ACORD 180 Instructions


ACORD 180 (1/97)Errors and Omissions Section, Electronic Products Manufacturers, Computer Services and Products

Use this form to apply for electronic data processors, electronic products
manufacturers, and computer services products E&O. It is not intended to be used with general manufacturing or general service risks.

This form was designed to be used in conjunction with the Commercial
Insurance Application – Applicant Information Section (ACORD 125).
Please turn to the chapter on ACORD 125 for information on that form.

IDENTIFICATION SECTION

Much of the information for the Identification Section should match the data found within the Applicant Information Section of ACORD 125. Nevertheless, it is still important to complete it. Many companies separate the applications by line of business for rating purposes. Not completing this portion of the application makes it difficult to keep track of the full account.

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

Producer
Producer’s name, address and telephone number.

Code
Identification code assigned to the agency or brokerage firm by the insurance company receiving this form.

Subcode
If the agency uses a subcode identification system with the company, enter the appropriate code.

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

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

Proposed Effective Date
Enter the Effective Date on which the terms and conditions of the policy are intended to commence.

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

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

Audit
Use this field to indicate the audit term for policies that are subject to periodic audit. If the audit period is known, enter the code:

A . . . . . . . . . . . . . . . . . . . . . . . . . . . . annual
S . . . . . . . . . . . . . . . . . . . . . . . . . . . . semi-annual
Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . quarterly
M. . . . . . . . . . . . . . . . . . . . . . . . . . . . monthly
O . . . . . . . . . . . . . . . . . . . . . . . . . . . . other

Miscellaneous
List all mergers or acquisitions by the applicant (including subsidiaries), in the past 5 years. If any occurred, attach the contractual agreement(s).

List all joint ventures in which the company is a partner.

POLICY/COVERAGE INFORMATION
Check the appropriate box to indicate whether “claims made” or “occurrence” coverage is to be provided. If “claims made,” show the proposed retroactive date.

Provide limits for “deductible,” “each claim,” “each occurrence,” “aggregate” and “retained limit,” if applicable. Also indicate if defense costs are to be included in the limits, and if first dollar defense is to be provided.

PRODUCTS AND SERVICES

1. List the estimated domestic, foreign and total gross sales, for
the last, current, and next fiscal years. Show the date that begins the company’s fiscal year.

2. List each product line or service provided, and the related sales.

3. List each manufactured electronic product, precision instrument, or medical device made or sold, or attach a product list.

4., 5., 6. Show the dollar amount of retail sales, wholesale sales, and income from other business activities.

7. Provide information about the acceptable downtime for the applicant’s products, according to the average customer needs.

8. Provide information about the worst thing that could happen to customers’ operations if the applicant’s product/service were to fail or stop working.

9. Provide information about the average life expectancy of each product.

10. Provide the average dollar cost of sales or contracts with customers.

11. Indicate the value of the largest sale or project.

12. List the names of the 5 largest customers.

13. Describe any new products or services planned for the upcoming year.

PRODUCT DEVELOPMENT AND QUALITY CONTROL

Questions 1 through 14 in this section provide critical information to the underwriter about the applicant’s product and quality standards, as well as service and repair procedures, and should be answered in detail. Use the Remarks section or a separate sheet of paper where necessary.

SUPPLIERS

Provide the percentage of components or parts:

  • supplied by outside vendors
  • designed by the applicant, but manufactured by suppliers
  • supplied by foreign based companies

Also indicate if the applicant ever agrees to hold harmless agreements.

SUB AND INDEPENDENT CONTRACTORS

Describe any development or product work that is contracted to others. Also indicate if products E&O coverage is required of contractors, and if the applicant requires certificates of insurance from these contractors.

DISTRIBUTION

Provide the percent of products that are directly shipped to:

Also indicate if the applicant ever agrees to hold harmless agreements.

MARKETING/CONTRACTS

This section relates to marketing practices, legal review of contracts, advertising and promotional material, sales staff training, and the presence or absence of standard warranty and liability limitation clauses in company contracts.

Attach copies of standard contracts, advertising and marketing material if requested by the underwriter.

GENERAL INFORMATION

Explain “yes” answers to questions 1 and 2 in the Remarks section.