ACORD 141 (2003/07) – Crime Section
This chapter provides instructions for completing the ACORD Crime Section (ACORD 141). The form addresses the basic underwriting and rating needs for Plan 1 forms A through H and Q as defined in the ISO Manual or the Surety Manual. Specific information on this plan and its sections can be found in these manuals. Additional information on Plan 1 forms I and J can be found in the Miscellaneous Crime Section, ACORD 151.
Use this form in conjunction with the Commercial Insurance Application – Applicant Information Section (ACORD 125). Refer to the chapter on the ACORD 125 for information on that form.
Much of the information for this section should match the data found within the Applicant Information Section of ACORD 125, however, it is still important to complete this section. Since many companies separate applications by line of business for rating purposes, not completing this
part of the application makes it difficult to keep track of the full account.
Month/day/year on which the form is completed.
Phone (A/C, No, Ext)
Producer’s telephone number.
Producer’s name, address and telephone number.
Identification code assigned to the agency or brokerage firm by
the insurance company receiving this form.
If the agency uses a subcode identification system with the company, enter the appropriate code.
Agency Customer ID
Customer’s identification number assigned by the agency.
Applicant (First Named Insured)
First Named Insured as it appears on ACORD 125.
Effective date on which the terms and conditions of the policy will commence.
Expiration date on which the terms and conditions of the policy will terminate unless renewed.
Indicate whether the agency or the company (direct) will bill the insured or other payor for the policy.
Indicate the plan that will pay the company for the policy. Use the company’s specific designation for the plan where possible (e.g., Prepaid, Annual, Semi-annual, Bi-monthly, 40-30-30).
Indicate the audit term for policies that are periodically audited. If the audit period is known, enter the code:
A . . . . . . . . . . . . . . . . . . . . . . . . . . . . annual
S . . . . . . . . . . . . . . . . . . . . . . . . . . . . semi-annual
Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . quarterly
M. . . . . . . . . . . . . . . . . . . . . . . . . . . . monthly
O . . . . . . . . . . . . . . . . . . . . . . . . . . . . other
This section is used to collect the coverage limits for Plan 1, forms A through H and Q.
A- Employee Dishonesty
If the risk is on a blanket or scheduled basis, enter the form limit and deductible.
Form covers money, securities and property other than money and securities at all premises of the insured against the cause of loss in the title above. If Blanket coverage applies, complete the Employee Classification section.
Form covers money, securities and property other than money and securities for the employees or employee positions shown in the schedule of this form against the cause of loss in the title above. If Schedule coverage applies, complete the reverse side of the Miscellaneous Crime Section application (ACORD 151).
If ERISA Employee Dishonesty applies, check the box and show the total asset value.
B- Forgery or Alteration
Form covers instruments such as checks, drafts and promissory notes that are made or drawn by the insured or an agent of the insured against the causes of loss in the above title. Enter the form limit and deductible.
C -Theft, Disappearance and Destruction
Form covers money and securities against the causes of loss in the title. Each of its two sections has a separate limit of insurance. The limit under Section 1 applies to all premises of the insured. The limit under Section 2 applies to all messengers of the insured outside the premises. Regardless whether Blanket or Schedule coverage is selected, the money and securities exposure information should be completed for all the insured’s locations on the reverse side of the application. The Safe and Vault, Messenger/Protection, and Premises/Safe Protection entries should also be completed. Complete a separate ACORD 141 for each additional covered location. For Schedule coverage, use the reverse side of ACORD 151.
D -Robbery and Safe Burglary
Form covers property other than money and securities against the causes of loss of robbery and safe burglary. The three limits on the application should be used as follows:
Limit 1 – Inside premises – robbery of custodians
Limit 2 – Inside premises – safe burglary
Limit 3 – Outside premises – robbery of messengers
Whether Blanket or Schedule Coverage is selected, the Property, Safe/Vault, Messenger/Protection, and Premises/Safe Protection entries must be completed for each location. If the money and securities endorsements for Coverage Form D is requested, complete information must be given.
Do not request the money and securities endorsement if the applicant requests Coverage Form C. Robbery and safe burglary of money and securities is part of the theft coverage provided under Coverage Form C.
E -Premises Burglary
Form covers property other than money and securities against burglary, and applies to all premises of the insured. Whether blanket or schedule, the Property, General Information and Premises/Safe Protection entries must be completed for each location. If the Special Covered Causes of Loss Coverage Form has been requested for personal property, do not
request Coverage Form E.
