Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 144 (2013/09)
Glass and Sign Section
ACORD 144, Glass and Sign Section, is used to apply for glass and
sign coverages written under an Inland Marine or Property policy.
The applicant should describe the glass or sign in detail, including lettering,
ornamentation, class, mechanical operation and other important information which aids in
the total evaluation of the risk.
This form was designed to be used in conjunction with ACORD 125, Commercial
Insurance Application, Applicant Information Section and ACORD 140, Property Section.
Refer to the instructions for ACORD 125 and ACORD 140 for information on those Forms.
IDENTIFICATION SECTION Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
INFORMATION SECTION
Date
Enter date: The date on which the form is completed.
IDENTIFICATION SECTION Agency
Enter text: The full name of the producer/agency.
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 Effective Date
Enter date: The effective date of the policy. The date that the terms and conditions of the
policy commence.
IDENTIFICATION SECTION Carrier
Enter text: The insurer's full legal company name(s) as found in the file 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.
IDENTIFICATION SECTION NAIC Code
Enter code: The identification code assigned to the insurer by the NAIC.
IDENTIFICATION SECTION Applicant / First Named Insured
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
GLASS SCHEDULE
Premises Number One
Enter number: The location number for the premises. As used here, the premises number
where the glass is located. This may also appear on the Application Information Section
(ACORD 125).
GLASS SCHEDULE
Building Number One
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
GLASS SCHEDULE
Item Number One
Enter identifier: The number assigned by the producer to identify glass to be scheduled.
Plates with the same dimensions and description can be batched under the same number.
ACORD 144 (2013/09) rev. 06-28-2013
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Section Name
Field Name
Field and/or Section Description
GLASS SCHEDULE
Number of Plates One
Enter number: The number of plates of glass to be insured with the same dimensions and
description.
GLASS SCHEDULE
Plate Size - Length One
Enter number: The horizontal length, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Width One
Enter number: The vertical width, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Area One
Enter number: The area, measured in square feet, of the plates to be insured. For odd-
sized plates, you may need to compute the area (e.g., the size needed to replace a round
piece of glass is a rectangle large enough to allow the circle to be cut from it).
GLASS SCHEDULE
Description One
Enter text: The detailed description of the glass to be insured. Identify stained glass items
and specify lettering, ornamentation, or class. Describe the type of frame holding each
piece of glass and whether or not it is safety glass.
GLASS SCHEDULE
Use and Position One
Enter text: The use and position of glass at each location (e.g., ground floor show
windows, ground floor door). This is especially important for freezer cases and display
windows. Indicate what floor the glass is on and whether it is interior or exterior glass.
GLASS SCHEDULE
Limit of Insurance One
Enter limit: The limit for the glass coverage. Replacement cost of the pane, plus lettering,
tape and any other item that increases the value.
GLASS SCHEDULE
Deductible One
Enter deductible: The deductible for the glass coverage.
GLASS SCHEDULE
Premises Number Two
Enter number: The location number for the premises. As used here, the premises number
where the glass is located. This may also appear on the Application Information Section
(ACORD 125).
GLASS SCHEDULE
Building Number Two
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
GLASS SCHEDULE
Item Number Two
Enter identifier: The number assigned by the producer to identify glass to be scheduled.
Plates with the same dimensions and description can be batched under the same number.
GLASS SCHEDULE
Number of Plates Two
Enter number: The number of plates of glass to be insured with the same dimensions and
description.
GLASS SCHEDULE
Plate Size - Length Two
Enter number: The horizontal length, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Width Two
Enter number: The vertical width, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Area Two
Enter number: The area, measured in square feet, of the plates to be insured. For odd-
sized plates, you may need to compute the area (e.g., the size needed to replace a round
piece of glass is a rectangle large enough to allow the circle to be cut from it).
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Section Name
Field Name
Field and/or Section Description
GLASS SCHEDULE
Description Two
Enter text: The detailed description of the glass to be insured. Identify stained glass items
and specify lettering, ornamentation, or class. Describe the type of frame holding each
piece of glass and whether or not it is safety glass.
GLASS SCHEDULE
Use and Position Two
Enter text: The use and position of glass at each location (e.g., ground floor show
windows, ground floor door). This is especially important for freezer cases and display
windows. Indicate what floor the glass is on and whether it is interior or exterior glass.
GLASS SCHEDULE
Limit of Insurance Two
Enter limit: The limit for the glass coverage. Replacement cost of the pane, plus lettering,
tape and any other item that increases the value.
GLASS SCHEDULE
Deductible Two
Enter deductible: The deductible for the glass coverage.
GLASS SCHEDULE
Premises Number Three
Enter number: The location number for the premises. As used here, the premises number
where the glass is located. This may also appear on the Application Information Section
(ACORD 125).
GLASS SCHEDULE
Building Number Three
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
GLASS SCHEDULE
Item Number Three
Enter identifier: The number assigned by the producer to identify glass to be scheduled.
