit amount for condo unit owners - owners loss assessment coverage amount.
PROPERTY COVERAGES Condo Unit Owners - Owners Loss Assessment - Deductible Enter deductible: The deductible amount for condo unit owners - owners loss assessment coverage.
PROPERTY COVERAGES Condo Unit Owners - Owners Loss Assessment - Included Check the box (if applicable): Indicates condo unit owners - owners loss assessment coverage is included in the policy.
PROPERTY COVERAGES Condo Unit Owners - Owners Loss Assessment - Form Number Enter identifier: The form number used by the company for condo unit owners - owners loss assessment coverage.
PROPERTY COVERAGES Condo Unit Owners - Owners Loss Assessment - Form Date Enter date: The edition date of the form used by the company for condo unit owners -owners loss assessment coverage.
PROPERTY COVERAGES Condo Unit Owners - Owners Loss Assessment - Premium Enter amount: The premium amount for condo unit owners - owners loss assessment coverage.
PROPERTY COVERAGES Condo Unit Owners - Owners Miscellaneous Real Property - Pol Level Check the box (if applicable): Indicates condo unit owners - owners miscellaneous real property coverage applies to the policy.
PROPERTY COVERAGES Condo Unit Owners - Owners Miscellaneous Real Property -Prem Level Check the box (if applicable): Indicates condo unit owners - owners miscellaneous real property coverage applies to a specific premises.
PROPERTY COVERAGES Condo Unit Owners - Owners Miscellaneous Real Property -Total Amount Enter limit: The total limit amount for condo unit owners - owners miscellaneous real property coverage amount.
PROPERTY COVERAGES Condo Unit Owners - Owners Miscellaneous Real Property -Deductible Enter deductible: The deductible amount for condo unit owners - owners miscellaneous real property coverage.
PROPERTY COVERAGES Condo Unit Owners - Owners Miscellaneous Real Property -Included Check the box (if applicable): Indicates condo unit owners - owners miscellaneous real property coverage is included in the policy.

ACORD 160 (2009/05) 37 of 64

Section Name Field Name Field and/or Section Description
PROPERTY COVERAGES Condo Unit Owners - Owners Miscellaneous Real Property -Form Number Enter identifier: The form number used by the company for condo unit owners - owners miscellaneous real property coverage.
PROPERTY COVERAGES Condo Unit Owners - Owners Miscellaneous Real Property -Form Date Enter date: The edition date of the form used by the company for condo unit owners -owners miscellaneous real property coverage.
PROPERTY COVERAGES Condo Unit Owners - Owners Miscellaneous Real Property -Premium Enter amount: The premium amount for condo unit owners - owners miscellaneous real property coverage.
PROPERTY COVERAGES Crime - Employee Dishonesty - Pol Level Check the box (if applicable): Indicates employee dishonesty coverage applies to the policy.
PROPERTY COVERAGES Crime - Employee Dishonesty -Prem Level Check the box (if applicable): Indicates employee dishonesty coverage applies to a specific premises.
PROPERTY COVERAGES Crime - Employee Dishonesty -Total Amount Enter limit: The total limit amount for employee dishonesty coverage amount.
PROPERTY COVERAGES Crime - Employee Dishonesty -Deductible Enter deductible: The deductible amount for employee dishonesty coverage.
PROPERTY COVERAGES Crime - Employee Dishonesty -Included Check the box (if applicable): Indicates employee dishonesty coverage is included in the policy.
PROPERTY COVERAGES Crime - Employee Dishonesty -Form Number Enter identifier: The form number used by the company for crime - employee dishonesty coverage.
PROPERTY COVERAGES Crime - Employee Dishonesty -Form Date Enter date: The edition date of the form used by the company for crime - employee dishonesty coverage.
PROPERTY COVERAGES Crime - Employee Dishonesty -Premium Enter amount: The premium amount for employee dishonesty coverage.
PROPERTY COVERAGES Crime - Forgery or Alteration - Pol Level Check the box (if applicable): Indicates crime - forgery or alteration coverage applies to the policy.
PROPERTY COVERAGES Crime - Forgery or Alteration -Prem Level Check the box (if applicable): Indicates crime - forgery or alteration coverage applies to a specific premises.
PROPERTY COVERAGES Crime - Forgery or Alteration -Total Amount Enter limit: The total limit amount for crime - forgery or alteration coverage amount.
PROPERTY COVERAGES Crime - Forgery or Alteration -Deductible Enter deductible: The deductible amount for crime - forgery or alteration coverage.
PROPERTY COVERAGES Crime - Forgery or Alteration -Included Check the box (if applicable): Indicates crime - forgery or alteration coverage is included in the policy.

ACORD 160 (2009/05) 38 of 64

Section Name Field Name Field and/or Section Description
PROPERTY COVERAGES Crime - Forgery or Alteration -Form Number Enter identifier: The form number used by the company for crime - forgery or alteration coverage.
PROPERTY COVERAGES Crime - Forgery or Alteration -Form Date Enter date: The edition date of the form used by the company for crime - forgery or alteration coverage.
PROPERTY COVERAGES Crime - Forgery or Alteration -Premium Enter amount: The premium amount for crime - forgery or alteration coverage.
PROPERTY COVERAGES Crime - Money & Securities Inside -Pol Level Check the box (if applicable): Indicates crime - money & securities inside coverage applies to the policy.
PROPERTY COVERAGES Crime - Money & Securities Inside -Prem Level Check the box (if applicable): Indicates crime - money & securities inside coverage applies to a specific premises.
PROPERTY COVERAGES Crime - Money & Securities Inside -Total Amount Enter limit: The total limit amount for crime - money & securities inside coverage amount.
PROPERTY COVERAGES Crime - Money & Securities Inside -Deductible Enter deductible: The deductible amount for crime - money & securities inside coverage.
PROPERTY COVERAGES Crime - Money & Securities Inside -Included Check the box (if applicable): Indicates crime - money & securities inside coverage is included in the policy.
PROPERTY COVERAGES Crime - Money & Securities Inside -Form Number Enter identifier: The form number used by the company for crime - money & securities inside coverage.
PROPERTY COVERAGES Crime - Money & Securities Inside -Form Date Enter date: The edition date of the form used by the company for crime - money & securities inside coverage.
PROPERTY COVERAGES Crime - Money & Securities Inside -Premium Enter amount: The premium amount for crime - money & securities inside coverage.
PROPERTY COVERAGES Crime - Money & Securities Outside - Pol Level Check the box (if applicable): Indicates crime - money & securities outside coverage applies to the policy.
PROPERTY COVERAGES Crime - Money & Securities Outside - Prem Level Check the box (if applicable): Indicates crime - money & securities outside coverage applies to a specific premises.
PROPERTY COVERAGES Crime - Money & Securities Outside - Total Amount Enter limit: The total limit amount for crime - money & securities outside coverage amount.
PROPERTY COVERAGES Crime - Money & Securities Outside - Deductible Enter deductible: The deductible amount for crime - money & securities outside coverage.
PROPERTY COVERAGES Crime - Money & Securities Outside - Included Check the box (if applicable): Indicates crime - money & securities outside coverage is included in the policy.
PROPERTY COVERAGES Crime - Money & Securities Outside - Form Number Enter identifier: The form number used by the company for crime - money & securities outside coverage.
PROPERTY COVERAGES Crime - Money & Securities Outside - Form Date Enter date: The edition date of the form used by the company for crime - money & securities outside coverage.

