ACORD 75 (2004/09) – Insurance Binder
The ACORD Insurance Binder addresses both Personal Lines and Commercial Lines risks, although most ACORD Personal Lines applications contain a “built-in” binder. For Commercial Lines, the layout format within the General Liability Section of the ACORD 75 is customized to the ISO Policy Simplification program.
Month/day/year on which the form is completed. (MM/DD/YYYY)
Agency’s name and address.
Phone (A/C, No, Ext)
Agency’s telephone number.
Agency’s fax number.
Identification code assigned to your agency or brokerage firm bythe insurance company receiving this form.
If your agency uses a subcode identification system with the company, enter the appropriate code.
Agency Customer ID
Customer’s identification number assigned by the agency.
Insured’s name and address as they appear on the policy declarations page.
Name of the applicable insurance company. Use the actual name of the company within the group to which this binder is being issued. Do not use group names.
Control number assigned to the binder for referencing purposes. If created by the agent, this number should be sequential and tracked within the Binder Log (ACORD 76). It may also be assigned by the company, in which case it might be the actual policy number. For control purposes, the number should be tracked within the Binder Log.
Effective Date and Time
Date on which the terms and conditions of the binder commenced. This date normally coincides with the effective date of the policy or of an endorsement to the policy. Indicate whether time is a.m. or p.m.
Expiration Date and Time
Date on which the terms and conditions of the policy will or have expired. Certain state laws limit the terms of a binder, so this date may not coincide with the policy expiration date. Indicate whether time is 12:01 a.m. or noon.
This Binder is issued to extend coverage in the above named company per expiring policy #
Check the available box and enter the policy number of the expiring policy. Use this option to extend coverage on a policy where renewal is not yet available.
Description of Operations / Vehicles / Property
Outline the operations of the insured, vehicle information and usage, and, for property exposures, location information. Examples include: Machine Tool Die Casters; 91 Chevy H10 Pick Up Truck – VIN C12345P8991, used for delivery; Location 1 – 123 North Main St, Hartford, Ct. If the location is the same as the mailing address, and this address is properly descriptive, state “same as mailing address,” rather than repeat the address.
All limits should be listed as dollar amounts.
Type of Insurance – Property
Complete this section when binding property coverages.
Causes of Loss
Check the appropriate box to indicate the Cause of Loss for which the property coverage is being bound. For options outside of Basic, Broad, orSpecial (Spec.), such as Spec. Excluding Theft or Homeowners – HO-3, enter the coverage name in the available space.
Subjects of insurance that are being covered and any necessary location information (e.g., Loc 1 Building Personal Property Dwelling).
Any deductible associated with the corresponding subject(s) of insurance.
Any applicable Coinsurance percentage associated with the corresponding subject(s) of insurance.
Type of Insurance – General Liability
Complete this section when binding general liability coverages.
Commercial General Liability
Check this box for Commercial General Liability (CGL) and the corresponding box to designate the type of policy issued and whether Claims Made or Occur. (Occurrence).
Other General Liability Coverages
Liability coverages not found on the form may be listed in the last three option boxes. The coverage type should be listed next to the available box (e.g., when binding Comprehensive Personal Liability, check the first box and insert “Comprehensive Personal Liability” on the line after the box).
For Commercial Lines policies, enter the classification code(s) and description of the class(es) for which the binder is being issued. Include any form numbers. For Personal Lines enter the policy form numbers.
Retro Date For Claims Made
If the Claims Made option box is checked, and there is a retroactive date, enter the date. If there is no retroactive date, enter “none.”
Complete the appropriate limits to match the policy declarations page. All limits should be listed as whole dollar amounts. Abbreviations are: Products Comp/Op Agg = Products Completed Operations Aggregate; Personal & Adv. Injury = Personal and Advertising Injury; Med. Exp. = Medical Expense
Type of Insurance – Automobile Liability
Complete this section when binding automobile liability coverages. Indicate which classes of vehicles are being bound by checking the appropriate boxes. Available options are: Any Auto, All Owned Autos, Scheduled Autos, Hired Autos and Non-Owned Autos. If coverage is for scheduled autos only, attach a list of the vehicles with their appropriate coverages. If other automobile coverages are desired, use the optional box and write the coverage name next to the box.
List any policy form numbers in this section.
Complete the appropriate limits to match the policy declarations page. All limits should be listed as whole dollar amounts. Use the optional limit line to list any coverage not specifically listed, such as AdditionalPersonal Injury Protection (APIP).
Type of Insurance – Auto Physical Damage
Complete this section when binding automobile physical damage coverages. If physical damage coverage is being bound, use the appropriate box to indicate Collision or Other than Collision coverage. List any deductibles in the available space.
All Vehicles/Scheduled Vehicles
Indicate if collision coverage applies to all or only scheduled vehicles.
Check the appropriate box to indicate what basis is to be used for determining the vehicle’s value. Options are: Actual Cash Value, Stated Amount and Other. For “Other,” list the valuation type in the space provided.
List the combined sum of the vehicle’s physical damage valuation.
Type of Insurance – Garage Liability
Complete this section only if you are binding garage liability. Use the available lines or the “Any Auto” option to indicate coverage specifics.
List any applicable coverage form numbers.
Complete the limits found on the Garage declarations page.
Type of Insurance – Excess Liability
Complete this section when binding some type of excess liability policy. For Umbrella policies, check the appropriate box. If the Other Than Umbrella box is checked, an additional reference should be made in the Coverage/Forms section stating the kind of policy and to which coverages the policy applies (e.g., Excess – Auto section).
Retro Date For Claims Made
If this is a Claims Made policy and there is a retroactive date, enter the date. If there is no retroactive date, enter “none.”
Complete the limits in accordance with the policy declarations page.
Type of Insurance – Workers Compensation and Employers Liability
Complete this section when binding workers compensation and/or employer’s liability policies. If the policy being bound is written using Statutory Limits, check the appropriate box. If Employers Liability is included, show the limits for “Each Accident,” “Disease-Each Employee,” and “Disease-Policy Limit.”
Special Conditions/Other Coverages
Provide any additional information pertinent to the bound policies. Include any special endorsements that are not specified in other sections of the binder. The area can also be used to add other coverages, refer to other binders, acknowledge receipt of deposit premium, or show fees, taxes and/or estimated premium.
NAME AND ADDRESS
Complete name and address of an additional interest if any have been indicated
Check the additional interest’s type in the appropriate box. Options are: Mortgagee, Loss Payee, Additional Insured or Other (Indicate).
List any loan number, account number or other controlling number that the additional interest may have assigned the insured.
Binders must be signed by authorized representatives of the issuing company.