| Section Name | Field Name | Field and/or Section Description |
| TITLE ACORD 70 (2009/06) | Personal Policy Change Request (Except Auto) | The title of the form. ACORD 70, Personal Policy Change Request (Except Auto), is used to request mid-term changes to any personal lines policy, except auto. For auto changes, see ACORD 71, Personal Auto Policy Change Request. This form should be used instead of individual turnaround endorsement requests. A copy of the request may be sent to the insured to confirm that the change is submitted to the company. The form provides for property, mobile home, inland marine, watercraft and umbrella changes. |
| IDENTIFICATION SECTION | Location Number | Enter number: The producer assigned number of the location. |
| IDENTIFICATION SECTION | Date | Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY) |
| IDENTIFICATION SECTION | Agency | Enter text: The full name of the producer/agency. |
| IDENTIFICATION SECTION | Enter text: The mailing address line one of the producer/agency. | |
| IDENTIFICATION SECTION | Enter text: The mailing address line two of the producer/agency. | |
| IDENTIFICATION SECTION | Enter text: The mailing address city name of the producer/agency. | |
| IDENTIFICATION SECTION | Enter code: The mailing address state or province code of the producer/agency. | |
| IDENTIFICATION SECTION | Enter code: The mailing address postal code of the producer/agency. | |
| IDENTIFICATION SECTION | Contact Name | Enter text: The name of the individual at the producer’s establishment that is the primary contact. |
| IDENTIFICATION SECTION | Phone (A/C, No, Ext) | Enter number: The producer’s contact person’s phone number. If applicable, include the area code and extension. |
| IDENTIFICATION SECTION | FAX | Enter number: The fax number of the producer/agency. |
| IDENTIFICATION SECTION | E-Mail Address | Enter text: The producer’s contact person e-mail address. |
| IDENTIFICATION SECTION | Code | Enter code: The identification code assigned to the producer (e.g. agency or brokerage firm) by the insurer. |
| IDENTIFICATION SECTION | Subcode | Enter code: The identification code assigned by the insurer to the sub-producer (e.g. person) within a producer’s office (e.g. agency or brokerage). |
| Section Name | Field Name | Field and/or Section Description |
| IDENTIFICATION SECTION | Agency Customer ID | Enter identifier: The customer’s identification number assigned by the producer (e.g. agency or brokerage). |
| IDENTIFICATION SECTION | Insured’s Name and Mailing Address if changed | Enter text: The named insured(s) as it/they will appear on the policy declarations page. |
| IDENTIFICATION SECTION | Enter text: The named insured’s mailing address line one. | |
| IDENTIFICATION SECTION | Enter text: The named insured’s mailing address line two. | |
| IDENTIFICATION SECTION | Enter text: The named insured’s mailing address city name. | |
| IDENTIFICATION SECTION | Enter code: The named insured’s mailing address state or province code. | |
| IDENTIFICATION SECTION | Enter code: The named insured’s mailing address postal code. | |
| IDENTIFICATION SECTION | Policy Type – Homeowner | Check the box (if applicable): Indicates the type of policy is homeowners. |
| IDENTIFICATION SECTION | Policy Type – Mobile Home | Check the box (if applicable): Indicates the type of policy is mobile home. |
| IDENTIFICATION SECTION | Policy Type – Inland Marine | Check the box (if applicable): Indicates the type of policy is inland marine. |
| IDENTIFICATION SECTION | Policy Type – Dwelling Fire | Check the box (if applicable): Indicates the type of policy is dwelling fire. |
| IDENTIFICATION SECTION | Policy Type – Watercraft | Check the box (if applicable): Indicates the type of policy is watercraft. |
| IDENTIFICATION SECTION | Policy Type – Umbrella | Check the box (if applicable): Indicates the type of policy is umbrella. |
| IDENTIFICATION SECTION | Effective Date of Change | Enter date: The date on which the change should take effect. |
| IDENTIFICATION SECTION | Inception Date of Policy | Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. |
| IDENTIFICATION SECTION | Expiration Date | Enter date: The date on which the terms and conditions of the policy will expire. |
| IDENTIFICATION SECTION | Carrier | Enter text: The insurer’s full legal company name(s) as found in thefile copy of 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. |
| Section Name | Field Name | Field and/or Section Description |
| IDENTIFICATION SECTION | NAIC Number | Enter code: The identification code assigned to the insurer by the NAIC. |
| IDENTIFICATION SECTION | Named Insured | Enter text: The named insured(s) as it/they will appear on the policy declarations page. |
| IDENTIFICATION SECTION | Policy Number | 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 | Attention | Enter text: The name of the individual at the insurance company that is the primary contact. |
| IDENTIFICATION SECTION | Account Number | Enter identifier: The account number to be used for billing purposes. This is the billing number assigned by the billing entity. If agency bill, the agency assigns; if direct bill, the insurer assigns. If the account already exists, the agent should provide the previously assigned number. |
| IDENTIFICATION SECTION | Direct Bill Policy | Check the box (if applicable): Indicates if the policy is to be direct billed. |
| IDENTIFICATION SECTION | Direct Bill Account | Check the box (if applicable): Indicates if the account is to be direct billed. |
| IDENTIFICATION SECTION | Agency Bill | Check the box (if applicable): Indicates if the policy is to be producer/agency billed. |
| IDENTIFICATION SECTION | Payment Plan – Full Pay | Check the box (if applicable): Indicates a full payment will be made on the policy. |
| IDENTIFICATION SECTION | Payment Plan – Annual | Check the box (if applicable): Indicates the policy will be paid annually. |
| IDENTIFICATION SECTION | Payment Plan – Semi-Annual | Check the box (if applicable): Indicates the policy will be paid semi-annually. |
| IDENTIFICATION SECTION | Payment Plan – Other | Check the box (if applicable): Indicates the policy will be paid in a frequency other than those listed. |
| IDENTIFICATION SECTION | Payment Plan – Description | Enter code: The payment plan for the policy (i.e., AN – Annual, MO – Monthly, QT -Quarterly, etc.). As used here, only enter the description when “other” is selected. |
| IDENTIFICATION SECTION | Payment Plan – Quarterly | Check the box (if applicable): Indicates the policy will be paid quarterly. |
| IDENTIFICATION SECTION | Payment Plan – Bi-Monthly | Check the box (if applicable): Indicates the policy will be paid bi-monthly. |
| IDENTIFICATION SECTION | Payment Plan – Monthly | Check the box (if applicable): Indicates the policy will be paid monthly. |
| Section Name | Field Name | Field and/or Section Description |
|---|---|---|
| IDENTIFICATION SECTION | Payor – Insured | Check the box (if applicable): Indicates the payor of the policy is the insured. |
| IDENTIFICATION SECTION | Payor – Mortgagee | Check the box (if applicable): Indicates the payor of the policy is the mortgagee. |
| IDENTIFICATION SECTION | Payor – Other | Check the box (if applicable): Indicates the payor of the policy is other than those listed. |
| IDENTIFICATION SECTION | Payor – Description | Enter text: The description of the payor of the policy. As used here, only enter the description when “other” is selected. |
| IDENTIFICATION SECTION | Premium Financed? | Enter Y for a “Yes” response. Input N for “No” response. Indicates if the premium has been financed. |
| IDENTIFICATION SECTION | Finance Company | Enter text: The name of the company financing the premium, if applicable. |
| IDENTIFICATION SECTION | Payment Method – Cash | Check the box (if applicable): Indicates the invoice will be paid in cash. |
| IDENTIFICATION SECTION | Payment Method – Check | Check the box (if applicable): Indicates the invoice will be paid by check. |
| IDENTIFICATION SECTION | Payment Method – Credit Card | Check the box (if applicable): Indicates the invoice will be paid by credit card. |
| IDENTIFICATION SECTION | Payment Method – EFT | Check the box (if applicable): Indicates the invoice will be paid using electronic funds transfer (EFT). |
| IDENTIFICATION SECTION | Payment Method –Payroll Deduction | Check the box (if applicable): Indicates the invoice will be paid by payroll deduction. |
| IDENTIFICATION SECTION | Payment Method – Pre-Authorized Draft/Check (PAC) | Check the box (if applicable): Indicates the invoice will be paid by a pre-authorized check or draft. |
| IDENTIFICATION SECTION | Payment Method – Other | Check the box (if applicable): Indicates the invoice will be paid by a means other than those listed. |
| IDENTIFICATION SECTION | Payment Method – Describe | Enter text: The method the invoice will be paid. As used here, only enter the description when “other” is selected. |
ACORD 70 (2009/06) rev. 07-31-2009 4 of 74 ACORD 70 (2009/06) rev. 07-31-2009 5 of 74 ACORD 70 (2009/06) rev. 07-31-2009 6 of 74 ACORD 70 (2009/06) rev. 07-31-2009 7 of 74 ACORD 70 (2009/06) rev. 07-31-2009 8 of 74 ACORD 70 (2009/06) rev. 07-31-2009 9 of 74 ACORD 70 (2009/06) rev. 07-31-2009 10 of 74
| Section Name | Field Name | Field and/or Section Description |
| COVERAGES/ LIMITS OF LIABILITY | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| COVERAGES/ LIMITS OF LIABILITY | Dwelling Limit | Enter limit: The limit associated with dwelling coverage. |
| COVERAGES/ LIMITS OF LIABILITY | Dwelling Premium | Enter amount: The premium associated with dwelling coverage. |
| COVERAGES/ LIMITS OF LIABILITY | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| COVERAGES/ LIMITS OF LIABILITY | Other Structures Limit | Enter limit: The limit associated with other structures coverage. |
| COVERAGES/ LIMITS OF LIABILITY | Other Structures Premium | Enter amount: The premium associated with other structures coverage. |
| Section Name | Field Name | Field and/or Section Description |
| COVERAGES/ LIMITS OF LIABILITY | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| COVERAGES/ LIMITS OF LIABILITY | Personal Property Limit | Enter limit: The limit associated with personal property coverage. |
| COVERAGES/ LIMITS OF LIABILITY | Personal Property Premiums | Enter amount: The premium associated with personal property coverage. |
| COVERAGES/ LIMITS OF LIABILITY | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| COVERAGES/ LIMITS OF LIABILITY | Loss of Use Limit | Enter limit: The limit associated with loss of use coverage. |
| COVERAGES/ LIMITS OF LIABILITY | Loss of Use Premiums | Enter amount: The premium associated with loss of use coverage. |
| Section Name | Field Name | Field and/or Section Description |
| COVERAGES/ LIMITS OF LIABILITY | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| COVERAGES/ LIMITS OF LIABILITY | Blanket Limit | Enter limit: The limit associated with blanket coverage which includes dwelling, other structures, personal property, and loss of use). |
| COVERAGES/ LIMITS OF LIABILITY | Blanket Premium | Enter amount: The premium associated with blanket coverage. |
| COVERAGES/ LIMITS OF LIABILITY | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| COVERAGES/ LIMITS OF LIABILITY | Rental Value Limit | Enter limit: The limit associated with rental value (dwelling fire only) coverage. |
| COVERAGES/ LIMITS OF LIABILITY | Rental Value Premium | Enter amount: The premium associated with rental value (dwelling fire only) coverage. |
| Section Name | Field Name | Field and/or Section Description |
| COVERAGES/ LIMITS OF LIABILITY | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| COVERAGES/ LIMITS OF LIABILITY | Additional Expense Limit | Enter limit: The limit associated with additional expense coverage. |
| COVERAGES/ LIMITS OF LIABILITY | Additional Expense Premium | Enter amount: The premium associated with additional expense coverage. |
| COVERAGES/ LIMITS OF LIABILITY | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| COVERAGES/ LIMITS OF LIABILITY | Personal Liability Each Occurrence Limit | Enter limit: The limit associated with personal liability each occurrence coverage. |
| COVERAGES/ LIMITS OF LIABILITY | Personal Liability Each Occurrence Premium | Enter amount: The premium associated with personal liability coverage. |
| Section Name | Field Name | Field and/or Section Description |
| COVERAGES/ LIMITS OF LIABILITY | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| COVERAGES/ LIMITS OF LIABILITY | Medical Payments Each Person Limit | Enter limit: The limit associated with medical payments each person coverage. |
| COVERAGES/ LIMITS OF LIABILITY | Medical Payments Each Person Premium | Enter amount: The premium associated with medical payments coverage. |
| COVERAGES/ LIMITS OF LIABILITY | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| DEDUCTIBLES | Base Type | Enter code: The deductible type (e.g. flat, percentage) for the base deductible. |
| DEDUCTIBLES | Base Amount | Enter deductible: The base deductible amount if the deductible is expressed as a dollar amount. |
| DEDUCTIBLES | Base Percentage | Enter percentage: The base percentage deductible if the deductible is expressed as a percentage. |
| Section Name | Field Name | Field and/or Section Description |
| DEDUCTIBLES | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| DEDUCTIBLES | Wind Type | Enter code: The deductible type (e.g. flat, percentage) for the wind/hail deductible. |
| DEDUCTIBLES | Wind Amount | Enter deductible: The wind/hail deductible amount if the deductible is expressed as a dollar amount. |
| DEDUCTIBLES | Wind Percentage | Enter percentage: The wind/hail percentage deductible if the deductible is expressed as a percentage. |
| DEDUCTIBLES | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| DEDUCTIBLES | Theft Type | Enter code: The deductible type (e.g. flat, percentage) for the theft deductible. |
| DEDUCTIBLES | Theft Amount | Enter deductible: The theft deductible amount if the deductible is expressed as a dollar amount. |
| DEDUCTIBLES | Theft Percentage | Enter percentage: The theft percentage deductible if the deductible is expressed as a percentage. |
| Section Name | Field Name | Field and/or Section Description |
| DEDUCTIBLES | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| DEDUCTIBLES | Named Hurricane Type | Enter code: The deductible type (e.g. flat, percentage) for the named hurricane deductible. |
| DEDUCTIBLES | Named Hurricane Amount | Enter deductible: The named hurricane deductible amount if the deductible is expressed as a dollar amount. |
| DEDUCTIBLES | Named Hurricane Percentage | Enter percentage: The named hurricane percentage deductible if the deductible is expressed as a percentage. |
| DEDUCTIBLES | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| DEDUCTIBLES | Annual Hurricane Type | Enter code: The deductible type (e.g. flat, percentage) for the annual hurricane deductible. |
| DEDUCTIBLES | Annual Hurricane Amount | Enter deductible: The annual hurricane deductible amount if the deductible is expressed as a dollar amount. |
| DEDUCTIBLES | Annual Hurricane Percentage | Enter percentage: The annual hurricane percentage deductible if the deductible is expressed as a percentage. |
| Section Name | Field Name | Field and/or Section Description |
| DEDUCTIBLES | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| DEDUCTIBLES | Other | Enter text: The coverage associated with the deductible you are entering. |
