ACORD Form 160 Business Owners Section Instructions

 

ACORD 160 (2009/05) 1 of 64

Universal wording updates to improve clarity and intent were made to all FIG text for this form on 06/30/2009.
Section Name	Field Name	Field and/or Section Description
TITLE ACORD 160 (2009/05)	Business Owners Application	The title of the form. ACORD 160, Business Owners Application is designed to be used with most business owners and small business policies. The form is attached to the ACORD 125, Commercial Insurance Application Applicant Information Section, and collects property, liability and additional coverages, such as accounts receivables, boiler and machinery, crime, glass, signs and valuable papers. Space is provided for company-specific additional coverages as well. The form can accommodate specialty programs, such as apartment, condominiums or restaurants. Individual carriers should be contacted for unique underwriting and any other information required by specific companies.
IDENTIFICATION SECTION	Agency Customer ID	Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage).
IDENTIFICATION SECTION	Date	Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY)
IDENTIFICATION SECTION	Agency Name	Enter text: The full name of the producer/agency.
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	Policy #	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	First Named Insured	Enter text: The named insured(s) as it/they will appear on the policy declarations page.
IDENTIFICATION SECTION	Policy Type - Standard	Check the box (if applicable): Indicates the type of policy/perils insured is standard.
IDENTIFICATION SECTION	Policy Type - Special	Check the box (if applicable): Indicates the type of policy/perils insured is special.

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Section Name	Field Name	Field and/or Section Description
IDENTIFICATION SECTION	Policy Type - Other	Check the box (if applicable): Indicates the type of policy/perils insured is other than those listed.
IDENTIFICATION SECTION	Policy Type - Other Description	Enter text: The description of the type of policy issued to the insured.
PREMIUM	Building	Enter amount: The total premium amount for the building coverages.
PREMIUM	Personal Property	Enter amount: The total premium amount for personal property coverages.
PREMIUM	Liability	Enter amount: The total premium amount for liability coverages.
PREMIUM	Optional Coverages	Enter amount: The total premium amount for optional coverages.
PREMIUM	Other Description	Enter text: The description of coverages associated with the total premium amount.
PREMIUM	Other Amount	Enter amount: The total premium amount for the coverages.
PREMIUM	Schedule Credits	Enter amount: The total premium amount for schedule credits.
PREMIUM	Deductible Credits	Enter amount: The total premium amount for deductible credits.
PREMIUM	Taxes Surcharge	Enter amount: The total premium amount for taxes surcharge.
PREMIUM	Other Description	Enter text: The description of coverages associated with the total premium amount.
PREMIUM	Other Amount	Enter amount: The total premium amount for the coverages.
PREMIUM	Other Description	Enter text: The description of coverages associated with the total premium amount.
PREMIUM	Other Amount	Enter amount: The total premium amount for the coverages.
PREMIUM	Minimum Premium	Enter amount: The minimum premium amount for the business owners (BOP) line of business.
PREMIUM	Total Premium	Enter amount: The premium amount for the business owners (BOP) line of business.
GENERAL INFORMATION	1. Do/have past, present or discontinued operations involving storing, treating, discharging, applying, disposing, or transporting of hazardous material?	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do/have past, present or discontinued operations involve(d) storing, treating, discharging, applying, disposing, or transporting of hazardous material?".
GENERAL INFORMATION	1. Remarks	Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION	2. Are athletic teams sponsored?	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are athletic teams sponsored?".
GENERAL INFORMATION	Type of Sport	Enter text: The description of the type of sport in which the sponsored athletic team is involved.
GENERAL INFORMATION	Contact Sport (Y / N)	Enter Y for a “Yes” response. Input N for “No” response. Indicates if the sponsored athletic is involved in a contact sport.
GENERAL INFORMATION	Age Group - 12 & Under	Check the box (if applicable): Indicates the sport participants are 12 years old or under.

ACORD 160 (2009/05) 3 of 64

Section Name	Field Name	Field and/or Section Description
GENERAL INFORMATION	Age Group - 13 - 18	Check the box (if applicable): Indicates the sport participants are 13 through 18 years old.
GENERAL INFORMATION	Age Group - Over 18	Check the box (if applicable): Indicates the sport participate are over 18 years old.
GENERAL INFORMATION	Extent of Sponsorship	Enter text: The description of the extent of sponsorship the named insured provides for the athletic team.
GENERAL INFORMATION	Type of Sport	Enter text: The description of the type of sport in which the sponsored athletic team is involved.
GENERAL INFORMATION	Contact Sport (Y / N)	Enter Y for a “Yes” response. Input N for “No” response. Indicates if the sponsored athletic is involved in a contact sport.
GENERAL INFORMATION	Age Group - 12 & Under	Check the box (if applicable): Indicates the sport participants are 12 years old or under.
GENERAL INFORMATION	Age Group - 13 - 18	Check the box (if applicable): Indicates the sport participants are 13 through 18 years old.
GENERAL INFORMATION	Age Group - Over 18	Check the box (if applicable): Indicates the sport participate are over 18 years old.
GENERAL INFORMATION	Extent of Sponsorship	Enter text: The description of the extent of sponsorship the named insured provides for the athletic team.
GENERAL INFORMATION	3. Do you obtain and verify certificates of insurance obtained from subcontractors, manufacturers and / or suppliers?	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do you obtain and verify certificates of insurance from subcontractors, manufacturers and / or suppliers?".
GENERAL INFORMATION	3. Remarks	Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION	4. Do you lease employees to or from other employers?	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do you lease employees to or from other employers?".
GENERAL INFORMATION	Lease To	Enter text: The additional interest's full name. As used here, this is the company that employees are leased to.
GENERAL INFORMATION	Workers Compensation Coverage Carried (Y / N)	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is workers compensation coverage carried?".
GENERAL INFORMATION	Lease To	Enter text: The additional interest's full name. As used here, this is the company that employees are leased to.
GENERAL INFORMATION	Workers Compensation Coverage Carried (Y / N)	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is workers compensation coverage carried?".
GENERAL INFORMATION	Lease From	Enter text: The additional interest's full name. As used here, this is the company that employees are leased from.