ACORD 160 (2009/05) 39 of 64

Section Name Field Name Field and/or Section Description
PROPERTY COVERAGES Crime - Money & Securities Outside - Premium Enter amount: The premium amount for crime - money & securities outside coverage.
PROPERTY COVERAGES Crime - Welfare & Pension Plan (ERISA) - Pol Level Check the box (if applicable): Indicates crime - welfare & pension plan (ERISA) coverage applies to the policy.
PROPERTY COVERAGES Crime - Welfare & Pension Plan (ERISA) - Prem Level Check the box (if applicable): Indicates crime - welfare & pension plan (ERISA) coverage applies to a specific premises.
PROPERTY COVERAGES Crime - Welfare & Pension Plan (ERISA) - Total Amount Enter limit: The total limit amount for crime - welfare & pension plan (ERISA) coverage amount.
PROPERTY COVERAGES Crime - Welfare & Pension Plan (ERISA) - Deductible Enter deductible: The deductible amount for crime - welfare & pension plan (ERISA) coverage.
PROPERTY COVERAGES Crime - Welfare & Pension Plan (ERISA) - Included Check the box (if applicable): Indicates crime - welfare & pension plan (ERISA) coverage is included in the policy.
PROPERTY COVERAGES Crime - Welfare & Pension Plan (ERISA) - Form Number Enter identifier: The form number used by the company for crime - welfare & pension plan (ERISA) coverage.
PROPERTY COVERAGES Crime - Welfare & Pension Plan (ERISA) - Form Date Enter date: The edition date of the form used by the company for crime - welfare & pension plan (ERISA) coverage.
PROPERTY COVERAGES Crime - Welfare & Pension Plan (ERISA) - Premium Enter amount: The premium amount for crime - welfare & pension plan (ERISA) coverage.
PROPERTY COVERAGES Earthquake - Pol Level Check the box (if applicable): Indicates earthquake coverage applies to the policy.
PROPERTY COVERAGES Earthquake - Prem Level Check the box (if applicable): Indicates earthquake coverage applies to a specific premises.
PROPERTY COVERAGES Earthquake - Territory Enter limit: The total limit amount for earthquake coverage amount.
PROPERTY COVERAGES Earthquake - Retrofit Type Enter text: The type of earthquake retrofit for the building.
PROPERTY COVERAGES Earthquake - Masonry Veneer % Enter percentage: The percentage of construction that is masonry veneer.
PROPERTY COVERAGES Earthquake - Deductible Amount Enter deductible: The deductible amount for earthquake coverage.
PROPERTY COVERAGES Earthquake - Deductible % Enter percentage: The percentage deductible for earthquake coverage.
PROPERTY COVERAGES Earthquake - Included Check the box (if applicable): Indicates earthquake coverage is included in the policy.
PROPERTY COVERAGES Earthquake - Form Number Enter identifier: The form number used by the company for earthquake coverage.
PROPERTY COVERAGES Earthquake - Form Date Enter date: The edition date of the form used by the company for earthquake coverage.
PROPERTY COVERAGES Earthquake - Premium Enter amount: The premium amount for earthquake coverage.
PROPERTY COVERAGES EDP - Equipment - Pol Level Check the box (if applicable): Indicates EDP equipment coverage applies to the policy.

ACORD 160 (2009/05) 40 of 64

Section Name Field Name Field and/or Section Description
PROPERTY COVERAGES EDP - Equipment - Prem Level Check the box (if applicable): Indicates EDP equipment coverage applies to a specific premises.
PROPERTY COVERAGES EDP - Equipment - Total Amount Enter limit: The total limit amount for EDP equipment coverage amount.
PROPERTY COVERAGES EDP - Equipment - Deductible Enter deductible: The deductible amount for EDP equipment coverage.
PROPERTY COVERAGES EDP - Equipment - Included Check the box (if applicable): Indicates EDP equipment coverage is included in the policy.
PROPERTY COVERAGES EDP - Equipment - Form Number Enter identifier: The form number used by the company for EDP equipment coverage.
PROPERTY COVERAGES EDP - Equipment - Form Date Enter date: The edition date of the form used by the company for EDP equipment coverage.
PROPERTY COVERAGES EDP - Equipment - Premium Enter amount: The premium amount for EDP equipment coverage.
PROPERTY COVERAGES EDP - Extra Expense - Pol Level Check the box (if applicable): Indicates EDP extra expense coverage applies to the policy.
PROPERTY COVERAGES EDP - Extra Expense - Prem Level Check the box (if applicable): Indicates EDP extra expense coverage applies to a specific premises.
PROPERTY COVERAGES EDP - Extra Expense - Total Amount Enter limit: The total limit amount for EDP extra expense coverage amount.
PROPERTY COVERAGES EDP - Extra Expense - Deductible Enter deductible: The deductible amount for EDP extra expense coverage.
PROPERTY COVERAGES EDP - Extra Expense - Included Check the box (if applicable): Indicates EDP extra expense coverage is included in the policy.
PROPERTY COVERAGES EDP - Extra Expense - Form Number Enter identifier: The form number used by the company for EDP extra expense coverage.
PROPERTY COVERAGES EDP - Extra Expense - Form Date Enter date: The edition date of the form used by the company for EDP extra expense coverage.
PROPERTY COVERAGES EDP - Extra Expense - Premium Enter amount: The premium amount for EDP extra expense coverage.
PROPERTY COVERAGES EDP - Data / Media - Pol Level Check the box (if applicable): Indicates EDP data / media coverage applies to the policy.
PROPERTY COVERAGES EDP - Data / Media - Prem Level Check the box (if applicable): Indicates EDP data / media coverage applies to a specific premises.
PROPERTY COVERAGES EDP - Data / Media - Total Amount Enter limit: The total limit amount for EDP data / media coverage amount.
PROPERTY COVERAGES EDP - Data / Media - Deductible Enter deductible: The deductible amount for EDP data / media coverage.
PROPERTY COVERAGES EDP - Data / Media - Included Check the box (if applicable): Indicates EDP data / media coverage is included in the policy.

ACORD 160 (2009/05) 41 of 64

Section Name Field Name Field and/or Section Description
PROPERTY COVERAGES EDP - Data / Media - Form Number Enter identifier: The form number used by the company for EDP data / media coverage.
PROPERTY COVERAGES EDP - Data / Media - Form Date Enter date: The edition date of the form used by the company for EDP data / media coverage.
PROPERTY COVERAGES EDP - Data / Media - Premium Enter amount: The premium amount for EDP data / media coverage.
PROPERTY COVERAGES Equipment Breakdown - Basic -Pol Level Check the box (if applicable): Indicates basic equipment breakdown coverage applies to the policy.
PROPERTY COVERAGES Equipment Breakdown - Basic -Prem Level Check the box (if applicable): Indicates basic equipment breakdown coverage applies to a specific premises.
PROPERTY COVERAGES Equipment Breakdown - Basic -Total Amount Enter limit: The total limit amount for basic equipment breakdown coverage amount.
PROPERTY COVERAGES Equipment Breakdown - Basic -Deductible Enter deductible: The deductible amount for basic equipment breakdown coverage.
PROPERTY COVERAGES Equipment Breakdown - Basic -Included Check the box (if applicable): Indicates basic equipment breakdown coverage is included in the policy.
PROPERTY COVERAGES Equipment Breakdown - Basic -Form Number Enter identifier: The form number used by the company for basic equipment breakdown coverage.
PROPERTY COVERAGES Equipment Breakdown - Basic -Form Date Enter date: The edition date of the form used by the company for basic equipment breakdown coverage.
PROPERTY COVERAGES Equipment Breakdown - Basic -Premium Enter amount: The premium amount for basic equipment breakdown coverage.
PROPERTY COVERAGES Equipment Breakdown - Broad -Pol Level Check the box (if applicable): Indicates broad equipment breakdown coverage applies to the policy.
PROPERTY COVERAGES Equipment Breakdown - Broad -Prem Level Check the box (if applicable): Indicates broad equipment breakdown coverage applies to a specific premises.
PROPERTY COVERAGES Equipment Breakdown - Broad -Total Amount Enter limit: The total limit amount for broad equipment breakdown coverage amount.
PROPERTY COVERAGES Equipment Breakdown - Broad -Deductible Enter deductible: The deductible amount for broad equipment breakdown coverage.
PROPERTY COVERAGES Equipment Breakdown - Broad -Included Check the box (if applicable): Indicates broad equipment breakdown coverage is included in the policy.
PROPERTY COVERAGES Equipment Breakdown - Broad -Form Number Enter identifier: The form number used by the company for broad equipment breakdown coverage.
PROPERTY COVERAGES Equipment Breakdown - Broad -Form Date Enter date: The edition date of the form used by the company for broad equipment breakdown coverage.