| DEDUCTIBLES | Other Type | Enter code: The deductible type (e.g. flat, percentage) for the other deductible. |
| DEDUCTIBLES | Other Amount | Enter deductible: The deductible amount if the deductible is expressed as a dollar amount. |
| DEDUCTIBLES | Other Percentage | Enter percentage: The percentage deductible if the deductible is expressed as a percentage. |
| DEDUCTIBLES | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| DEDUCTIBLES | Other | Enter text: The coverage associated with the deductible you are entering. |
| DEDUCTIBLES | Other Type | Enter code: The deductible type (e.g. flat, percentage) for the other deductible. |
| DEDUCTIBLES | Other Amount | Enter deductible: The deductible amount if the deductible is expressed as a dollar amount. |
| DEDUCTIBLES | Other Percentage | Enter percentage: The percentage deductible if the deductible is expressed as a percentage. |
| Section Name | Field Name | Field and/or Section Description |
| DEDUCTIBLES | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| DEDUCTIBLES | Other | Enter text: The coverage associated with the deductible you are entering. |
| DEDUCTIBLES | Other Type | Enter code: The deductible type (e.g. flat, percentage) for the other deductible. |
| DEDUCTIBLES | Other Amount | Enter deductible: The deductible amount if the deductible is expressed as a dollar amount. |
| DEDUCTIBLES | Other Percentage | Enter percentage: The percentage deductible if the deductible is expressed as a percentage. |
| DEDUCTIBLES | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| DEDUCTIBLES | Other | Enter text: The coverage associated with the deductible you are entering. |
| DEDUCTIBLES | Other Type | Enter code: The deductible type (e.g. flat, percentage) for the other deductible. |
| DEDUCTIBLES | Other Amount | Enter deductible: The deductible amount if the deductible is expressed as a dollar amount. |
| DEDUCTIBLES | Other Percentage | Enter percentage: The percentage deductible if the deductible is expressed as a percentage. |
| Section Name | Field Name | Field and/or Section Description |
| DEDUCTIBLES | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| DEDUCTIBLES | Other | Enter text: The coverage associated with the deductible you are entering. |
| DEDUCTIBLES | Other Type | Enter code: The deductible type (e.g. flat, percentage) for the other deductible. |
| DEDUCTIBLES | Other Amount | Enter deductible: The deductible amount if the deductible is expressed as a dollar amount. |
| DEDUCTIBLES | Other Percentage | Enter percentage: The percentage deductible if the deductible is expressed as a percentage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Premises Liability Extension – Number of Premises | Enter number: The number of premises covered by the additional premises liability extension. This is used when you don’t have the full detail about the individual locations. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Premises Liability Extension Form Number | Enter identifier: The form number used by the company for additional premises liability extension. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Premises Liability Extension – Form Date | Enter date: The edition date of the form used by the company for additional premises liability extension. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Premises Liability Extension – Premium | Enter amount: The premium associated with additional premises liability extension. |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Premises Liability Extension – Loc # | Enter number: The producer assigned location number for the premises covered by additional premises liability extension. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Premises Liability Extension – Terr | Enter code: The liability territory for the location specified. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Premises Liability Extension – Form Number | Enter identifier: The form number used by the company for additional premises liability extension. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Premises Liability Extension – Form Date | Enter date: The edition date of the form used by the company for additional premises liability extension. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Premises Liability Extension – Premium | Enter amount: The premium associated with additional premises liability extension. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Premises Liability Extension – Location Number | Enter number: The producer assigned location number for the premises covered by additional premises liability extension. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Premises Liability Extension – Terr | Enter code: The liability territory for the location specified. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Premises Liability Extension – Form Number | Enter identifier: The form number used by the company for additional premises liability extension. |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Premises Liability Extension – Form Date | Enter date: The edition date of the form used by the company for additional premises liability extension. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Premises Liability Extension – Premium | Enter amount: The premium associated with additional premises liability extension. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Premises Liability Extension – Location Number | Enter number: The producer assigned location number for the premises covered by additional premises liability extension. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Premises Liability Extension – Territory | Enter code: The liability territory for the location specified. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Premises Liability Extension – Form Number | Enter identifier: The form number used by the company for additional premises liability extension. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Premises Liability Extension – Form Date | Enter date: The edition date of the form used by the company for additional premises liability extension. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Premises Liability Extension – Premium | Enter amount: The premium associated with additional premises liability extension. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others – Number of Premises | Enter number: The number of premises covered by the additional residence rented to others. This is used when you don’t have the full detail about the individual locations. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others – Med Pay | Enter Y for a “Yes” response. Input N for “No” response. Indicates if medical payments coverage is included. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others – Form Number | Enter identifier: The form number used by the company for additional residence rented to others. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others – Form Date | Enter date: The edition date of the form used by the company for additional residence rented to others. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others – Premium | Enter amount: The premium for additional residence rented to others coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others – Location Number | Enter number: The producer assigned location number for the premises covered by additional residence rented to others. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others- Territory | Enter code: The liability territory for the location specified. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others – Number of Families | Enter number: The number of families of the additional residence rented to others. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others – Medical Payments | Enter Y for a “Yes” response. Input N for “No” response. Indicates if medical payments coverage is included. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others – Form Number | Enter identifier: The form number used by the company for additional residence rented to others. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others – Form Date | Enter date: The edition date of the form used by the company for additional residence rented to others. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others – Premium | Enter amount: The premium for additional residence rented to others coverage. |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others – Location Number | Enter number: The producer assigned location number for the premises covered by additional residence rented to others. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others- Territory | Enter code: The liability territory for the location specified. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others – Number of Families | Enter number: The number of families of the additional residence rented to others. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others – Medical Payments | Enter Y for a “Yes” response. Input N for “No” response. Indicates if medical payments coverage is included. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others – Form Number | Enter identifier: The form number used by the company for additional residence rented to others. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others – Form Date | Enter date: The edition date of the form used by the company for additional residence rented to others. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others – Premium | Enter amount: The premium for additional residence rented to others coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others – Location Number | Enter number: The producer assigned location number for the premises covered by additional residence rented to others. |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others- Territory | Enter code: The liability territory for the location specified. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others – Number of Families | Enter number: The number of families of the additional residence rented to others. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others – Medical Payments | Enter Y for a “Yes” response. Input N for “No” response. Indicates if medical payments coverage is included. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others – Form Number | Enter identifier: The form number used by the company for additional residence rented to others. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others – Form Date | Enter date: The edition date of the form used by the company for additional residence rented to others. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Additional Residence Rented To Others – Premium | Enter amount: The premium for additional residence rented to others coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES -ENDORSEMENTS | Builders Risk Only – Theft of Building Materials – Included | Check the box (if applicable): Indicates the builders risk theft of building materials coverage is included. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Builders Risk Only – Theft of Building Materials – Form Number | Enter identifier: The form number used by the company for builders risk theft of building materials. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Builders Risk Only – Theft of Building Materials – Form Date | Enter date: The edition date of the form used by the company for builders risk theft of building materials. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Builders Risk Only – Theft of Building Materials – Premium | Enter amount: The premium for builders risk theft of building materials coverage. |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES -ENDORSEMENTS | Builders Risk Only – Collapse due to hydro-static pressure – Included | Check the box (if applicable): Indicates the builders risk collapse due to hydro-static pressure coverage is included. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Builders Risk Only – 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. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Builders Risk Only – 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. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Builders Risk Only – Collapse due to hydro-static pressure – Premium | Enter amount: The premium for builders risk collapse due to hydro-static pressure. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES -ENDORSEMENTS | Building Ordinance or Law Coverage – Aggregate Limit | Enter limit: The aggregate limit for building ordinance or law coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Building Ordinance or Law Coverage – Increase Limit | Enter limit: The increased limit for building ordinance or law coverage. |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES -ENDORSEMENTS | Building Ordinance or Law Coverage – Included | Check the box (if applicable): Indicates the building ordinance or law coverage is included. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Building Ordinance or Law Coverage – Rebuild Percentage | Enter percentage: The rebuild percentage for building ordinance or law coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Building Ordinance or Law Coverage – Form Number | Enter identifier: The form number used by the company for building ordinance or law coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Building Ordinance or Law Coverage – Form Date | Enter date: The edition date of the form used by the company for building ordinance or law coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Building Ordinance or Law Coverage – Premium | Enter amount: The premium for building ordinance or law coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES -ENDORSEMENTS | Business Property At Home -Included | Check the box (if applicable): Indicates the business property at home coverage is included. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Business Property At Home – Limit | Enter limit: The limit for business property at home coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Business Property At Home – Form Number | Enter identifier: The form number used by the company for business property at home coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Business Property At Home – Form Date | Enter date: The edition date of the form used by the company for business property at home coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Business Property At Home -Premium | Enter amount: The premium for business property at home coverage. |
ACORD 70 (2009/06) rev. 07-31-2009 21 of 74
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES -ENDORSEMENTS | Business Property Away From Home – Included | Check the box (if applicable): Indicates the business property away from home coverage is included. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Business Property Away From Home – Limit | Enter limit: The limit for business property away from home coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Business Property Away From Home – Form Number | Enter identifier: The form number used by the company for business property away from home coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Business Property Away From Home – Form Date | Enter date: The edition date of the form used by the company for business property away from home coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Business Property Away From Home – Premium | Enter amount: The premium for business property away from home coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES -ENDORSEMENTS | Debris Removal – Included | Check the box (if applicable): Indicates the debris removal coverage is included. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Debris Removal – Limit | Enter limit: The limit for debris removal coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | 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 |