Plates with the same dimensions and description can be batched under the same number.
GLASS SCHEDULE
Number of Plates Three
Enter number: The number of plates of glass to be insured with the same dimensions and
description.
GLASS SCHEDULE
Plate Size - Length Three
Enter number: The horizontal length, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Width Three
Enter number: The vertical width, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Area Three
Enter number: The area, measured in square feet, of the plates to be insured. For odd-
sized plates, you may need to compute the area (e.g., the size needed to replace a round
piece of glass is a rectangle large enough to allow the circle to be cut from it).
GLASS SCHEDULE
Description Three
Enter text: The detailed description of the glass to be insured. Identify stained glass items
and specify lettering, ornamentation, or class. Describe the type of frame holding each
piece of glass and whether or not it is safety glass.
GLASS SCHEDULE
Use and Position Three
Enter text: The use and position of glass at each location (e.g., ground floor show
windows, ground floor door). This is especially important for freezer cases and display
windows. Indicate what floor the glass is on and whether it is interior or exterior glass.
GLASS SCHEDULE
Limit of Insurance Three
Enter limit: The limit for the glass coverage. Replacement cost of the pane, plus lettering,
tape and any other item that increases the value.
GLASS SCHEDULE
Deductible Three
Enter deductible: The deductible for the glass coverage.
ACORD 144 (2013/09) rev. 06-28-2013
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Section Name
Field Name
Field and/or Section Description
GLASS SCHEDULE
Premises Number Four
Enter number: The location number for the premises. As used here, the premises number
where the glass is located. This may also appear on the Application Information Section
(ACORD 125).
GLASS SCHEDULE
Building Number Four
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
GLASS SCHEDULE
Item Number Four
Enter identifier: The number assigned by the producer to identify glass to be scheduled.
Plates with the same dimensions and description can be batched under the same number.
GLASS SCHEDULE
Number of Plates Four
Enter number: The number of plates of glass to be insured with the same dimensions and
description.
GLASS SCHEDULE
Plate Size - Length Four
Enter number: The horizontal length, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Width Four
Enter number: The vertical width, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Area Four
Enter number: The area, measured in square feet, of the plates to be insured. For odd-
sized plates, you may need to compute the area (e.g., the size needed to replace a round
piece of glass is a rectangle large enough to allow the circle to be cut from it).
GLASS SCHEDULE
Description Four
Enter text: The detailed description of the glass to be insured. Identify stained glass items
and specify lettering, ornamentation, or class. Describe the type of frame holding each
piece of glass and whether or not it is safety glass.
GLASS SCHEDULE
Use and Position Four
Enter text: The use and position of glass at each location (e.g., ground floor show
windows, ground floor door). This is especially important for freezer cases and display
windows. Indicate what floor the glass is on and whether it is interior or exterior glass.
GLASS SCHEDULE
Limit of Insurance Four
Enter limit: The limit for the glass coverage. Replacement cost of the pane, plus lettering,
tape and any other item that increases the value.
GLASS SCHEDULE
Deductible Four
Enter deductible: The deductible for the glass coverage.
GLASS SCHEDULE
Premises Number Five
Enter number: The location number for the premises. As used here, the premises number
where the glass is located. This may also appear on the Application Information Section
(ACORD 125).
GLASS SCHEDULE
Building Number Five
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
GLASS SCHEDULE
Item Number Five
Enter identifier: The number assigned by the producer to identify glass to be scheduled.
Plates with the same dimensions and description can be batched under the same number.
GLASS SCHEDULE
Number of Plates Five
Enter number: The number of plates of glass to be insured with the same dimensions and
description.
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Section Name
Field Name
Field and/or Section Description
GLASS SCHEDULE
Plate Size - Length Five
Enter number: The horizontal length, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Width Five
Enter number: The vertical width, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Area Five
Enter number: The area, measured in square feet, of the plates to be insured. For odd-
sized plates, you may need to compute the area (e.g., the size needed to replace a round
piece of glass is a rectangle large enough to allow the circle to be cut from it).
GLASS SCHEDULE
Description Five
Enter text: The detailed description of the glass to be insured. Identify stained glass items
and specify lettering, ornamentation, or class. Describe the type of frame holding each
piece of glass and whether or not it is safety glass.
GLASS SCHEDULE
Use and Position Five
Enter text: The use and position of glass at each location (e.g., ground floor show
windows, ground floor door). This is especially important for freezer cases and display
windows. Indicate what floor the glass is on and whether it is interior or exterior glass.
GLASS SCHEDULE
Limit of Insurance Five
Enter limit: The limit for the glass coverage. Replacement cost of the pane, plus lettering,
tape and any other item that increases the value.
GLASS SCHEDULE
Deductible Five
Enter deductible: The deductible for the glass coverage.
GLASS SCHEDULE
Premises Number Six
Enter number: The location number for the premises. As used here, the premises number
where the glass is located. This may also appear on the Application Information Section
(ACORD 125).
