ACORD 138MT Instructions


 
Section Name Field Name Field and/or Section Description
TITLE ACORD 138 MT (2009/08) Montana Garage and Dealers, Coverages/Limits Section The title of the form. ACORD 138 MT, Montana Garage and Dealers Coverages/Limits Section, is used to collect the coverage and limit information necessary to write Garage and Dealers insurance in this state. Required disclosure and coverage acceptance or rejection information is also included. Use this form with ACORD 128, Garage and Dealers Section. The following are the specific differences in this state. * Personal Injury Protection coverage is not available; this is not a “no-fault” state. * Uninsured Motorist Property Damage and Underinsured Motorists Property Damage coverages are not available. * Provision is made to select “stacked” or “non-stacked” coverage under Uninsured and Underinsured Motorists BI coverages. * A statement has been added to the back of the form, referencing the offering of Uninsured Motorists coverage, and the applicants right to reject coverage. Applicant must sign his/her initials. * A state-specific privacy notice is added.
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 Enter text: The full name of the producer/agency.
IDENTIFICATION SECTION Policy Number Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number.
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 Named Insured(s) Enter text: The named insured(s) as it/they will appear on the policy declarations page.
ACORD 138 MT (2009/08) rev. 08-31-2009 2 of 10

Section Name Field Name Field and/or Section Description
IDENTIFICATION SECTION Carrier Enter text: The insurer’s full legal company name(s) as found in thefile 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.
COVERAGES / LIMITS Automobile (Checkbox) Check the box (if applicable): Indicates the policy coverage includes automobile. Note that automobile and premises operations coverages can apply.
COVERAGES / LIMITS Premises Operations (Checkbox) Check the box (if applicable): Indicates the policy coverage includes premises operations. Note that both automobile and premises operations coverages can apply.
COVERAGES / LIMITS Liability 21 Check the box (if applicable): Indicates any auto is covered. As used here, Garage or Dealers policies use numeric symbols on the policy declarations to indicate the type(s) of vehicles for which coverage is in effect. Be sure to check the appropriate box for each type of coverage. Only those symbols specified for a coverage may be used. Symbols 21 through 26 provide fleet automatic coverage. Symbol 21 includes Hired and Non-Ownedauto coverage. If symbol 21 is not used and Hired Auto (symbol 28) or Non-Owned Auto (symbol 29) coverage is desired, those symbols must be checked. The symbols indicate the automobiles to which each coverage applies. The symbol “triggers”” the coverage. For exact policy definitions of the symbols, please refer to the company’s policy declarations page.
COVERAGES / LIMITS Liability 22 Check the box (if applicable): Indicates all owned autos are covered.
COVERAGES / LIMITS Liability 23 Check the box (if applicable): Indicates only owned private passengers autos are covered.
COVERAGES / LIMITS Liability 24 Check the box (if applicable): Indicates owned autos other than private passenger autos are covered.
COVERAGES / LIMITS Liability 27 Check the box (if applicable): Indicates specifically described autos are covered.
COVERAGES / LIMITS Liability 28 Check the box (if applicable): Indicates only hired autos are covered.
COVERAGES / LIMITS Liability 29 Check the box (if applicable): Indicates non-owned autos used in garage business are covered.
COVERAGES / LIMITS Other Covered Auto Symbol Check the box (if applicable): Indicates that a symbol other than those listed should be used.
COVERAGES / LIMITS Other Covered Auto Symbol Description Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable.
ACORD 138 MT (2009/08) rev. 08-31-2009 3 of 10