| OPTIONAL COVERAGES -ENDORSEMENTS | Debris Removal – Form Date | Enter date: The edition date of the form used by the company for debris removal coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Debris Removal – Premium | Enter amount: The premium for debris removal coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES -ENDORSEMENTS | Earthquake – % Ded | Enter percentage: The percentage deductible for earthquake coverage if the deductible is expressed as a percentage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Earthquake – Deductible Amount | Enter deductible: The deductible amount for earthquake coverage if the deductible is expressed in dollars. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Earthquake – Zone | Enter code: The earthquake zone (territory) associated with the coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Earthquake – Retrofit Type | Enter text: The type of earthquake retrofit for the residence. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Earthquake – % Masonry Veneer | Enter percentage: The percentage of construction that is masonry veneer. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Earthquake – Form Number | Enter identifier: The form number used by the company for earthquake coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Earthquake – Form Date | Enter date: The edition date of the form used by the company for earthquake coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Earthquake – Premium | Enter amount: The premium for earthquake coverage. |
ACORD 70 (2009/06) rev. 07-31-2009 23 of 74 ACORD 70 (2009/06) rev. 07-31-2009 24 of 74
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Employers Liability Limit | Enter limit: The limit amount for employers liability coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Employers Liability – # of Employees | Enter number: The number of employees associated with employers liability coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Employers Liability – Form Number | Enter identifier: The form number used by the company for employers liability coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Employers Liability – Form Date | Enter date: The edition date of the form used by the company for employers liability coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Employers Liability – Premium | Enter amount: The premium for employers 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. |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Fire Dept Service Charge – | Check the box (if applicable): Indicates the fire department service charge coverage is |
| (continued) | Included | included. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Fire Dept Service Charge – Form Number | Enter identifier: The form number used by the company for fire department surcharge coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Fire Dept Service Charge – Form | Enter date: The edition date of the form used by the company for fire department |
| (continued) | Date | surcharge coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Fire Dept Service Charge – | |
| (continued) | Premium | Enter amount: The premium for fire department surcharge coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | ||
| (continued) | Flood – Building Limit | Enter limit: The building limit for flood coverage. |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Flood – Contents Limit | Enter limit: The contents limit for flood coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Flood – Form Number | Enter identifier: The form number used by the company for flood coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Flood – Form Date | Enter date: The edition date of the form used by the company for flood coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Flood – Premium | Enter amount: The premium for flood coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Fungus and Mold – Excl Liability | Check the box (if applicable): Indicates that liability is excluded from fungus and mold coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Fungus and Mold – Excl Prop Damage | Check the box (if applicable): Indicates that property damage is excluded from fungus and mold coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Fungus and Mold – Property | Enter limit: The property limit for fungus and mold coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Fungus and Mold – Liability | Enter limit: The liability limit for fungus and mold coverage. |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Fungus and Mold – Form Number | Enter identifier: The form number used by the company for fungus and mold coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Fungus and Mold – Form Date | Enter date: The edition date of the form used by the company for fungus and mold coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Fungus and Mold – Premium | Enter amount: The premium for fungus and mold coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Golf Carts Liability – Included | Check the box (if applicable): Indicates the golf cart liability coverage is included. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Golf Carts Liability – # of Golf Carts | Enter number: The number of golf carts to be covered. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Golf Carts Liability – Description | Enter text: The description of the golf carts. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Golf Carts Liability – Form Number | Enter identifier: The form number used by the company for golf cart liability coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Golf Carts Liability – Form Date | Enter date: The edition date of the form used by the company for golf cart liability coverage. |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | ||
| (continued) | Golf Carts Liability – Premium | Enter amount: The premium for golf cart liability coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Golf Carts – Physical Damage – | |
| (continued) | Limit | Enter limit: The limit for golf cart physical damage coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Golf Carts – Physical Damage -Form Number | Enter identifier: The form number used by the company for golf cart physical damage coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Golf Carts – Physical Damage – | Enter date: The edition date of the form used by the company for golf cart physical |
| (continued) | Form Date | damage coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Golf Carts – Physical Damage – | |
| (continued) | Premium | Enter amount: The premium for golf cart physical damage coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | ||
| (continued) | Identity Fraud Expense – Included | Check the box (if applicable): Indicates identity fraud expense coverage is included. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Identity Fraud Expense – Form Number | Enter identifier: The form number used by the company for identity fraud expense coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Identity Fraud Expense – Form | |
| (continued) | Date | Enter date: The edition date of the form used by the company for identity fraud expense. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | ||
| (continued) | Identity Fraud Expense – Premium | Enter amount: The premium for identity fraud expense coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Incidentals Farming Pers Liab – | Enter Y for a “Yes” response. Input N for “No” response. Indicates if medical payments is |
| (continued) | Medical Payments | included in the incidental farming personal liability coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Incidentals Farming Pers Liab – | |
| (continued) | Form Number | Enter identifier: The form number used by the company for incidental farming coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Incidentals Farming Pers Liab -Form Date | Enter date: The edition date of the form used by the company for incidental farming coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Incidentals Farming Pers Liab – | |
| (continued) | Premium | Enter amount: The premium for incidental farming coverage. |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES – | Increased Cov C Special Liability | |
| ENDORSEMENTS | Limits – Electrical Apparatus In | Enter limit: The total limit amount for increased coverage c special liability limit – electronic |
| (continued) | and Out Of Vehicle – Total Limit | apparatus in and out of vehicle. |
| Increased Cov C Special Liability | ||
| OPTIONAL COVERAGES – | Limits – Electrical Apparatus In | |
| ENDORSEMENTS | and Out Of Vehicle – Increased | Enter limit: The increased limit amount for increased coverage c special liability limit – |
| (continued) | Limit | electronic apparatus in and out of vehicle. |
| OPTIONAL COVERAGES – | Increased Cov C Special Liability | |
| ENDORSEMENTS | Limits – Electrical Apparatus In | Enter identifier: The form number used by the company for increased coverage c special |
| (continued) | and Out Of Vehicle – Form Number | liability limit – electronic apparatus in and out of vehicle. |
| OPTIONAL COVERAGES – | Increased Cov C Special Liability | |
| ENDORSEMENTS | Limits – Electrical Apparatus In | Enter date: The edition date of the form used by the company for increased coverage c |
| (continued) | and Out Of Vehicle – Form Date | special liability limit – electronic apparatus in and out of vehicle. |
| OPTIONAL COVERAGES – | Increased Cov C Special Liability | |
| ENDORSEMENTS | Limits – Electrical Apparatus In | Enter amount: The premium for increased coverage c special liability limit – electronic |
| (continued) | and Out Of Vehicle – Premium | apparatus in and out of vehicle.> |
ACORD 70 (2009/06) rev. 07-31-2009 30 of 74 ACORD 70 (2009/06) rev. 07-31-2009 31 of 74
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES – | Increased Cov C Special Liability | |
| ENDORSEMENTS | Limits – Electrical Apparatus In | Enter limit: The total limit amount for increased coverage c special liability limit – electronic |
| (continued) | Vehicle -Total Limit | apparatus in vehicle. |
| OPTIONAL COVERAGES – | Increased Cov C Special Liability | |
| ENDORSEMENTS | Limits – Electrical Apparatus In | Enter limit: The increased limit amount for increased coverage c special liability limit – |
| (continued) | Vehicle – Increased Limit | electronic apparatus in vehicle. |
| OPTIONAL COVERAGES – | Increased Cov C Special Liability | |
| ENDORSEMENTS | Limits – Electrical Apparatus In | Enter identifier: The form number used by the company for increased coverage c special |
| (continued) | Vehicle – Form Number | liability limit – electronic apparatus in vehicle. |
| OPTIONAL COVERAGES – | Increased Cov C Special Liability | |
| ENDORSEMENTS | Limits – Electrical Apparatus In | Enter date: The edition date of the form used by the company for increased coverage c |
| (continued) | Vehicle – Form Date | special liability limit – electronic apparatus in vehicle. |
| OPTIONAL COVERAGES – | Increased Cov C Special Liability | |
| ENDORSEMENTS | Limits – Electrical Apparatus In | Enter amount: The premium for increased coverage c special liability limit – electronic |
| (continued) | Vehicle – Premium | apparatus in vehicle. |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Increased Cov C Special Liability – | |
| (continued) | Guns – Total Limit | Enter limit: The total limit amount for increased coverage c special liability limit – guns. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Increased Cov C Special Liability -Guns – Increased Limit | Enter limit: The increased limit amount for increased coverage c special liability limit -guns. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Increased Cov C Special Liability – | Enter identifier: The form number used by the company for increased coverage c special |
| (continued) | Guns – Form Number | liability limit – guns. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Increased Cov C Special Liability – | Enter date: The edition date of the form used by the company for increased coverage c |
| (continued) | Guns – Form Date | special liability limit – guns. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Increased Cov C Special Liability – | |
| (continued) | Guns – Premium | Enter amount: The premium for increased coverage c special liability limit – guns. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Increased Cov C Special Liability – | |
| (continued) | Money – Total Limit | Enter limit: The total limit amount for increased coverage c special liability limit – money. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Increased Cov C Special Liability – | Enter limit: The increased limit amount for increased coverage c special liability limit – |
| (continued) | Money- Increased Limit | money. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Increased Cov C Special Liability – | Enter identifier: The form number used by the company for increased coverage c special |
| (continued) | Money- Form Number | liability limit – money. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Increased Cov C Special Liability – | Enter date: The edition date of the form used by the company for increased coverage c |
| (continued) | Money- Form Date | special liability limit – money. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Increased Cov C Special Liability – | |
| (continued) | Money- Premium | Enter amount: The premium for increased coverage c special liability limit – money. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Increased Cov C Special Liability – | |
| (continued) | Securities – Total Limit | Enter limit: The total limit amount for increased coverage c special liability limit – securities. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Increased Cov C Special Liability – | Enter limit: The increased limit amount for increased coverage c special liability limit – |
| (continued) | Securities – Increased Limit | securities. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Increased Cov C Special Liability – | Enter identifier: The form number used by the company for increased coverage c special |
| (continued) | Securities- Form Number | liability limit – securities. |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Increased Cov C Special Liability – | Enter date: The edition date of the form used by the company for increased coverage c |
| (continued) | Securities- Form Date | special liability limit – securities. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Increased Cov C Special Liability – | |
| (continued) | Securities- Premium | Enter amount: The premium for increased coverage c special liability limit – securities. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Increased Cov C Special Liability – | Enter limit: The total limit amount for increased coverage c special liability limit – |
| (continued) | Silverware – Total Limit | silverware. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Increased Cov C Special Liability – | Enter limit: The increased limit amount for increased coverage c special liability limit |
