ACORD 143 Instructions


ACORD 143 (2004/01) – Transportation Section
This chapter provides the user with basic instructions for completing the ACORD Transportation Section (ACORD 143). The section addresses the basic underwriting and rating needs for monoline or package policies with the Inland Marine coverages of Transportation and Motor Truck Cargo Legal Liability.

This form is to be used in conjunction with the Commercial InsuranceApplication – Applicant Information Section (ACORD 125) and the Vehicle Schedule (ACORD 129). Refer to the chapters on these forms for specific information on completing them.

IDENTIFICATION SECTION

Much of the information for this section should match the data found within the Applicant Information Section of ACORD 125. Nevertheless, it is still important to complete it. Since many companies separate the 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.

Date
Month/day/year on which the form is completed.

Producer
Producer’s name, address and telephone number.

Applicant (First Named Insured)
First Named Insured as it appears on the ACORD 125.

Proposed Eff. Date
Effective date on which the terms and conditions of the policy will commence.

Proposed Exp. Date
Expiration date on which the terms and conditions of the policy will terminate unless renewed.

Billing Plan
Indicate whether the agency or the company (direct) will bill the insured or other payor for the policy.

Payment Plan
Indicate the plan to be used to pay the company for the policy. Use the company’s specific designation for the plan where possible (e.g., Prepaid, Annual, Semi-annual, Bi-monthly, 40-30-30).

Audit
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

INTEREST

This part of the form applies to both Transportation Insurance and Motor Truck Cargo Legal Liability. The balance of the front of this application is used to request Transportation Coverage, and the entire reverse for Motor Truck Cargo Legal Liability. Indicate the relationship of the applicant to the property being shipped.

Common Carrier
General right to operate as a carrier for any shipper over certain routes and for types of non-exempt commodities.

Contract Carrier
Right to haul interstate for certain customers. The trucker is limited to no more than 10 contracts.

Shipper of Owned Property
Indicate if an insurable interest in the property has been shipped on owned vehicles or other vehicles while in transit by virtue of ownership.

Other
List any other trucking relationship(s) in detail.

TYPE

Indicate the type(s) of Insuring Agreement desired.

Transportation
Applies when insurance is desired on property owned by the applicant, whether the property is shipped in the applicant’s vehicles or in public conveyances. Provides no Legal Liability coverage.

Motor Truck Cargo Legal Liability
Applies when insurance is desired on property in the care, custody or control of the applicant, and for which the applicant is responsible as a carrier for hire.

Open or Annual
Indicate if policy is being written on an Open or Annual basis.

Open
Continuous monthly reporting policy. The values change monthly, as reported.

Annual
Policy written with a specified term limit.

Other
Provide pertinent information regarding coverages or explain the applicant’s other interest.

TRANSPORTATION

This section should be used to request Transportation Insurance, or coverage on goods owned by the applicant, whether the goods are shipped in the applicant’s own vehicles or on public conveyances. This insurance covers property only and does not provide coverage for Legal Liability.

OPERATIONS

Property Shipped
Specifically describe the property to be insured while in transit, and indicate if the property is also produced by the applicant. Attach a supplemental page if necessary.

Points of Origin
Origination point of the property to be shipped.

Points of Destination
Destination to which the property is to be shipped.

Territory
Area of operations for transported merchandise. This may be specific (e.g., a certain city, state or route); or general (e.g., eastern states from Vermont to Maryland, West Coast states, Midwest, etc.). Major cities covered in the territory should also be provided, as well as the number of drivers within the territory.

Annual Gross Sales
Estimated annual amount of sales.

Conveyances Used
Complete sections that apply next to the mode of transportation used to transport the property to be insured.

Annual Value Shipped at Applicant’s Risk
Specify per classification, the total annual dollar amount of incoming, outgoing or interplant cargos shipped or received by the applicant.

Incoming
Dollar value of all yearly incoming shipments.

Outgoing
Dollar value of all yearly outgoing shipments.

Interplant
Dollar value of all yearly shipments sent between the applicant’s plants.

Average Value per Shipment
Average value of shipments on any type of conveyance used by the applicant.

Limit of Liability
Limits should be 100 percent of the maximum value carried.

Bill of Lading
Written document explaining the terms of shipment. Specify the released Bill of Lading for the property shipped per conveyance type (e.g., 60 cents per pound. If full value is insured, indicate on the appropriate line).

Perils
Indicate the perils the coverage is to be written on. Check the appropriate options. Options are Special Form, Named Perils and Named Perils Including Theft.