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Section Name	Field Name	Field and/or Section Description
GENERAL INFORMATION	Workers Compensation Coverage Carried (Y / N)	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is workers compensation coverage carried?".
GENERAL INFORMATION	Lease From	Enter text: The additional interest's full name. As used here, this is the company that employees are leased from.
GENERAL INFORMATION	Workers Compensation Coverage Carried (Y / N)	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is workers compensation coverage carried?".
GENERAL INFORMATION	5. Do you own or operate any other business?	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do you own or operate any other business?".
GENERAL INFORMATION	Street, City, State, Zip	Enter text: The first address line of the physical location.
GENERAL INFORMATION		Enter text: The city of the physical location.
GENERAL INFORMATION		Enter code: The state or province of the physical location.
GENERAL INFORMATION		Enter code: The postal code of the physical location.
GENERAL INFORMATION	Type of Business or Loc - Service	Check the box (if applicable): Indicates the nature of business is service.
GENERAL INFORMATION	Type of Business or Loc - Office	Check the box (if applicable): Indicates the nature of business is an office.
GENERAL INFORMATION	Type of Business or Loc - Retail	Check the box (if applicable): Indicates the nature of business is retail.
GENERAL INFORMATION	Type of Business or Loc -Wholesale	Check the box (if applicable): Indicates the nature of business is wholesale.
GENERAL INFORMATION	Type of Business or Loc - Other	Check the box (if applicable): Indicates the nature of business is other than those listed.
GENERAL INFORMATION	Type of Business or Loc - Other Description	Enter text: The description of the nature/type of business.
GENERAL INFORMATION	Building Interest - Own	Check the box (if applicable): Indicates the named insured's interest in the building is as its owner.
GENERAL INFORMATION	Building Interest - Lease	Check the box (if applicable): Indicates the named insured leases the building.
GENERAL INFORMATION	Building Interest - Rent	Check the box (if applicable): Indicates the named insured rents the building.
GENERAL INFORMATION	Building Interest - Other	Check the box (if applicable): Indicates the named insured's interest is the building is other than as its owner or tenant.
GENERAL INFORMATION	Building Interest - Other Description	Enter text: The description of the insured's interest is the building when it is other than as its owner or tenant.
GENERAL INFORMATION	Operations	Enter text: The description of the operations of this risk. A restatement of the products classification wording is often not sufficient (e.g., "Metal Goods Manufacturing NOC" could include anything from paper clips to bridge girders).
GENERAL INFORMATION	Street, City, State, Zip	Enter text: The first address line of the physical location.
GENERAL INFORMATION		Enter text: The city of the physical location.
GENERAL INFORMATION		Enter code: The state or province of the physical location.

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Section Name	Field Name	Field and/or Section Description
GENERAL INFORMATION		Enter code: The postal code of the physical location.
GENERAL INFORMATION	Type of Business or Loc - Service	Check the box (if applicable): Indicates the nature of business is service.
GENERAL INFORMATION	Type of Business or Loc - Office	Check the box (if applicable): Indicates the nature of business is an office.
GENERAL INFORMATION	Type of Business or Loc - Retail	Check the box (if applicable): Indicates the nature of business is retail.
GENERAL INFORMATION	Type of Business or Loc -Wholesale	Check the box (if applicable): Indicates the nature of business is wholesale.
GENERAL INFORMATION	Type of Business or Loc - Other	Check the box (if applicable): Indicates the nature of business is other than those listed.
GENERAL INFORMATION	Type of Business or Loc - Other Description	Enter text: The description of the nature/type of business.
GENERAL INFORMATION	Building Interest - Own	Check the box (if applicable): Indicates the named insured's interest in the building is as its owner.
GENERAL INFORMATION	Building Interest - Lease	Check the box (if applicable): Indicates the named insured leases the building.
GENERAL INFORMATION	Building Interest - Rent	Check the box (if applicable): Indicates the named insured rents the building.
GENERAL INFORMATION	Building Interest - Other	Check the box (if applicable): Indicates the named insured's interest is the building is other than as its owner or tenant.
GENERAL INFORMATION	Building Interest - Other Description	Enter text: The description of the insured's interest is the building when it is other than as its owner or tenant.
GENERAL INFORMATION	Operations	Enter text: The description of the operations of this risk. A restatement of the products classification wording is often not sufficient (e.g., "Metal Goods Manufacturing NOC" could include anything from paper clips to bridge girders).
GENERAL INFORMATION	6. In addition to your primary nature of business are you also involved in manufacture, relabeling or repackaging of others products?	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "In addition to your primary nature of business are you also involved in the manufacture, relabeling or repackaging of others products?".
GENERAL INFORMATION	6. Remarks	Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION	7. In addition to your primary nature of business are you also involved in the mixing of others products?	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "In addition to your primary nature of business are you also involved in the mixing of others products?".
GENERAL INFORMATION	7. Remarks	Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.

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Section Name	Field Name	Field and/or Section Description
	8. Do you rent or loan equipment	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the
GENERAL INFORMATION	to others?	question, "Do you rent or loan equipment to others?".
GENERAL INFORMATION	Equipment	Enter text: The description of the item.
		Check the box (if applicable): Indicates the subclass / grouping of property into which the
GENERAL INFORMATION	Type of Equipment - Small Tools	item falls is small tools.
	Type of Equipment - Large	Check the box (if applicable): Indicates the subclass / grouping of property into which the
GENERAL INFORMATION	Equipment	item falls is large equipment.
		Enter Y for a “Yes” response. Input N for “No” response. Indicates instructions are given
GENERAL INFORMATION	Instruction Given (Y / N)	on how to use the item when it is rented or loaned to others.
GENERAL INFORMATION	Equipment	Enter text: The description of the item.
		Check the box (if applicable): Indicates the subclass / grouping of property into which the
GENERAL INFORMATION	Type of Equipment - Small Tools	item falls is small tools.
	Type of Equipment - Large	Check the box (if applicable): Indicates the subclass / grouping of property into which the
GENERAL INFORMATION	Equipment	item falls is large equipment.
		Enter Y for a “Yes” response. Input N for “No” response. Indicates instructions are given
GENERAL INFORMATION	Instruction Given (Y / N)	on how to use the item when it is rented or loaned to others.
	9. Does the operation have hours
	after 9:00 PM and / or 24 hour	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the
GENERAL INFORMATION	operations?	question, "Does the operation have hours after 9:00 PM and / or 24 hour operations?".
GENERAL INFORMATION	Start Time	Enter time: The starting time for the normal business day.
GENERAL INFORMATION	End Time	Enter time: The closing time for the normal business day.
GENERAL INFORMATION	24 Hour Operations	Check the box (if applicable): Indicates the business is open 24 hours a day.
		Enter text: The description of any additional information required for underwriting or rating.
REMARKS	Remarks	Attach ACORD 101, Additional Remarks Schedule, if more space is required.
		Enter identifier: The customer's identification number assigned by the producer (e.g.
IDENTIFICATION SECTION	Agency Customer ID	agency or brokerage).
LIABILITY COVERAGES -	Bodily Injury and Property Damage
POLICY LEVEL	- Occurrence	Enter limit: The bodily injury each occurrence limit amount.
LIABILITY COVERAGES -	Bodily Injury and Property Damage
POLICY LEVEL	- Aggregate	Enter limit: The commercial general liability policy, bodily injury aggregate limit amount.
LIABILITY COVERAGES -	Bodily Injury and Property Damage
POLICY LEVEL	- Deductible	Enter amount: The deductible applicable to the Bodily Injury coverage.
LIABILITY COVERAGES -	Bodily Injury and Property Damage
POLICY LEVEL	- Included	Check the box (if applicable): Indicates bodily injury coverage is included in the policy.

