ACORD 60NY Instructions


Section Name Field Name Field and/or Section Description
TITLE ACORD 60 NY (2008/03) New York Homeowners Supplement, Workers Compensation Additional Information In New York, ISO Workers Compensation Endorsement HO 24 93 must be attached to all homeowners policies other than Forms HO 00 04 and HO 00 06, when the policy covers owner-occupants of one through four family dwellings. When the policy is issued with either HO 00 04 or HO 00 06, producers should use this supplement to determine if HO 24 93 must be attached and to provide the insurance company with necessaryinformation not obtained by the Homeowners application. Refer to the ISO manual for eligibility rules with respect to the use of HO 24 93.
IDENTIFICATION SECTION Agency Customer ID Customer’s identification number assigned by the agency or brokerage.
IDENTIFICATION SECTION Agency Producer’s name.
IDENTIFICATION SECTION Applicant / Named Insured(s) Full name of the applicant as it should appear on the policy. The First Named Insured is given certain rights and responsibilities by the policy contract language. If more than one insured is named, be sure the one intended to receive these rights and responsibilities is named first and any additional insureds identified as such. If joint ownership, the name used may include both names (e.g., John and Mary Smith).
IDENTIFICATION SECTION Policy Number The number assigned by theinsurance company for the policy. In general, policy numbers will not appear on new business applications since they are not known at that point in time.
IDENTIFICATION SECTION Carrier Name of the insurance company (or residual market plan) that will receive the application. Do not use group names, use the actual name of the company within the group in which you wish to have the policy issued.
IDENTIFICATION SECTION NAIC Code The identification code assigned to the company by the NAIC.
HO 00 04 1. Two-Family Dwellings
HO 00 04 A. Is the applicant a co-owner of the dwelling, as well as an occupant of an apartment in the dwelling? Enter Y for a “YES” response. Enter N for a “NO” response.
HO 00 04 B. Is the other apartment occupied by the other co-owner? Enter Y for a “YES” response. Enter N for a “NO” response.
HO 00 04 C. Are the living quarters separate, with separate entrances? Enter Y for a “YES” response. Enter N for a “NO” response.
HO 00 04 D. Does the other co-owner have aHomeowners policy that provides building coverage? Enter Y for a “YES” response. Enter N for a “NO” response.
HO 00 04 2. Three or Four Family Dwellings
HO 00 04 A. Is the applicant an owner of the dwelling who occupies an apartment in the dwelling? Enter Y for a “YES” response. Enter N for a “NO” response.
HO 00 04 B. Is the policy to include premises liability coverage for the entire property? Enter Y for a “YES” response. Enter N for a “NO” response.
HO 00 04 3. All Dwellings
HO 00 04 Is the applicant atenant of an apartment in a dwelling that is also occupied by an owner? Enter Y for a “YES” response. Enter N for a “NO” response.
HO 00 04 4. One-Four Family Dwellings
HO 00 04 Is the applicant an owner of any additional dwelling located in New York state that is to be insured under this policy? Enter Y for a “YES” response. Enter N for a “NO” response.
HO 00 06 1. Is the applicant an owner-occupant? Enter Y for a “YES” response. Enter N for a “NO” response.
HO 00 06 2. Is the applicant an owner of any additional location in New York? Enter Y for a “YES” response. Enter N for a “NO” response.
SIGNATURE Producer’s Signature Producer must sign the for