GLASS SCHEDULE
Building Number Six
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
GLASS SCHEDULE
Item Number Six
Enter identifier: The number assigned by the producer to identify glass to be scheduled.
Plates with the same dimensions and description can be batched under the same number.
GLASS SCHEDULE
Number of Plates Six
Enter number: The number of plates of glass to be insured with the same dimensions and
description.
GLASS SCHEDULE
Plate Size - Length Six
Enter number: The horizontal length, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Width Six
Enter number: The vertical width, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Area Six
Enter number: The area, measured in square feet, of the plates to be insured. For odd-
sized plates, you may need to compute the area (e.g., the size needed to replace a round
piece of glass is a rectangle large enough to allow the circle to be cut from it).
GLASS SCHEDULE
Description Six
Enter text: The detailed description of the glass to be insured. Identify stained glass items
and specify lettering, ornamentation, or class. Describe the type of frame holding each
piece of glass and whether or not it is safety glass.
ACORD 144 (2013/09) rev. 06-28-2013
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Section Name
Field Name
Field and/or Section Description
GLASS SCHEDULE
Use and Position Six
Enter text: The use and position of glass at each location (e.g., ground floor show
windows, ground floor door). This is especially important for freezer cases and display
windows. Indicate what floor the glass is on and whether it is interior or exterior glass.
GLASS SCHEDULE
Limit of Insurance Six
Enter limit: The limit for the glass coverage. Replacement cost of the pane, plus lettering,
tape and any other item that increases the value.
GLASS SCHEDULE
Deductible Six
Enter deductible: The deductible for the glass coverage.
GLASS SCHEDULE
Premises Number Seven
Enter number: The location number for the premises. As used here, the premises number
where the glass is located. This may also appear on the Application Information Section
(ACORD 125).
GLASS SCHEDULE
Building Number Seven
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
GLASS SCHEDULE
Item Number Seven
Enter identifier: The number assigned by the producer to identify glass to be scheduled.
Plates with the same dimensions and description can be batched under the same number.
GLASS SCHEDULE
Number of Plates Seven
Enter number: The number of plates of glass to be insured with the same dimensions and
description.
GLASS SCHEDULE
Plate Size - Length Seven
Enter number: The horizontal length, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Width Seven
Enter number: The vertical width, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Area Seven
Enter number: The area, measured in square feet, of the plates to be insured. For odd-
sized plates, you may need to compute the area (e.g., the size needed to replace a round
piece of glass is a rectangle large enough to allow the circle to be cut from it).
GLASS SCHEDULE
Description Seven
Enter text: The detailed description of the glass to be insured. Identify stained glass items
and specify lettering, ornamentation, or class. Describe the type of frame holding each
piece of glass and whether or not it is safety glass.
GLASS SCHEDULE
Use and Position Seven
Enter text: The use and position of glass at each location (e.g., ground floor show
windows, ground floor door). This is especially important for freezer cases and display
windows. Indicate what floor the glass is on and whether it is interior or exterior glass.
GLASS SCHEDULE
Limit of Insurance Seven
Enter limit: The limit for the glass coverage. Replacement cost of the pane, plus lettering,
tape and any other item that increases the value.
GLASS SCHEDULE
Deductible Seven
Enter deductible: The deductible for the glass coverage.
GLASS SCHEDULE
Premises Number Eight
Enter number: The location number for the premises. As used here, the premises number
where the glass is located. This may also appear on the Application Information Section
(ACORD 125).
ACORD 144 (2013/09) rev. 06-28-2013
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Section Name
Field Name
Field and/or Section Description
GLASS SCHEDULE
Building Number Eight
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
GLASS SCHEDULE
Item Number Eight
Enter identifier: The number assigned by the producer to identify glass to be scheduled.
Plates with the same dimensions and description can be batched under the same number.
GLASS SCHEDULE
Number of Plates Eight
Enter number: The number of plates of glass to be insured with the same dimensions and
description.
GLASS SCHEDULE
Plate Size - Length Eight
Enter number: The horizontal length, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Width Eight
Enter number: The vertical width, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Area Eight
Enter number: The area, measured in square feet, of the plates to be insured. For odd-
sized plates, you may need to compute the area (e.g., the size needed to replace a round
piece of glass is a rectangle large enough to allow the circle to be cut from it).
GLASS SCHEDULE
Description Eight
Enter text: The detailed description of the glass to be insured. Identify stained glass items
and specify lettering, ornamentation, or class. Describe the type of frame holding each
piece of glass and whether or not it is safety glass.
GLASS SCHEDULE
Use and Position Eight
Enter text: The use and position of glass at each location (e.g., ground floor show
windows, ground floor door). This is especially important for freezer cases and display
windows. Indicate what floor the glass is on and whether it is interior or exterior glass.
GLASS SCHEDULE
Limit of Insurance Eight
Enter limit: The limit for the glass coverage. Replacement cost of the pane, plus lettering,
tape and any other item that increases the value.