ACORD 160 (2009/05) 7 of 64

Section Name	Field Name	Field and/or Section Description
LIABILITY COVERAGES -	Bodily Injury and Property Damage
POLICY LEVEL	- Form Number	Enter identifier: The form number used by the company for bodily injury coverage.
LIABILITY COVERAGES -	Bodily Injury and Property Damage
POLICY LEVEL	- Form Date	Enter date: The edition date of the form used by the company for bodily injury coverage.
LIABILITY COVERAGES -	Bodily Injury and Property Damage
POLICY LEVEL	- Premium	Enter amount: The premium amount for bodily injury coverage.
		Enter limit: The general liability, medical expense each person limit amount. Any questions
LIABILITY COVERAGES -	Medical Expense (per person) -	about appropriate limits or applicable policy coverage(s) should be answered by the
POLICY LEVEL	Total Amount	issuing insurer(s).
LIABILITY COVERAGES -	Medical Expense (per person) -
POLICY LEVEL	Deductible	Enter deductible: The deductible amount for medical expense coverage.
LIABILITY COVERAGES -	Medical Expense (per person) -	Check the box (if applicable): Indicates medical expense coverage is included in the
POLICY LEVEL	Included	policy.
LIABILITY COVERAGES -	Medical Expense (per person) -
POLICY LEVEL	Form Number	Enter identifier: The form number used by the company for medical expense coverage.
LIABILITY COVERAGES -POLICY LEVEL	Medical Expense (per person) -Form Date	Enter date: The edition date of the form used by the company for medical expense coverage.
LIABILITY COVERAGES -	Medical Expense (per person) -
POLICY LEVEL	Premium	Enter amount: The premium amount for medical expense coverage.
		Enter limit: The general liability, personal and advertising injury limit amount. Any
LIABILITY COVERAGES -	Personal & Advertising Injury -	questions about appropriate limits or applicable policy coverage(s) should be answered by
POLICY LEVEL	Total Amount	the issuing insurer(s).
LIABILITY COVERAGES -	Personal & Advertising Injury -
POLICY LEVEL	Deductible	Enter deductible: The deductible amount for personal and advertising injury coverage.
LIABILITY COVERAGES -	Personal & Advertising Injury -	Check the box (if applicable): Indicates personal and advertising injury coverage is
POLICY LEVEL	Included	included in the policy.
LIABILITY COVERAGES -POLICY LEVEL	Personal & Advertising Injury -Form Number	Enter identifier: The form number used by the company for personal and advertising injury coverage.
LIABILITY COVERAGES -	Personal & Advertising Injury -	Enter date: The edition date of the form used by the company for personal and advertising
POLICY LEVEL	Form Date	injury coverage.
LIABILITY COVERAGES -	Personal & Advertising Injury -
POLICY LEVEL	Premium	Enter amount: The premium amount for personal and advertising injury coverage.
		Enter limit: The general liability, products and completed operations aggregate limit
LIABILITY COVERAGES -	Products & Completed Operations	amount. Any questions about appropriate limits or applicable policy coverage(s) should be
POLICY LEVEL	Total Amount	answered by the issuing insurer(s).

ACORD 160 (2009/05) 8 of 64

Section Name	Field Name	Field and/or Section Description
LIABILITY COVERAGES -POLICY LEVEL	Products & Completed Operations Deductible	Enter deductible: The deductible amount for products and completed operations coverage.
LIABILITY COVERAGES -	Products & Completed Operations	Check the box (if applicable): Indicates products and completed operations coverage is
POLICY LEVEL	Included	included in the policy.
LIABILITY COVERAGES -	Products & Completed Operations	Enter identifier: The form number used by the company for products and completed
POLICY LEVEL	Form Number	operations coverage.
LIABILITY COVERAGES -	Products & Completed Operations	Enter date: The edition date of the form used by the company for products and completed
POLICY LEVEL	Form Date	operations coverage.
LIABILITY COVERAGES -	Products & Completed Operations
POLICY LEVEL	Premium	Enter amount: The premium amount for products and completed operations coverage.
	Professional Liability -
LIABILITY COVERAGES -	Employment Practices Liability
POLICY LEVEL	(EPLI) - Total Amount	Enter limit: The limit amount for employment practices liability (EPLI) coverage.
	Professional Liability -
LIABILITY COVERAGES -	Employment Practices Liability
POLICY LEVEL	(EPLI) - Retroactive Date	Enter date: The retroactive date for employment practices liability (EPLI) coverage.
	Professional Liability -
LIABILITY COVERAGES -	Employment Practices Liability	Enter deductible: The deductible amount for employment practices liability (EPLI)
POLICY LEVEL	(EPLI) - Deductible	coverage.
	Professional Liability -
LIABILITY COVERAGES -	Employment Practices Liability	Check the box (if applicable): Indicates employment practices liability (EPLI) coverage is
POLICY LEVEL	(EPLI) - Included	included in the policy.
	Professional Liability -
LIABILITY COVERAGES -	Employment Practices Liability	Enter identifier: The form number used by the company for employment practices liability
POLICY LEVEL	(EPLI) - Form Number	(EPLI) coverage.
	Professional Liability -
LIABILITY COVERAGES -	Employment Practices Liability	Enter date: The edition date of the form used by the company for employment practices
POLICY LEVEL	(EPLI) - Form Date	liability (EPLI) coverage.
	Professional Liability -
LIABILITY COVERAGES -	Employment Practices Liability
POLICY LEVEL	(EPLI) - Premium	Enter amount: The premium amount for employment practices liability (EPLI) coverage.
LIABILITY COVERAGES -	Professional Liability - Directors &
POLICY LEVEL	Officers - Total Amount	Enter limit: The limit amount for directors and officers (D&O) coverage.
LIABILITY COVERAGES -	Professional Liability - Directors &
POLICY LEVEL	Officers - Retroactive Date	Enter date: The retroactive date for Directors & Officers (D&O) coverage.