Section Name Field Name Field and/or Section Description
COVERAGES / LIMITS EA Acc ($) Auto Only Enter limit: The liability each accident limit for garage operations auto only. For Dealers, use this field to enter the Policy Combined Single Limit.
COVERAGES / LIMITS Other Than Auto Only ($) Enter limit: The liability each accident limit for garage operations other than auto only.
COVERAGES / LIMITS Aggregate ($) Enter limit: The liability aggregate limit for garage operations other than auto only.
COVERAGES / LIMITS Dealers Only-Limited Check the box (if applicable): Indicates the liability coverage is limited for dealers.
COVERAGES / LIMITS Dealers Only-Unlimited Check the box (if applicable): Indicates the liability coverage is unlimited for dealers.
COVERAGES / LIMITS Medical Payments 21 Check the box (if applicable): Indicates any auto is covered.
COVERAGES / LIMITS Medical Payments 22 Check the box (if applicable): Indicates all owned autos are covered.
COVERAGES / LIMITS Medical Payments 23 Check the box (if applicable): Indicates only owned private passengers autos are covered.
COVERAGES / LIMITS Medical Payments 24 Check the box (if applicable): Indicates owned autos other than private passenger autos are covered.
COVERAGES / LIMITS Medical Payments 27 Check the box (if applicable): Indicates specifically described autos are covered.
COVERAGES / LIMITS Medical Payments 28 Check the box (if applicable): Indicates only hired autos are covered.
COVERAGES / LIMITS Medical Payments 29 Check the box (if applicable): Indicates non-owned autos used in garage business are covered.
COVERAGES / LIMITS Other Covered Auto Symbol Check the box (if applicable): Indicates that a symbol other than those listed should be used.
COVERAGES / LIMITS Other Covered Auto Symbol Description Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable.
COVERAGES / LIMITS Limit ($) Enter limit: The medical payments per person limit.
COVERAGES / LIMITS Stkd Check the box (if applicable): Indicates the uninsured motorists coverage is stacked.
COVERAGES / LIMITS Non-Stkd Check the box (if applicable): Indicates the uninsured motorists coverage is not stacked.
COVERAGES / LIMITS Uninsured Motorists 22 Check the box (if applicable): Indicates all owned autos are covered.
COVERAGES / LIMITS Uninsured Motorists 23 Check the box (if applicable): Indicates only owned private passengers autos are covered.
COVERAGES / LIMITS Uninsured Motorists 24 Check the box (if applicable): Indicates owned autos other than private passenger autos are covered.
COVERAGES / LIMITS Uninsured Motorists 26 Check the box (if applicable): Indicates owned autos subject to uninsured motorists law are covered.
COVERAGES / LIMITS Uninsured Motorists 27 Check the box (if applicable): Indicates specifically described autos are covered.
COVERAGES / LIMITS Other Covered Auto Symbol Check the box (if applicable): Indicates that a symbol other than those listed should be used.
ACORD 138 MT (2009/08) rev. 08-31-2009 4 of 10

Section Name Field Name Field and/or Section Description
COVERAGES / LIMITS Other Covered Auto Symbol Description Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable.
COVERAGES / LIMITS CSL (checkbox) Check the box (if applicable): Indicates if the limit shown is for combined single limit on the coverage.
COVERAGES / LIMITS BI Ea Per (checkbox) Check the box (if applicable): Indicates if the limit shown is the bodily injury each person limit on the coverage.
COVERAGES / LIMITS Amount Enter limit: The uninsured motorists bodily injury per person limit. The use of this limit varies by state. (in some states this may contain the combined single limit per accident limit amount.)
COVERAGES / LIMITS BI Each Accident ($) Enter limit: The uninsured motorists bodily injury per accident limit (in some states this may contain the uninsured motorists combined single limit per accident limit). The use of this limit varies by state.
COVERAGES / LIMITS Stkd Check the box (if applicable): Indicates the underinsured motorists coverage is stacked.
COVERAGES / LIMITS Non-Stkd Check the box (if applicable): Indicates the underinsured motorists coverage is not stacked.
COVERAGES / LIMITS Underinsured Motorist 22 Check the box (if applicable): Indicates all owned autos are covered.
COVERAGES / LIMITS Underinsured Motorist 23 Check the box (if applicable): Indicates only owned private passengers autos are covered.
COVERAGES / LIMITS Underinsured Motorist 24 Check the box (if applicable): Indicates owned autos other than private passenger autos are covered.
COVERAGES / LIMITS Underinsured Motorist 26 Check the box (if applicable): Indicates owned autos subject to uninsured motorists law are covered.
COVERAGES / LIMITS Underinsured Motorist 27 Check the box (if applicable): Indicates specifically described autos are covered.
COVERAGES / LIMITS Other Covered Auto Symbol Check the box (if applicable): Indicates that a symbol other than those listed should be used.
COVERAGES / LIMITS Other Covered Auto Symbol Description Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable.
COVERAGES / LIMITS CSL (Checkbox) Check the box (if applicable): Indicates if the limit shown is for combined single limit on the coverage.
COVERAGES / LIMITS BI EA PER (Checkbox) Check the box (if applicable): Indicates if the limit shown is the bodily injury each person limit on the coverage.
COVERAGES / LIMITS Amount Enter limit: The underinsured motorists bodily injury per person limit. The use of this limit varies by state. In some states this may contain the combined single limit each accident amount
ACORD 138 MT (2009/08) rev. 08-31-2009 5 of 10