F -Computer Fraud
Form covers money, securities and property other than money and securities against computer fraud. It is designed to insure against property loss caused by a non-employee using the applicant’s computer system. Since the coverage is similar to a loss caused by an employee using the computer system, limits should be the same as Coverage Form A.
Form covers money, securities and property other than money and securities against extortion. It applies to one or more premises of the insured with a single limit of insurance for all premises.
H- Premises Theft and Robbery Outside
Form covers property other than money and securities against theft whether blanket or schedule. Each of its two sections has a separate limit of insurance. Section 1 limit (Theft) applies to all premises of the insured; Section 2 limit (Robbery Outside) applies to all messengers of the insured.
Q- Robbery & Safe Burglary Money & Securities
This coverage form covers money and securities against the causes of loss in the title. It has two sections. Separate limits apply to Robbery of a Custodian and Safe Burglary under section 1 and this section applies to all premises of the insured. The section 2 limit applies to all messengers of the insured.
Provide information about additional Plan 1 Forms under Remarks. . Information on Forms I and J are found on ACORD 151.
COVERAGE AMENDMENTS (Endorsements)
There are many endorsements available for the various crime coverage forms. Refer to the Commercial Lines Manual or Surety Manual for the pertinent rating and underwriting information needed for each endorsement.
ERISA EMPLOYEE DISHONESTY- ADDITIONAL INFORMATION
(Coverage Forms A & B)
Show the name of each plan, principal address, number of trustees or employees handling the plan assets, and the number of plan participants. If more than on eplan, provide the necessary information for each plan separately.
CLASSIFICATION OF EMPLOYEES/LOCATIONS
(Coverage Forms A & B)
Complete when requesting Plan 1 Coverage forms A or B.
Number of employees by classification who handle or have custody of money or securities.
Number of Officers
Number of officers other than agents or partners.
Total Number of Other Employees
Number of all other employees not included in the employee classification count.
Manufacturers, Processors, Wholesalers or Distributors: Number of Retail Locations
Number of retail locations for the listed classifications.
All Other Classes: Number of Locations Other Than Home or Head Offices
Number of locations other than the home or head office for all other types of classifications.
CONTROLS (Coverage Form A)
Fundamental information to underwrite Coverage Forms A and B. Do not submit requests for these coverages without complete information in this section. Explain any Yes responses to questions 5 -8 in the Remarks section (e.g., if the duties described in questions 5, 6 and 7 are performed by the owner or other excluded people (partners or directors), an explanation of this will avoid future correspondence. Conversely; if the individual performing these duties is to be a covered employee, attach a narrative explaining the applicant’s accounting and internal control procedures to minimize an employee dishonesty loss). Questions 5, 6 and 7 address the most common areas where employee dishonesty losses have occurred.
1. Is there an audit by?
Method by which the company accounts are formally audited.
2. Audit frequency?
Timing of the formal audits.
3. Does audit include inventory?
Indicate if formal audits go beyond looking into the company books, and include a review of all inventory.
4. Audit report is rendered to
Indicate who receives and reviews the final copy of the audit.
5. Are bank accounts reconciled by someone not authorized to deposit or
Indicate who reconciles the accounts and how are they reconciled.
6. Is countersignature of checks required? If not, who signs?
Indicate who has check-signing authority.
7. Will securities be subject to joint control of two or more responsible
Indicate who has control of the company securities.
8. Are all officers and employees required to take annual vacations of at
least five consecutive business days?
Indicate the procedures taken when book-keepers and executives take vacation, and who takes over.
MONEY – SECURITIES (Coverage Form C or Q- Blanket Coverage,
Complete this section for Coverage Form C, or Coverage Form Q if you request the Money and Securities endorsement.
For each category (Inside, Messenger #1, Messenger #2) carefully separate the exposure limits. Each type of exposure is rated differently. They are:
- Checks for deposit
- Checks for accounts payable
- Payroll Checks
- Money Overnight
- Securities (in bank/safe deposit)
Securities, including charge account receipts from national charge accounts, will carry a rate 30 percent less than the money rate.
If the applicant makes nightly deposits which reduce the overnight exposure, a reduced limit for Coverage Form C while the premises is/are closed may be requested. There is a premium credit for that reduction. If securities are in a safe deposit box, consider offering Coverage Form I (Lessees of Safe Deposit Boxes) to insure that exposure.
PROPERTY (Coverage Forms D, E and H)
Specify the property to be insured. Along with the property description, list the maximum value of the property. There are sublimits in these coverage forms for significantly valuable items, like jewelry made of precious metals. In such cases, the applicant is a candidate for the appropriate form of Inland Marine insurance designed for those exposures.