ACORD 160 (2009/05) 9 of 64

Section Name	Field Name	Field and/or Section Description
LIABILITY COVERAGES -	Professional Liability - Directors &
POLICY LEVEL	Officers - Deductible	Enter deductible: The deductible amount for directors and officers (D&O) coverage.
LIABILITY COVERAGES -	Professional Liability - Directors &	Check the box (if applicable): Indicates directors and officers (D&O) coverage is included
POLICY LEVEL	Officers - Included	in the policy.
LIABILITY COVERAGES -POLICY LEVEL	Professional Liability - Directors & Officers - Form Number	Enter identifier: The form number used by the company for directors and officers (D&O) coverage.
LIABILITY COVERAGES -	Professional Liability - Directors &	Enter date: The edition date of the form used by the company for directors and officers
POLICY LEVEL	Officers - Form Date	(D&O) coverage.
LIABILITY COVERAGES -	Professional Liability - Directors &
POLICY LEVEL	Officers - Premium	Enter amount: The premium amount for directors and officers (D&O) coverage.
LIABILITY COVERAGES -	Tenants Legal Liability - Total
POLICY LEVEL	Amount	Enter limit: The limit amount for tenants legal liability coverage.
LIABILITY COVERAGES -	Tenants Legal Liability -
POLICY LEVEL	Deductible	Enter deductible: The deductible amount for tenants legal liability coverage.
LIABILITY COVERAGES -		Check the box (if applicable): Indicates tenants legal liability coverage is included in the
POLICY LEVEL	Tenants Legal Liability - Included	policy.
LIABILITY COVERAGES -	Tenants Legal Liability - Form
POLICY LEVEL	Number	Enter identifier: The form number used by the company for tenants legal liability coverage.
LIABILITY COVERAGES -		Enter date: The edition date of the form used by the company for tenants legal liability
POLICY LEVEL	Tenants Legal Liability - Form Date	coverage.
LIABILITY COVERAGES -
POLICY LEVEL	Tenants Legal Liability - Premium	Enter amount: The premium amount for tenants legal liability coverage.
LIABILITY COVERAGES -	Auto - Hired Physical Damage -
POLICY LEVEL	Total Amount	Enter limit: The limit amount for hired auto physical damage coverage.
LIABILITY COVERAGES -	Auto - Hired Physical Damage -
POLICY LEVEL	Deductible	Enter deductible: The deductible amount for hired auto physical damage coverage.
LIABILITY COVERAGES -	Auto - Hired Physical Damage -	Check the box (if applicable): Indicates hired auto physical damage coverage is included
POLICY LEVEL	Included	in the policy.
LIABILITY COVERAGES -POLICY LEVEL	Auto - Hired Physical Damage -Form Number	Enter identifier: The form number used by the company for hired auto physical damage coverage.
LIABILITY COVERAGES -	Auto - Hired Physical Damage -	Enter date: The edition date of the form used by the company for hired auto physical
POLICY LEVEL	Form Date	damage coverage.
LIABILITY COVERAGES -	Auto - Hired Physical Damage -
POLICY LEVEL	Premium	Enter amount: The premium amount for hired auto physical damage coverage.
LIABILITY COVERAGES -	Auto - Hired Liability - Bodily
POLICY LEVEL	Injury - Total Amount	Enter limit: The limit amount for hired auto bodily injury coverage.

ACORD 160 (2009/05) 10 of 64

Section Name	Field Name	Field and/or Section Description
LIABILITY COVERAGES -	Auto - Hired Liability - Bodily
POLICY LEVEL	Injury - Deductible	Enter deductible: The deductible amount for hired auto bodily injury coverage.
LIABILITY COVERAGES -	Auto - Hired Liability - Bodily	Check the box (if applicable): Indicates hired auto bodily injury coverage is included in the
POLICY LEVEL	Injury - Included	policy.
LIABILITY COVERAGES -	Auto - Hired Liability - Bodily	Enter identifier: The form number used by the company for hired auto bodily injury
POLICY LEVEL	Injury - Form Number	coverage.
LIABILITY COVERAGES -	Auto - Hired Liability - Bodily	Enter date: The edition date of the form used by the company for hired auto bodily injury
POLICY LEVEL	Injury - Form Date	coverage.
LIABILITY COVERAGES -	Auto - Hired Liability - Bodily
POLICY LEVEL	Injury - Premium	Enter amount: The premium amount for hired auto bodily injury coverage.
LIABILITY COVERAGES -	Auto - Hired Liability - Property
POLICY LEVEL	Damage - Total Amount	Enter limit: The limit amount for hired auto property damage coverage.
LIABILITY COVERAGES -	Auto - Hired Liability - Property
POLICY LEVEL	Damage - Deductible	Enter deductible: The deductible amount for hired auto property damage coverage.
LIABILITY COVERAGES -	Auto - Hired Liability - Property	Check the box (if applicable): Indicates hired auto property damage coverage is included
POLICY LEVEL	Damage - Included	in the policy.
LIABILITY COVERAGES -	Auto - Hired Liability - Property	Enter identifier: The form number used by the company for hired auto property damage
POLICY LEVEL	Damage - Form Number	coverage.
LIABILITY COVERAGES -	Auto - Hired Liability - Property	Enter date: The edition date of the form used by the company for hired auto property
POLICY LEVEL	Damage - Form Date	damage coverage.
LIABILITY COVERAGES -	Auto - Hired Liability - Property
POLICY LEVEL	Damage - Premium	Enter amount: The premium amount for hired auto property damage coverage.
LIABILITY COVERAGES -
POLICY LEVEL	Auto - Non-Owned - Total Amount	Enter limit: The limit amount for non-owned auto coverage.
LIABILITY COVERAGES -
POLICY LEVEL	Auto - Non-Owned - Deductible	Enter deductible: The deductible amount for non-owned auto coverage.
LIABILITY COVERAGES -
POLICY LEVEL	Auto - Non-Owned - Included	Check the box (if applicable): Indicates non-owned auto coverage is included in the policy.
LIABILITY COVERAGES -
POLICY LEVEL	Auto - Non-Owned - Form Number	Enter identifier: The form number used by the company for non-owned auto coverage.
LIABILITY COVERAGES -POLICY LEVEL	Auto - Non-Owned - Form Date	Enter date: The edition date of the form used by the company for non-owned auto coverage.
LIABILITY COVERAGES -
POLICY LEVEL	Auto - Non-Owned - Premium	Enter amount: The premium amount for non-owned auto coverage.
LIABILITY COVERAGES -	Employee Benefits Liability - Total
POLICY LEVEL	Amount	Enter limit: The general liability employee benefits limit amount.