GLASS SCHEDULE
Deductible Eight
Enter deductible: The deductible for the glass coverage.
GLASS SCHEDULE
Premises Number Nine
Enter number: The location number for the premises. As used here, the premises number
where the glass is located. This may also appear on the Application Information Section
(ACORD 125).
GLASS SCHEDULE
Building Number Nine
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
GLASS SCHEDULE
Item Number Nine
Enter identifier: The number assigned by the producer to identify glass to be scheduled.
Plates with the same dimensions and description can be batched under the same number.
GLASS SCHEDULE
Number of Plates Nine
Enter number: The number of plates of glass to be insured with the same dimensions and
description.
GLASS SCHEDULE
Plate Size - Length Nine
Enter number: The horizontal length, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Width Nine
Enter number: The vertical width, measured in feet, of the plates to be insured.
ACORD 144 (2013/09) rev. 06-28-2013
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Section Name
Field Name
Field and/or Section Description
GLASS SCHEDULE
Plate Size - Area Nine
Enter number: The area, measured in square feet, of the plates to be insured. For odd-
sized plates, you may need to compute the area (e.g., the size needed to replace a round
piece of glass is a rectangle large enough to allow the circle to be cut from it).
GLASS SCHEDULE
Description Nine
Enter text: The detailed description of the glass to be insured. Identify stained glass items
and specify lettering, ornamentation, or class. Describe the type of frame holding each
piece of glass and whether or not it is safety glass.
GLASS SCHEDULE
Use and Position Nine
Enter text: The use and position of glass at each location (e.g., ground floor show
windows, ground floor door). This is especially important for freezer cases and display
windows. Indicate what floor the glass is on and whether it is interior or exterior glass.
GLASS SCHEDULE
Limit of Insurance Nine
Enter limit: The limit for the glass coverage. Replacement cost of the pane, plus lettering,
tape and any other item that increases the value.
GLASS SCHEDULE
Deductible Nine
Enter deductible: The deductible for the glass coverage.
GLASS SCHEDULE
Premises Number Ten
Enter number: The location number for the premises. As used here, the premises number
where the glass is located. This may also appear on the Application Information Section
(ACORD 125).
GLASS SCHEDULE
Building Number Ten
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
GLASS SCHEDULE
Item Number Ten
Enter identifier: The number assigned by the producer to identify glass to be scheduled.
Plates with the same dimensions and description can be batched under the same number.
GLASS SCHEDULE
Number of Plates Ten
Enter number: The number of plates of glass to be insured with the same dimensions and
description.
GLASS SCHEDULE
Plate Size - Length Ten
Enter number: The horizontal length, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Width Ten
Enter number: The vertical width, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Area Ten
Enter number: The area, measured in square feet, of the plates to be insured. For odd-
sized plates, you may need to compute the area (e.g., the size needed to replace a round
piece of glass is a rectangle large enough to allow the circle to be cut from it).
GLASS SCHEDULE
Description Ten
Enter text: The detailed description of the glass to be insured. Identify stained glass items
and specify lettering, ornamentation, or class. Describe the type of frame holding each
piece of glass and whether or not it is safety glass.
ACORD 144 (2013/09) rev. 06-28-2013
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Section Name
Field Name
Field and/or Section Description
GLASS SCHEDULE
Use and Position Ten
Enter text: The use and position of glass at each location (e.g., ground floor show
windows, ground floor door). This is especially important for freezer cases and display
windows. Indicate what floor the glass is on and whether it is interior or exterior glass.
GLASS SCHEDULE
Limit of Insurance Ten
Enter limit: The limit for the glass coverage. Replacement cost of the pane, plus lettering,
tape and any other item that increases the value.
GLASS SCHEDULE
Deductible Ten
Enter deductible: The deductible for the glass coverage.
GLASS SCHEDULE
Premises Number Eleven
Enter number: The location number for the premises. As used here, the premises number
where the glass is located. This may also appear on the Application Information Section
(ACORD 125).
GLASS SCHEDULE
Building Number Eleven
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
GLASS SCHEDULE
Item Number Eleven
Enter identifier: The number assigned by the producer to identify glass to be scheduled.
Plates with the same dimensions and description can be batched under the same number.
GLASS SCHEDULE
Number of Plates Eleven
Enter number: The number of plates of glass to be insured with the same dimensions and
description.
GLASS SCHEDULE
Plate Size - Length Eleven
Enter number: The horizontal length, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Width Eleven
Enter number: The vertical width, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Area Eleven
Enter number: The area, measured in square feet, of the plates to be insured. For odd-
sized plates, you may need to compute the area (e.g., the size needed to replace a round
piece of glass is a rectangle large enough to allow the circle to be cut from it).
GLASS SCHEDULE
Description Eleven
Enter text: The detailed description of the glass to be insured. Identify stained glass items
and specify lettering, ornamentation, or class. Describe the type of frame holding each
piece of glass and whether or not it is safety glass.