ACORD 160 (2009/05) 42 of 64

Section Name Field Name Field and/or Section Description
PROPERTY COVERAGES Equipment Breakdown - Broad -Premium Enter amount: The premium amount for broad equipment breakdown coverage.
PROPERTY COVERAGES Equipment Breakdown - Spoilage -Pol Level Check the box (if applicable): Indicates equipment breakdown - spoilage coverage applies to the policy.
PROPERTY COVERAGES Equipment Breakdown - Spoilage -Prem Level Check the box (if applicable): Indicates equipment breakdown - spoilage coverage applies to a specific premises.
PROPERTY COVERAGES Equipment Breakdown - Spoilage -Total Amount Enter limit: The total limit amount for equipment breakdown - spoilage coverage amount.
PROPERTY COVERAGES Equipment Breakdown - Spoilage -Deductible Enter deductible: The deductible amount for equipment breakdown - spoilage coverage.
PROPERTY COVERAGES Equipment Breakdown - Spoilage -Included Check the box (if applicable): Indicates equipment breakdown - spoilage coverage is included in the policy.
PROPERTY COVERAGES Equipment Breakdown - Spoilage -Form Number Enter identifier: The form number used by the company for equipment breakdown -spoilage coverage.
PROPERTY COVERAGES Equipment Breakdown - Spoilage -Form Date Enter date: The edition date of the form used by the company for equipment breakdown -spoilage coverage.
PROPERTY COVERAGES Equipment Breakdown - Spoilage -Premium Enter amount: The premium amount for equipment breakdown - spoilage coverage.
IDENTIFICATION SECTION Agency Customer ID Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage).
IDENTIFICATION SECTION Loc # Enter number: The producer assigned number of the location.
IDENTIFICATION SECTION Bldg # Enter number: The building number for the premises. Used when more than one building exists at an individual location.
PROPERTY COVERAGES Extra Expense - Pol Level Check the box (if applicable): Indicates extra expense coverage applies to the policy.
PROPERTY COVERAGES Extra Expense - Prem Level Check the box (if applicable): Indicates extra expense coverage applies to a specific premises.
PROPERTY COVERAGES Extra Expense - Actual Loss Sustained Check the box (if applicable): Indicates the coverage is on an actual loss sustained basis.
PROPERTY COVERAGES Extra Expense - Actual Loss Sustained No. of Months Enter number: The number of months of coverage.
PROPERTY COVERAGES Extra Expense - Total Amount Enter limit: The total limit amount for extra expense coverage amount.
PROPERTY COVERAGES Extra Expense - Deductible Enter deductible: The deductible amount for extra expense coverage.
PROPERTY COVERAGES Extra Expense - Included Check the box (if applicable): Indicates extra expense coverage is included in the policy.

ACORD 160 (2009/05) 43 of 64

Section Name Field Name Field and/or Section Description
PROPERTY COVERAGES Extra Expense - Form Number Enter identifier: The form number used by the company for extra expense coverage.
PROPERTY COVERAGES Extra Expense - Form Date Enter date: The edition date of the form used by the company for extra expense coverage.
PROPERTY COVERAGES Extra Expense - Premium Enter amount: The premium amount for extra expense coverage.
PROPERTY COVERAGES Fine Arts - Pol Level Check the box (if applicable): Indicates fine arts coverage applies to the policy.
PROPERTY COVERAGES Fine Arts - Prem Level Check the box (if applicable): Indicates fine arts coverage applies to a specific premises.
PROPERTY COVERAGES Fine Arts - Total Amount Enter limit: The total limit amount for fine arts coverage amount.
PROPERTY COVERAGES Fine Arts - Deductible Enter deductible: The deductible amount for fine arts coverage.
PROPERTY COVERAGES Fine Arts - Included Check the box (if applicable): Indicates fine arts coverage is included in the policy.
PROPERTY COVERAGES Fine Arts - Form Number Enter identifier: The form number used by the company for fine arts coverage.
PROPERTY COVERAGES Fine Arts - Form Date Enter date: The edition date of the form used by the company for fine arts coverage.
PROPERTY COVERAGES Fine Arts - Premium Enter amount: The premium amount for fine arts coverage.
PROPERTY COVERAGES Floater - Contractor's Equipment -Pol Level Check the box (if applicable): Indicates contractor's equipment floater coverage applies to the policy.
PROPERTY COVERAGES Floater - Contractor's Equipment -Prem Level Check the box (if applicable): Indicates contractor's equipment floater coverage applies to a specific premises.
PROPERTY COVERAGES Floater - Contractor's Equipment -Total Amount Enter limit: The total limit amount for contractor's equipment floater coverage amount.
PROPERTY COVERAGES Floater - Contractor's Equipment -Deductible Enter deductible: The deductible amount for contractor's equipment floater coverage.
PROPERTY COVERAGES Floater - Contractor's Equipment -Included Check the box (if applicable): Indicates contractor's equipment floater coverage is included in the policy.
PROPERTY COVERAGES Floater - Contractor's Equipment -Form Number Enter identifier: The form number used by the company for contractor's equipment floater coverage.
PROPERTY COVERAGES Floater - Contractor's Equipment -Form Date Enter date: The edition date of the form used by the company for contractor's equipment floater coverage.
PROPERTY COVERAGES Floater - Contractor's Equipment -Premium Enter amount: The premium amount for contractor's equipment floater coverage.
PROPERTY COVERAGES Floater - Installation - Pol Level Check the box (if applicable): Indicates installation floater coverage applies to the policy.
PROPERTY COVERAGES Floater - Installation - Prem Level Check the box (if applicable): Indicates installation floater coverage applies to a specific premises.
PROPERTY COVERAGES Floater - Installation - Total Amount Enter limit: The total limit amount for installation floater coverage amount.

ACORD 160 (2009/05) 44 of 64

Section Name Field Name Field and/or Section Description
PROPERTY COVERAGES Floater - Installation - Deductible Enter deductible: The deductible amount for installation floater coverage.
PROPERTY COVERAGES Floater - Installation - Included Check the box (if applicable): Indicates installation floater coverage is included in the policy.
PROPERTY COVERAGES Floater - Installation - Form Number Enter identifier: The form number used by the company for installation floater coverage.
PROPERTY COVERAGES Floater - Installation - Form Date Enter date: The edition date of the form used by the company for installation floater coverage.
PROPERTY COVERAGES Floater - Installation - Premium Enter amount: The premium amount for installation floater coverage.
PROPERTY COVERAGES Floater - Leased / Rented Equipment - Pol Level Check the box (if applicable): Indicates leased / rented equipment floater coverage applies to the policy.
PROPERTY COVERAGES Floater - Leased / Rented Equipment - Prem Level Check the box (if applicable): Indicates leased / rented equipment floater coverage applies to a specific premises.
PROPERTY COVERAGES Floater - Leased / Rented Equipment - Total Amount Enter limit: The total limit amount for leased / rented equipment floater coverage amount.
PROPERTY COVERAGES Floater - Leased / Rented Equipment - Deductible Enter deductible: The deductible amount for leased / rented equipment floater coverage.
PROPERTY COVERAGES Floater - Leased / Rented Equipment - Included Check the box (if applicable): Indicates leased / rented equipment floater coverage is included in the policy.
PROPERTY COVERAGES Floater - Leased / Rented Equipment - Form Number Enter identifier: The form number used by the company for leased / rented equipment floater coverage.
PROPERTY COVERAGES Floater - Leased / Rented Equipment - Form Date Enter date: The edition date of the form used by the company for leased / rented equipment floater coverage.
PROPERTY COVERAGES Floater - Leased / Rented Equipment - Premium Enter amount: The premium amount for leased / rented equipment floater coverage.
PROPERTY COVERAGES Flood - Building - Pol Level Check the box (if applicable): Indicates flood building coverage applies to the policy.
PROPERTY COVERAGES Flood - Building - Prem Level Check the box (if applicable): Indicates flood building coverage applies to a specific premises.
PROPERTY COVERAGES Flood - Building - Total Amount Enter limit: The total limit amount for flood building coverage amount.
PROPERTY COVERAGES Flood - Building - Deductible Enter deductible: The deductible amount for flood building coverage.
PROPERTY COVERAGES Flood - Building - Included Check the box (if applicable): Indicates flood building coverage is included in the policy.
PROPERTY COVERAGES Flood - Building - Form Number Enter identifier: The form number used by the company for flood building coverage.
PROPERTY COVERAGES Flood - Building - Form Date Enter date: The edition date of the form used by the company for flood building coverage.
PROPERTY COVERAGES Flood - Building - Premium Enter amount: The premium amount for flood building coverage.