ACORD 160 (2009/05) 11 of 64

Section Name	Field Name	Field and/or Section Description
LIABILITY COVERAGES -	Employee Benefits Liability -	Enter date: The retroactive date that is the earliest date for which an occurrence could
POLICY LEVEL	Retroactive Date	"trigger" coverage under Employee Benefits coverage.
LIABILITY COVERAGES -POLICY LEVEL	Employee Benefits Liability -Deductible	Enter deductible: The deductible per claim applicable to Employee Benefits Liability coverage.
LIABILITY COVERAGES -	Employee Benefits Liability -	Check the box (if applicable): Indicates employee benefits coverage is included in the
POLICY LEVEL	Included	policy.
LIABILITY COVERAGES -	Employee Benefits Liability - Form
POLICY LEVEL	Number	Enter identifier: The form number used by the company for employee benefits coverage.
LIABILITY COVERAGES -POLICY LEVEL	Employee Benefits Liability - Form Date	Enter date: The edition date of the form used by the company for employee benefits coverage.
LIABILITY COVERAGES -	Employee Benefits Liability -
POLICY LEVEL	Premium	Enter amount: The premium amount for employee benefits coverage.
LIABILITY COVERAGES -	Extended Employee Dishonesty -
POLICY LEVEL	Total Amount	Enter limit: The limit amount for extended employee dishonesty coverage.
LIABILITY COVERAGES -	Extended Employee Dishonesty -
POLICY LEVEL	Deductible	Enter deductible: The deductible amount for extended employee dishonesty coverage.
LIABILITY COVERAGES -	Extended Employee Dishonesty -	Check the box (if applicable): Indicates extended employee dishonesty coverage is
POLICY LEVEL	Included	included in the policy.
LIABILITY COVERAGES -POLICY LEVEL	Extended Employee Dishonesty -Form Number	Enter identifier: The form number used by the company for extended employee dishonesty coverage.
LIABILITY COVERAGES -	Extended Employee Dishonesty -	Enter date: The edition date of the form used by the company for extended employee
POLICY LEVEL	Form Date	dishonesty coverage.
LIABILITY COVERAGES -	Extended Employee Dishonesty -
POLICY LEVEL	Premium	Enter amount: The premium amount for extended employee dishonesty coverage.
LIABILITY COVERAGES -	Freight or Passenger Elevators
POLICY LEVEL	Inspection Fee - Total Amount	Enter limit: The limit amount for freight or passenger elevators inspection fee coverage.
LIABILITY COVERAGES -	Freight or Passenger Elevators	Enter deductible: The deductible amount for freight or passenger elevators inspection fee
POLICY LEVEL	Inspection Fee - Deductible	coverage.
LIABILITY COVERAGES -	Freight or Passenger Elevators	Check the box (if applicable): Indicates freight or passenger elevators inspection fee
POLICY LEVEL	Inspection Fee - Included	coverage is included in the policy.
LIABILITY COVERAGES -	Freight or Passenger Elevators	Enter identifier: The form number used by the company for freight or passenger elevators
POLICY LEVEL	Inspection Fee - Form Number	inspection fee coverage.
LIABILITY COVERAGES -	Freight or Passenger Elevators	Enter date: The edition date of the form used by the company for freight or passenger
POLICY LEVEL	Inspection Fee - Form Date	elevators inspection fee coverage.
LIABILITY COVERAGES -	Freight or Passenger Elevators	Enter amount: The premium amount for freight or passenger elevators inspection fee
POLICY LEVEL	Inspection Fee - Premium	coverage.

ACORD 160 (2009/05) 12 of 64

Section Name	Field Name	Field and/or Section Description
LIABILITY COVERAGES -
POLICY LEVEL	Garage - Collision - Total Amount	Enter limit: The limit amount for garage collision coverage.
LIABILITY COVERAGES -
POLICY LEVEL	Garage - Collision - Deductible	Enter deductible: The deductible amount for garage collision coverage.
LIABILITY COVERAGES -
POLICY LEVEL	Garage - Collision - Included	Check the box (if applicable): Indicates garage collision coverage is included in the policy.
LIABILITY COVERAGES -
POLICY LEVEL	Garage - Collision - Form Number	Enter identifier: The form number used by the company for garage collision coverage.
LIABILITY COVERAGES -		Enter date: The edition date of the form used by the company for garage collision
POLICY LEVEL	Garage - Collision - Form Date	coverage.
LIABILITY COVERAGES -
POLICY LEVEL	Garage - Collision - Premium	Enter amount: The premium amount for garage collision coverage.
LIABILITY COVERAGES -	Garage - Comprehensive / OTC -
POLICY LEVEL	Total Amount	Enter limit: The limit amount for garage comprehensive coverage.
LIABILITY COVERAGES -	Garage - Comprehensive / OTC -
POLICY LEVEL	Deductible	Enter deductible: The deductible amount for garage comprehensive coverage.
LIABILITY COVERAGES -	Garage - Comprehensive / OTC -	Check the box (if applicable): Indicates garage comprehensive coverage is included in the
POLICY LEVEL	Included	policy.
LIABILITY COVERAGES -POLICY LEVEL	Garage - Comprehensive / OTC -Form Number	Enter identifier: The form number used by the company for garage comprehensive coverage.
LIABILITY COVERAGES -POLICY LEVEL	Garage - Comprehensive / OTC -Form Date	Enter date: The edition date of the form used by the company for garage comprehensive coverage.
LIABILITY COVERAGES -	Garage - Comprehensive / OTC -
POLICY LEVEL	Premium	Enter amount: The premium amount for garage comprehensive coverage.
LIABILITY COVERAGES -
POLICY LEVEL	Garage Keepers - Loc 1 - Loc #	Enter number: The producer assigned location number for the premises.
LIABILITY COVERAGES -	Garage Keepers - Loc 1 - Total
POLICY LEVEL	Amount	Enter limit: The limit amount for garage keepers coverage.
LIABILITY COVERAGES -	Garage Keepers - Loc 1 -
POLICY LEVEL	Deductible	Enter deductible: The deductible amount for garage keepers coverage.
LIABILITY COVERAGES -		Check the box (if applicable): Indicates the garage keepers coverage is included in the
POLICY LEVEL	Garage Keepers - Loc 1 - Included	policy.
LIABILITY COVERAGES -	Garage Keepers - Loc 1 - Form
POLICY LEVEL	Number	Enter identifier: The form number used by the company for garage keepers coverage.
LIABILITY COVERAGES -POLICY LEVEL	Garage Keepers - Loc 1 - Form Date	Enter date: The edition date of the form used by the company for garage keepers coverage.