Section Name Field Name Field and/or Section Description
COVERAGES / LIMITS BI Each Accident ($) Enter limit: The underinsured motorists bodily injury per accident limit (in some states this may contain the underinsured motorists combined single per accident limit). The use of this limit varies by state.
PHYSICAL DAMAGE Comp / OTC Check the box (if applicable): Indicates the physical damage is comprehensive/other than collision.
PHYSICAL DAMAGE Specified Perils Check the box (if applicable): Indicates the physical damage coverage is for specified perils.
PHYSICAL DAMAGE Perils option field Enter text: The codes associated with specified perils coverage. The codes are: F – Fire, F&T – Fire and Theft, FTW – Fire, Theft and Wind, LSP – Limited Specified Perils, SP -Specified Perils.
PHYSICAL DAMAGE Specified Perils 22 Check the box (if applicable): Indicates all owned autos are covered.
PHYSICAL DAMAGE Specified Perils 23 Check the box (if applicable): Indicates only owned private passengers autos are covered.
PHYSICAL DAMAGE Specified Perils 24 Check the box (if applicable): Indicates owned autos other than private passenger autos are covered.
PHYSICAL DAMAGE Specified Perils 27 Check the box (if applicable): Indicates specifically described autos are covered.
PHYSICAL DAMAGE Specified Perils 28 Check the box (if applicable): Indicates only hired autos are covered.
PHYSICAL DAMAGE Specified Perils 31 Check the box (if applicable): Indicates autos on consignment and dealer autos are covered.
PHYSICAL DAMAGE Other Covered Auto Symbol Check the box (if applicable): Indicates that a symbol other than those listed should be used.
PHYSICAL DAMAGE Other Covered Auto Symbol Description Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable.
PHYSICAL DAMAGE LOC # One Enter number: The producer assigned number for the location.
PHYSICAL DAMAGE Enter the Limits for Each Location One Enter limit: The physical damage comprehensive/other than collision or specified perils limit amount.
PHYSICAL DAMAGE Deductible Per Auto One Enter deductible: The physical damage comprehensive/other than collision or specified perils per auto deductible amount.
PHYSICAL DAMAGE Maximum Deductible Per Loss One Enter deductible: The physical damage comprehensive/other than collision or specified perils maximum deductible per loss amount.
PHYSICAL DAMAGE LOC # Two Enter number: The producer assigned number for the location.
PHYSICAL DAMAGE Enter the Limits for Each Location Two Enter limit: The physical damage comprehensive/other than collision or specified perils limit amount.
PHYSICAL DAMAGE Deductible Per Auto Two Enter deductible: The physical damage comprehensive/other than collision or specified perils per auto deductible amount.
ACORD 138 MT (2009/08) rev. 08-31-2009 6 of 10

Section Name Field Name Field and/or Section Description
PHYSICAL DAMAGE Maximum Deductible Per Loss Two Enter deductible: The physical damage comprehensive/other than collision or specified perils maximum deductible per loss amount.
PHYSICAL DAMAGE LOC # Three Enter number: The producer assigned number for the location.
PHYSICAL DAMAGE Enter the Limits for Each Location Three Enter limit: The physical damage comprehensive/other than collision or specified perils limit amount.
PHYSICAL DAMAGE Deductible Per Auto Three Enter deductible: The physical damage comprehensive/other than collision or specified perils per auto deductible amount.
PHYSICAL DAMAGE Maximum Deductible Per Loss Three Enter deductible: The physical damage comprehensive/other than collision or specified perils maximum deductible per loss amount.
PHYSICAL DAMAGE Collision 22 Check the box (if applicable): Indicates all owned autos are covered.
PHYSICAL DAMAGE Collision 23 Check the box (if applicable): Indicates only owned private passengers autos are covered.
PHYSICAL DAMAGE Collision 24 Check the box (if applicable): Indicates owned autos other than private passenger autos are covered.
PHYSICAL DAMAGE Collision 27 Check the box (if applicable): Indicates specifically described autos are covered.
PHYSICAL DAMAGE Collision 28 Check the box (if applicable): Indicates only hired autos are covered.
PHYSICAL DAMAGE Collision 31 Check the box (if applicable): Indicates autos on consignment and dealer autos are covered.
PHYSICAL DAMAGE Other Covered Auto Symbol Check the box (if applicable): Indicates that a symbol other than those listed should be used.
PHYSICAL DAMAGE Other Covered Auto Symbol Description Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable.
PHYSICAL DAMAGE Collision-Deductible ($) Enter deductible: The physical damage collision deductible amount.
PHYSICAL DAMAGE Additional Coverage Description Enter text: The description of other coverage (not the limit) on the vehicle policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
PHYSICAL DAMAGE Additional Coverage Covered Auto Symbols Enter text: The symbols that apply to the other coverage listed.
PHYSICAL DAMAGE Additional Coverage Limit Enter limit: The limit amount of the other coverage.
GARAGE KEEPERS Legal Liability Check the box (if applicable): Indicates the policy is to be written on a legal liability basis.
GARAGE KEEPERS Direct Basis Check the box (if applicable): Indicates the policy is to be written on a direct basis.
GARAGE KEEPERS Primary Check the box (if applicable): Indicates this policy is the primary coverage.
GARAGE KEEPERS Excess Check the box (if applicable): Indicates this policy is for excess coverage.
GARAGE KEEPERS Comp / OTC Check the box (if applicable): Indicates the garage keepers coverage is comprehensive/other than collision.
ACORD 138 MT (2009/08) rev. 08-31-2009 7 of 10