GLASS SCHEDULE
Use and Position Eleven
Enter text: The use and position of glass at each location (e.g., ground floor show
windows, ground floor door). This is especially important for freezer cases and display
windows. Indicate what floor the glass is on and whether it is interior or exterior glass.
GLASS SCHEDULE
Limit of Insurance Eleven
Enter limit: The limit for the glass coverage. Replacement cost of the pane, plus lettering,
tape and any other item that increases the value.
GLASS SCHEDULE
Deductible Eleven
Enter deductible: The deductible for the glass coverage.
GLASS SCHEDULE
Premises Number Twelve
Enter number: The location number for the premises. As used here, the premises number
where the glass is located. This may also appear on the Application Information Section
(ACORD 125).
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Section Name
Field Name
Field and/or Section Description
GLASS SCHEDULE
Building Number Twelve
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
GLASS SCHEDULE
Item Number Twelve
Enter identifier: The number assigned by the producer to identify glass to be scheduled.
Plates with the same dimensions and description can be batched under the same number.
GLASS SCHEDULE
Number of Plates Twelve
Enter number: The number of plates of glass to be insured with the same dimensions and
description.
GLASS SCHEDULE
Plate Size - Length Twelve
Enter number: The horizontal length, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Width Twelve
Enter number: The vertical width, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Area Twelve
Enter number: The area, measured in square feet, of the plates to be insured. For odd-
sized plates, you may need to compute the area (e.g., the size needed to replace a round
piece of glass is a rectangle large enough to allow the circle to be cut from it).
GLASS SCHEDULE
Description Twelve
Enter text: The detailed description of the glass to be insured. Identify stained glass items
and specify lettering, ornamentation, or class. Describe the type of frame holding each
piece of glass and whether or not it is safety glass.
GLASS SCHEDULE
Use and Position Twelve
Enter text: The use and position of glass at each location (e.g., ground floor show
windows, ground floor door). This is especially important for freezer cases and display
windows. Indicate what floor the glass is on and whether it is interior or exterior glass.
GLASS SCHEDULE
Limit of Insurance Twelve
Enter limit: The limit for the glass coverage. Replacement cost of the pane, plus lettering,
tape and any other item that increases the value.
GLASS SCHEDULE
Deductible Twelve
Enter deductible: The deductible for the glass coverage.
GLASS SCHEDULE
Premises Number Thirteen
Enter number: The location number for the premises. As used here, the premises number
where the glass is located. This may also appear on the Application Information Section
(ACORD 125).
GLASS SCHEDULE
Building Number Thirteen
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
GLASS SCHEDULE
Item Number Thirteen
Enter identifier: The number assigned by the producer to identify glass to be scheduled.
Plates with the same dimensions and description can be batched under the same number.
GLASS SCHEDULE
Number of Plates Thirteen
Enter number: The number of plates of glass to be insured with the same dimensions and
description.
GLASS SCHEDULE
Plate Size - Length Thirteen
Enter number: The horizontal length, measured in feet, of the plates to be insured.
GLASS SCHEDULE
Plate Size - Width Thirteen
Enter number: The vertical width, measured in feet, of the plates to be insured.
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Section Name
Field Name
Field and/or Section Description
GLASS SCHEDULE
Plate Size - Area Thirteen
Enter number: The area, measured in square feet, of the plates to be insured. For odd-
sized plates, you may need to compute the area (e.g., the size needed to replace a round
piece of glass is a rectangle large enough to allow the circle to be cut from it).
GLASS SCHEDULE
Description Thirteen
Enter text: The detailed description of the glass to be insured. Identify stained glass items
and specify lettering, ornamentation, or class. Describe the type of frame holding each
piece of glass and whether or not it is safety glass.
GLASS SCHEDULE
Use and Position Thirteen
Enter text: The use and position of glass at each location (e.g., ground floor show
windows, ground floor door). This is especially important for freezer cases and display
windows. Indicate what floor the glass is on and whether it is interior or exterior glass.
GLASS SCHEDULE
Limit of Insurance Thirteen
Enter limit: The limit for the glass coverage. Replacement cost of the pane, plus lettering,
tape and any other item that increases the value.
GLASS SCHEDULE
Deductible Thirteen
Enter deductible: The deductible for the glass coverage.
GLASS SCHEDULE
Total Premium
Enter amount: The total premium amount for glass coverage.
SIGN SCHEDULE
Premises Number One
Enter number: The location number for the premises. As used here, the premises number
where the sign is located. This may also appear on the Application Information Section
(ACORD 125).
SIGN SCHEDULE
Building Number One
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
SIGN SCHEDULE
Item Number One
Enter identifier: The number assigned by the producer to identify the sign to be scheduled.
SIGN SCHEDULE
Inside/Outside One
Enter code: Indicates if the sign is located inside or outside a building. Different rates may
apply for each.
SIGN SCHEDULE
Description One
Enter text: The detailed description of the kind and size of the sign to be insured. Specify
any lettering or ornamentation including whether the sign has mechanical parts or lighting.
