| 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 OwnersApplication | 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 copyof 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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). |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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). |
| 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). |
| 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. |
| 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. |
| 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. |
| 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.) |
| 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). |
| 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). |
| 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). |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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 |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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. |
| 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). |