ACORD 160 (2009/05) 13 of 64

Section Name	Field Name	Field and/or Section Description
LIABILITY COVERAGES -
POLICY LEVEL	Garage Keepers - Loc 1 - Premium	Enter amount: The premium amount for garage keepers coverage.
LIABILITY COVERAGES -
POLICY LEVEL	Garage Keepers - Loc 2 - Loc #	Enter number: The producer assigned location number for the premises.
LIABILITY COVERAGES -	Garage Keepers - Loc 2 - Total
POLICY LEVEL	Amount	Enter limit: The limit amount for garage keepers coverage.
LIABILITY COVERAGES -	Garage Keepers - Loc 2 -
POLICY LEVEL	Deductible	Enter deductible: The deductible amount for garage keepers coverage.
LIABILITY COVERAGES -		Check the box (if applicable): Indicates the garage keepers coverage is included in the
POLICY LEVEL	Garage Keepers - Loc 2 - Included	policy.
LIABILITY COVERAGES -	Garage Keepers - Loc 2 - Form
POLICY LEVEL	Number	Enter identifier: The form number used by the company for garage keepers coverage.
LIABILITY COVERAGES -POLICY LEVEL	Garage Keepers - Loc 2 - Form Date	Enter date: The edition date of the form used by the company for garage keepers coverage.
LIABILITY COVERAGES -
POLICY LEVEL	Garage Keepers - Loc 2 - Premium	Enter amount: The premium amount for garage keepers coverage.
LIABILITY COVERAGES -
POLICY LEVEL	Garage Keepers - Loc 3 - Loc #	Enter number: The producer assigned location number for the premises.
LIABILITY COVERAGES -	Garage Keepers - Loc 3 - Total
POLICY LEVEL	Amount	Enter limit: The limit amount for garage keepers coverage.
LIABILITY COVERAGES -	Garage Keepers - Loc 3 -
POLICY LEVEL	Deductible	Enter deductible: The deductible amount for garage keepers coverage.
LIABILITY COVERAGES -		Check the box (if applicable): Indicates the garage keepers coverage is included in the
POLICY LEVEL	Garage Keepers - Loc 3 - Included	policy.
LIABILITY COVERAGES -	Garage Keepers - Loc 3 - Form
POLICY LEVEL	Number	Enter identifier: The form number used by the company for garage keepers coverage.
LIABILITY COVERAGES -POLICY LEVEL	Garage Keepers - Loc 3 - Form Date	Enter date: The edition date of the form used by the company for garage keepers coverage.
LIABILITY COVERAGES -
POLICY LEVEL	Garage Keepers - Loc 3 - Premium	Enter amount: The premium amount for garage keepers coverage.
LIABILITY COVERAGES -	Garage Keepers - Legal or Direct -
POLICY LEVEL	Legal	Check the box (if applicable): Indicates the policy is to be written on a legal liability basis.
LIABILITY COVERAGES -	Garage Keepers - Legal or Direct -
POLICY LEVEL	Direct	Check the box (if applicable): Indicates the policy is to be written on a direct basis.
LIABILITY COVERAGES -	Garage Keepers - Legal or Direct -
POLICY LEVEL	Total Amount	Enter limit: The limit amount for garage keepers coverage.

ACORD 160 (2009/05) 14 of 64

Section Name	Field Name	Field and/or Section Description
LIABILITY COVERAGES -	Garage Keepers - Legal or Direct -
POLICY LEVEL	Deductible	Enter deductible: The deductible amount for garage keepers coverage.
LIABILITY COVERAGES -	Garage Keepers - Legal or Direct -	Check the box (if applicable): Indicates the garage keepers coverage is included in the
POLICY LEVEL	Included	policy.
LIABILITY COVERAGES -	Garage Keepers - Legal or Direct -
POLICY LEVEL	Form Number	Enter identifier: The form number used by the company for garage keepers coverage.
LIABILITY COVERAGES -POLICY LEVEL	Garage Keepers - Legal or Direct -Form Date	Enter date: The edition date of the form used by the company for garage keepers coverage.
LIABILITY COVERAGES -	Garage Keepers - Legal or Direct -
POLICY LEVEL	Premium	Enter amount: The premium amount for garage keepers coverage.
LIABILITY COVERAGES -	Liquor Liability - General
POLICY LEVEL	Aggregate	Enter limit: The limit amount for liquor liability coverage.
LIABILITY COVERAGES -
POLICY LEVEL	Liquor Liability - Per Person	Enter limit: The limit amount for liquor liability coverage.
LIABILITY COVERAGES -
POLICY LEVEL	Liquor Liability - Other Description	Enter text: The description of the liquor liability limit.
LIABILITY COVERAGES -
POLICY LEVEL	Liquor Liability - Other Total Limit	Enter limit: The limit amount for liquor liability coverage.
LIABILITY COVERAGES -
POLICY LEVEL	Liquor Liability - Deductible	Enter deductible: The deductible amount for liquor liability coverage.
LIABILITY COVERAGES -
POLICY LEVEL	Liquor Liability - Included	Check the box (if applicable): Indicates liquor liability coverage is included in the policy.
LIABILITY COVERAGES -
POLICY LEVEL	Liquor Liability - Form Number	Enter identifier: The form number used by the company for liquor liability coverage.
LIABILITY COVERAGES -
POLICY LEVEL	Liquor Liability - Form Date	Enter date: The edition date of the form used by the company for liquor liability coverage.
LIABILITY COVERAGES -
POLICY LEVEL	Liquor Liability - Premium	Enter amount: The premium amount for liquor liability coverage.
LIABILITY COVERAGES -
POLICY LEVEL	Medical Payments - Total Amount	Enter limit: The limit amount for medical payments coverage.
LIABILITY COVERAGES -
POLICY LEVEL	Medical Payments - Deductible	Enter deductible: The deductible amount for medical payments coverage.
LIABILITY COVERAGES -		Check the box (if applicable): Indicates medical payments coverage is included in the
POLICY LEVEL	Medical Payments - Included	policy.
LIABILITY COVERAGES -
POLICY LEVEL	Medical Payments - Form Number	Enter identifier: The form number used by the company for medical payments coverage.

ACORD 160 (2009/05) 15 of 64

Section Name	Field Name	Field and/or Section Description
LIABILITY COVERAGES -		Enter date: The edition date of the form used by the company for medical payments
POLICY LEVEL	Medical Payments - Form Date	coverage.
LIABILITY COVERAGES -
POLICY LEVEL	Medical Payments - Premium	Enter amount: The premium amount for medical payments coverage.
	Mobile Equipment Subject to
LIABILITY COVERAGES -	Motor Vehicle Laws - Total
POLICY LEVEL	Amount	Enter limit: The limit amount for mobile equipment subject to motor vehicle laws coverage.
LIABILITY COVERAGES -	Mobile Equipment Subject to	Enter deductible: The deductible amount for mobile equipment subject to motor vehicle
POLICY LEVEL	Motor Vehicle Laws - Deductible	laws coverage.
LIABILITY COVERAGES -	Mobile Equipment Subject to	Check the box (if applicable): Indicates mobile equipment subject to motor vehicle laws
POLICY LEVEL	Motor Vehicle Laws - Included	coverage is included in the policy.
	Mobile Equipment Subject to
LIABILITY COVERAGES -	Motor Vehicle Laws - Form	Enter identifier: The form number used by the company for mobile equipment subject to
POLICY LEVEL	Number	motor vehicle laws coverage.
LIABILITY COVERAGES -	Mobile Equipment Subject to	Enter date: The edition date of the form used by the company for mobile equipment
POLICY LEVEL	Motor Vehicle Laws - Form Date	subject to motor vehicle laws coverage.
LIABILITY COVERAGES -POLICY LEVEL	Mobile Equipment Subject to Motor Vehicle Laws - Premium	Enter amount: The premium amount for mobile equipment subject to motor vehicle laws coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Coverages Schedule Attached	Check the box (if applicable): Indicates a coverages schedule is attached.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Coverage Code	Enter code: The code for the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Description	Enter text: The description of other coverage (not the limit) on the general liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Limit	Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Limit Applies To	Enter code: The code identifying what the limit applies to (i.e. per occurrence).