Specify neon light, electrical, fluorescent bulbs, etc.
SIGN SCHEDULE
Limit of Insurance One
Enter amount: The limit for the sign coverage. The replacement cost for the sign.
SIGN SCHEDULE
Deductible One
Enter deductible: The deductible for the sign coverage.
SIGN SCHEDULE
Premises Number Two
Enter number: The location number for the premises. As used here, the premises number
where the sign is located. This may also appear on the Application Information Section
(ACORD 125).
SIGN SCHEDULE
Building Number Two
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
SIGN SCHEDULE
Item Number Two
Enter identifier: The number assigned by the producer to identify the sign to be scheduled.
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Section Name
Field Name
Field and/or Section Description
SIGN SCHEDULE
Inside/Outside Two
Enter code: Indicates if the sign is located inside or outside a building. Different rates may
apply for each.
SIGN SCHEDULE
Description Two
Enter text: The detailed description of the kind and size of the sign to be insured. Specify
any lettering or ornamentation including whether the sign has mechanical parts or lighting.
Specify neon light, electrical, fluorescent bulbs, etc.
SIGN SCHEDULE
Limit of Insurance Two
Enter amount: The limit for the sign coverage. The replacement cost for the sign.
SIGN SCHEDULE
Deductible Two
Enter deductible: The deductible for the sign coverage.
SIGN SCHEDULE
Premises Number Three
Enter number: The location number for the premises. As used here, the premises number
where the sign is located. This may also appear on the Application Information Section
(ACORD 125).
SIGN SCHEDULE
Building Number Three
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
SIGN SCHEDULE
Item Number Three
Enter identifier: The number assigned by the producer to identify the sign to be scheduled.
SIGN SCHEDULE
Inside/Outside Three
Enter code: Indicates if the sign is located inside or outside a building. Different rates may
apply for each.
SIGN SCHEDULE
Description Three
Enter text: The detailed description of the kind and size of the sign to be insured. Specify
any lettering or ornamentation including whether the sign has mechanical parts or lighting.
Specify neon light, electrical, fluorescent bulbs, etc.
SIGN SCHEDULE
Limit of Insurance Three
Enter amount: The limit for the sign coverage. The replacement cost for the sign.
SIGN SCHEDULE
Deductible Three
Enter deductible: The deductible for the sign coverage.
SIGN SCHEDULE
Premises Number Four
Enter number: The location number for the premises. As used here, the premises number
where the sign is located. This may also appear on the Application Information Section
(ACORD 125).
SIGN SCHEDULE
Building Number Four
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
SIGN SCHEDULE
Item Number Four
Enter identifier: The number assigned by the producer to identify the sign to be scheduled.
SIGN SCHEDULE
Inside/Outside Four
Enter code: Indicates if the sign is located inside or outside a building. Different rates may
apply for each.
SIGN SCHEDULE
Description Four
Enter text: The detailed description of the kind and size of the sign to be insured. Specify
any lettering or ornamentation including whether the sign has mechanical parts or lighting.
Specify neon light, electrical, fluorescent bulbs, etc.
SIGN SCHEDULE
Limit of Insurance Four
Enter amount: The limit for the sign coverage. The replacement cost for the sign.
SIGN SCHEDULE
Deductible Four
Enter deductible: The deductible for the sign coverage.
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Section Name
Field Name
Field and/or Section Description
SIGN SCHEDULE
Premises Number Five
Enter number: The location number for the premises. As used here, the premises number
where the sign is located. This may also appear on the Application Information Section
(ACORD 125).
SIGN SCHEDULE
Building Number Five
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
SIGN SCHEDULE
Item Number Five
Enter identifier: The number assigned by the producer to identify the sign to be scheduled.
SIGN SCHEDULE
Inside/Outside Five
Enter code: Indicates if the sign is located inside or outside a building. Different rates may
apply for each.
SIGN SCHEDULE
Description Five
Enter text: The detailed description of the kind and size of the sign to be insured. Specify
any lettering or ornamentation including whether the sign has mechanical parts or lighting.
Specify neon light, electrical, fluorescent bulbs, etc.
SIGN SCHEDULE
Limit of Insurance Five
Enter amount: The limit for the sign coverage. The replacement cost for the sign.
SIGN SCHEDULE
Deductible Five
Enter deductible: The deductible for the sign coverage.
SIGN SCHEDULE
Premises Number Six
Enter number: The location number for the premises. As used here, the premises number
where the sign is located. This may also appear on the Application Information Section
(ACORD 125).
SIGN SCHEDULE
Building Number Six
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
SIGN SCHEDULE
Item Number Six
Enter identifier: The number assigned by the producer to identify the sign to be scheduled.
SIGN SCHEDULE
Inside/Outside Six
Enter code: Indicates if the sign is located inside or outside a building. Different rates may
apply for each.