ACORD 160 (2009/05) 45 of 64

Section Name Field Name Field and/or Section Description
PROPERTY COVERAGES Flood - Contents - Pol Level Check the box (if applicable): Indicates flood contents coverage applies to the policy.
PROPERTY COVERAGES Flood - Contents - Prem Level Check the box (if applicable): Indicates flood contents coverage applies to a specific premises.
PROPERTY COVERAGES Flood - Contents - Total Amount Enter limit: The total limit amount for flood contents coverage amount.
PROPERTY COVERAGES Flood - Contents - Deductible Enter deductible: The deductible amount for flood contents coverage.
PROPERTY COVERAGES Flood - Contents - Included Check the box (if applicable): Indicates flood contents coverage is included in the policy.
PROPERTY COVERAGES Flood - Contents - Form Number Enter identifier: The form number used by the company for flood contents coverage.
PROPERTY COVERAGES Flood - Contents - Form Date Enter date: The edition date of the form used by the company for flood contents coverage.
PROPERTY COVERAGES Flood - Contents - Premium Enter amount: The premium amount for flood contents coverage.
PROPERTY COVERAGES Fungi / Bacteria / Mold - Pol Level Check the box (if applicable): Indicates fungi / bacteria / mold coverage applies to the policy.
PROPERTY COVERAGES Fungi / Bacteria / Mold - Prem Level Check the box (if applicable): Indicates fungi / bacteria / mold coverage applies to a specific premises.
PROPERTY COVERAGES Fungi / Bacteria / Mold - Total Amount Enter limit: The total limit amount for fungi / bacteria / mold coverage amount.
PROPERTY COVERAGES Fungi / Bacteria / Mold -Deductible Enter deductible: The deductible amount for fungi / bacteria / mold coverage.
PROPERTY COVERAGES Fungi / Bacteria / Mold - Included Check the box (if applicable): Indicates fungi / bacteria / mold coverage is included in the policy.
PROPERTY COVERAGES Fungi / Bacteria / Mold - Form Number Enter identifier: The form number used by the company for fungi / bacteria / mold coverage.
PROPERTY COVERAGES Fungi / Bacteria / Mold - Form Date Enter date: The edition date of the form used by the company for fungi / bacteria / mold coverage.
PROPERTY COVERAGES Fungi / Bacteria / Mold - Premium Enter amount: The premium amount for fungi / bacteria / mold coverage.
PROPERTY COVERAGES Hail Exclusion - Prem Level Check the box (if applicable): Indicates hail exclusion applies to the policy.
PROPERTY COVERAGES Hail Exclusion - Included Check the box (if applicable): Indicates hail exclusion applies to a specific premises.
PROPERTY COVERAGES Hail Exclusion - Form Number Enter number: The form number used by the company for hail exclusion.
PROPERTY COVERAGES Hail Exclusion - Form Date Enter date: The edition date of the form used by the company for hail exclusion.
PROPERTY COVERAGES Hail Exclusion - Premium Enter amount: The premium amount for hail exclusion.
PROPERTY COVERAGES Mine Subsidence - Pol Level Check the box (if applicable): Indicates mine subsidence coverage applies to the policy.

ACORD 160 (2009/05) 46 of 64

Section Name Field Name Field and/or Section Description
PROPERTY COVERAGES Mine Subsidence - Prem Level Check the box (if applicable): Indicates mine subsidence coverage applies to a specific premises.
PROPERTY COVERAGES Mine Subsidence - Limit Enter limit: The total limit amount for mine subsidence coverage amount.
PROPERTY COVERAGES Mine Subsidence - Construction Material Enter code: The type of construction material.
PROPERTY COVERAGES Mine Subsidence - Property Description Enter text: The description of the property.
PROPERTY COVERAGES Mine Subsidence - Deductible Enter deductible: The deductible amount for mine subsidence coverage.
PROPERTY COVERAGES Mine Subsidence - Included Check the box (if applicable): Indicates mine subsidence coverage is included in the policy.
PROPERTY COVERAGES Mine Subsidence - Form Number Enter identifier: The form number used by the company for mine subsidence coverage.
PROPERTY COVERAGES Mine Subsidence - Form Date Enter date: The edition date of the form used by the company for mine subsidence coverage.
PROPERTY COVERAGES Mine Subsidence - Premium Enter amount: The premium amount for mine subsidence coverage.
PROPERTY COVERAGES New Acquired Property - Building -Pol Level Check the box (if applicable): Indicates newly acquired property - building coverage applies to the policy.
PROPERTY COVERAGES New Acquired Property - Building -Prem Level Check the box (if applicable): Indicates newly acquired property - building coverage applies to a specific premises.
PROPERTY COVERAGES New Acquired Property - Building -Total Amount Enter limit: The total limit amount for newly acquired property - building coverage amount.
PROPERTY COVERAGES New Acquired Property - Building -Deductible Enter deductible: The deductible amount for newly acquired property - building coverage.
PROPERTY COVERAGES New Acquired Property - Building -Included Check the box (if applicable): Indicates newly acquired property - building coverage is included in the policy.
PROPERTY COVERAGES New Acquired Property - Building -Form Number Enter identifier: The form number used by the company for newly acquired property -building coverage.
PROPERTY COVERAGES New Acquired Property - Building -Form Date Enter date: The edition date of the form used by the company for newly acquired property building coverage.
PROPERTY COVERAGES New Acquired Property - Building -Premium Enter amount: The premium amount for newly acquired property - building coverage.
PROPERTY COVERAGES New Acquired Property - Personal -Pol Level Check the box (if applicable): Indicates newly acquired property - personal coverage applies to the policy.
PROPERTY COVERAGES New Acquired Property - Personal -Prem Level Check the box (if applicable): Indicates newly acquired property - personal coverage applies to a specific premises.

ACORD 160 (2009/05) 47 of 64

Section Name Field Name Field and/or Section Description
PROPERTY COVERAGES New Acquired Property - Personal -Total Amount Enter limit: The total limit amount for newly acquired property - personal coverage amount.
PROPERTY COVERAGES New Acquired Property - Personal -Deductible Enter deductible: The deductible amount for newly acquired property - personal coverage.
PROPERTY COVERAGES New Acquired Property - Personal -Included Check the box (if applicable): Indicates newly acquired property - personal coverage is included in the policy.
PROPERTY COVERAGES New Acquired Property - Personal -Form Number Enter identifier: The form number used by the company for newly acquired property -personal coverage.
PROPERTY COVERAGES New Acquired Property - Personal -Form Date Enter date: The edition date of the form used by the company for newly acquired property personal coverage.
PROPERTY COVERAGES New Acquired Property - Personal -Premium Enter amount: The premium amount for newly acquired property - personal coverage.
PROPERTY COVERAGES Ordinance - Building Ordinance Or Law - Pol Level Check the box (if applicable): Indicates building ordinance or law coverage applies to the policy.
PROPERTY COVERAGES Ordinance - Building Ordinance Or Law - Prem Level Check the box (if applicable): Indicates building ordinance or law coverage applies to a specific premises.
PROPERTY COVERAGES Ordinance - Building Ordinance Or Law - Aggregate Enter limit: The aggregate limit amount for building ordinance or law coverage amount.
PROPERTY COVERAGES Ordinance - Building Ordinance Or Law - Increased Enter limit: The increased limit amount for building ordinance or law coverage amount.
PROPERTY COVERAGES Ordinance - Building Ordinance Or Law - % Rebuild Enter percentage: The rebuild percentage for building ordinance or law coverage.
PROPERTY COVERAGES Ordinance - Building Ordinance Or Law - Deductible Enter deductible: The deductible amount for building ordinance or law coverage.
PROPERTY COVERAGES Ordinance - Building Ordinance Or Law - Included Check the box (if applicable): Indicates building ordinance or law coverage is included in the policy.
PROPERTY COVERAGES Ordinance - Building Ordinance Or Law - Form Number Enter identifier: The form number used by the company for building ordinance or law coverage.
PROPERTY COVERAGES Ordinance - Building Ordinance Or Law - Form Date Enter date: The edition date of the form used by the company for building ordinance or law coverage.
PROPERTY COVERAGES Ordinance - Building Ordinance Or Law - Premium Enter amount: The premium amount for building ordinance or law coverage.
PROPERTY COVERAGES Ordinance - Building Ordinance Demolition Cost - Pol Level Check the box (if applicable): Indicates building ordinance demolition cost coverage applies to the policy.
PROPERTY COVERAGES Ordinance - Building Ordinance Demolition Cost - Prem Level Check the box (if applicable): Indicates building ordinance demolition cost coverage applies to a specific premises.