ACORD 160 (2009/05) 16 of 64

Section Name	Field Name	Field and/or Section Description
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Limit	Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Limit Applies To	Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Deductible	Enter amount: The deductible applicable to the Other Coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Deductible Type	Enter code: The type of deductible (e.g. Flat, Percent, etc.)
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Options	Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Options	Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Terr	Enter code: The rating territory code applicable to the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY		Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to a
LEVEL	Y / N	question associated with the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY	Description of Credit / Surcharge
LEVEL	Amount	Enter text: The description of credits and / or surcharges applicable to the policy.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Premium	Enter amount: The premium for other general liability coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Coverage Code	Enter code: The code for the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Description	Enter text: The description of other coverage (not the limit) on the general liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).

ACORD 160 (2009/05) 17 of 64

Section Name	Field Name	Field and/or Section Description
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Limit	Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Limit Applies To	Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Limit	Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Limit Applies To	Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Deductible	Enter amount: The deductible applicable to the Other Coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Deductible Type	Enter code: The type of deductible (e.g. Flat, Percent, etc.)
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Options	Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Options	Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Terr	Enter code: The rating territory code applicable to the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY		Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to a
LEVEL	Y / N	question associated with the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY	Description of Credit / Surcharge
LEVEL	Amount	Enter text: The description of credits and / or surcharges applicable to the policy.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Premium	Enter amount: The premium for other general liability coverage.

ACORD 160 (2009/05) 18 of 64

Section Name	Field Name	Field and/or Section Description
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Coverage Code	Enter code: The code for the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Description	Enter text: The description of other coverage (not the limit) on the general liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Limit	Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Limit Applies To	Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Limit	Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Limit Applies To	Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Deductible	Enter amount: The deductible applicable to the Other Coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Deductible Type	Enter code: The type of deductible (e.g. Flat, Percent, etc.)
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Options	Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Options	Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Terr	Enter code: The rating territory code applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Y / N	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to a question associated with the coverage.

ACORD 160 (2009/05) 19 of 64

Section Name	Field Name	Field and/or Section Description
LIABILITY ADDITIONAL
COVERAGES - POLICY	Description of Credit / Surcharge
LEVEL	Amount	Enter text: The description of credits and / or surcharges applicable to the policy.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Premium	Enter amount: The premium for other general liability coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Coverage Code	Enter code: The code for the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Description	Enter text: The description of other coverage (not the limit) on the general liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Limit	Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Limit Applies To	Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Limit	Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Limit Applies To	Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Deductible	Enter amount: The deductible applicable to the Other Coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Deductible Type	Enter code: The type of deductible (e.g. Flat, Percent, etc.)
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Options	Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Options	Enter code: The code for an option applicable to the coverage.

ACORD 160 (2009/05) 20 of 64

Section Name	Field Name	Field and/or Section Description
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Terr	Enter code: The rating territory code applicable to the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY		Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to a
LEVEL	Y / N	question associated with the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY	Description of Credit / Surcharge
LEVEL	Amount	Enter text: The description of credits and / or surcharges applicable to the policy.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Premium	Enter amount: The premium for other general liability coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Coverage Code	Enter code: The code for the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Description	Enter text: The description of other coverage (not the limit) on the general liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Limit	Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Limit Applies To	Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Limit	Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Limit Applies To	Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Deductible	Enter amount: The deductible applicable to the Other Coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Deductible Type	Enter code: The type of deductible (e.g. Flat, Percent, etc.)

ACORD 160 (2009/05) 21 of 64

Section Name	Field Name	Field and/or Section Description
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Options	Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Options	Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Terr	Enter code: The rating territory code applicable to the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY		Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to a
LEVEL	Y / N	question associated with the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY	Description of Credit / Surcharge
LEVEL	Amount	Enter text: The description of credits and / or surcharges applicable to the policy.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Premium	Enter amount: The premium for other general liability coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Coverage Code	Enter code: The code for the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Description	Enter text: The description of other coverage (not the limit) on the general liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Limit	Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Limit Applies To	Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Limit	Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Limit Applies To	Enter code: The code identifying what the limit applies to (i.e. per occurrence).

ACORD 160 (2009/05) 22 of 64

Section Name	Field Name	Field and/or Section Description
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Deductible	Enter amount: The deductible applicable to the Other Coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Deductible Type	Enter code: The type of deductible (e.g. Flat, Percent, etc.)
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Options	Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Options	Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Terr	Enter code: The rating territory code applicable to the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY		Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to a
LEVEL	Y / N	question associated with the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY	Description of Credit / Surcharge
LEVEL	Amount	Enter text: The description of credits and / or surcharges applicable to the policy.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Premium	Enter amount: The premium for other general liability coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Coverage Code	Enter code: The code for the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Description	Enter text: The description of other coverage (not the limit) on the general liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Limit	Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Limit Applies To	Enter code: The code identifying what the limit applies to (i.e. per occurrence).

ACORD 160 (2009/05) 23 of 64

Section Name	Field Name	Field and/or Section Description
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Limit	Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Limit Applies To	Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Deductible	Enter amount: The deductible applicable to the Other Coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Deductible Type	Enter code: The type of deductible (e.g. Flat, Percent, etc.)
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Options	Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Options	Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Terr	Enter code: The rating territory code applicable to the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY		Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to a
LEVEL	Y / N	question associated with the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY	Description of Credit / Surcharge
LEVEL	Amount	Enter text: The description of credits and / or surcharges applicable to the policy.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Premium	Enter amount: The premium for other general liability coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Coverage Code	Enter code: The code for the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Description	Enter text: The description of other coverage (not the limit) on the general liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).

ACORD 160 (2009/05) 24 of 64

Section Name	Field Name	Field and/or Section Description
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Limit	Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Limit Applies To	Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Limit	Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Limit Applies To	Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Deductible	Enter amount: The deductible applicable to the Other Coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Deductible Type	Enter code: The type of deductible (e.g. Flat, Percent, etc.)
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Options	Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Options	Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Terr	Enter code: The rating territory code applicable to the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY		Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to a
LEVEL	Y / N	question associated with the coverage.
LIABILITY ADDITIONAL
COVERAGES - POLICY	Description of Credit / Surcharge
LEVEL	Amount	Enter text: The description of credits and / or surcharges applicable to the policy.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Premium	Enter amount: The premium for other general liability coverage.

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Section Name	Field Name	Field and/or Section Description
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Coverage Code	Enter code: The code for the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Description	Enter text: The description of other coverage (not the limit) on the general liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Limit	Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Limit Applies To	Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Limit	Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Limit Applies To	Enter code: The code identifying what the limit applies to (i.e. per occurrence).
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Deductible	Enter amount: The deductible applicable to the Other Coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Deductible Type	Enter code: The type of deductible (e.g. Flat, Percent, etc.)
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Options	Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Options	Enter code: The code for an option applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Terr	Enter code: The rating territory code applicable to the coverage.
LIABILITY ADDITIONAL COVERAGES - POLICY LEVEL	Y / N	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to a question associated with the coverage.