| (continued) | Silverware – Increased Limit | silverware. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Increased Cov C Special Liability – | Enter identifier: The form number used by the company for increased coverage c special |
| (continued) | Silverware – Form Number | liability limit -silverware. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Increased Cov C Special Liability – | Enter date: The edition date of the form used by the company for increased coverage c |
| (continued) | Silverware – Form Date | special liability limit -silverware. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Increased Cov C Special Liability – | |
| (continued) | Silverware – Premium | Enter amount: The premium for increased coverage c special liability limit -silverware. |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Inflation Guard – Percentage Increase | Enter percentage: The increase percentage for inflation guard coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Inflation Guard – Form Number | Enter identifier: The form number used by the company for inflation guard coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Inflation Guard Form Date | Enter date: The edition date of the form used by the company for inflation guard coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Inflation Guard Premium | Enter amount: The premium for inflation guard coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Loss Assessment – Limit | Enter limit: The limit amount for loss assessment coverage. |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Loss Assessment – Form Number | Enter identifier: The form number used by the company for loss assessment coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Loss Assessment – Form Date | Enter date: The edition date of the form used by the company for loss assessment coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Loss Assessment – Premium | Enter amount: The premium for loss assessment coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Mine Subsidence – Limit | Enter limit: The limit for mine subsidence coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Mine Subsidence – Const Material | Enter code: The type of construction material. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Mine Subsidence – Property Desc | Enter text: The description of the property. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Mine Subsidence – Form Number | Enter identifier: The form number used by the company for mine subsidence coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Mine Subsidence – Form Date | Enter date: The edition date of the form used by the company for mine subsidence coverage. |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | ||
| (continued) | Mine Subsidence – Premium | Enter amount: The premium for mine subsidence coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES – | Office, Professional Private | |
| ENDORSEMENTS | School, Studio – Residence | Check the box (if applicable): Indicates that increased contents is required for office, |
| (continued) | Premises – Requires Incr Contents | professional private school, studio – residence premises coverage. |
| OPTIONAL COVERAGES – | Office, Professional Private | |
| ENDORSEMENTS | School, Studio – Residence | Check the box (if applicable): Indicates that increased contents is not required for office, |
| (continued) | Premises -Incr Cont Not Required | professional private school, studio – residence premises coverage. |
| OPTIONAL COVERAGES – | Office, Professional Private | |
| ENDORSEMENTS | School, Studio – Residence | Enter limit: The other structures limit for office, professional private school, studio – |
| (continued) | Premises – Other Structures | residence premises coverage. |
| OPTIONAL COVERAGES – | Office, Professional Private | |
| ENDORSEMENTS | School, Studio – Residence | Enter code: The territory for office, professional private school, studio – residence |
| (continued) | Premises – Territory | premises coverage. |
| OPTIONAL COVERAGES – | Office, Professional Private | |
| ENDORSEMENTS | School, Studio – Residence | Enter code: The type of structure for office, professional private school, studio – residence |
| (continued) | Premises – Structure Type | premises coverage. |
| OPTIONAL COVERAGES – | Office, Professional Private | |
| ENDORSEMENTS | School, Studio – Residence | Enter Y for a “Yes” response. Input N for “No” response. Indicates if medical payments is |
| (continued) | Premises – Med Pay | included in the office, professional private school, studio – residence premises coverage. |
| Section Name | Field Name | Field and/or Section Description |
| Office, Professional Private | ||
| OPTIONAL COVERAGES – | School, Studio – Residence | |
| ENDORSEMENTS | Premises – Business/Structure | Enter text: The description of the business or structure for office, professional private |
| (continued) | Description | school, studio – residence premises coverage. |
| OPTIONAL COVERAGES – | Office, Professional Private | |
| ENDORSEMENTS | School, Studio – Residence | Enter identifier: The form number used by the company for office, professional private |
| (continued) | Premises – Form Number | school, studio – residence premises coverage. |
| OPTIONAL COVERAGES – | Office, Professional Private | |
| ENDORSEMENTS | School, Studio – Residence | Enter date: The edition date of the form used by the company for office, professional |
| (continued) | Premises – Form Date | private school, studio – residence premises coverage. |
| OPTIONAL COVERAGES – | Office, Professional Private | |
| ENDORSEMENTS | School, Studio – Residence | Enter amount: The premium for office, professional private school, studio – residence |
| (continued) | Premises – Premium | premises coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Other Structures – Individual | |
| (continued) | Structure – Limit | Enter limit: The limit for other structures – individual structure coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Other Structures – Individual Structure – Structure Desc | Enter text: The description of the individual structure for other structures – individual structure coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Other Structures – Individual Structure – Form Number | Enter identifier: The form number used by the company for other structures – individual structure coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Other Structures – Individual | Enter date: The edition date of the form used by the company for other structures – |
| (continued) | Structure – Form Date | individual structure coverage. |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Other Structures – Individual | |
| (continued) | Structure – Premium | Enter amount: The premium for other structures – individual structure coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | ||
| (continued) | Plants, Shrubs & Trees – Included | Check the box (if applicable): Indicates that plants, shrubs and trees coverage is included. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | ||
| (continued) | Plants, Shrubs & Trees – Limit | Enter limit: The limit for plants, shrubs and trees coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Plants, Shrubs & Trees – Form Number | Enter identifier: The form number used by the company for plants, shrubs and trees coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Plants, Shrubs & Trees – Form Date | Enter date: The edition date of the form used by the company for plants, shrubs and trees coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | ||
| (continued) | Plants, Shrubs & Trees – Premium | Enter amount: The premium for plants, shrubs and trees coverage. |
ACORD 70 (2009/06) rev. 07-31-2009 39 of 74
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Refrigerated Food Products – | Check the box (if applicable): Indicates that refrigerated food products coverage is |
| (continued) | Included | included. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | ||
| (continued) | Refrigerated Food Products – Limit | Enter amount: The limit for refrigerated food products coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Refrigerated Food Products – Form Number | Enter identifier: The form number used by the company for refrigerated food products coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Refrigerated Food Products – Form | Enter date: The edition date of the form used by the company for refrigerated food |
| (continued) | Date | products coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Refrigerated Food Products – | |
| (continued) | Premium | Enter amount: The premium for refrigerated food products coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Replacement Cost – Contents – | Check the box (if applicable): Indicates that replacement cost – contents coverage is |
| (continued) | Included | included. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Replacement Cost – Contents -Form Number | Enter identifier: The form number used by the company for replacement cost – contents coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Replacement Cost – Contents -Form Date | Enter date: The edition date of the form used by the company for replacement cost -contents coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Replacement Cost – Contents – | |
| (continued) | Premium | Enter amount: The premium for replacement cost – contents coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Replacement Cost – Dwelling – | Check the box (if applicable): Indicates that replacement cost – dwelling coverage is |
| (continued) | Included | included. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Replacement Cost – Dwelling -Form Number | Enter identifier: The form number used by the company for replacement cost – dwelling coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Replacement Cost – Dwelling – | Enter date: The edition date of the form used by the company for replacement cost – |
| (continued) | Form Date | dwelling coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Replacement Cost – Dwelling – | |
| (continued) | Premium | Enter amount: The premium for replacement cost – dwelling coverage. |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Replacement Cost – Full Value – | Check the box (if applicable): Indicates that replacement cost full value coverage is |
| (continued) | Included | included. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Replacement Cost – Full Value | Enter percentage: The maximum percentage of increased replacement cost selected in |
| (continued) | Cost – Max % | accordance with the company rules. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Replacement Cost – Full Value -Form Number | Enter identifier: The form number used by the company for full value replacement cost coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Replacement Cost – Full Value -Form Date | Enter date: The edition date of the form used by the company for full value replacement cost coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Replacement Cost – Full Value – | |
| (continued) | Premium | Enter amount: The premium for full value replacement cost coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | ||
| (continued) | Sink Hole Collapse – Included | Check the box (if applicable): Indicates sink hole collapse coverage is included. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | ||
| (continued) | Sink Hole Collapse – Form Number | Enter identifier: The form number used by the company for sink hole collapse. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | ||
| (continued) | Sink Hole Collapse – Form Date | Enter date: The edition date of the form used by the company for sink hole collapse. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | ||
| (continued) | Sink Hole Collapse – Premium | Enter amount: The premium for sink hole collapse. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES – | Unit-Owners Additions & | |
| ENDORSEMENTS | Alterations Special Coverage – | Check the box (if applicable): Indicates unit owners additions and alterations special |
| (continued) | Included | coverage is included. |
| OPTIONAL COVERAGES – | Unit-Owners Additions & | |
| ENDORSEMENTS | Alterations Special Coverage – | |
| (continued) | Limit | Enter limit: The limit for unit owners additions and alterations special coverage. |
| OPTIONAL COVERAGES – | Unit-Owners Additions & | |
| ENDORSEMENTS | Alterations Special Coverage – | Enter identifier: The form number used by the company for unit owners additions and |
| (continued) | Form Number | alterations special coverage. |
| OPTIONAL COVERAGES – | Unit-Owners Additions & | |
| ENDORSEMENTS | Alterations Special Coverage – | Enter date: The edition date of the form used by the company for unit owners additions |
| (continued) | Form Date | and alterations special coverage. |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES – | Unit-Owners Additions & | |
| ENDORSEMENTS | Alterations Special Coverage – | |
| (continued) | Premium | Enter amount: The premium for unit owners additions and alterations special coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Unscheduled Jewelry, Watches, | |
| (continued) | Furs – Aggregate | Enter limit: The aggregate limit for unscheduled jewelry, watches and furs coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Unscheduled Jewelry, Watches, | |
| (continued) | Furs – Increased | Enter limit: The increased limit for unscheduled jewelry, watches and furs coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Unscheduled Jewelry, Watches, | Enter identifier: The form number used by the company for unscheduled jewelry, watches |
| (continued) | Furs – Form Number | and furs coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Unscheduled Jewelry, Watches, | Enter date: The edition date of the form used by the company for unscheduled jewelry, |
| (continued) | Furs – Form Date | watches and furs coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Unscheduled Jewelry, Watches, | |
| (continued) | Furs – Premium | Enter amount: The premium for unscheduled jewelry, watches and furs coverage. |
ACORD 70 (2009/06) rev. 07-31-2009 44 of 74
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Water Backup of Sewers & Drains – | Check the box (if applicable): Indicates water backup of sewers and drains coverage is |
| (continued) | Included | included. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Water Backup of Sewers & Drains – | |
| (continued) | Limit | Enter limit: The limit for water backup of sewers and drains coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Water Backup of Sewers & Drains – | Enter identifier: The form number used by the company for water backup of sewers and |
| (continued) | Form Number | drains coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Water Backup of Sewers & Drains – | Enter date: The edition date of the form used by the company for water backup of sewers |
| (continued) | Form Date | and drains coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Water Backup of Sewers & Drains – | |
| (continued) | Premium | Enter amount: The premium for water backup of sewers and drains coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Enter limit: The limit for watercraft liability coverage if you are not using a Watercraft | |
| (continued) | Watercraft Liability – Limit | application. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | ||