SIGN SCHEDULE
Description Six
Enter text: The detailed description of the kind and size of the sign to be insured. Specify
any lettering or ornamentation including whether the sign has mechanical parts or lighting.
Specify neon light, electrical, fluorescent bulbs, etc.
SIGN SCHEDULE
Limit of Insurance Six
Enter amount: The limit for the sign coverage. The replacement cost for the sign.
SIGN SCHEDULE
Deductible Six
Enter deductible: The deductible for the sign coverage.
SIGN SCHEDULE
Premises Number Seven
Enter number: The location number for the premises. As used here, the premises number
where the sign is located. This may also appear on the Application Information Section
(ACORD 125).
SIGN SCHEDULE
Building Number Seven
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
SIGN SCHEDULE
Item Number Seven
Enter identifier: The number assigned by the producer to identify the sign to be scheduled.
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Section Name
Field Name
Field and/or Section Description
SIGN SCHEDULE
Inside/Outside Seven
Enter code: Indicates if the sign is located inside or outside a building. Different rates may
apply for each.
SIGN SCHEDULE
Description Seven
Enter text: The detailed description of the kind and size of the sign to be insured. Specify
any lettering or ornamentation including whether the sign has mechanical parts or lighting.
Specify neon light, electrical, fluorescent bulbs, etc.
SIGN SCHEDULE
Limit of Insurance Seven
Enter amount: The limit for the sign coverage. The replacement cost for the sign.
SIGN SCHEDULE
Deductible Seven
Enter deductible: The deductible for the sign coverage.
SIGN SCHEDULE
Premises Number Eight
Enter number: The location number for the premises. As used here, the premises number
where the sign is located. This may also appear on the Application Information Section
(ACORD 125).
SIGN SCHEDULE
Building Number Eight
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
SIGN SCHEDULE
Item Number Eight
Enter identifier: The number assigned by the producer to identify the sign to be scheduled.
SIGN SCHEDULE
Inside/Outside Eight
Enter code: Indicates if the sign is located inside or outside a building. Different rates may
apply for each.
SIGN SCHEDULE
Description Eight
Enter text: The detailed description of the kind and size of the sign to be insured. Specify
any lettering or ornamentation including whether the sign has mechanical parts or lighting.
Specify neon light, electrical, fluorescent bulbs, etc.
SIGN SCHEDULE
Limit of Insurance Eight
Enter amount: The limit for the sign coverage. The replacement cost for the sign.
SIGN SCHEDULE
Deductible Eight
Enter deductible: The deductible for the sign coverage.
SIGN SCHEDULE
Premises Number Nine
Enter number: The location number for the premises. As used here, the premises number
where the sign is located. This may also appear on the Application Information Section
(ACORD 125).
SIGN SCHEDULE
Building Number Nine
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
SIGN SCHEDULE
Item Number Nine
Enter identifier: The number assigned by the producer to identify the sign to be scheduled.
SIGN SCHEDULE
Inside/Outside Nine
Enter code: Indicates if the sign is located inside or outside a building. Different rates may
apply for each.
SIGN SCHEDULE
Description Nine
Enter text: The detailed description of the kind and size of the sign to be insured. Specify
any lettering or ornamentation including whether the sign has mechanical parts or lighting.
Specify neon light, electrical, fluorescent bulbs, etc.
SIGN SCHEDULE
Limit of Insurance Nine
Enter amount: The limit for the sign coverage. The replacement cost for the sign.
SIGN SCHEDULE
Deductible Nine
Enter deductible: The deductible for the sign coverage.
GLASS SCHEDULE
Total Premium
Enter amount: The total premium amount for sign coverage.
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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).
GENERAL INFORMATION
Are there any partial or complete
painted plates? Yes/No
Enter Y for a Yes response. Input N for No response. Indicate if any plate glass to be
insured has any design or lettering painted on it. If yes, specify what percentage of the
plate has been painted. Include the type of decoration and if hand-painted.
GENERAL INFORMATION
Remarks
Enter text: An explanation of any partial or complete painted plates.
GENERAL INFORMATION
Any plates fixed, glued or in angle
settings? Yes/No
Enter Y for a Yes response. Input N for No response. Indicates whether any plates are
Fixed, Glued or in angle setting. If yes, describe which plates are fixed, glued, or in
special angle settings.
GENERAL INFORMATION
Remarks
Enter text: An explanation of any plates that have fixed or glued angle settings.
GENERAL INFORMATION
Any obstruction or unusual
settings? Yes/No
Enter Y for a Yes response. Input N for No response. Indicates if glass has any
obstructions or has other unusual features that make replacement difficult, or if the frames
are unusual. Both situations can make it difficult or costly to repair/replace.
GENERAL INFORMATION
Remarks
Enter text: An explanation of any obstruction or unusual settings.
GENERAL INFORMATION
Does applicant wish to insure tape
on glass? Yes/No
Enter Y for a Yes response. Input N for No response. Indicates if the applicant wishes
to insure tape on glass. If yes, specify the type of tape and the value.