ACORD 160 (2009/05) 48 of 64

Section Name Field Name Field and/or Section Description
PROPERTY COVERAGES Ordinance - Building Ordinance Demolition Cost - Total Limit Enter limit: The total limit amount for building ordinance demolition cost coverage amount.
PROPERTY COVERAGES Ordinance - Building Ordinance Demolition Cost - Deductible Enter deductible: The deductible amount for building ordinance demolition cost coverage.
PROPERTY COVERAGES Ordinance - Building Ordinance Demolition Cost - Included Check the box (if applicable): Indicates building ordinance demolition cost coverage is included in the policy.
PROPERTY COVERAGES Ordinance - Building Ordinance Demolition Cost - Form Number Enter identifier: The form number used by the company for building ordinance demolition cost coverage.
PROPERTY COVERAGES Ordinance - Building Ordinance Demolition Cost - Form Date Enter date: The edition date of the form used by the company for building ordinance demolition cost coverage.
PROPERTY COVERAGES Ordinance - Building Ordinance Demolition Cost - Premium Enter amount: The premium amount for building ordinance demolition cost coverage.
PROPERTY COVERAGES Ordinance - Building Ordinance Increased Construction Cost - Pol Level Check the box (if applicable): Indicates building ordinance increased construction cost coverage applies to the policy.
PROPERTY COVERAGES Ordinance - Building Ordinance Increased Construction Cost -Prem Level Check the box (if applicable): Indicates building ordinance increased construction cost coverage applies to a specific premises.
PROPERTY COVERAGES Ordinance - Building Ordinance Increased Construction Cost -Total Amount Enter limit: The total limit amount for building ordinance increased construction cost coverage amount.
PROPERTY COVERAGES Ordinance - Building Ordinance Increased Construction Cost -Deductible Enter deductible: The deductible amount for building ordinance increased construction cost coverage.
PROPERTY COVERAGES Ordinance - Building Ordinance Increased Construction Cost -Included Check the box (if applicable): Indicates building ordinance increased construction cost coverage is included in the policy.
PROPERTY COVERAGES Ordinance - Building Ordinance Increased Construction Cost -Form Number Enter identifier: The form number used by the company for building ordinance increased construction cost coverage.
PROPERTY COVERAGES Ordinance - Building Ordinance Increased Construction Cost -Form Date Enter date: The edition date of the form used by the company for building ordinance increased construction cost coverage.
PROPERTY COVERAGES Ordinance - Building Ordinance Increased Construction Cost -Premium Enter amount: The premium amount for building ordinance increased construction cost coverage.

ACORD 160 (2009/05) 49 of 64

Section Name Field Name Field and/or Section Description
PROPERTY COVERAGES Outdoor Property - Pol Level Check the box (if applicable): Indicates outdoor property coverage applies to the policy.
PROPERTY COVERAGES Outdoor Property - Prem Level Check the box (if applicable): Indicates outdoor property coverage applies to a specific premises.
PROPERTY COVERAGES Outdoor Property - Total Amount Enter limit: The total limit amount for outdoor property coverage amount.
PROPERTY COVERAGES Outdoor Property - Deductible Enter deductible: The deductible amount for outdoor property coverage.
PROPERTY COVERAGES Outdoor Property - Included Check the box (if applicable): Indicates outdoor property coverage is included in the policy.
PROPERTY COVERAGES Outdoor Property - Form Number Enter identifier: The form number used by the company for outdoor property coverage.
PROPERTY COVERAGES Outdoor Property - Form Date Enter date: The edition date of the form used by the company for outdoor property coverage.
PROPERTY COVERAGES Outdoor Property - Premium Enter amount: The premium amount for outdoor property coverage.
PROPERTY COVERAGES Peak Season - Regular - Pol Level Check the box (if applicable): Indicates peak season - regular coverage applies to the policy.
PROPERTY COVERAGES Peak Season - Regular - Prem Level Check the box (if applicable): Indicates peak season - regular coverage applies to a specific premises.
PROPERTY COVERAGES Peak Season - Regular - Total Amount Enter limit: The total limit amount for peak season - regular coverage amount.
PROPERTY COVERAGES Peak Season - Regular -Deductible Enter deductible: The deductible amount for peak season - regular coverage.
PROPERTY COVERAGES Peak Season - Regular - Included Check the box (if applicable): Indicates peak season - regular coverage is included in the policy.
PROPERTY COVERAGES Peak Season - Regular - Form Number Enter identifier: The form number used by the company for peak season - regular coverage.
PROPERTY COVERAGES Peak Season - Regular - Form Date Enter date: The edition date of the form used by the company for peak season - regular coverage.
PROPERTY COVERAGES Peak Season - Regular - Premium Enter amount: The premium amount for peak season - regular coverage.
PROPERTY COVERAGES Peak Season - Additional - Pol Level Check the box (if applicable): Indicates peak season - additional coverage applies to the policy.
PROPERTY COVERAGES Peak Season - Additional - Prem Level Check the box (if applicable): Indicates peak season - additional coverage applies to a specific premises.
PROPERTY COVERAGES Peak Season - Additional - Total Amount Enter limit: The total limit amount for peak season - additional coverage amount.

ACORD 160 (2009/05) 50 of 64

Section Name Field Name Field and/or Section Description
PROPERTY COVERAGES Peak Season - Additional -Deductible Enter deductible: The deductible amount for peak season - additional coverage.
PROPERTY COVERAGES Peak Season - Additional -Included Check the box (if applicable): Indicates peak season - additional coverage is included in the policy.
PROPERTY COVERAGES Peak Season - Additional - Form Number Enter identifier: The form number used by the company for peak season - additional coverage.
PROPERTY COVERAGES Peak Season - Additional - Form Date Enter date: The edition date of the form used by the company for peak season - additional coverage.
PROPERTY COVERAGES Peak Season - Additional -Premium Enter amount: The premium amount for peak season - additional coverage.
PROPERTY COVERAGES Property BPP - Improvements & Betterments / RC / ACV - Pol Level Check the box (if applicable): Indicates business personal property improvements & betterments coverage applies to the policy.
PROPERTY COVERAGES Property BPP - Improvements & Betterments / RC / ACV - Prem Level Check the box (if applicable): Indicates business personal property improvements & betterments coverage applies to a specific premises.
PROPERTY COVERAGES Property BPP - Improvements & Betterments / RC / ACV - Total Limit Enter limit: The total limit amount for business personal property improvements & betterments coverage amount.
PROPERTY COVERAGES Property BPP - Improvements & Betterments / RC / ACV -Deductible Enter deductible: The deductible amount for business personal property improvements & betterments coverage.
PROPERTY COVERAGES Property BPP - Improvements & Betterments / RC / ACV - Included Check the box (if applicable): Indicates business personal property improvements & betterments coverage is included in the policy.
PROPERTY COVERAGES Property BPP - Improvements & Betterments / RC / ACV - Form Number Enter identifier: The form number used by the company for building personal property improvements & betterments coverage.
PROPERTY COVERAGES Property BPP - Improvements & Betterments / RC / ACV - Form Date Enter date: The edition date of the form used by the company for building personal property improvements & betterments coverage.
PROPERTY COVERAGES Property BPP - Improvements & Betterments / RC / ACV - Premium Enter amount: The premium amount for business personal property improvements & betterments coverage.
PROPERTY COVERAGES Sign - Pol Level Check the box (if applicable): Indicates sign coverage applies to the policy.
PROPERTY COVERAGES Sign - Prem Level Check the box (if applicable): Indicates sign coverage applies to a specific premises.

