ACORD 126 FILLABLE PDF

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ACORD , Commercial General Liability Section, is a form of insurance designed to protect owners and operators of businesses from a wide variety of liability exposures.

If required for self-insurance, the self-insured license or contract number. The date that the terms and conditions of the policy commence. Use the actual name of the company within the group to which the policy has been issued. Any questions about appropriate limits or applicable policy coverage s should be answered by the issuing insurer s. LIMITS Other: check box Check the box if applicable : Indicates the general liability policy, general aggregate limit applies to code is other than those listed.

Use this section to provide any additional information required for underwriting or rating. All classifications should be grouped by location number. Enter the appropriate class description from the table in this field. The contents of this data element depends on the rating basis used.

The full amount of exposure is contained. Enter code: The rating territory code based on location from the appropriate state exception page. Proposed Retroactive Date Enter date: The retroactive date you are requesting for the policy being applied for. If this is the first such policy, the date will be the same as the proposed retroactive date shown on the preceding field.

If this is a renewal, it is the effective date of the first policy issued in the sequence of uninterrupted Claims Made policies. Has any product, work, accident or location been excluded, uninsured or self-insured from any previous coverage?

Was tail coverage purchased under any previous policy? Does applicant draw plans, designs, or specifications for others?

Do any operations include blasting or utilize or store explosive material? Do any operations include evacuation, tunneling, underground work or earth moving? Do your subcontractors carry coverages or limits less than yours?

Are subcontractors allowed to work without providing you with Certificates of Insurance? Does applicant lease equipment to others with or without operators? Does applicant install, service or demonstrate products? Foreign products sold, distributed, or used as components? Research and development conducted or new products planned? Guarantees, warranties, hold harmless agreements? Products recalled, discontinued, changed?

Products under label of others? Does any named insured sell to any other named insured? Jewelry, Furs, Contractors Equipment, etc. 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.

Any medical facilities provided or medical professionals employed or contracted? Do operations involve storing, treating, discharging, applying, disposing or transporting hazardous material? Any listed operations sold, acquired, or discontinued in the last five 5 years?

Is any machinery or equipment loaned or rented to others? Any watercraft, docks, floats owned, hired, or leased? Is a fee charged for parking? Are any recreational facilities provided?

Is there a swimming pool on the premises? Any sporting or social events sponsored? Any structural alterations contemplated? Any demolition exposure contemplated? Has applicant been active in or is currently active in joint ventures? Do you lease employees to or from others? Is there a labor interchange with any other business or subsidiaries? Are daycare facilities operated or controlled?

Have any crimes occurred or been attempted on your premises within the last three 3 years? Is there a formal, written safety and security policy in effect? Commercial General Liability Section. The title of the form. 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.

Enter date: The effective date of the policy. Check the box if applicable : Indicates the claims made or occurrence option applies for the general liability policy. Check the box if applicable : Indicates the general liability policy, occurrence basis applies.

Check the box if applicable : Indicates the owners and contractors protective option applies for the general liability policy. Check the box if applicable : Indicates other coverage not found on the form exists for the general liability policy.

Enter text: The description of other coverage not the limit on the general liability policy. Check the box if applicable : Indicates that a deductible is requested on the coverage other than Property Damage or Bodily Injury.

Enter text: The type of deductible being requested other than property damage and bodily injury. Check the box if applicable : Indicates that a per claim deductible applies to individual claims even if the claims are all related to the same occurrence or event. Check the box if applicable : Indicates that a per occurrence deductible applies once to each occurrence no matter how many individual claims result from the occurrence or event.

Enter limit: The general liability, general aggregate limit amount. Check the box if applicable : Indicates the general liability policy, general aggregate limit applies per policy.

Check the box if applicable : Indicates the general liability policy, general aggregate limit applies per project. Check the box if applicable : Indicates the general liability policy, general aggregate limit applies per location. Check the box if applicable : Indicates the general liability policy, general aggregate limit applies to code is other than those listed.

Enter code: The limit applies to code for the general liability policy, general aggregate limit. Enter limit: The general liability, products and completed operations aggregate limit amount.

Enter limit: The general liability, personal and advertising injury limit amount. Enter limit: The general liability, each occurrence limit amount. Enter limit: The general liability, damage to rented premises each occurrence limit amount. Enter limit: The general liability, medical expense each person limit amount. Enter text: The description of other coverage not the limit. Enter limit: The general liability, other coverage limit amount. Enter text: The remarks associated with the general liability line of business.

Enter number: A unique within location number distinguishing this unit-at-risk from the others. Enter code: The general liability class code that corresponds to the classification description shown in the previous field.

Enter amount: The amount of the exposure used for this class code in calculating the premium. Enter date: The retroactive date you are requesting for the policy being applied for.

Enter text: An explanation of a response to a general information or underwriting question. Yes checkbox. Enter text: The name used to identify the product manufactured or sold or service provided by the applicant. Enter amount: The whole dollar estimate of the annual sales receipts realized by this product or service.

Check the box if applicable : Indicates the additional interest is not any of the types listed on the form. Check the box if applicable : Indicates if the additional interest requires a Certificate of Insurance,. Enter identifier: The loan number, account number or other controlling number that the additional interest may have assigned the insured. Enter text: The description of the property class of the scheduled item i.

Enter number: The producer assigned number of the scheduled item which has an additional interest. Enter text: The description of the item of interest if needed to further clarify.

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