Deductible
Deductible for the transportation coverage.

Number Operated
Specify the exact number of vehicles used or operated by the applicant for each of the groups listed. Vehicle types are:
Trucks
Tractors
Trailers
Tank Trucks
Refrigerated Units

Special Units Owned/Operated
List all other vehicles owned or operated by the applicant for which this insurance applies (e.g., extra-wide or extra-long or large tank trucks, mobile cranes, tandem trailers and house movers).

VEHICLE SCHEDULE

Use this section to identify vehicles which transport property of the applicant. The section can be supplemented by the ACORD Vehicle Schedule (ACORD 129) which highlights important features in the ACORD Vehicle Schedule related to this coverage line. Not all information found in the ACORD Vehicle Schedule is necessary to complete this application.

Veh #
Number assigned by the agent to this vehicle to track during the application process.

Year
Vehicle’s model year.

Vehicle Make
Manufacturer’s name of the vehicle. (e.g., Ford)

Vehicle Model
Model name of the vehicle. (e.g., Mustang)

Body Type
Body type of the vehicle. (e.g., 2-door)

V.I.N.
Vehicle identification number (VIN) or serial number assigned by the manufacturer.

Date Purchased
Date the vehicle was purchased.

New/Used
Indicate if the vehicle was purchased new or used.

Radius of Operations
Average radius in miles that this vehicle travels.

F.O.B.

If materials are shipped F.O.B. (Free on Board) point of destination, the seller is liable for damages caused during transportation. If materials are shipped F.O.B. point of departure, the buyer is liable for damages. Indicate if contingent coverage is desired on F.O.B. shipments. Contingent coverage is either “in excess of” or “in lieu of” coverage provided by the shipper and affords protection when the shipper’s insurance is incorrect or inadequate, or when differences in conditions (DIC) exist. Enter the percentage of annual gross sales represented by F.O.B. shipments.

GENERAL INFORMATION

Use the Remarks section to provide additional information for any questions answered “Yes.” The overview below lists information that should be added to the Remarks section for “Yes” responses.

1. Is there a vehicle maintenance program in operation?
Explain the type of program and if maintenance records are kept on file.

2. Does applicant obtain MVR verification for drivers?
Indicate if applicant reviews MVRs on all assigned drivers and frequency. Indicate if review is upon hiring only. If no, explain.

3. Does applicant have a driver recruiting method?
Describe the recruiting method and indicate if written and/or road tests are conducted.

4. Do drivers receive a regular physical?
Indicate the frequency of the physical.

5. Any waterborne shipments to be covered?
Specify the body of water and the method of transportation.

6. Are vehicles equipped with theft alarms?
List the type of alarm installed.

7. Are vehicles left unlocked when unattended?
If yes, give circumstances.

8. Are vehicles left loaded overnight?
If yes, give circumstances. Indicate where trucks are parked, describe any security provided, and who is responsible.

9. Does applicant back haul property of others?
Indicate contract terms.

REMARKS
Use this section to provide any additional information required for underwriting or rating.

MOTOR TRUCK CARGO LEGAL LIABILITY
This section is used to request Motor Truck Cargo Legal Liability insurance, or coverage on property in the care, custody or control of the applicant, for which the applicant is responsible as a carrier for hire.

OPERATIONS

Property Hauled
Specifically describe the property of others that the applicant hauls.

Gross Receipts Last 12 Months
Amount of gross receipts for shipments handled the past 12 months.

Gross Receipts Next 12 Months
Estimated amount of gross receipts for next 12 months of shipments.

Territory
Area of operations for transported merchandise. This may be specific (e.g., a certain city, state or route); or general (e.g., Eastern states from Vermont to Maryland, West Coast states, Midwest, etc.). Major cities covered in the territory should also be provided as well as the number of drivers within the territory.

Average Distance
State in miles the average distance the applicant hauls.

Maximum Distance
State in miles the farthest distance the applicant hauls.
List Target Commodities Carried List all property hauled which might be exposed to additional risk, including pharmaceuticals, stereos, computers, meat, seafoods, televisions, audio-visual equipment, alcoholic beverages, cigarettes, explosives, flammables, auto parts, clothing and furs.

Percent of Gross Revenues
Percent of gross revenues earned from transporting each target commodity.

Maximum Value per Vehicle
Maximum value of each target commodity carried on any one vehicle.

State Filings Required
List all states requiring filings for the regulation of the trucking industry. Indicate if a P.U.C. (Public Utility Commission), P.S.C. (Public Safety Commission) or I.C.C. (Interstate Commerce Commission) filing is required. Enter all known docket numbers for these filings.

