ACORD 138NJ Instructions


ACORD 138 NJ (2004/11) – New Jersey Garage and Dealers, Coverages/Limits Section

Use ACORD 138 NJ to collect the coverage, limits and premium information necessary to write Garage and Dealers insurance in this state.
Use this form with ACORD 128, Garage and Dealers Section.


The following are the specific differences in this state.


* Personal Injury Protection coverages have been revised to provide for unique New Jersey coverages. Refer to your state Manual.

* Uninsured and Underinsured Motorists coverages are combined.


* Comprehensive is known as “other than collision coverage”.


* The fraud statement on the back of the form is revised to comply with New Jersey law.


* A statement has been added referencing the offer of Uninsured/Underinsured Motorists coverage up to the policy’s BI limits.

IDENTIFICATION SECTION

Date

Month/day/year (MM/DD/YYYY) on which the form is completed.


Agency

Producer’s name.

Applicant (First Named Insured)

Full name of the applicant as it should appear on the policy. The First Named Insured is given certain rights and responsibilities by the policy contract language. If more than one insured is named, be sure the one intended to receive these rights and responsibilities is named first and any additional insureds identified as such. If joint ownership, the name used may include both names (e.g., John and Mary Smith).

COVERAGES/LIMITS

Covered Auto Symbols

Garage or Dealers policies use numeric symbols on the policy declarations to indicate the type(s) of vehicles for which coverage is in effect. Be sure to place an X in the appropriate box for each type of coverage. Only those symbols specified for a coverage may be used, symbols 21 through 26 provide fleet automatic coverage. Symbol 21 includes Hired and Non-Owned auto coverage. If symbol 21 is not used and Hired Auto (symbol 28) or Non-Owned Auto (symbol 29) coverage is desired, those symbols must be checked.

The symbols indicate the automobiles to which each coverage applies. The symbol “trigger” the coverage. For exact policy definitions of the symbols, please refer to the company’s policy declarations page.


Coverages & Limits

The format for the Limit section is designed primarily for one limit per coverage. If a coverage requires more than one limit, and multiple limits will not fit within the allotted space, enter “See Below” and use either the optional other coverage area or endorsements area to enter the multiple limits. Split limits should be listed in the format of:

BI – Each Person / BI – Each occurrence / PD – Each Occurrence. Example: 100,000/300,000/200,000 would represent: BI = each person of $100,000, BI = each occurrence of $300,000 and PD = each occurrence of $200,000.

Liability

For garage operations enter the limits in the following fashion:

  • Auto Only Enter the Each Accident Limit.
  • Other Than Auto Only Enter the Each Accident Limit and the Aggregate Limit.
  • For Dealers, use the Auto Only field to enter the Policy Combined Single Limit. Also check the appropriate box to indicate if this is Limited or Unlimited coverage.

Personal Injury Protection

Refer to applicable State Manual for Options. Include any deductible selected by the applicant.

Ext Med Exp

Enter the appropriate medical payments limits. Indicate if this limit is for Automobile coverage, Premises (Prem.) Operations coverage or both.

Uninsured/Underinsured Motorists

Enter any applicable uninsured motorist limit(s) as required by state law.

PHYSICAL DAMAGE

For Physical Damage or Other Than Collision Coverage, complete this section.


Other Than Collision/Specified Perils

Indicate if the coverage is to be Other Than Collision or Specified Perils. For Specified Perils coverage, list under the option box which perils are to be covered. Codes are:

  • F Fire
  • F&T Fire and Theft
  • F,T&W Fire, Theft and Wind
  • LSP Limited Specified Perils
  • SP Specified Perils

LOC #

The location Number for the Physical Damage coverages should correspond to a location number documented on the ACORD 125.

Enter the Limits for Each Location

Enter the liability limit (sum of all autos being covered) per each location.

Deductible Per Auto

Enter the deductible that applies on a per auto basis.

Maximum Deductible Per Loss

Enter the maximum deductible that will apply on a per loss basis.

Collision

Enter the collision deductible amount.

Other

Write in any additional coverages, along with their coverage auto symbols, limits and deductibles that may be desired. Examples of coverages include: Personal Injury Liability Coverage, Elevator Collision Coverage, Fire, Legal Liability.

GARAGE KEEPERS

Complete this section if coverage is being requested for vehicles left in the applicant’s care, custody or control for service, repairs or storage.


Legal Liability

If the Garage Keepers is to be written on a Legal Liability basis, check this box.

Direct Basis

If the Garage Keepers is to be written on a Legal Liability basis, check this box and indicate if this is Primary or Excess insurance.

Comp/Specified Perils (OTC)

Indicate if the other than collision coverage is to be Comprehensive or Specified Perils. For Specified Perils coverage, list under the option box which perils are to be covered. Codes are:

  • F Fire
  • F&T Fire and Theft
  • F,T&W Fire, Theft and Wind
  • LSP Limited Specified Perils
  • SP Specified Perils

LOC #

The location Number for the Physical Damage coverages should correspond to a location number documented on the ACORD 125.

Enter the Limits for Each Location

Enter the liability limit (sum of all autos being covered) per each location.

# of Autos

Enter the number of autos located on the premises.

Deductible Per Auto

Enter the deductible that applies on a per auto basis.

Maximum Deductible Per Loss

Enter the maximum deductible that will apply on a per loss basis.

Collision

Enter the collision deductible amount.

LOC #

The location Number for the Garage Keepers coverages should correspond to a location number documented on the ACORD 125.

Enter the Limits for Each Location

Enter the liability limit (sum of all autos being covered) per each location.

# of Autos

Enter the number of autos located on the premises.

Deductible Per Auto

Enter the deductible that applies on a per auto basis.

Other

Write in any additional coverages, along with their coverage auto symbols, limits and deductibles that may be desired. Examples of coverages include: Personal Injury Liability Coverage, Elevator Collision Coverage, Fire, Legal Liability.

Physical Damage Reporting Period

If the policy will be on a Reporting basis, enter the timing of the reporting period. Examples: Monthly, Quarterly, Semi-Annual. For Non-Reporting policies, check the appropriate box.

# Dealer Plates/Repairer Plates

Enter the total number of sets of plates issued to the applicant.

# Transportation Plates

Enter the total number of sets of plates issued to the applicant.

# Hoists

Enter the number of hoists located on the premises.

Temporary Location Limit

Enter the limit for covered autos stored temporarily off premises.

Transit Limit

Enter the limit for covered autos in transit.

Endorsements

Enter any endorsements that apply. Be sure to include the form numbers and the required information for attaching the endorsement.

Applicant’s Signature

The applicant should read and understand the Fair Credit Reporting Act, the Privacy Act (where applicable), the Applicant’s Statement, and any other disclosure information on the form before personally signing theapplication.

Date

Date the form was signed.

Producer’s Signature

The producer should sign the application. This is required in most states.

National Producer Number

The National Producer Number assigned by the NAIC should be shown.