| (continued) | Watercraft Liability – Form Number | Enter identifier: The form number used by the company for watercraft liability coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Enter date: The edition date of the form used by the company for watercraft liability | |
| (continued) | Watercraft Liability – Form Date | coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | ||
| (continued) | Watercraft Liability – Premium | Enter amount: The premium for watercraft liability coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Watercraft Physical Damage | Enter limit: The limit for watercraft physical damage coverage if you are not using a |
| (continued) | Physical Damage – Limit | Watercraft application. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Watercraft Physical Damage -Form Number | Enter identifier: The form number used by the company for watercraft physical damage coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Watercraft Physical Damage – | Enter date: The edition date of the form used by the company for watercraft physical |
| (continued) | Form Date | damage coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Watercraft Physical Damage – | |
| (continued) | Premium | Enter amount: The premium for watercraft physical damage coverage. |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Windstorm Exclusion – Yes | Check the box (if applicable): Indicates that windstorm exclusion applies. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Windstorm Exclusion – Form Number | Enter identifier: The form number used by the company for windstorm exclusion. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Windstorm Exclusion – Form Date | Enter date: The edition date of the form used by the company for windstorm exclusion. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Windstorm Exclusion – Premium | Enter amount: The premium for windstorm exclusion. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Workers Compensation – Full Time Inservant – # of Employees | Enter number: The number of employees associated with workers compensation full time In Servant coverage. |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Workers Compensation – Full Time | Enter identifier: The form number used by the company for workers compensation full |
| (continued) | Inservant – Form Number | time In Servant coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Workers Compensation – Full Time | Enter date: The edition date of the form used by the company for workers compensation |
| (continued) | Inservant – Form Date | full time In Servant coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Workers Compensation – Full Time | |
| (continued) | Inservant – Premium | Enter amount: The premium for workers compensation full time In Servant coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Workers Compensation – | Enter number: The number of employees associated with workers compensation |
| (continued) | Incidental – # of Employees | incidental coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Workers Compensation – | Enter identifier: The form number used by the company for workers compensation |
| (continued) | Incidental – Form Number | incidental coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Workers Compensation – | Enter date: The edition date of the form used by the company for workers compensation |
| (continued) | Incidental – Form Date | incidental coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Workers Compensation – | |
| (continued) | Incidental – Premium | Enter amount: The premium for workers compensation incidental 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. |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES -ENDORSEMENTS | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Workers Compensation – Part | Enter number: The number of employees associated with workers compensation part time |
| (continued) | Time Outservant – # of Employees | Out Servant coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Workers Compensation – Part | Enter identifier: The form number used by the company for workers compensation part |
| (continued) | Time Outservant – Form Number | time Out Servant coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Workers Compensation – Part | Enter date: The edition date of the form used by the company for workers compensation |
| (continued) | Time Outservant – Form Date | part time Out Servant coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Workers Compensation – Part | |
| (continued) | Time Outservant – Premium | Enter amount: The premium for workers compensation part time Out Servant coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | ||
| (continued) | Coverage Description | Enter text: The description of the coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | ||
| (continued) | Coverage Code | Enter code: The code associated with the type of coverage being requested. |
ACORD 70 (2009/06) rev. 07-31-2009 49 of 74
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Type Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Limit 1 | Enter amount: The first limit associated with the coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Applies To 1 | Enter code: The code identifying what the first limit applies to (e.g. Per Person, Per Occurrence, etc.). |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Limit 2 | Enter amount: The second limit associated with the coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Applies To 2 | Enter code: The code identifying what the second limit applies to (e.g. Per Person, Per Occurrence, etc.). |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Deductible | Enter amount: The deductible associated with the coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Deductible Type | Enter code: The type of deductible (e.g. Flat, Percent, etc.) |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Territory | Enter code: The rating territory for the coverage. |
| OPTIONAL COVERAGES -ENDORSEMENTS (continued) | Options | Enter text: The description of options applicable to the coverage (e.g. Included, Excluded, Rejected, etc.). |
| Section Name | Field Name | Field and/or Section Description |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | Enter Y for a “Yes” response. Input N for “No” response. Indicates a “Yes” or “No” option | |
| (continued) | Y/N | for the coverage, if applicable. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | ||
| (continued) | Coverage – Form Number | Enter identifier: The form number used by the company for the coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | ||
| (continued) | Coverage – Form Date | Enter date: The edition date of the form used by the company for the coverage. |
| OPTIONAL COVERAGES – | ||
| ENDORSEMENTS | ||
| (continued) | Coverage – Premium | Enter amount: The premium for the coverage. |
| RATING/UNDERWRITING | Add | Check the box (if applicable): Indicates if the type of change being requested is an add. |
| RATING/UNDERWRITING | Change | Check the box (if applicable): Indicates if the type of change being requested is a change to an existing piece of data. |
| RATING/UNDERWRITING | Delete | Check the box (if applicable): Indicates if the type of change being request is a delete. |
| RATING/UNDERWRITING | Construction – Masonry Veneer | Check the box (if applicable): Indicates the construction of the structure is masonry veneer. |
| RATING/UNDERWRITING | Construction – Percent Masonry Veneer | Enter percentage: The percentage of the structure that is masonry veneer. |
| RATING/UNDERWRITING | Construction – Fire Resistive | Check the box (if applicable): Indicates the construction of the structure is fire resistive. |
| RATING/UNDERWRITING | Construction – Percent Fire Resistive | Enter percentage: The percentage of the structure that is fire resistive. |
| RATING/UNDERWRITING | Construction – Frame | Check the box (if applicable): Indicates the construction of the structure is frame. |
| RATING/UNDERWRITING | Construction – Percent Frame | Enter percentage: The percentage of the structure that is frame. |
| RATING/UNDERWRITING | Construction – Masonry | Check the box (if applicable): Indicates the construction of the structure is masonry. |
| RATING/UNDERWRITING | Construction – Percent Masonry | Enter percentage: The percentage of the structure that is masonry. |
| RATING/UNDERWRITING | Construction – MFG Home | Check the box (if applicable): Indicates the construction of the structure is a manufactured home. |
| RATING/UNDERWRITING | Construction – Percent Manufactured | Enter percentage: The percentage of the structure that is manufactured. |
| RATING/UNDERWRITING | Construction – Steel | Check the box (if applicable): Indicates the construction of the structure is steel. |
| RATING/UNDERWRITING | Construction – Percent Steel | Enter percentage: The percentage of the structure that is steel. |
| Section Name | Field Name | Field and/or Section Description |
| RATING/UNDERWRITING | Construction – Poured Concrete | Check the box (if applicable): Indicates the construction of the structure is poured concrete. |
| RATING/UNDERWRITING | Construction – Percent Poured Concrete | Enter percentage: The percentage of the structure that is poured concrete. |
| RATING/UNDERWRITING | Construction – Log | Check the box (if applicable): Indicates the construction of the structure is log. |
| RATING/UNDERWRITING | Construction – Percent Log | Enter percentage: The percentage of the structure that is log. |
| RATING/UNDERWRITING | Construction – Other | Check the box (if applicable): Indicates the construction of the structure is other than those listed. |
| RATING/UNDERWRITING | Construction – Other Description | 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 As used here, this is the construction type of the structure other than those listed. |
| RATING/UNDERWRITING | Construction – Percent Other | Enter percentage: The percentage of the structure that is other than those types listed. |
| RATING/UNDERWRITING | Siding Type – Aluminum Siding | Check the box (if applicable): Indicates the siding on the structure is aluminum. |
| RATING/UNDERWRITING | Siding Type – Percent Aluminum Siding | Enter percentage: The percentage of the structure that is sided in aluminum. |
| RATING/UNDERWRITING | Siding Type – Stucco | Check the box (if applicable): Indicates the siding on the structure is stucco. |
| RATING/UNDERWRITING | Siding Type – Percent Stucco | Enter percentage: The percentage of the structure that is sided in stucco. |
| RATING/UNDERWRITING | Siding Type – Vinyl Siding/Plastic | Check the box (if applicable): Indicates the siding on the structure is vinyl or plastic. |
| RATING/UNDERWRITING | Siding Type – Percent Vinyl Siding/Plastic | Enter percentage: The percentage of the structure that is sided in vinyl or plastic. |
| RATING/UNDERWRITING | Siding Type – Cedar Wood Shingle | Check the box (if applicable): Indicates the siding on the structure is cedar or wood shingle. |
| RATING/UNDERWRITING | Siding Type – Percent Cedar Wood Shingle | Enter percentage: The percentage of the structure that is sided in cedar or wood shingle. |
| RATING/UNDERWRITING | Siding Type – EIFSCB (on Cinder Block) | Check the box (if applicable): Indicates the siding on the structure is exterior insulation and finishing system on cinder block (EIFSCB). |
| RATING/UNDERWRITING | Siding Type – Percent EIFSCB (on Cinder Block) | Enter percentage: The percentage of the structure that is sided in exterior insulation and finishing system on cinder block (EIFSCB) |
| Section Name | Field Name | Field and/or Section Description |
| RATING/UNDERWRITING | Siding Type – EIFSS (on Studs) | Check the box (if applicable): Indicates the siding on the structure is exterior insulation and finishing system on studs (EIFSS). |
| RATING/UNDERWRITING | Siding Type – Percent EIFSS (on Studs) | Enter percentage: The percentage of the structure that is sided in exterior insulation and finishing system on studs (EIFSS). |
| RATING/UNDERWRITING | Siding Type – Other | Check the box (if applicable): Indicates the siding on the structure is other than those listed. |
| RATING/UNDERWRITING | Siding Type – Other Description | Enter text: The type of siding on the structure. |
| RATING/UNDERWRITING | Siding Type – Percent Other Siding | Enter percentage: The percentage of the structure that is sided in other than the those types listed. |
| RATING/UNDERWRITING | Siding Type – Year EIFS Installed | Enter year: The year the EIFS (exterior insulation and finishing system) was installed. |
| RATING/UNDERWRITING | Course of Construction – Builders Risk | Check the box (if applicable): Indicates the structure is new construction (builders risk). |
| RATING/UNDERWRITING | Course of Construction -Renovation | Check the box (if applicable): Indicates the structure is being renovated. |
| RATING/UNDERWRITING | Course of Construction -Reconstruction | Check the box (if applicable): Indicates the structure is being reconstructed. |
| RATING/UNDERWRITING | Usage Type – Primary | Check the box (if applicable): Indicates that this is the primary residence. |
| RATING/UNDERWRITING | Usage Type – Secondary | Check the box (if applicable): Indicates that this is a secondary residence. |
| RATING/UNDERWRITING | Usage Type – Seasonal | Check the box (if applicable): Indicates that this is a seasonal residence. |
| RATING/UNDERWRITING | Usage Type – Farm | Check the box (if applicable): Indicates the residence is a farm. |
| RATING/UNDERWRITING | Usage Type – Other | Check the box (if applicable): Indicates the usage of the residence is other than those listed. |
| RATING/UNDERWRITING | Usage Type – Other Description | Enter text: The description of the usage of the residence. |
| RATING/UNDERWRITING | Occupancy – Owner | Check the box (if applicable): Indicates the residence is occupied by the owner. |
| RATING/UNDERWRITING | Occupancy – Tenant | Check the box (if applicable): Indicates the residence is occupied by tenants. |
| RATING/UNDERWRITING | Occupancy – Unoccupied | Check the box (if applicable): Indicates the residence is unoccupied. |
| RATING/UNDERWRITING | Occupancy – Vacant | Check the box (if applicable): Indicates the residence is vacant. |
| RATING/UNDERWRITING | Occupancy – Other | Check the box (if applicable): Indicates the residence is occupied by other than those listed. |
| RATING/UNDERWRITING | Occupancy – Other Description | Enter text: The description of the inhabitants of the residence. |
| RATING/UNDERWRITING | Housekeeping Condition -Excellent | Check the box (if applicable): Indicates the evaluation of the interior upkeep of the residence is excellent. |
| RATING/UNDERWRITING | Housekeeping Condition -Good | Check the box (if applicable): Indicates the evaluation of the interior upkeep of the residence is good. |
| Section Name | Field Name | Field and/or Section Description |
| RATING/UNDERWRITING | Housekeeping Condition – Average | Check the box (if applicable): Indicates the evaluation of the interior upkeep of the residence is average. |
| RATING/UNDERWRITING | Housekeeping Condition – Below Average | Check the box (if applicable): Indicates the evaluation of the interior upkeep of the residence is below average. |
| RATING/UNDERWRITING | Distance To Tidal Water | Enter number: The distance to the nearest tidal water. |
| RATING/UNDERWRITING | Distance To Tidal Water Miles | Check the box (if applicable): Indicates the distance to tidal water entered is in miles. |