GENERAL INFORMATION
Remarks
Enter text: An explanation as to whether the applicant wishes to insured tape on glass.
GENERAL INFORMATION
Does applicant wish to insure
lettering on glass? Yes/No
Enter Y for a Yes response. Input N for No response. Indicates if applicant has special
lettering to be insured. Specify type of lettering and give approximate value.
GENERAL INFORMATION
Remarks
Enter text: An explanation as to whether the applicant wishes to insure lettering on glass.
GENERAL INFORMATION
Is glass protected by wire mesh or
U.L.-approved burglary resistant
glazing material? Yes/No
Enter Y for a Yes response. Input N for No response. Indicates if the glass is protected
by wire mesh or U.L. approved burglary resistant glazing material. Describe the security
measures taken to protect the glass.
GENERAL INFORMATION
Remarks
Enter text: An explanation as to whether glass is protected by wire mesh or U.L. approved
burglary resistant glazing material.
GENERAL INFORMATION
Is all exterior glass above second
floor? Yes/No
Enter Y for a Yes response. Input N for No response. Indicates if all exterior glass is
above the second floor. If no, describe which panes are located above the second floor.
GENERAL INFORMATION
Remarks
Enter text: An explanation as to whether all exterior glass is above the second floor.
GENERAL INFORMATION
Is all exterior glass insured?
Yes/No
Enter Y for a Yes response. Input N for No response. Indicates if all exterior glass is to
be insured. If no, describe what panes are not being insured and their floor location.
GENERAL INFORMATION
Remarks
Enter text: An explanation as to whether all exterior glass is insured.
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Section Name
Field Name
Field and/or Section Description
GENERAL INFORMATION
Is any glass structural? Yes/No
Enter Y for a Yes response. Input N for No response. Indicates if any glass is
structural. If yes, describe which panes are part of the building structure.
GENERAL INFORMATION
Remarks
Enter text: An explanation as to whether any glass is structural.
GENERAL INFORMATION
Is the building or area under
construction? Yes/No
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question Are there buildings under construction or being remodeled?
GENERAL INFORMATION
Remarks
Enter text: An explanation as to whether the building or area is under construction.
GENERAL INFORMATION
Does glass or signs have
scratches, cracks or defects?
Yes/No
Enter Y for a Yes response. Input N for No response. Indicates if the glass or signs
have scratches, cracks or defects. If yes, describe any defects in the glass or sign at the
time of this application. Indicate whether any corrective measures are underway. Provide
diagram, if required, and specify location of glass.
GENERAL INFORMATION
Remarks
Enter text: An explanation as to whether any glass or signs have scratches, cracks or
defects.
GENERAL INFORMATION
Did agent inspect signs or glass?
Yes/No
Enter Y for a Yes response. Input N for No response. Indicates if the agent has
inspected the signs or glass. If yes, indicate the inspection date and location. Attach a
photograph if one is available.
GENERAL INFORMATION
Remarks
Enter text: An explanation as to whether an agent inspected the signs or glass.
GENERAL INFORMATION
Are any locations with glass or
signs vacant? Yes/No
Enter Y for a Yes response. Input N for No response. Indicates if any locations with
glass or signs are vacant. If yes, indicate which locations are vacant and when occupancy
is expected, and if any security precautions have been taken to protect the premises.
GENERAL INFORMATION
Remarks
Enter text: An explanation as to whether any location with glass or signs are vacant.
GENERAL INFORMATION
Any signs off premises or not
attached to building? Yes/No
Enter Y for a Yes response. Input N for No response. Indicates if any signs are off
premises or not attached to the building. If yes, specify location and type of protection
provided for the sign. Indicate if any signs to be covered are not attached to building
locations described in the Applicant Information Section (ACORD 125). Give location of
signs.
GENERAL INFORMATION
Remarks
Enter text: An explanation as to whether there are any signs off premises or not attached
to buildings.
REMARKS
Remarks
Enter text: The general remarks associated with glass and sign coverage. Use this
section to provide any additional information required for underwriting or rating.
IDENTIFICATION SECTION Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
REMARKS
Remarks
Enter text: The general remarks associated with glass and sign coverage. Use this
section to provide any additional information required for underwriting or rating.
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Section Name
Field Name
Field and/or Section Description
SIGNATURE
Producer's Signature
Sign here: Accommodates the signature of the authorized representative (e.g. producer,
agent, broker, etc.) of the company(ies) listed on the document. This is required in most
states.
SIGNATURE
Producer's Name (Please Print)
Enter text: The name of the authorized representative of the producer, agency and/or
broker that signed the form.
SIGNATURE
State Producer License No
(Required in FL)
Enter identifier: The State License Number of the producer.
SIGNATURE
Applicant's Signature
Sign here: Accommodates the signature of the applicant or named insured.
SIGNATURE
Date
Enter date: The date the form was signed by the named insured.
SIGNATURE
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).
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