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Section Name	Field Name	Field and/or Section Description
LIABILITY ADDITIONAL
COVERAGES - POLICY	Description of Credit / Surcharge
LEVEL	Amount	Enter text: The description of credits and / or surcharges applicable to the policy.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL	Premium	Enter amount: The premium for other general liability coverage.
		Enter identifier: The customer's identification number assigned by the producer (e.g.
IDENTIFICATION SECTION	Agency Customer ID	agency or brokerage).
IDENTIFICATION SECTION	Loc #	Enter number: The producer assigned number of the location.
		Enter number: The building number for the premises. Used when more than one building
IDENTIFICATION SECTION	Bldg #	exists at an individual location.
		Enter Y for a “Yes” response. Input N for “No” response. Indicates if a blanket rate is being
PREMISES	Blanket Rate	requested.
PREMISES	Building Description	Enter text: This describes the particular sublocation in a manner sufficient to distinguish it from other sublocations at a given location. An example might be "3 story blue structure on the left of the main building".
PREMISES	Check if Primary Premises	Check the box (if applicable): Indicates if the location / building is the primary premises.
	Description of all occupancies at
PREMISES	this premises	Enter text: The description of the buildings occupancy.
		Enter text: The description of the buildings, structures, activities conducted, or use of the
PREMISES	Right Exposure	adjacent property to the right of the insured premises.
		Enter number: The distance to the adjacent exposure on the right of the insured premises
PREMISES	Distance	in linear feet.
		Enter text: The description of the buildings, structures, activities conducted, or use of the
PREMISES	Left Exposure	adjacent property to the left of the insured premises.
		Enter number: The distance to the adjacent exposure on the left of the insured premises
PREMISES	Distance	in linear feet.
		Enter text: The description of the buildings, structures, activities conducted, or use of the
PREMISES	Front Exposure	adjacent property to the front of the insured premises.
		Enter number: The distance to the adjacent exposure on the front of the insured premises
PREMISES	Distance	in linear feet.
		Enter text: The description of the buildings, structures, activities conducted, or use of the
PREMISES	Rear Exposure	adjacent property to the rear of the insured premises.

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Section Name	Field Name	Field and/or Section Description
PREMISES	Distance	Enter number: The distance to the adjacent exposure on the rear of the insured premises in linear feet.
PREMISES	Annual Sales Receipts	Enter amount: The total annual gross sales or receipts.
PREMISES	Total Payroll	Enter amount: The total annual payroll of the business in whole dollars.
PREMISES	Class Code	Enter code: The industry code that identifies the exposure. This code is derived from Insurance Services Office or a company code list.
PREMISES	Rate#	Enter number: The rate number for the exposure defined by the insurer.
PREMISES	Rate Group	Enter code: The rate group for the exposure defined by the insurer.
PREMISES	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.
PREMISES	Rate Terr.	Enter code: Enter the Insurance Services Office (ISO) or company rating territory for this location.
PREMISES	Distance to Hydrant Ft.	Enter number: The distance in feet from the nearest hydrant that supports the protection class used.
PREMISES	Distance to Fire Station Mi.	Enter number: The distance in miles from the nearest fire station that supports the protection class used.
PREMISES	Fire District - Name	Enter text: The property's fire district name.
PREMISES	Fire District Code Number	Enter code: The property's fire district code number which can be found in the individual states manual pages.
PROPERTY	Building Limit	Enter limit: The building limit amount.
PROPERTY	% Coins	Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage. As used here, this information is for the building.
PROPERTY	Valuation - RC	Check the box (if applicable): Indicate the replacement cost will be used to determine the amount paid on a claim. As used here, this information is for the building.
PROPERTY	Valuation - FVRC	Check the box (if applicable): Indicate the full value replacement cost will be used to determine the amount paid on a claim. As used here, this information is for the building.
PROPERTY	Valuation - ACV	Check the box (if applicable): Indicate the actual cash value will be used to determine the amount paid on a claim. As used here, this information is for the building.

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Section Name	Field Name	Field and/or Section Description
PROPERTY	Valuation - Other	Check the box (if applicable): Indicate the method used to determine the amount paid on a claim is other than those listed. As used here, this information is for the building.
PROPERTY	Valuation - Other Description	Enter code: Indicate the method which will be used to determine the amount paid on a claim. Valuation methods are: ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value As used here, this information is for the building.
PROPERTY	INFL%	Enter percentage: The inflation guard percentage gives an automatic increase in the amount of coverage based on a percentage over time. List both the percentage amount and the period of time during which it applies (e.g., 4% per year). As used here, this information is for the building.
PROPERTY	Deductible Type	Enter code: The type of deductible (e.g. Flat, Percent, etc.) As used here, this information is for the building.
PROPERTY	Deductible	Enter deductible: The deductible amount that is to apply to this subject of insurance. As used here, this information is for the building.
PROPERTY	Deductible Type	Enter code: The type of deductible (e.g. Flat, Percent, etc.) As used here, this information is for the building.
PROPERTY	Deductible	Enter deductible: The deductible amount that is to apply to this subject of insurance. As used here, this information is for the building.
PROPERTY	Personal Property Limit	Enter limit: The personal property limit amount.
PROPERTY	% Coins	Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage. As used here, this information is for personal property.
PROPERTY	Valuation - RC	Check the box (if applicable): Indicate the replacement cost will be used to determine the amount paid on a claim. As used here, this information is for personal property.
PROPERTY	Valuation - FVRC	Check the box (if applicable): Indicate the full value replacement cost will be used to determine the amount paid on a claim. As used here, this information is for personal property.

Section Name	Field Name	Field and/or Section Description
PROPERTY	Valuation - ACV	Check the box (if applicable): Indicate the actual cash value will be used to determine the amount paid on a claim. As used here, this information is for personal property.
PROPERTY	Valuation - Other	Check the box (if applicable): Indicate the method used to determine the amount paid on a claim is other than those listed. As used here, this information is for personal property.
PROPERTY	Valuation - Other Description	Enter code: Indicate the method which will be used to determine the amount paid on a claim. Valuation methods are: ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market Value As used here, this information is for personal property.
PROPERTY	INFL%	Enter percentage: The inflation guard percentage gives an automatic increase in the amount of coverage based on a percentage over time. List both the percentage amount and the period of time during which it applies (e.g., 4% per year). As used here, this information is for personal property.
PROPERTY	Deductible Type	Enter code: The type of deductible (e.g. Flat, Percent, etc.) As used here, this information is for personal property.
PROPERTY	Deductible	Enter deductible: The deductible amount that is to apply to this subject of insurance. As used here, this information is for personal property.
PROPERTY	Deductible Type	Enter code: The type of deductible (e.g. Flat, Percent, etc.) As used here, this information is for personal property.
PROPERTY	Deductible	Enter deductible: The deductible amount that is to apply to this subject of insurance. As used here, this information is for personal property.
PROPERTY	Year Built	Enter year: The year the building at each location was originally constructed. Specify in the Remarks section any significant additions or renovations and the year they were completed.

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