| RATING/UNDERWRITING | Distance To Tidal Water Feet | Check the box (if applicable): Indicates the distance to tidal water entered is in feet. |
| RATING/UNDERWRITING | Purchase Price | Enter amount: The purchase price of the residence. |
| RATING/UNDERWRITING | Purchase Date | Enter date: The date the residence was purchased, (MM/DD/YYYY). |
| RATING/UNDERWRITING | Wiring – Copper | Check the box (if applicable): Indicates the residence has copper wiring. |
| RATING/UNDERWRITING | Wiring – Aluminum | Check the box (if applicable): Indicates the residence has aluminum wiring. |
| RATING/UNDERWRITING | Wiring – Knob & Tube | Check the box (if applicable): Indicates the residence has knob and tube wiring. |
| RATING/UNDERWRITING | Wiring – Last Inspected Date | Enter date: The date the wiring was last inspected. |
| RATING/UNDERWRITING | Protection Device Type -Central/Smoke | Check the box (if applicable): Indicates the smoke alarm notifies an outside service that in turn reports to the appropriate policy or fire station. |
| RATING/UNDERWRITING | Protection Device Type -Central/Temp | Check the box (if applicable): Indicates the temperature alarm reports to an outside service that in turn reports to the appropriate police or fire station. |
| RATING/UNDERWRITING | Protection Device Type -Central/Burglar | Check the box (if applicable): Indicates the burglar alarm rings at an alarm company. |
| RATING/UNDERWRITING | Protection Device Type -Direct/Smoke | Check the box (if applicable): Indicates the smoke alarm reports directly to the appropriate fire station. |
| RATING/UNDERWRITING | Protection Device Type -Direct/Temp | Check the box (if applicable): Indicates the temperature alarm reports directly to the appropriate fire station. |
| RATING/UNDERWRITING | Protection Device Type -Direct/Burglar | Check the box (if applicable): Indicates the burglar alarm reports directly to the appropriate police station. |
| RATING/UNDERWRITING | Protection Device Type -Local/Smoke | Check the box (if applicable): Indicates that the smoke alarm sounds or appears on the premises. |
| RATING/UNDERWRITING | Protection Device Type -Local/Temp | Check the box (if applicable): Indicates the temperature alarm sounds or appears on the premises. |
| RATING/UNDERWRITING | Protection Device Type -Local/Burglar | Check the box (if applicable): Indicates the burglar alarm sounds or appears outside the premises. |
| RATING/UNDERWRITING | Door Lock – Deadbolt | Check the box (if applicable): Indicates that all exterior entry doors are fitted with deadbolt locks. |
| RATING/UNDERWRITING | Door Lock – Spring | Check the box (if applicable): Indicates that all exterior entry doors are fitted with spring locks. |
| Section Name | Field Name | Field and/or Section Description |
| RATING/UNDERWRITING | Door Lock – Other | Check the box (if applicable): Indicates that all exterior entry doors are fitted with locks other than those listed. |
| RATING/UNDERWRITING | Door Lock – Description | Enter text: The type of locks on exterior entry doors. |
| RATING/UNDERWRITING | Sprinkler – Partial | Check the box (if applicable): Indicates the building is equipped with a partial fire sprinkler system. |
| RATING/UNDERWRITING | Sprinkler – Full | Check the box (if applicable): Indicates the building is equipped with a full fire sprinkler system. |
| RATING/UNDERWRITING | Fire Extinguisher | Check the box (if applicable): Indicate that the residence is equipped with fire extinguisher(s). |
| RATING/UNDERWRITING | Distance to Hydrant | Enter number: The distance in feet from the nearest hydrant that supports the protection class used. |
| RATING/UNDERWRITING | Distance to Fire Station | Enter number: The distance in miles from the nearest fire station that supports the protection class used. |
| RATING/UNDERWRITING | # of Fire Divisions | Enter number: The number of fire divisions in the building. |
| RATING/UNDERWRITING | # Units Fire Div | Enter number: The number of units within a fire division. |
| RATING/UNDERWRITING | Territory | Enter code: The industry or company specific code that identifies the rating territory for this item. The source of this code is individual insurer, Insurance Services Office or State Insurance Department manuals. |
| RATING/UNDERWRITING | Fire Premium Group | Enter identifier: The fire premium group used to determine the applicable rate based upon the dwelling’s location, construction, and fire protection code. |
| RATING/UNDERWRITING | Pers Liab Terr | Enter code: The personal liability territory code unique to owners, landlords and tenants needed for liability coverage. |
| RATING/UNDERWRITING | EC Prem Group | Enter identifier: The premium group for extended coverage. |
| RATING/UNDERWRITING | 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. |
| RATING/UNDERWRITING | Fire/EC Rate | Enter rate: The Fire and extended coverage rate used to develop a rate for additional coverage of hazards or risks. |
| RATING/UNDERWRITING | Fire District Name | Enter text: The property’s fire district name. |
| RATING/UNDERWRITING | Fire District Code | Enter code: The property’s fire district code number which can be found in the individual states manual pages. |
| RATING/UNDERWRITING | Electrical System Circuit Breakers | Check the box (if applicable): Indicates the electrical panel uses circuit breakers. |
| RATING/UNDERWRITING | Electrical System Fuses | Check the box (if applicable): Indicates the electrical panel uses fuses. |
| RATING/UNDERWRITING | Number of Amps | Enter number: The electrical capacity of the wiring in amperes (amps). |
| Section Name | Field Name | Field and/or Section Description |
| RATING/UNDERWRITING | Date Heating System Last Serviced | Enter date: The date (MM/DD/YYYY) the heating system was last serviced. |
| RATING/UNDERWRITING | Primary Heat | Enter text: The primary type of fuel/power used for heating. |
| RATING/UNDERWRITING | Primary Heat – None | Check the box (if applicable): Indicates the residence has no primary heat source. |
| RATING/UNDERWRITING | Secondary: | Enter text: The secondary type of fuel/power used for heating. |
| RATING/UNDERWRITING | None | Check the box (if applicable): Indicates the residence has no secondary heat source. |
| RATING/UNDERWRITING | Security – Visible from road | Check the box (if applicable): Indicates the structure is visible from the road. |
| RATING/UNDERWRITING | Security – Visible to neighbors | Check the box (if applicable): Indicates the structure is visible from another dwelling that is occupied during the day. |
| RATING/UNDERWRITING | Security – Occupied Daily | Check the box (if applicable): Indicates the residence usually has an adult home during the day. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Add | Check the box (if applicable): Indicates if the type of change being requested is an add. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Change | Check the box (if applicable): Indicates if the type of change being requested is a change to an existing piece of data. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Delete | Check the box (if applicable): Indicates if the type of change being request is a delete. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Year Built | Enter year: The year the structure was built (YYYY). |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Market Value | Enter amount: The current market value for which the residence could be sold. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Replacement Cost | Enter amount: The estimated total dollar amount required to rebuild the residence without depreciation. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Total Living Area Sq Ft | Enter number: The residence’s total square footage of living area (excluding basements). |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Basement Area | Enter number: The residence’s total square footage of the basement. |
| Section Name | Field Name | Field and/or Section Description |
|---|---|---|
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Garage | Enter number: The residence’s total square footage of the garage. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Breezeway | Enter number: The residence’s total square footage of the breezeway. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Fireplaces – Chimneys | Enter number: The total number of outside and inside chimneys in the residence. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Fireplaces – Hearths | Enter number: The total number of hearths in the residence. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Fireplaces – Pre-Fab | Enter number: The total number of prefabricated fireplaces in the residence. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Fireplaces – Wood stove insert | Enter number: The total number of wood stove inserts in the residence. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | # Rooms | Enter number: The total number of rooms in the residence, including full and half bathrooms. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | # Apartments | Enter number: The number of separate living units in structure. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | # Families | Enter number: The number of separate family units in the dwelling. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | # Household Residents | Enter number: The number of residents in the household. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | # Weeks Rented | Enter number: The number of weeks the residence is occupied or rented to others. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Tax Code | Enter code: The code which normally represents the location for which a surcharge is being applied (city, county or state). |
| Section Name | Field Name | Field and/or Section Description |
| HOMEOWNER / | Enter code: The industry code used to collect the building code effectiveness grade code. | |
| DWELLING FIRE | The source of this code list is public protection classification or individual insurer rating | |
| RATING/UNDERWRITING | Bldg Code Grade | manuals. |
| HOMEOWNER / | ||
| DWELLING FIRE | Building Code Grade – Inspected | Enter Y for a “Yes” response. Input N for “No” response. Indicate if the structure has been |
| RATING/UNDERWRITING | Y/N | inspected specific to its Building Code effectiveness grade. |
| HOMEOWNER / | ||
| DWELLING FIRE | Check the box (if applicable): Indicates that a non-smoking rating credit may apply to the | |
| RATING/UNDERWRITING | Rating Credits – Non-Smoker | location. |
| HOMEOWNER / | ||
| DWELLING FIRE | Check the box (if applicable): Indicates that a manned security rating credit may apply to | |
| RATING/UNDERWRITING | Rating Credits – Manned Security | the location. |
| HOMEOWNER / | ||
| DWELLING FIRE | Rating Credits – Lighting | Check the box (if applicable): Indicates that a lightning protection rating credit may apply |
| RATING/UNDERWRITING | Protection | to the location. |
| HOMEOWNER / | ||
| DWELLING FIRE | Rating Credits – Off Premises Theft | Check the box (if applicable): Indicates that an off premises theft exclusion rating credit |
| RATING/UNDERWRITING | Exclusion | may apply to the location. |
| HOMEOWNER / | ||
| DWELLING FIRE | ||
| RATING/UNDERWRITING | Rating Credits – Other | Check the box (if applicable): Indicates that other rating credits may apply to the location. |
| HOMEOWNER / | ||
| DWELLING FIRE | ||
| RATING/UNDERWRITING | Rating Credits – Other Description | Enter text: The description of the other rating credits that may apply. |
| HOMEOWNER / | ||
| DWELLING FIRE | ||
| RATING/UNDERWRITING | Residence Type – Dwelling | Check the box (if applicable): Indicates the type of residence being insured is a dwelling. |
| HOMEOWNER / | ||
| DWELLING FIRE | Check the box (if applicable): Indicates the type of residence being insured is an | |
| RATING/UNDERWRITING | Residence Type – Apartment | apartment. |
| HOMEOWNER / | ||
| DWELLING FIRE | Check the box (if applicable): Indicates the type of residence being insured is a | |
| RATING/UNDERWRITING | Residence Type – Condominium | condominium. |
| HOMEOWNER / | ||
| DWELLING FIRE | Check the box (if applicable): Indicates the type of residence being insured is a | |
| RATING/UNDERWRITING | Residence Type – Townhouse | townhouse. |
| Section Name | Field Name | Field and/or Section Description |
|---|---|---|
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Residence Type – Rowhouse | Check the box (if applicable): Indicates the type of residence being insured is a row house. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Residence Type – Co-Op | Check the box (if applicable): Indicates the type of residence being insured is a cooperative. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Residence Type – Mobile Home | Check the box (if applicable): Indicates the type of residence being insured is a mobile home. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Residence Type – Other | Check the box (if applicable): Indicates the type of residence being insured is other than those listed. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Residence Type – Other Description | Enter text: The description of the type of residence (e.g. apartment, condominium, etc.). |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Swimming Pool – None | Check the box (if applicable): Indicates there is no swimming pool on the premises. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Swimming Pool – Above ground | Check the box (if applicable): Indicates the swimming pool is above ground. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Swimming Pool – In-Ground | Check the box (if applicable): Indicates the swimming pool is in the ground. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Swimming Pool – Approved Fence | Check the box (if applicable): Indicates the swimming pool is surrounded by a fence that is an approved height. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Swimming Pool – Diving Board | Check the box (if applicable): Indicates the swimming pool has a diving board. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Swimming Pool – Slide | Check the box (if applicable): Indicates the swimming pool has a slide. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Swimming Pool – Other | Check the box (if applicable): Indicates there is additional information to describe the pool. |
| Section Name | Field Name | Field and/or Section Description |
|---|---|---|
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Swimming Pool – Other Description | Enter text: The additional information to describe the swimming pool. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Dwelling Location – In City Limits | Check the box (if applicable): Indicates the residence is within the city limits. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Dwelling Location – In Fire District | Check the box (if applicable): Indicates the residence is within a fire district. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Dwelling Location – In Protected Suburb | Check the box (if applicable): Indicates the residence is within a protected suburb. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Dwelling Location – Other | Check the box (if applicable): Indicates the residence is other than those listed. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Dwelling Location – Other Description | Enter text: The description of the residence location. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Wind Class – Resistive | Check the box (if applicable): Indicates the wind class is resistive. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Wind Class – Semi-resistive | Check the box (if applicable): Indicates the wind class is semi-resistive. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Wind Class – Other | Check the box (if applicable): Indicates the wind class is other than those listed. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Wind Class – Other Description. | Enter text: The description of the wind class when “other” has been checked. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Rating – Class | Check the box (if applicable): Indicates the method of rating used for an HO-4 or HO-6 policy is class rating. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Rating – Specific | Check the box (if applicable): Indicates the method of rating used for an HO-4 or HO-6 policy is specific rating. |