GENERAL INFORMATION (All Coverage Forms Except A & B)
This section provides basic underwriting information for Coverage Forms C, D, E, F, G and H. The gross sales information is necessary for rating Coverage Forms F and G.
Hours and days per week that the business is open for normal operations (e.g., 9:00 AM to 5:00 PM, Monday through Saturday).
Avg. No. Employees on Duty
Average number of employees on duty during business hours.
Checks Stamped for Deposit Only
Yes or No.
Frequency of Deposits
Frequency that deposits are made to the bank (e.g., daily, twice a week).
Night Depository Used
Yes or No.
Annual Gross Sales or Receipts
Indicate dollar amount for the last fiscal year.
Double Cylinder Door Locks
Indicate if the premises is protected by this type of lock.
Supplemental information such as police patrol, central shopping center guard information, proprietary closed circuit television, etc.
SAFE/VAULT (Coverage Forms C, D & Q)
This section provides underwriting and rating information for Coverage Forms C, D and Q. If you cannot classify the type of safe, enter the exact information on the label of the safe in the Remarks area.
Manufacturer’s name of the safe or vault.
Check the appropriate box to indicate if the rating is based on the Underwriters Laboratories, Inc. (U.L.) or the Safe Manufacturers National Association (SMNA).
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.
Indicate if the door is round or square.
Identify the presence of combination locks as well as their placement on the safe/vault. Place an “X” in all boxes that apply.
Measurement in inches.
Measurement in inches.
MESSENGER PROTECTION (Coverage Forms C,D & Q)
This section is required for Coverage Forms C, D, and Q.
Messenger number to which this information applies.
# of Guards Per Messenger
Number of guards assigned to work with each messenger.
Private Conveyance Used?
Indicate if the messenger uses a car or truck provided for his/her exclusive use during the entire trip.
Safety Satchel Used?
Indicate if the insured’s property is carried in an Underwriters Laboratories-approved safety satchel (e.g., a key-locked bank depository bag or case with handcuffs).
PREMISES/SAFE PROTECTION (Coverage Forms C, D, E and H)
Complete this section to describe the location’s security systems.
Style of alarm(s) protecting this premises and any safe or vault. Available options are:
- Hold-Up – A manual or semiautomatic control which can transmit an alarm in the event of a hold-up
- Premises – 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
- Safe/Vault – 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 for all safes/vaults
Any applicable features of the alarm.
- Local Gong – A bell located outside the premises
- Central Station – A private security service which monitors the alarm system and may dispatch security officers in response to an alarm
- Police Connect – Indicate if alarms (hold-up and burglar) are transmitted to police headquarters rather than to a private control station
- With Keys – Indicate if security service or police have keys to respond to alarms
Grade or class A, B, C, etc. This indicates the time required to respond to a signal from the alarm system. Please refer to manual.
- Extent of Protection for Safe/Vault
- Extent of the alarm protection for the safe or vault.
- Partial – Alarm covers around door only
- Complete – Alarm covers sides, top walls, floor and ceiling
Extent of Protection for Premises
Extent of the premises alarm as defined in the ISO Classification and Rating Manual.
Alarm Installed & Serviced By
Name of the company installing and servicing the alarm system. Alarm companies often install, maintain and service the system, as well as to provide central station facilities.
Number of guards within the premises or at its door during regular business hours.
Number of watchpersons on the premises during non-office hours.
- Type of watchperson reporting.
- Rpt/Cent. St – Report to a central station on an hourly basis
- Clock Hrly – Register hourly with an approved watchperson’s clock (Detex Time Clock, etc.)
- Don’t Signal – Do not do any type of reporting or registering
Alarms which are approved by the Underwriters Laboratories (UL) are identified by a certificate. Record the certificate number. (Note: UL certification can apply to the entire system or to individual parts.)
UL certificate expiration date.
Accessible Openings & Protection
Provide information regarding access to the premises. Indicate number of doors and if they are protected. Indicate what type of locks are used, and if there is a gate or bars.
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.
AUDIT PROCEDURES- SAA COMMERCIAL CRIME POLICY
Complete when requesting commercial crime coverage following SAA procedures.
INTERNAL CONTROLS OTHER THAN AUDIT PROCEDURES
Also complete this section when requesting commercial crime coverage following SAA procedures.
Provide any additional information required for underwriting or rating.
Show what corrective measures have been taken by the applicant to prevent future losses, or to provide additional safe information.