ACORD 160 (2009/05) 51 of 64

Section Name Field Name Field and/or Section Description
PROPERTY COVERAGES Sign - Total Amount Enter limit: The total limit amount for sign coverage amount.
PROPERTY COVERAGES Sign - Deductible Enter deductible: The deductible amount for sign coverage.
PROPERTY COVERAGES Sign - Included Check the box (if applicable): Indicates sign coverage is included in the policy.
PROPERTY COVERAGES Sign - Form Number Enter number: The form number used by the company for sign coverage.
PROPERTY COVERAGES Sign - Form Date Enter date: The edition date of the form used by the company for sign coverage.
PROPERTY COVERAGES Sign - Premium Enter amount: The premium amount for sign coverage.
PROPERTY COVERAGES Terrorism - Domestic - Pol Level Check the box (if applicable): Indicates domestic terrorism coverage applies to the policy.
PROPERTY COVERAGES Terrorism - Domestic - Prem Level Check the box (if applicable): Indicates domestic terrorism coverage applies to a specific premises.
PROPERTY COVERAGES Terrorism - Domestic - Included Check the box (if applicable): Indicates domestic terrorism coverage is included in the policy.
PROPERTY COVERAGES Terrorism - Domestic - Form Number Enter identifier: The form number used by the company for domestic terrorism coverage.
PROPERTY COVERAGES Terrorism - Domestic - Form Date Enter date: The edition date of the form used by the company for domestic terrorism coverage.
PROPERTY COVERAGES Terrorism - Domestic - Premium Enter amount: The premium amount for domestic terrorism.
PROPERTY COVERAGES Terrorism - Foreign - Pol Level Check the box (if applicable): Indicates foreign terrorism coverage applies to the policy.
PROPERTY COVERAGES Terrorism - Foreign - Prem Level Check the box (if applicable): Indicates foreign terrorism coverage applies to a specific premises.
PROPERTY COVERAGES Terrorism - Foreign - Accept Check the box (if applicable): Indicates the named insured rejects foreign terrorism coverage.
PROPERTY COVERAGES Terrorism - Foreign - Reject Check the box (if applicable): Indicates the named insured accepts foreign terrorism coverage.
PROPERTY COVERAGES Terrorism - Foreign - Included Check the box (if applicable): Indicates foreign terrorism coverage is included in the policy.
PROPERTY COVERAGES Terrorism - Foreign - Form Number Enter identifier: The form number used by the company for foreign terrorism coverage.
PROPERTY COVERAGES Terrorism - Foreign - Form Date Enter date: The edition date of the form used by the company for foreign terrorism coverage.
PROPERTY COVERAGES Terrorism - Foreign - Premium Enter amount: The premium amount for foreign terrorism.
PROPERTY COVERAGES Transit - Pol Level Check the box (if applicable): Indicates transit coverage applies to the policy.
PROPERTY COVERAGES Transit - Prem Level Check the box (if applicable): Indicates transit coverage applies to a specific premises.
PROPERTY COVERAGES Transit - Total Amount Enter limit: The total limit amount for transit coverage amount.

ACORD 160 (2009/05) 52 of 64

Section Name Field Name Field and/or Section Description
PROPERTY COVERAGES Transit - Deductible Enter deductible: The deductible amount for transit coverage.
PROPERTY COVERAGES Transit - Included Check the box (if applicable): Indicates transit coverage is included in the policy.
PROPERTY COVERAGES Transit - Form Number Enter identifier: The form number used by the company for transit coverage.
PROPERTY COVERAGES Transit - Form Date Enter date: The edition date of the form used by the company for transit coverage.
PROPERTY COVERAGES Transit - Premium Enter amount: The premium amount for transit coverage.
PROPERTY COVERAGES Valuable Papers - Pol Level Check the box (if applicable): Indicates valuable papers coverage applies to the policy.
PROPERTY COVERAGES Valuable Papers - Prem Level Check the box (if applicable): Indicates valuable papers coverage applies to a specific premises.
PROPERTY COVERAGES Valuable Papers - Total Amount Enter limit: The total limit amount for valuable papers coverage amount.
PROPERTY COVERAGES Valuable Papers - Deductible Enter deductible: The deductible amount for valuable papers coverage.
PROPERTY COVERAGES Valuable Papers - Included Check the box (if applicable): Indicates valuable papers coverage is included in the policy.
PROPERTY COVERAGES Valuable Papers - Form Number Enter identifier: The form number used by the company for valuable papers coverage.
PROPERTY COVERAGES Valuable Papers - Form Date Enter date: The edition date of the form used by the company for valuable papers coverage.
PROPERTY COVERAGES Valuable Papers - Premium Enter amount: The premium amount for valuable papers coverage.
PROPERTY COVERAGES Wind Exclusion - Pol Level Check the box (if applicable): Indicates wind exclusion applies to the policy.
PROPERTY COVERAGES Wind Exclusion - Prem Level Check the box (if applicable): Indicates wind exclusion applies to a specific premises.
PROPERTY COVERAGES Wind Exclusion - Included Check the box (if applicable): Indicates wind exclusion is included in the policy.
PROPERTY COVERAGES Wind Exclusion - Form Number Enter identifier: The form number used by the company for wind exclusion.
PROPERTY COVERAGES Wind Exclusion - Form Date Enter date: The edition date of the form used by the company for wind exclusion.
PROPERTY COVERAGES Wind Exclusion - Premium Enter amount: The premium amount for wind exclusion.
PROPERTY COVERAGES -PREMISES LEVEL Ground Floor Glass - # Plates Enter number: The number of plates of glass to be insured with the same dimensions and description. As used here, this is ground floor glass.
PROPERTY COVERAGES -PREMISES LEVEL Ground Floor Glass - Area Sq Ft Enter number: The area, measured in square feet, of the plates to be insured. For odd-sized plates, you may need to compute the area (e.g., the size needed to replace a round piece of glass is a rectangle large enough to allow the circle to be cut from it). As used here, this is ground floor glass.
PROPERTY COVERAGES -PREMISES LEVEL Ground Floor Glass - Length Linear Ft Enter number: The horizontal length, measured in feet, of the plates to be insured. As used here, this is ground floor glass.
PROPERTY COVERAGES -PREMISES LEVEL Ground Floor Glass - Glass Type Enter code: The industry code identifying the class for the type of glass. The source of this code is the Insurance Services Office CLM. As used here, this is ground floor glass.

ACORD 160 (2009/05) 53 of 64

Section Name Field Name Field and/or Section Description
PROPERTY COVERAGES -PREMISES LEVEL Ground Floor Glass - Interior Check the box (if applicable): Indicates glass is located inside the building. As used here, this is ground floor glass.
PROPERTY COVERAGES -PREMISES LEVEL Ground Floor Glass - Tenants Exterior Check the box (if applicable): Indicates glass is located outside a tenant area. As used here, this is ground floor glass.
PROPERTY COVERAGES -PREMISES LEVEL Ground Floor Glass - Value Enter amount: The actual value / cost per plate of glass. As used here, this is ground floor glass.
PROPERTY COVERAGES -PREMISES LEVEL Ground Floor Glass - Deductible Enter deductible: The deductible for the glass coverage. As used here, this is ground floor glass.
PROPERTY COVERAGES -PREMISES LEVEL Above Ground Floor Glass - # Plates Enter number: The number of plates of glass to be insured with the same dimensions and description. As used here, this is above ground floor glass.
PROPERTY COVERAGES -PREMISES LEVEL Above Ground Floor Glass - Area Sq Ft Enter number: The area, measured in square feet, of the plates to be insured. For odd-sized plates, you may need to compute the area (e.g., the size needed to replace a round piece of glass is a rectangle large enough to allow the circle to be cut from it). As used here, this is above ground floor glass.
PROPERTY COVERAGES -PREMISES LEVEL Above Ground Floor Glass -Length Linear Ft Enter number: The horizontal length, measured in feet, of the plates to be insured. As used here, this is above ground floor glass.
PROPERTY COVERAGES -PREMISES LEVEL Above Ground Floor Glass - Glass Type Enter code: The industry code identifying the class for the type of glass. The source of this code is the Insurance Services Office CLM. As used here, this is above ground floor glass.
PROPERTY COVERAGES -PREMISES LEVEL Above Ground Floor Glass -Interior Check the box (if applicable): Indicates glass is located inside the building. As used here, this is above ground floor glass.
PROPERTY COVERAGES -PREMISES LEVEL Above Ground Floor Glass -Tenants Exterior Check the box (if applicable): Indicates glass is located outside a tenant area. As used here, this is above ground floor glass.
PROPERTY COVERAGES -PREMISES LEVEL Above Ground Floor Glass - Value Enter amount: The actual value / cost per plate of glass. As used here, this is above ground floor glass.
PROPERTY COVERAGES -PREMISES LEVEL Above Ground Floor Glass -Deductible Enter deductible: The deductible for the glass coverage. As used here, this is above ground floor glass.
PROPERTY ADDITIONAL COVERAGES - POLICY LEVEL Coverages Schedule Attached Check the box (if applicable): Indicates a coverages schedule is attached.
PROPERTY ADDITIONAL COVERAGES Coverage Code Enter code: The code for the coverage.
PROPERTY ADDITIONAL COVERAGES Coverage Description Enter text: The description of the coverage.
PROPERTY ADDITIONAL COVERAGES Pol Level Check the box (if applicable): Indicates the coverage applies at the policy level.