| Section Name | Field Name | Field and/or Section Description |
| HOMEOWNER / | ||
| DWELLING FIRE | ||
| RATING/UNDERWRITING | Foundation – Open | Check the box (if applicable): Indicates the foundation of the structure is open. |
| HOMEOWNER / | ||
| DWELLING FIRE | ||
| RATING/UNDERWRITING | Foundation – Closed | Check the box (if applicable): Indicates the foundation of the structure is closed. |
| HOMEOWNER / | ||
| DWELLING FIRE | ||
| RATING/UNDERWRITING | Foundation – None | Check the box (if applicable): Indicates there is no foundation on the structure. |
| HOMEOWNER / | ||
| DWELLING FIRE | Check the box (if applicable): Indicates the wind storm shutters are a class that provides | |
| RATING/UNDERWRITING | Storm Shutters – A | protection from wind and debris. |
| HOMEOWNER / | ||
| DWELLING FIRE | Check the box (if applicable): Indicates the wind storm shutters are a class that provides | |
| RATING/UNDERWRITING | Storm Shutters – B | protection from wind only. |
| HOMEOWNER / | ||
| DWELLING FIRE | Check the box (if applicable): Indicates the wind storm shutters are a class other than | |
| RATING/UNDERWRITING | Other | those listed. |
| HOMEOWNER / | ||
| DWELLING FIRE | ||
| RATING/UNDERWRITING | Describe Other | Enter text: The description of the wind storm shutter class. |
| HOMEOWNER / | ||
| DWELLING FIRE | ||
| RATING/UNDERWRITING | Hurricane Resistive Glass | Check the box (if applicable): Indicates the glass is resistive to hurricanes. |
| HOMEOWNER / | ||
| DWELLING FIRE | ||
| RATING/UNDERWRITING | Fuel Storage Tank – None | Check the box (if applicable): Indicates there is no fuel storage tank on the premises. |
| HOMEOWNER / | ||
| DWELLING FIRE | Fuel Storage Tank – Indoors, | Check the box (if applicable): Indicates the fuel storage tank is located indoors, above |
| RATING/UNDERWRITING | Above ground masonry floor | ground on a masonry floor. |
| HOMEOWNER / | ||
| DWELLING FIRE | Fuel Storage Tank – Indoors, | Check the box (if applicable): Indicates the fuel storage tank is located indoors, above |
| RATING/UNDERWRITING | Above ground no masonry floor | ground not on a masonry floor. |
| HOMEOWNER / | ||
| DWELLING FIRE | Fuel Storage Tank – Outdoors, | Check the box (if applicable): Indicates the fuel storage tank is outdoors and above |
| RATING/UNDERWRITING | Above ground | ground. |
| Section Name | Field Name | Field and/or Section Description |
| HOMEOWNER / | ||
| DWELLING FIRE | Fuel Storage Tank – Outdoors, | Check the box (if applicable): Indicates the fuel storage tank is outdoors and below |
| RATING/UNDERWRITING | Below ground | ground. |
| HOMEOWNER / | ||
| DWELLING FIRE | ||
| RATING/UNDERWRITING | Fuel Line Location – Underground | Check the box (if applicable): Indicates the fuel line is underground. |
| HOMEOWNER / | ||
| DWELLING FIRE | Fuel Line Location – Through | |
| RATING/UNDERWRITING | foundation | Check the box (if applicable): Indicates the fuel line goes through the foundation. |
| HOMEOWNER / | ||
| DWELLING FIRE | Check the box (if applicable): Indicates if partial wiring improvements have been made | |
| RATING/UNDERWRITING | Renovations – Wiring – Part | since the original construction. |
| HOMEOWNER / | ||
| DWELLING FIRE | Check the box (if applicable): Indicates if complete wiring improvements have been made | |
| RATING/UNDERWRITING | Renovations – Wiring – Complete | since the original construction. |
| HOMEOWNER / | ||
| DWELLING FIRE | ||
| RATING/UNDERWRITING | Renovations – Wiring – Year | Enter year: The year the wiring improvements took place. |
| HOMEOWNER / | ||
| DWELLING FIRE | Check the box (if applicable): Indicates if partial plumbing improvements have been made | |
| RATING/UNDERWRITING | Renovations – Plumbing – Part | since the original construction. |
| HOMEOWNER / | ||
| DWELLING FIRE | Renovations – Plumbing – | Check the box (if applicable): Indicates if complete plumbing improvements have been |
| RATING/UNDERWRITING | Complete | made since the original construction. |
| HOMEOWNER / | ||
| DWELLING FIRE | ||
| RATING/UNDERWRITING | Renovations – Plumbing – Year | Enter year: The year the plumbing improvements took place. |
| HOMEOWNER / | ||
| DWELLING FIRE | Check the box (if applicable): Indicates if partial heating improvements have been made | |
| RATING/UNDERWRITING | Renovations – Heating – Part | since the original construction. |
| HOMEOWNER / | ||
| DWELLING FIRE | Check the box (if applicable): Indicates if complete heating improvements have been | |
| RATING/UNDERWRITING | Renovations – Heating – Complete | made since the original construction. |
| HOMEOWNER / | ||
| DWELLING FIRE | ||
| RATING/UNDERWRITING | Renovations – Heating – Year | Enter year: The year the heating improvements took place. |
| Section Name | Field Name | Field and/or Section Description |
|---|---|---|
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Renovations – Roofing – Part | Check the box (if applicable): Indicates if partial roofing improvements have been made since the original construction. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Renovations – Roofing – Complete | Check the box (if applicable): Indicates if complete roofing improvements have been made since the original construction. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Renovations – Roofing – Year | Enter year: The year the roofing improvements took place. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Renovations – Exterior Paint – Year | Check the box (if applicable): The year the exterior of the structure was last painted. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Plumbing Condition -Excellent | Check the box (if applicable): Indicates the plumbing system condition is excellent. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Plumbing Condition – Good | Check the box (if applicable): Indicates the plumbing system condition is good. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Plumbing Condition – Average | Check the box (if applicable): Indicates the plumbing system condition is average. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Plumbing Condition – Below Average | Check the box (if applicable): Indicates the plumbing system condition is below average. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Any Known Leaks | Enter Y for a “Yes” response. Input N for “No” response. Indicates there are known leaks in the plumbing system. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Roof Condition – Excellent | Check the box (if applicable): Indicates the condition of the roof is excellent. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Roof Condition – Good | Check the box (if applicable): Indicates the condition of the roof is good. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Roof Condition – Average | Check the box (if applicable): Indicates the condition of the roof is average. |
| Section Name | Field Name | Field and/or Section Description |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Roof Condition – Below Average | Check the box (if applicable): Indicates the condition of the roof is below average. |
| HOMEOWNER / DWELLING FIRE RATING/UNDERWRITING | Roof Material | Enter code: The material used to construct the roof. Examples: * Composition (fiberglass, asphalt, etc.) * Metal * Poured * Slate * Tile * Wood Shake/Shingle |
| MOBILE HOME RATING/UNDERWRITING | Add | Check the box (if applicable): Indicates if the type of change being requested is an add. |
| MOBILE HOME RATING/UNDERWRITING | Change | Check the box (if applicable): Indicates if the type of change being requested is a change to an existing piece of data. |
| MOBILE HOME RATING/UNDERWRITING | Delete | Check the box (if applicable): Indicates if the type of change being request is a delete. |
| MOBILE HOME RATING/UNDERWRITING | Mobile Home – New | Enter Y for a “Yes” response. Input N for “No” response. Indicates if the mobile home was purchased new. |
| MOBILE HOME RATING/UNDERWRITING | Mobile Home – Year | Enter year: The model year of the mobile home. |
| MOBILE HOME RATING/UNDERWRITING | Mobile Home – Make | Enter text: The name of the manufacturer of the mobile home. |
| MOBILE HOME RATING/UNDERWRITING | Mobile Home – Model | Enter text: The manufacturer’s model name for the mobile home. |
| MOBILE HOME RATING/UNDERWRITING | Mobile Home – ID Number | Enter identifier: The serial number for this mobile home. |
| MOBILE HOME RATING/UNDERWRITING | Length | Enter number: The length of the mobile home expressed in feet. |
| MOBILE HOME RATING/UNDERWRITING | Width | Enter number: The width of the mobile home expressed in feet. |
| MOBILE HOME RATING/UNDERWRITING | Doublewide | Enter Y for a “Yes” response. Input N for “No” response. Indicates if the mobile home is a doublewide construction. |
| MOBILE HOME RATING/UNDERWRITING | Skirted | Enter Y for a “Yes” response. Input N for “No” response. Indicates if the mobile home is skirted. |
| MOBILE HOME RATING/UNDERWRITING | # of Bedrooms | Enter number: The number of bedrooms in the mobile home. |
| Section Name | Field Name | Field and/or Section Description |
|---|---|---|
| MOBILE HOME RATING/UNDERWRITING | Tie Down – None | Check the box (if applicable): Indicates the mobile home has no tie downs. |
| MOBILE HOME RATING/UNDERWRITING | Tie Down – Full | Check the box (if applicable): Indicates the mobile home tie downs are full. |
| MOBILE HOME RATING/UNDERWRITING | Tie Down – Chassis Only | Check the box (if applicable): Indicates the mobile home tie downs are chassis only. |
| MOBILE HOME RATING/UNDERWRITING | Tie Down – Overtop Only | Check the box (if applicable): Indicates the mobile home tie downs are overtop only. |
| MOBILE HOME RATING/UNDERWRITING | Permanent Connection – Electricity | Check the box (if applicable): Indicates the mobile home has a permanent connection to electricity. |
| MOBILE HOME RATING/UNDERWRITING | Permanent Connection – Water | Check the box (if applicable): Indicates the mobile home has a permanent connection to water. |
| MOBILE HOME RATING/UNDERWRITING | Permanent Connection – Sewer | Check the box (if applicable): Indicates the mobile home has a permanent connection to the sewer. |
| MOBILE HOME RATING/UNDERWRITING | Cooking Location – End | Check the box (if applicable): Indicates the mobile home has a cooking location at the end of the residence. |
| MOBILE HOME RATING/UNDERWRITING | Cooking Location – Middle | Check the box (if applicable): Indicates the mobile home has a cooking location in the middle of the residence. |
| MOBILE HOME RATING/UNDERWRITING | Cooking Location – None | Check the box (if applicable): Indicates the mobile home has no cooking location. |
| MOBILE HOME RATING/UNDERWRITING | Mobile Home Foundation -Continuous Masonry | Check the box (if applicable): Indicates the foundation is continuous masonry. |
| MOBILE HOME RATING/UNDERWRITING | Mobile Home Foundation – Post & Pier | Check the box (if applicable): Indicates the foundation is post and pier. |
| MOBILE HOME RATING/UNDERWRITING | Mobile Home Foundation – Other | Check the box (if applicable): Indicates the foundation is other than those listed. |
| MOBILE HOME RATING/UNDERWRITING | Mobile Home Foundation – Other Description | Enter text: The foundation of the mobile home. |
| MOBILE HOME RATING/UNDERWRITING | Mobile Home Park Name | Enter text: The name of the mobile home park. |
| MOBILE HOME RATING/UNDERWRITING | Date park established | Enter date: The date the mobile home park was established. |
| MOBILE HOME RATING/UNDERWRITING | Number of permanent spaces in park | Enter number: The number of permanent spaces in the mobile home park. |
| MOBILE HOME RATING/UNDERWRITING | Consecutive Months Occupied Each Year | Enter number: The number of consecutive months the mobile home is occupied each year. |
| Section Name | Field Name | Field and/or Section Description |
| 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. |
| ADDITIONAL INTEREST | Add | Check the box (if applicable): Indicates if the type of change being requested is an add. |
| ADDITIONAL INTEREST | Change | Check the box (if applicable): Indicates if the type of change being requested is a change to an existing piece of data. |
| ADDITIONAL INTEREST | Delete | Check the box (if applicable): Indicates if the type of change being request is a delete. |
| ADDITIONAL INTEREST | Interest Additional Insured | Check the box (if applicable): Indicates the additional interest type is an additional insured. |
| ADDITIONAL INTEREST | Lienholder | Check the box (if applicable): Indicates the additional interest type is a lien holder. |
| ADDITIONAL INTEREST | Loss Payee | Check the box (if applicable): Indicates the additional interest type is a loss payee. |
| ADDITIONAL INTEREST | Mortgagee | Check the box (if applicable): Indicates the additional interest type is a mortgagee. |
| ADDITIONAL INTEREST | Trustee | Check the box (if applicable): Indicates the additional interest type is a trustee. |
| ADDITIONAL INTEREST | Other | Check the box (if applicable): Indicates the additional interest is not any of the types listed on the form. |
| ADDITIONAL INTEREST | Other Description | Enter text: The description of the type of interest in the item. |
| ADDITIONAL INTEREST | Rank: | Enter number: The ranking of ‘this’ additional interest when multiple additional interests are associated with the same item. |
| ADDITIONAL INTEREST | Certificate Required | Check the box (if applicable): Indicates if the additional interest requires a Certificate of Insurance, |
| ADDITIONAL INTEREST | Name And Address | Enter text: The additional interest’s full name. |
| ADDITIONAL INTEREST | Enter text: The additional interest’s mailing address line one. | |
| ADDITIONAL INTEREST | Enter text: The additional interest’s mailing address line two. | |
| ADDITIONAL INTEREST | Enter text: The additional interest’s mailing address city name. | |
| ADDITIONAL INTEREST | Enter code: The additional interest’s mailing address state or province code. | |
| ADDITIONAL INTEREST | Enter code: The additional interest’s mailing address postal code. | |
| ADDITIONAL INTEREST | Enter code: The additional interest’s country code. | |
| ADDITIONAL INTEREST | Reference #: | Enter identifier: The loan number, account number or other controlling number that the additional interest may have assigned the insured. |
| ADDITIONAL INTEREST | Interest in Item Number Location: | Enter number: The producer assigned number of the location which has an additional interest. |
| ADDITIONAL INTEREST | Building: | Enter number: The producer assigned number of the building which has an additional interest. |
| Section Name | Field Name | Field and/or Section Description |