Section Name Field Name Field and/or Section Description
GARAGE KEEPERS Specified Perils Check the box (if applicable): Indicates the garage keepers coverage is for specified perils.
GARAGE KEEPERS Perils option field Enter text: The codes associated with specified perils coverage. The codes are: F – Fire, F&T – Fire and Theft, FTW – Fire, Theft and Wind, LSP – Limited Specified Perils, SP -Specified Perils.
GARAGE KEEPERS 30 (Checkbox) Check the box (if applicable): Indicates autos left for service, repairs and/or storage are covered.
GARAGE KEEPERS Other Covered Auto Symbol Check the box (if applicable): Indicates that a symbol other than those listed should be used.
GARAGE KEEPERS Other Covered Auto Symbol Description Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable.
GARAGE KEEPERS LOC # One Enter number: The producer assigned number for the location. ‘The location number for the physical damage coverages should correspond to a location number documented on the ACORD 125.
GARAGE KEEPERS Enter the Limits for Each Location One Enter limit: The garage keepers comprehensive/other than collision or specified perils limit amount.
GARAGE KEEPERS # of Autos One Enter number: The number of vehicles located on the premises.
GARAGE KEEPERS Deductible Per Auto One Enter deductible: The garage keepers comprehensive/other than collision or specified perils per auto deductible amount.
GARAGE KEEPERS Maximum Deductible Per Loss One Enter deductible: The garage keepers comprehensive/other than collision or specified perils maximum deductible per loss amount.
GARAGE KEEPERS LOC # Two Enter number: The producer assigned number for the location. ‘The location number for the physical damage coverages should correspond to a location number documented on the ACORD 125.
GARAGE KEEPERS Enter the Limits for Each Location Two Enter limit: The garage keepers comprehensive/other than collision or specified perils limit amount.
GARAGE KEEPERS # of Autos Two Enter number: The number of vehicles located on the premises.
GARAGE KEEPERS Deductible Per Auto Two Enter deductible: The garage keepers comprehensive/other than collision or specified perils per auto deductible amount.
GARAGE KEEPERS Maximum Deductible Per Loss Two Enter deductible: The garage keepers comprehensive/other than collision or specified perils maximum deductible per loss amount.
GARAGE KEEPERS LOC # Three Enter number: The producer assigned number for the location. ‘The location number for the physical damage coverages should correspond to a location number documented on the ACORD 125.
GARAGE KEEPERS Enter the Limits for Each Location Three Enter limit: The garage keepers comprehensive/other than collision or specified perils limit amount.
ACORD 138 MT (2009/08) rev. 08-31-2009 8 of 10

Section Name Field Name Field and/or Section Description
GARAGE KEEPERS # of Autos Three Enter number: The number of vehicles located on the premises.
GARAGE KEEPERS Deductible Per Auto Three Enter deductible: The garage keepers comprehensive/other than collision or specified perils per auto deductible amount.
GARAGE KEEPERS Maximum Deductible Per Loss Three Enter deductible: The garage keepers comprehensive/other than collision or specified perils maximum deductible per loss amount.
GARAGE KEEPERS 30 (checkbox) Two Check the box (if applicable): Indicates autos left for service, repairs and/or storage are covered.
GARAGE KEEPERS Other Covered Auto Symbol Check the box (if applicable): Indicates that a symbol other than those listed should be used.
GARAGE KEEPERS Other Covered Auto Symbol Description Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable.
GARAGE KEEPERS LOC # Four Enter number: The producer assigned number for the location. The location number for the garage keepers coverages should correspond to a location number documented on the ACORD 125.
GARAGE KEEPERS Enter the Limits for Each Location Four Enter limit: The garage keepers collision limit amount.
GARAGE KEEPERS # of Autos Four Enter number: The number of vehicles located on the premises.
GARAGE KEEPERS Deductible Per Auto Four Enter deductible: The garage keepers collision per auto deductible amount.
GARAGE KEEPERS LOC # Five Enter number: The producer assigned number for the location. The location number for the garage keepers coverages should correspond to a location number documented on the ACORD 125.
GARAGE KEEPERS Enter the Limits for Each Location Five Enter limit: The garage keepers collision limit amount.
GARAGE KEEPERS # of Autos Five Enter number: The number of vehicles located on the premises.
GARAGE KEEPERS Deductible Per Auto Five Enter deductible: The garage keepers collision per auto deductible amount.
GARAGE KEEPERS LOC # Six Enter number: The producer assigned number for the location. The location number for the garage keepers coverages should correspond to a location number documented on the ACORD 125.
GARAGE KEEPERS Enter the Limits for Each Location Six Enter limit: The garage keepers collision limit amount.
GARAGE KEEPERS # of Autos Six Enter number: The number of vehicles located on the premises.
GARAGE KEEPERS Deductible Per Auto Six Enter deductible: The garage keepers collision per auto deductible amount.
GARAGE KEEPERS Additional Coverage Description Enter text: The description of other coverage (not the limit) on the vehicle policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
ACORD 138 MT (2009/08) rev. 08-31-2009 9 of 10