Limit of Liability
Amount of insurance required for each applicable category. If different limits exist for different vehicles, show the limits of liability per vehicle in the Remarks section or on a separate sheet of paper.

Per Single Conveyance
Amount of insurance required per conveyance which is the aggregate limit being moved by a motorized unit (e.g., Truck with Semi-Trailer or Full Trailer).

Per Disaster
Specify the overall disaster limit required.

Loading/Unloading
If loading or unloading coverage is desired, place an “X” in the box, and indicate the limit of liability and deductible desired.

Perils
Indicate the perils the coverage is to be based on. Check the appropriate option. Options are: Special Form, Named Perils, Named Perils including Theft and Loading/Unloading.

Deductible
Deductible for the chosen perils coverage.

Number Operated
Specify the exact number of vehicles used or operated by the applicant for each of the groups listed. Vehicle types are:
Trucks
Tractors
Trailers
Tank Trailers
Refrigerated Units

Special Units Owned/Operated
List all other vehicles owned or operated by the applicant for which this insurance applies (e.g., extra wide trailers, large tank trucks, mobile cranes, tandem trailers and house movers).

TERMINALS

Terminal locations are buildings (or enclosed areas) owned or used by the applicant and operated as points of holding, distribution, warehousing, or layovers for property off vehicles.

Location #
Assign a number to each terminal location. If locations are the same as shown on the Applicant Information Section (ACORD 125), use the same number in the space provided.

Address
Give the address of each terminal for each location.

Average Value At Terminal
Average value of goods held at each terminal location.

Maximum Value
Maximum value of goods held at each terminal location.

Limit of Liability
Limit required for each terminal location. The limits should be 100 percent of the maximum value carried.

VEHICLE SCHEDULE

Use this section to identify vehicles used by the applicant to transport property of others. This section can be supplemented by the ACORD Vehicle Schedule (ACORD 129), and highlights important features found in the ACORD Vehicle Schedule related to this line of coverage. Not all information found in the ACORD Vehicle Schedule is necessary to complete this application.

Veh #
Number assigned by the agent to this vehicle to track during the application process.

Year
Vehicle’s model year.

Vehicle Make
Manufacturer’s name of the vehicle. (e.g., Ford)

Vehicle Model
Model name of the vehicle. (e.g., Mustang)

Body Type
Body type of the vehicle. (e.g., 2-door)

V.I.N.
Vehicle identification number (VIN) or serial number assigned by the manufacturer.

Date Purchased
Date the vehicle was purchased.

New/Used
Indicate if the vehicle was purchased new or used.

Radius of Operations
Average radius in miles that this vehicle travels.

GENERAL INFORMATION

Use the Remarks section to provide additional information for any questions answered “Yes.” The overview below lists information that should be added to the Remarks section for “Yes” responses.

1. Is there a vehicle maintenance program in operation?
Explain the type of program and if maintenance records are kept on file.

2. Does applicant obtain MVR verification for drivers?
Indicate if applicant reviews MVRs on all assigned drivers and frequency. Indicate if the review is upon hiring only. If no, explain.

3. Does applicant have a driver recruiting method?
Describe the recruiting method and indicate if written and/or road tests are conducted.

4. Do drivers receive a regular physical?
Indicate the frequency of the physical examinations.

5. Are vehicles equipped with theft alarms?
List the type of alarm installed.

6. Are vehicles left unlocked when unattended?
If yes, give circumstances.

7. Are overages, shortages and damage claims pending?
Enter the amount of any such outstanding claims.

8. Are any vehicles operated for the applicant by others?
Indicate if any vehicles are owned, leased or operated solely for the applicant by private or contract carriers. Give agreement conditions.

9. Do terminals have fire protection (sprinklers, hoses, etc.)?
Describe all such fire protection devices.

10. Do terminals have security systems (guards, alarms, fences, lights, dogs,
etc.)?
Describe all such security systems.

11. Are vehicles left loaded overnight?
Indicate where trucks are parked and describe any security provided.

12. Is applicant an owner operator?
Complete vehicle section.

13. Does the applicant hire owner operators?
Give the conditions of all agreements with owners and indicate if an insurance certificate is required.

14. Does the applicant triplease to others?
Give the conditions of all agreements with owners and indicate if an insurance certificate is required.

15. Does the applicant back haul property of others?
Give the conditions of all agreements with owners and indicate if an insurance certificate is required.

REMARKS
Use this space to add any additional comments or explanation.