| ADDITIONAL INTEREST | Vehicle: | Enter number: The producer assigned number of the vehicle which has an additional interest. |
| ADDITIONAL INTEREST | Boat: | Enter number: The producer assigned number of the boat which has an additional interest. |
| ADDITIONAL INTEREST | Item Class | Enter text: The description of the property class of the scheduled item (i.e. Jewelry, Furs, Contractors Equipment, etc.). |
| ADDITIONAL INTEREST | Item | Enter number: The producer assigned number of the scheduled item which has an additional interest. |
| ADDITIONAL INTEREST | Item Description: | Enter text: The description of the item of interest if needed to further clarify. For a vehicle, list the make, model and VIN number. For a scheduled item, list the description, such as three carat diamond in six point setting. |
| ADDITIONAL INTEREST | Add | Check the box (if applicable): Indicates if the type of change being requested is an add. |
| ADDITIONAL INTEREST | Change | Check the box (if applicable): Indicates if the type of change being requested is a change to an existing piece of data. |
| ADDITIONAL INTEREST | Delete | Check the box (if applicable): Indicates if the type of change being request is a delete. |
| ADDITIONAL INTEREST | Interest Additional Insured | Check the box (if applicable): Indicates the additional interest type is an additional insured. |
| ADDITIONAL INTEREST | Lienholder | Check the box (if applicable): Indicates the additional interest type is a lien holder. |
| ADDITIONAL INTEREST | Loss Payee | Check the box (if applicable): Indicates the additional interest type is a loss payee. |
| ADDITIONAL INTEREST | Mortgagee | Check the box (if applicable): Indicates the additional interest type is a mortgagee. |
| ADDITIONAL INTEREST | Trustee | Check the box (if applicable): Indicates the additional interest type is a trustee. |
| ADDITIONAL INTEREST | Other | Check the box (if applicable): Indicates the additional interest is not any of the types listed on the form. |
| ADDITIONAL INTEREST | Other Description | Enter text: The description of the type of interest in the item. |
| ADDITIONAL INTEREST | Rank: | Enter number: The ranking of ‘this’ additional interest when multiple additional interests are associated with the same item. |
| ADDITIONAL INTEREST | Certificate Required | Check the box (if applicable): Indicates if the additional interest requires a Certificate of Insurance, |
| ADDITIONAL INTEREST | Name And Address | Enter text: The additional interest’s full name. |
| ADDITIONAL INTEREST | Enter text: The additional interest’s mailing address line one. | |
| ADDITIONAL INTEREST | Enter text: The additional interest’s mailing address line two. | |
| ADDITIONAL INTEREST | Enter text: The additional interest’s mailing address city name. | |
| ADDITIONAL INTEREST | Enter code: The additional interest’s mailing address state or province code. | |
| ADDITIONAL INTEREST | Enter code: The additional interest’s mailing address postal code. |
| Section Name | Field Name | Field and/or Section Description |
| ADDITIONAL INTEREST | Enter code: The additional interest’s country code. | |
| ADDITIONAL INTEREST | Reference #: | Enter identifier: The loan number, account number or other controlling number that the additional interest may have assigned the insured. |
| ADDITIONAL INTEREST | Interest in Item Number Location: | Enter number: The producer assigned number of the location which has an additional interest. |
| ADDITIONAL INTEREST | Building: | Enter number: The producer assigned number of the building which has an additional interest. |
| ADDITIONAL INTEREST | Vehicle: | Enter number: The producer assigned number of the vehicle which has an additional interest. |
| ADDITIONAL INTEREST | Boat: | Enter number: The producer assigned number of the boat which has an additional interest. |
| ADDITIONAL INTEREST | Item Class | Enter text: The description of the property class of the scheduled item (i.e. Jewelry, Furs, Contractors Equipment, etc.). |
| ADDITIONAL INTEREST | Item | Enter number: The producer assigned number of the scheduled item which has an additional interest. |
| ADDITIONAL INTEREST | Item Description: | Enter text: The description of the item of interest if needed to further clarify. For a vehicle, list the make, model and VIN number. For a scheduled item, list the description, such as three carat diamond in six point setting. |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | # | Enter number: The number assigned to the item by the producer. |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | Property Description | Enter text: The full description of the item including serial numbers, if applicable. |
| Section Name | Field Name | Field and/or Section Description |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | Purchase / Appraisal Date | Enter date: The date on which the item described was either purchased or last appraised. |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | Amount of Insurance | Enter amount: The value (limit of liability) of the item described. |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | # | Enter number: The number assigned to the item by the producer. |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | Property Description | >Enter text: The full description of the item including serial numbers, if applicable. |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | Purchase / Appraisal Date | Enter date: The date on which the item described was either purchased or last appraised. |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | Amount of Insurance | Enter amount: The value (limit of liability) of the item described. |
ACORD 70 (2009/06) rev. 07-31-2009 69 of 74
| Section Name | Field Name | Field and/or Section Description |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | # | Enter number: The number assigned to the item by the producer. |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | Property Description | Enter text: The full description of the item including serial numbers, if applicable. |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | Purchase / Appraisal Date | Enter date: The date on which the item described was either purchased or last appraised. |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | Amount of Insurance | Enter amount: The value (limit of liability) of the item described. |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | Type of Change | Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I – Informational Only No Change. Various combinations of changes are permitted in one submission. Use “A” to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use “D” to delete an item (e.g., delete a vehicle, delete a driver). Use “C” to change an item in the policy (e.g., change a deductible, change coverage limits). Use “I” to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter “A” in the type of change for Collision. Enter “I” in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | # | Enter number: The number assigned to the item by the producer. |
| Section Name | Field Name | Field and/or Section Description |
|---|---|---|
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | Property Description | Enter text: The full description of the item including serial numbers, if applicable. |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | Purchase / Appraisal Date | Enter date: The date on which the item described was either purchased or last appraised. |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | Amount of Insurance | Enter amount: The value (limit of liability) of the item described. |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | Unattended Car Coverage (Stamps/Coins) | Check the box (if applicable): Indicates that unattended automobile coverage for stamps and coins applies to a property class. |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | Broad Form Pair & Set Coverage | Check the box (if applicable): Indicates that broad form pair and set coverage applies to a property class. |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | Non-Mobile Organ Coverage | Check the box (if applicable): Indicates that non-mobile organ coverage applies to a property class. |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | Safe Credit (Identify Property, Safe Class, etc) | Check the box (if applicable): Indicates that safe credit applies to a property class. |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | ACV Loss Settlement | Check the box (if applicable): Indicates the loss settlement basis is the actual cash value of the item. |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | Replacement Cost Loss Settlement | Check the box (if applicable): Indicates the loss settlement basis is the replacement cost of the item. |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | Breakage Coverage | Check the box (if applicable): Indicates that breakage coverage applies to a property class. |
| PERSONAL INLAND MARINE/SCHEDULE OF PROPERTY | Blanket Coverage | Check the box (if applicable): Indicates that blanket coverage applies. |
| WATERCRAFT COVERAGES/LIMITS OF LIABILITY | Add | Check the box (if applicable): Indicates if the type of change being requested is an add. |
| Section Name | Field Name | Field and/or Section Description |
|---|---|---|
| WATERCRAFT COVERAGES/LIMITS OF LIABILITY | Change | Check the box (if applicable): Indicates if the type of change being requested is a change to an existing piece of data. |
| WATERCRAFT COVERAGES/LIMITS OF LIABILITY | Delete | Check the box (if applicable): Indicates if the type of change being request is a delete. |
| WATERCRAFT COVERAGES/LIMITS OF LIABILITY | Hull | Enter limit: The limit for boat (hull) coverage. This may include collision liability. |
| WATERCRAFT COVERAGES/LIMITS OF LIABILITY | Outboard Motor 1 | Enter limit: The limit for outboard motor coverage. |
| WATERCRAFT COVERAGES/LIMITS OF LIABILITY | Outboard Motor 2 | Enter limit: The limit for outboard motor coverage. |
| WATERCRAFT COVERAGES/LIMITS OF LIABILITY | Portable Accessories | Enter limit: The limit for portable accessories (equipment not permanently attached to the boat) coverage. |
| WATERCRAFT COVERAGES/LIMITS OF LIABILITY | Trailer | Enter limit: The limit for trailer coverage. |
| WATERCRAFT COVERAGES/LIMITS OF LIABILITY | Liability | Enter limit: The limit amount for combined single limit liability (may be called protection and indemnity). |
| WATERCRAFT COVERAGES/LIMITS OF LIABILITY | Medical Payments | Enter limit: The limit for medical payments for bodily injury to occupants of the boat coverage. |
| WATERCRAFT COVERAGES/LIMITS OF LIABILITY | Uninsured Boaters Liability | Enter limit: The each accident limit for uninsured boaters coverage. |
| WATERCRAFT COVERAGES/LIMITS OF LIABILITY | Deductible | Enter deductible: The deductible for boat (hull) coverage. |
| PERSONAL UMBRELLA COVERAGES/LIMITS OF LIABILITY | Add | Check the box (if applicable): Indicates if the type of change being requested is an add. |
| Section Name | Field Name | Field and/or Section Description |
|---|---|---|
| PERSONAL UMBRELLA COVERAGES/LIMITS OF LIABILITY | Change | Check the box (if applicable): Indicates if the type of change being requested is a change to an existing piece of data. |
| PERSONAL UMBRELLA COVERAGES/LIMITS OF LIABILITY | Delete | Check the box (if applicable): Indicates if the type of change being requested is a delete. |
| PERSONAL UMBRELLA COVERAGES/LIMITS OF LIABILITY | Policy Amount | Enter limit: The policy liability limit for personal umbrella coverage. |
| PERSONAL UMBRELLA COVERAGES/LIMITS OF LIABILITY | Retention | Enter amount: The amount of liability retained by the insured. Retention is usually expressed in whole dollars, but can be a percentage. |
| PERSONAL UMBRELLA COVERAGES/LIMITS OF LIABILITY | Other Coverages, Automobile, Personal Liability, Watercraft, Recreational Vehicles | Enter text: The description of other underlying coverages. |
| PERSONAL UMBRELLA COVERAGES/LIMITS OF LIABILITY | Automobile BI | Enter limit: The bodily injury each person limit on the underlying automobile policy. As used here, enter the bodily injury each accident limit in the combined single limit each accident field. |
| PERSONAL UMBRELLA COVERAGES/LIMITS OF LIABILITY | Automobile PD | Enter limit: The property damage each accident limit on the underlying automobile policy. |
| PERSONAL UMBRELLA COVERAGES/LIMITS OF LIABILITY | Automobile CSL | Enter limit: The combined single limit on the underlying automobile policy. As used here, contains the combined single or bodily injury each accident limit. |
| PERSONAL UMBRELLA COVERAGES/LIMITS OF LIABILITY | Personal Liability | Enter limit: The liability limit on the underlying homeowners policy. As used here, this contains the personal liability limit from the homeowners or dwelling fire policy. |
| PERSONAL UMBRELLA COVERAGES/LIMITS OF LIABILITY | Watercraft BI | Enter limit: The bodily injury each person limit on the underlying watercraft policy. As used here, enter the bodily injury each accident limit in the combined single limit each accident field. |
| PERSONAL UMBRELLA COVERAGES/LIMITS OF LIABILITY | Watercraft PD | Enter limit: The property damage each accident limit on the underlying watercraft policy. |
| PERSONAL UMBRELLA COVERAGES/LIMITS OF LIABILITY | Watercraft CSL | Enter limit: The combined single limit on the underlying watercraft policy. As used here, contains the combined single or bodily injury each accident limit. |
| Section Name | Field Name | Field and/or Section Description |
| PERSONAL UMBRELLA COVERAGES/LIMITS OF LIABILITY | Recreational Vehicles BI | Enter limit: The bodily injury each person limit on the underlying recreational vehicle policy. As used here, enter the bodily injury each accident limit in the combined single limit each accident field. |
| PERSONAL UMBRELLA COVERAGES/LIMITS OF LIABILITY | Recreational Vehicles PD | Enter limit: The property damage limit on the underlying recreational vehicle policy. |
| PERSONAL UMBRELLA COVERAGES/LIMITS OF LIABILITY | Recreational Vehicles CSL | Enter limit: The combined single limit on the underlying recreational vehicle policy. As used here, contains the combined single or bodily injury each accident limit. |
| REMARKS | Remarks | Enter text: The remarks associated with a policy change. Attach ACORD 101, Additional Remarks Schedule, if more space is required. |
| SIGNATURES | Producer’s Signature / Insured’s Signature | Sign here: Accommodates the signature of the authorized representative (e.g. producer, agent, broker, etc.) by all companies to issue Certificates. This is required in most states. |
| SIGNATURES | Producer’s Name (Please Print) | Enter text: The name of the authorized representative of the producer, agency and/or broker that signed the form. |
| SIGNATURES | State Producer License Number | Enter identifier: The State License Number of the producer. As used here, this is required in Florida. |
| SIGNATURES | Insured’s Signature | Sign here: Accommodates the signature of the applicant or named insured. |
| SIGNATURES | Date | Enter date: The date the form was signed by the named insured. |
| SIGNATURES | National Producer Number | Enter identifier: The National Producer Number (NPN) as defined in the National Insurance Producer Registry (NIPR). Note: The NPN is not the same as the producer state license number. |
| Edition | Date | The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM). |