ACORD 160 (2009/05) 54 of 64

Section Name Field Name Field and/or Section Description
PROPERTY ADDITIONAL COVERAGES Prem Level Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL COVERAGES Total Amount Enter limit: The limit amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Included Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL COVERAGES Form Number Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Form Date Enter date: The edition date of the form used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Premium Enter amount: The premium amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Coverage Code Enter code: The code for the coverage.
PROPERTY ADDITIONAL COVERAGES Coverage Description Enter text: The description of the coverage.
PROPERTY ADDITIONAL COVERAGES Pol Level Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL COVERAGES Prem Level Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL COVERAGES Total Amount Enter limit: The limit amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Included Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL COVERAGES Form Number Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Form Date Enter date: The edition date of the form used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Premium Enter amount: The premium amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Coverage Code Enter code: The code for the coverage.

ACORD 160 (2009/05) 55 of 64

Section Name Field Name Field and/or Section Description
PROPERTY ADDITIONAL COVERAGES Coverage Description Enter text: The description of the coverage.
PROPERTY ADDITIONAL COVERAGES Pol Level Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL COVERAGES Prem Level Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL COVERAGES Total Amount Enter limit: The limit amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Included Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL COVERAGES Form Number Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Form Date Enter date: The edition date of the form used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Premium Enter amount: The premium amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Coverage Code Enter code: The code for the coverage.
PROPERTY ADDITIONAL COVERAGES Coverage Description Enter text: The description of the coverage.
PROPERTY ADDITIONAL COVERAGES Pol Level Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL COVERAGES Prem Level Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL COVERAGES Total Amount Enter limit: The limit amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Included Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL COVERAGES Form Number Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Form Date Enter date: The edition date of the form used by the company for the coverage.

ACORD 160 (2009/05) 56 of 64

Section Name Field Name Field and/or Section Description
PROPERTY ADDITIONAL COVERAGES Premium Enter amount: The premium amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Coverage Code Enter code: The code for the coverage.
PROPERTY ADDITIONAL COVERAGES Coverage Description Enter text: The description of the coverage.
PROPERTY ADDITIONAL COVERAGES Pol Level Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL COVERAGES Prem Level Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL COVERAGES Total Amount Enter limit: The limit amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Included Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL COVERAGES Form Number Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Form Date Enter date: The edition date of the form used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Premium Enter amount: The premium amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Coverage Code Enter code: The code for the coverage.
PROPERTY ADDITIONAL COVERAGES Coverage Description Enter text: The description of the coverage.
PROPERTY ADDITIONAL COVERAGES Pol Level Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL COVERAGES Prem Level Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL COVERAGES Total Amount Enter limit: The limit amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Included Check the box (if applicable): Indicates the coverage is included in the policy.

ACORD 160 (2009/05) 57 of 64

Section Name Field Name Field and/or Section Description
PROPERTY ADDITIONAL COVERAGES Form Number Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Form Date Enter date: The edition date of the form used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Premium Enter amount: The premium amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Coverage Code Enter code: The code for the coverage.
PROPERTY ADDITIONAL COVERAGES Coverage Description Enter text: The description of the coverage.
PROPERTY ADDITIONAL COVERAGES Pol Level Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL COVERAGES Prem Level Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL COVERAGES Total Amount Enter limit: The limit amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Included Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL COVERAGES Form Number Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Form Date Enter date: The edition date of the form used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Premium Enter amount: The premium amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Coverage Code Enter code: The code for the coverage.
PROPERTY ADDITIONAL COVERAGES Coverage Description Enter text: The description of the coverage.
PROPERTY ADDITIONAL COVERAGES Pol Level Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL COVERAGES Prem Level Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL COVERAGES Total Amount Enter limit: The limit amount for the coverage.

ACORD 160 (2009/05) 58 of 64

Section Name Field Name Field and/or Section Description
PROPERTY ADDITIONAL COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Included Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL COVERAGES Form Number Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Form Date Enter date: The edition date of the form used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Premium Enter amount: The premium amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Coverage Code Enter code: The code for the coverage.
PROPERTY ADDITIONAL COVERAGES Coverage Description Enter text: The description of the coverage.
PROPERTY ADDITIONAL COVERAGES Pol Level Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL COVERAGES Prem Level Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL COVERAGES Total Amount Enter limit: The limit amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Included Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL COVERAGES Form Number Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Form Date Enter date: The edition date of the form used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Premium Enter amount: The premium amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Coverage Code Enter code: The code for the coverage.
PROPERTY ADDITIONAL COVERAGES Coverage Description Enter text: The description of the coverage.
PROPERTY ADDITIONAL COVERAGES Pol Level Check the box (if applicable): Indicates the coverage applies at the policy level.

ACORD 160 (2009/05) 59 of 64

Section Name Field Name Field and/or Section Description
PROPERTY ADDITIONAL COVERAGES Prem Level Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL COVERAGES Total Amount Enter limit: The limit amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Included Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL COVERAGES Form Number Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Form Date Enter date: The edition date of the form used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Premium Enter amount: The premium amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Coverage Code Enter code: The code for the coverage.
PROPERTY ADDITIONAL COVERAGES Coverage Description Enter text: The description of the coverage.
PROPERTY ADDITIONAL COVERAGES Pol Level Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL COVERAGES Prem Level Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL COVERAGES Total Amount Enter limit: The limit amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Included Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL COVERAGES Form Number Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Form Date Enter date: The edition date of the form used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Premium Enter amount: The premium amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Coverage Code Enter code: The code for the coverage.

ACORD 160 (2009/05) 60 of 64

Section Name Field Name Field and/or Section Description
PROPERTY ADDITIONAL COVERAGES Coverage Description Enter text: The description of the coverage.
PROPERTY ADDITIONAL COVERAGES Pol Level Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL COVERAGES Prem Level Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL COVERAGES Total Amount Enter limit: The limit amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Included Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL COVERAGES Form Number Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Form Date Enter date: The edition date of the form used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Premium Enter amount: The premium amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Coverage Code Enter code: The code for the coverage.
PROPERTY ADDITIONAL COVERAGES Coverage Description Enter text: The description of the coverage.
PROPERTY ADDITIONAL COVERAGES Pol Level Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL COVERAGES Prem Level Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL COVERAGES Total Amount Enter limit: The limit amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Deductible Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL COVERAGES Included Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL COVERAGES Form Number Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL COVERAGES Form Date Enter date: The edition date of the form used by the company for the coverage.

