ACORD 175 Instructions


ACORD 175 (2003/08)Commercial Policy Change Request

This chapter provides basic instructions needed to complete the Commercial Policy Change Request (ACORD 175).

Information in this chapter will refer the user to the application section chapter where the full policy sections are discussed. Additional information will be explained as necessary.

IDENTIFICATION SECTION

Complete this section for all change requests.

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

Agency
Agency’s name, address, telephone and fax number.

Code
Identification code assigned to your agency or brokerage firm by the insurer receiving this form.

Subcode
If your agency uses sub-code identification system with the insurer, enter the appropriate code.

Agency Customer ID
Customer’s identification number assigned by the agency.

Insured’s Name
First named insured as listed on the current declarations page. If this name is to be changed, list the new name in the Remarks section.

Insured’s Mailing Address If Changed
Mailing address only if it has changed.

Policy Type
Policy types or lines of business within a package policy that are being changed on this request. Only one policy, as controlled by a policy number, should be entered per change request.

Company
Name of the applicable insurance company, and the NAIC code number of the company that issued the policy being changed. Use the “Attention” space to identify a particular underwriter, if necessary.

Policy Number
Policy number created by the company exactly as it appears on the policy declarations page.

Effective Date of Change
Date that the requested change is to commence. Only one effective date of change should be made per change request.

Policy Inception Date
Effective date of the policy as listed on the policy declarations page.

Policy Expiration Date
Expiration date of the policy as listed on the policy declarations page.

For each section below you may Add, Change or Delete data. Only one form of adjustment should be made per section. (If you check both Add and Delete, the company will not know which data is being added and which should be deleted.) Most sections have at least two iterations to handle the addition and deletion of an item such as a vehicle.

PREMISES INFORMATION SECTION

NATURE OF BUSINESS/DESCRIPTION OF OPERATIONS

Refer to the chapter on the ACORD 125 for unique data element descriptions.

AUTO-VEHICLE DESCRIPTION/LIMITS

If an addition or change is being made to the policy level limits, check the “Policy Limit(s) Changed” box. Also check the appropriate box for Add, Change or Delete. Limits should be adjusted in the last line of the section. To delete a limit, write “delete” in the appropriate limit box.

To delete a vehicle, check the delete box and only enter the data for the Vehicle Year, Make, Model, Body Type and Vin/Serial Number.

Refer to the applicable state manual for no fault/personal injury protection coverages. Each state where these coverages are available has unique mandatory coverage and unique coverage options. Use the Remarks section to describe coverage to be provided.

Refer to the guidelines for ACORD 129 for other unique data element descriptions.

DRIVER INFORMATION

Refer to the chapter on the ACORD 127 for unique data element descriptions.

WORKERS’ COMPENSATION RATING INFORMATION

For each classification, indicate if it is an Add (new class), Change (new premium basis) or Delete (class is to be removed). All data elements should be completed for each type of change. Refer to the chapter on ACORD 130 for unique data element descriptions.

PROPERTY/INLAND MARINE – PREMISES INFORMATION

Refer to the chapter on the ACORD 140 for unique data element descriptions.

INLAND MARINE- SCHEDULED EQUIPMENT

Refer to the chapter on the ACORD 146 for unique data element descriptions.

GENERAL LIABILITY – LIMITS

Use section to indicate general liability limits changes. New limits cannot be added or deleted on this form, only changed.

GENERAL LIABILITY – SCHEDULE OF HAZARDS

For each classification, indicate if it is an Add (new class), Change (new premium basis) or Delete (class is to be removed). All data elements should be completed for each type of change. Refer to the chapter on ACORD 126 for unique data element descriptions.

UMBRELLA CHANGES

Use this section to describe changes in limits, retained limit, or other changes such as an increase or decrease in coverage provided. Describe these changes in the space provided, or use the Remarks section.

ADDITIONAL INTEREST

This section should be used to collect information on any additional interest or receiver of Certificates of Insurance.

Interest
Check all appropriate boxes that apply to the additional interest.

Name and Address
List the additional Interest’s name and mailing address.

Interest in Item
Use section to designate exactly what the additional interest has an interest in. If the additional interest has an interest in multiple items, such as a lienholder on multiple vehicles, list all numbers associated with the additional interest. Examples:

Location 2, Building 3, Item 7 (As per schedule)
Vehicle # 2 & 3

Certificate Required
If a Certificate of Insurance is required, check this box.

Reference Number
List any reference number such as a loan number that may help tie the additional interest to item.

ADDITIONAL CHANGES/REMARKS

List any additional change information required to correctly underwrite and rate the request.

PRODUCER’S SIGNATURE / INSURED’S SIGNATURE

Space is provided for signatures of the producer and/or the insured.

Some companies require one or both signatures when limits of insurance are increased or reduced, or other changes are made that are considered significant to the company.

Refer to your company rules.

Many companies, or state laws, require the insured’s signature when auto, liability, no fault, or uninsured motorists coverage is changed or deleted. Refer to your company or state rules.