ACORD 404 (2000/05) – Agriculture Liability Section
This guide provides the user with basic instructions for completing
ACORD Agriculture Liability Section. This form was designed to
handle the basic underwriting needs for agriculture liability exposures.
If the risk is to be provided with commercial general liability rather than
farm liability coverage, use ACORD 125, Commercial Insurance
Application, and ACORD 126, Commercial General Liability
Section. For umbrella or excess liability coverage, use either ACORD
83, Personal Umbrella Application, or ACORD 131, Umbrella
This form was designed to be used in conjunction with Agriculture
Application – Applicant Information Section, ACORD 401. Please turn
to the chapter on ACORD 401 for information on that form.
Much of the information for the Identification Section should match the data found within the Applicant Information Section of ACORD 401; it is still important to complete it. Many companies separate the applications by subline of business for rating purposes. Not completing this portion of the application makes it difficult to keep track of the full account.
Month/day/year on which the form is completed.
Producer’s name, address and telephone number.
Identification code assigned to the agency or brokerage firm by the insurance company receiving this form.
If the agency uses a subcode identification system with the company, enter the appropriate code.
Agency Customer ID
Customers identification number assigned by the agency.
Named Insured/Applicant’s Name
Show the named insured or applicant exactly as shown on ACORD 401.
Company, Account Number, Policy Number, New/Renewal, Effective Date, Expiration Date
Enter exactly as shown on ACORD 401.
Provision is made for recording Bodily Injury and Property Damage Liability, Personal and Advertising Injury Liability Medical Payments, FireDamage Coverage, Damage to Property of Others, and Personal Liability Coverage (AAIS), if applicable. For other combinations of liability coverage, use the blank lines.
Show separate limits where applicable. Note that different aggregate limits may apply to separate coverages or exposures.
Consult your company manual for applicable rules.
If Commercial General Liability is to apply, use Acord 125, Commercial Insurance Application, and ACORD 126, Commercial General Liability Section.
Enter the applicable ISO, AAIS, or company code for each type of exposure.Show location number if applicable.
Descriptions of coverage have been provided that track with ISO or AAIS rules. If company unique rules apply, use the blank spaces provided. Show Increased Limit Factors, Basis Rates and Premium for applicable exposures.
ADDITIONAL INTEREST/CERTIFICATE RECIPIENT
Use this section to show additional interests that have been, or are requested to be, added to the liability policy.