ACORD 160 (2009/05) 61 of 64

Section Name Field Name Field and/or Section Description
PROPERTY ADDITIONAL COVERAGES Premium Enter amount: The premium amount for the coverage.
IDENTIFICATION SECTION Agency Customer ID Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage).
IDENTIFICATION SECTION Loc # Enter number: The producer assigned number of the location.
IDENTIFICATION SECTION Bldg # Enter number: The building number for the premises. Used when more than one building exists at an individual location.
PREMISES GENERAL INFORMATION 1. Does applicant have a heating or processing boiler? Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does applicant have a heating or processing boiler?".
PREMISES GENERAL INFORMATION Date of Last Inspection Enter date: The date of the last inspection.
PREMISES GENERAL INFORMATION Current Carrier for Boiler & Machinery coverage: Enter text: The insurer name on any other applicable insurance. As used here, this is the current carrier for boiler and machinery coverage.
PREMISES GENERAL INFORMATION 2. Any specialized equipment, such as medical equipment or other, valued over $100,000? Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any specialized equipment, such as medical equipment or other, valued over $100,000?".
PREMISES GENERAL INFORMATION 2. Remarks Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
PREMISES GENERAL INFORMATION 3. Is all equipment inspected annually and well maintained. Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is all equipment inspected annually and well maintained?".
PREMISES GENERAL INFORMATION 4. Is there a swimming pool on the premises? Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is there a swimming pool on the premises?".
PREMISES GENERAL INFORMATION Approved Fence Check the box (if applicable): Indicates the swimming pool is surrounded by a fence that is an approved height.
PREMISES GENERAL INFORMATION Limited Access Check the box (if applicable): Indicates there is limited access to the swimming pool.
PREMISES GENERAL INFORMATION Diving Board Check the box (if applicable): Indicates the swimming pool has a diving board.
PREMISES GENERAL INFORMATION Slide Check the box (if applicable): Indicates the swimming pool has a slide.
PREMISES GENERAL INFORMATION Above Ground Check the box (if applicable): Indicates the swimming pool is above ground.
PREMISES GENERAL INFORMATION In Ground Check the box (if applicable): Indicates the swimming pool is in the ground.

ACORD 160 (2009/05) 62 of 64

Section Name Field Name Field and/or Section Description
PREMISES GENERAL INFORMATION Life Guard Check the box (if applicable): Indicates there is life guard for the swimming pool.
PREMISES GENERAL INFORMATION 5. Is the building under construction? Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is the building under construction?".
PREMISES GENERAL INFORMATION 5. Remarks Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
APARTMENT AND CONDOMINIUMS 1. Is there a playground on premises? Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is there a playground on premises?".
APARTMENT AND CONDOMINIUMS 1. Remarks Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
APARTMENT AND CONDOMINIUMS 2. Is aluminum wiring used? Enter Y for a “Yes” response. Input N for “No” response. Indicates if aluminum wiring is used in the structure.
APARTMENT AND CONDOMINIUMS Installation Date Enter date: The date the wiring was installed.
APARTMENT AND CONDOMINIUMS Description Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
APARTMENT AND CONDOMINIUMS 3. Is developer or contractor a board member? Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is developer or contractor a board member?".
APARTMENT AND CONDOMINIUMS 4. Is a property manager employed? Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is a property manager employed?".
APARTMENT AND CONDOMINIUMS Coverage Applies To Bare Walls Check the box (if applicable): Indicates coverage applies to bare walls.
APARTMENT AND CONDOMINIUMS Coverage Applies To Finished Walls Check the box (if applicable): Indicates coverage applies to finished walls.
APARTMENT AND CONDOMINIUMS Smoke Detectors - None Check the box (if applicable): Indicates there is no smoke detector.
APARTMENT AND CONDOMINIUMS Smoke Detectors - Battery Check the box (if applicable): Indicates the smoke detector is battery operated.
APARTMENT AND CONDOMINIUMS Smoke Detectors - Wired Check the box (if applicable): Indicates the smoke detector is wired.
APARTMENT AND CONDOMINIUMS # of Fire Divisions Enter number: The number of fire divisions in the building.
APARTMENT AND CONDOMINIUMS # Units Per Fire Division Enter number: The number of units within a fire division.
APARTMENT AND CONDOMINIUMS # Units Owner Occupied Enter number: The number of units that are owner occupied.

ACORD 160 (2009/05) 63 of 64

Section Name Field Name Field and/or Section Description
CRIME Alarm Type - Hold Up Check the box (if applicable): Indicates the alarm type is a hold-up alarm. A manual or semiautomatic control which can transmit an alarm in the event of a hold-up. As used here, complete this section in regards to the location and protection systems for this risk. Information on the classification of safes, vaults and alarm systems can be found in the Crime Section of the ISO Commercial Lines Manual.
CRIME Alarm Type - Premises Check the box (if applicable): Indicates the alarm type is a premises alarm. A sensing device installed on premises which transmits an alarm in the event of unauthorized entry. The Premises Extent must be completed for Premises Alarms.
CRIME Alarm Type - Safe / Vault Check the box (if applicable): Indicates the alarm type is a safe/vault alarm. A system that protects the safe or vault and is connected to an outside central station, gong or siren. The Extent of Protection for safe/vault must be completed.
CRIME Alarm Type - Other Check the box (if applicable): Indicates the alarm type is other than those listed.
CRIME Alarm Type - Other Description Enter text: The description of the type of alarm.
CRIME Alarm Description - Local Gong Check the box (if applicable): Indicates the burglar alarm sounds or appears outside the premises.
CRIME Alarm Description - Central Station with Keys Check the box (if applicable): Indicates the alarm company, located off the insured's premises, has keys to the applicant's property.
CRIME Alarm Description - Central Station without Keys Check the box (if applicable): Indicates the burglar alarm rings at an alarm company.
CRIME Alarm Description - Police Connect Check the box (if applicable): Indicates if alarms (hold-up and burglar) are transmitted to police headquarters rather than to a private control station
CRIME Grade Enter code: The alarm grade as described in the Insurance Services Office crime rating manual (e.g., AA, A, B, C) which indicates the time required to respond to a signal from the alarm system.
CRIME Extent of Protection for Safe/Vault Partial Check the box (if applicable): Indicates the extent of protection for the safe/vault is partial and covers around the door only.
CRIME Extent of Protection for Safe/Vault Complete Check the box (if applicable): Indicates the extent of protection for the safe/vault is complete and covers the sides, top walls, floor and ceiling.
CRIME Extent of Protection for Premises -1 Check the box (if applicable): Indicates the extent of protection for the premises is premises 1 as defined in the ISO Classification and Rating Manual.
CRIME Extent of Protection for Premises -2 Check the box (if applicable): Indicates the extent of protection for the premises is premises 2 as defined in the ISO Classification and Rating Manual.
CRIME Extent of Protection for Premises -3 Check the box (if applicable): Indicates the extent of protection for the premises is premises 3 as defined in the ISO Classification and Rating Manual.
CRIME Certificate # Enter identifier: The Underwriters Laboratories or other testing organization Certificate Number, if applicable. Attach a copy of the certificate to the application.

ACORD 160 (2009/05) 64 of 64

Section Name Field Name Field and/or Section Description
CRIME Expiration Date Enter date: The expiration date of the certificate.
CRIME Safe/Vault/Receptacle Manufacturers Name Enter text: The safe or vault manufacturer's name.
CRIME Label - UL Check the box (if applicable): Indicates the rating is based on Underwriters Laboratories, Inc. (UL).
CRIME Label - SMNA Check the box (if applicable): Indicates the rating is based on Safe Manufacturers National Association (SMNA).
CRIME Class Enter code: The construction classification representing the extent of burglary protection for this safe or vault. Use the classification from the Burglary label and not the Fire label located on the safe or vault. For industry definitions of the classifications, refer to the Commercial Lines Manual.
CRIME Maximum Cash on Premises Enter amount: The maximum amount of cash kept on the premises during normal business hours.
CRIME Maximum Cash With Messenger Enter amount: The maximum amount of cash messengers are allowed to carry for the applicant.
CRIME Money on Premises Overnight Enter amount: The maximum exposure amount for money overnight.
CRIME Frequency of Deposits Enter code: The frequency of deposits.
CRIME Dbl. Cyl. Door Locks Enter Y for a “Yes” response. Input N for “No” response. Indicates the type of locks on the entry doors of the insured premises are double cylinder door locks.
CRIME Safe Door Construction Enter text: The construction of the safe, vault or other receptacle (e.g., 4-inch steel door, with 12-inch reinforced stone walls).
CRIME Other Protection Enter text: The description of other protective measures or devices (e.g., if windows have steel grates and are connected to an alarm). Indicate if the building has skylights and if windows are visible from the street.
REMARKS Enter text: The description of any additional information required for underwriting or rating. Attach ACORD 101, Additional Remarks Schedule, if more space is required.
Edition Date The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM).
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