Section Name Field Name Field and/or Section Description
GARAGE KEEPERS Additional Coverage Covered Auto Symbols Enter text: The symbols that apply to the other coverage listed.
GARAGE KEEPERS Additional Coverage Limit Enter limit: The limit amount of the other coverage.
GARAGE KEEPERS Physical Damage Reporting Period Enter text: The timing of the reporting period if the policy will be on a Reporting basis. Examples: Monthly, Quarterly, Semi-Annual.
GARAGE KEEPERS Physical Damage Non-Reporting Check the box (if applicable): Indicates the policy is on a non-reporting basis.
GARAGE KEEPERS # Dealer Plates/Repairer Plates Enter number: The total number of sets of dealer or repairer plates issued to the named insured.
GARAGE KEEPERS # Transportation Plates Enter number: The total number of sets of transportation plates issued to the applicant.
GARAGE KEEPERS # Hoists Enter number: The total number of hoists located on the premises.
GARAGE KEEPERS Temporary Location Limit Enter limit: The limit for covered autos stored temporarily off premises.
GARAGE KEEPERS Transit Limit Enter limit: The limit for covered autos in transit.
ENDORSEMENTS / REMARKS Remarks Enter text: The remarks associated with the Garage and Dealers line of business. Enter any endorsements that apply. Be sure to include the form numbers and the required information for attaching the endorsement. 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).
ENDORSEMENTS / REMARKS Remarks Enter text: The remarks associated with the Garage and Dealers line of business. Enter any endorsements that apply. Be sure to include the form numbers and the required information for attaching the endorsement. Attach ACORD 101, Additional Remarks Schedule, if more space is required.
GARAGE KEEPERS UM Stacked Coverage (initials) Initial here: The named insured’s initials. As used here, indicates the named insured has rejected uninsured motorists and underinsured motorists coverage.
GARAGE KEEPERS UM Stacked Coverage (initials) Initial here: The named insured’s initials. As used here, indicates the named insured has been offered stacked uninsured motorists coverage.
GARAGE KEEPERS UM Non-Stacked Coverage (initials) Initial here: The named insured’s initials. As used here, indicates the named insured has been offered non-stacked uninsured motorists coverage.
GARAGE KEEPERS UIM Stacked Coverage (initials) Initial here: The named insured’s initials. As used here, indicates the named insured has been offered stacked underinsured motorists coverage.
GARAGE KEEPERS UIM Non-Stacked Coverage (initials) Initial here: The named insured’s initials. As used here, indicates the named insured has been offered non-stacked underinsured motorists coverage.
Section Name Field Name Field and/or Section Description
GARAGE KEEPERS Applicant’s Signature Sign here: Accommodates the signature of the applicant or named insured. As used here, the applicant should read and understand the Fair Credit Reporting Act, the Privacy Act (where applicable), the Applicant’s Statement, and any other disclosure information on the form before personally signing the application.
GARAGE KEEPERS Date Enter date: The date the form was signed by the named insured.
GARAGE KEEPERS Producer’s Signature Sign here: Accommodates the signature of the authorized representative (e.g. producer, agent, broker, etc.). by all companies to issue Certificates. This is required in most states.
GARAGE KEEPERS National Producer Number Enter identifier: The National Producer Number (NPN) as defined in the National Insurance Producer Registry (NIPR). Note: The NPN is not the same as the producer state license number.
Edition Date The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM).