Additional premises information schedule page of acord. Acord 125, commercial insurance application, applicant information section, is used in the underwriting process for any commercial accountacord 125, commercial insurance application, applicant information section, is used in the underwriting process for any commercial accountsubmission. Select a prefilled acord 125, 126 or 140 document in. A typical monoline cgl policy might be structured similarly to this. Use this stepbystep guide to complete the acord 125 200403 form quickly and with excellent precision. Do terminals have fire protection sprinklers, hoses, etc. Remarks acord 101, additional remarks schedule, may be attached if more space is required mine subsidence coverage required in il, in, ky and wv accept coverage reject coverage limit. Attach to acord 125 remarks acord 101, additional remarks schedule, may be attached if more space is required mine subsidence coverage required in il, in, ky and wv accept coverage reject coverage limit. Acord 125 200608 page 2 of 3 notice of insurance information practices personal information about you, including information from a credit report, may be collected from persons other than you in connection with this application for insurance and subsequent policy renewals. Pdfiller accord 125 fill online, printable, fillable.
Acord 125 200104 copy of the notice of information practices privacy has been given to the applicant. Important if claims made is checked in the policy information section below, this is an application for a. Additional interest not all fields apply to all scenarios provide only the necessary data. Agency management features have now been added to our web version. Failure to disclose the existence of an arson conviction is a misdemeanor. Agentbroker of record change please be advised that we wish to name as our exclusive representative effective. Additional interest not all fields apply to all scenarios provide only the necessary data policy number effective datenamed insureds. Acord 125 fill out and sign printable pdf template signnow. Other coverages, restrictions andor endorsements for hirednonowned auto coverages attach the applicable state business auto section, acord 7 important if claims made is checked in the coverage limits section below, this is an application for a claimsmade policy. The applicant information section is the foundation on which the acord commercial application program is built. Remarks acord 101, additional remarks schedule, may be attached if more space is required acord 129 attached for additional vehicles page 3 of 4 agency customer id. Create the application an application can be generated for a policy in both the client profile or in policy details.
A speeding violation of up to six 6 mph that occurs in an area with a maximum posted speed limit from 30 mph through 54 mph, or 2. The acord name and logo are registered marks of acord acord 36 200701 new agency current agency current producer policy numbers effective date expiration date named insured line of business. Acord 125 commercial insurance application cluett commercial. How to create a commercial insurance application acord. Commercial general liability section acord 126 201109. Important if claims made is checked in the policy information section below, this is an application for a claimsmade policy. A speeding violation of up to six 6 mph that occurs in. The applicant information section is the foundation on which the acord commercial application program. Acord 125 201603 page 3 of 4 occur dateexplanation resolution resolve date occur dateexplanation resolution resolve date 14. Acord 126 was designed to be used in conjunction with the commercial insurance application applicant information section acord 125. Prior carrier information remarks processing instructions acord 101, additional remarks schedule, may be attached if more space is required. This authorization replaces any other authorization that may have been. Agentbroker of record change please be advised that we wish to name as our exclusive representative effective for the lines of business shown above, currently in force or submitted by application.
Logon from anywhere in the world from any browser without installing any software and fill in any acord form and save the data to our secure server. Acord 126 200705 page 3 of 4 explain all yes responses for all past or present operations y n any person who knowingly and with intent to defraud any insurance company or another person files an application for insurance or. The acord 823 will generate automatically with the application for any commercial policy with more than four 4 locations. The advanced tools of the editor will lead you through the editable pdf template. This form is a section and should be attached to the acord125 when submitted.
Acord 75 209 the acord name and logo are registered marks of acord page 1 of 2 199320 acord corporation. To create this form you may begin at the policy or package level. Do terminals have security systems guards, alarms, 3. Remarks acord 101, additional remarks schedule, may be attached if more space is required attach to acord 125 the acord name and logo are registered marks of acord. The acord name and logo are registered marks of acord. A speeding violation of up to ten 10 mph that occurs in an area with a maximum posted speed limit.
How to create a commercial insurance application acord 125. Acord 126 200705 page 3 of 4 any person who knowingly and with intent to defraud any insurance company or another person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading information concerning any. Acord 125 201109 remarks processing instructions acord 101, additional remarks schedule, may be attached if more space is required page 3 of 4. Agentbroker of record change first choice insurance. If yes, attach acord 815 for liability exposure andor acord 816 for property exposure 12. Prior carrier information remarks processing instructions acord 101, additional remarks schedule, may be attached if more space is required page 3 of 4. Penalties may include imprisonment, fines, denial of insurance and civil damages. In ri, this question must be answered by any applicant for property insurance.