ACORD 160 (2014/12) - BUSINESS OWNERS SECTION

ACORD 160 (2014/12) - BUSINESS OWNERS SECTION
ACORD 160, Business Owners Section, is designed to be used with most business owners and small business policies. The form must be
attached to 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.
Form Page 1
Section Name
Field Name
Description
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 date on which the form is completed. (MM/DD/YYYY)
IDENTIFICATION SECTION
Agency Name
Enter text: The full name of the producer / agency.
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. (MM/DD/YYYY)
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
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.
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.
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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 Estimated Premium
Enter amount: The total estimated 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
Remarks
Enter text: An explanation of any past, present or discontinued operations that involve storing,
treating, discharging, applying, disposing or transporting hazardous material.
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 team
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.
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GENERAL INFORMATION
Age Group - Over 18
Check the box (if applicable): Indicates the sport participants 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 team
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 participants 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
Remarks
Enter text: An explanation as to why you do not obtain and verify certificates of insurance
obtained from subcontractors, manufacturers and/or suppliers.
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.
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?.
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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 other 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 in the building is other than
those listed.
GENERAL INFORMATION
Building Interest - Other
Description
Enter text: The description of the insured's interest in the building when it is other than those
listed.
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).
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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 other 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 in the building is other than
those listed.
GENERAL INFORMATION
Building Interest - Other
Description
Enter text: The description of the insured's interest in the building when it is other than those
listed.
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?.
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GENERAL INFORMATION
Remarks
Enter text: An explanation as to whether you are also involved in the manufactured, relabeling or
repackaging of others products in addition to your primary business.
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
Remarks
Enter text: An explanation as to whether you are also involved in the mixing of others products in
addition to your primary business.
GENERAL INFORMATION
8. Do you rent or loan
equipment to others?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Do you rent or loan equipment to others?.
GENERAL INFORMATION
Equipment
Enter text: The description of the item.
GENERAL INFORMATION
Type of Equipment - Small
Tools
Check the box (if applicable): Indicates the subclass / grouping of property into which the item
falls is small tools.
GENERAL INFORMATION
Type of Equipment - Large
Equipment
Check the box (if applicable): Indicates the subclass / grouping of property into which the item
falls is large equipment.
GENERAL INFORMATION
Instruction Given (Y / N)
Enter Y for a Yes response. Input N for No response. Indicates whether instruction is given
on how to use the item when it is rented or loaned to others.
GENERAL INFORMATION
Equipment
Enter text: The description of the item.
GENERAL INFORMATION
Type of Equipment - Small
Tools
Check the box (if applicable): Indicates the subclass / grouping of property into which the item
falls is small tools.
GENERAL INFORMATION
Type of Equipment - Large
Equipment
Check the box (if applicable): Indicates the subclass / grouping of property into which the item
falls is large equipment.
GENERAL INFORMATION
Instruction Given (Y / N)
Enter Y for a Yes response. Input N for No response. Indicates whether instruction is given
on how to use the item when it is rented or loaned to others.
GENERAL INFORMATION
9. Does the operation have
hours after 9:00 PM and/or
24 hour operations?
Enter Y for a Yes response. Input N for No response. Indicates the response to the 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.
REMARKS
Remarks
Enter text: The description of any additional information required for underwriting or rating the
business owners line of business. ACORD 101, Additional Remarks Schedule, may be
attached if more space is required.
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Form Page 2
Section Name
Field Name
Description
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g., agency or
brokerage).
LIABILITY COVERAGES -
POLICY LEVEL
Bodily Injury and Property
Damage - Occurrence
Enter limit: The bodily injury each occurrence limit amount. As used here, this is the Bodily
Injury and Property Damage limit per occurrence.
LIABILITY COVERAGES -
POLICY LEVEL
Bodily Injury and Property
Damage - Aggregate
Enter limit: The commercial general liability policy, bodily injury aggregate limit amount. As used
here, this is the Bodily Injury and Property Damage aggregate limit.
LIABILITY COVERAGES -
POLICY LEVEL
Bodily Injury and Property
Damage - Deductible
Enter deductible: The deductible applicable to the Bodily Injury coverage. As used here, this is
the Bodily Injury and Property Damage deductible.
LIABILITY COVERAGES -
POLICY LEVEL
Bodily Injury and Property
Damage - Included
Check the box (if applicable): Indicates bodily injury coverage is included in the policy. As used
here, indicates Bodily Injury and Property Damage coverage is included in the policy.
LIABILITY COVERAGES -
POLICY LEVEL
Bodily Injury and Property
Damage - Form Number
Enter identifier: The form number used by the company for bodily injury coverage. As used
here, this is the form number used by the company for Bodily Injury and Property Damage
coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Bodily Injury and Property
Damage - Form Date
Enter date: The edition date of the form used by the company for bodily injury coverage. As
used here, the edition date of the form used by the company for Bodily Injury and Property
Damage coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Bodily Injury and Property
Damage - Premium
Enter amount: The premium amount for bodily injury coverage. As used here, the premium
amount for Bodily Injury and Property Damage coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Medical Expense (per
person) - Total Amount
Enter limit: The general liability, medical expense each person limit amount. Any questions
about appropriate limits or applicable policy coverage(s) should be answered by the issuing
insurer(s).
LIABILITY COVERAGES -
POLICY LEVEL
Medical Expense (per
person) - Deductible
Enter deductible: The deductible amount for medical expense coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Medical Expense (per
person) - Included
Check the box (if applicable): Indicates medical expense coverage is included in the policy.
LIABILITY COVERAGES -
POLICY LEVEL
Medical Expense (per
person) - 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 -
POLICY LEVEL
Medical Expense (per
person) - Premium
Enter amount: The premium amount for medical expense coverage.
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LIABILITY COVERAGES -
POLICY LEVEL
Personal & Advertising
Injury - Total Amount
Enter limit: The general liability, personal and advertising injury limit amount. Any questions
about appropriate limits or applicable policy coverage(s) should be answered by the issuing
insurer(s).
LIABILITY COVERAGES -
POLICY LEVEL
Personal & Advertising
Injury - Deductible
Enter deductible: The deductible amount for personal and advertising injury coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Personal & Advertising
Injury - Included
Check the box (if applicable): Indicates personal and advertising injury coverage is 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 -
POLICY LEVEL
Personal & Advertising
Injury - Form Date
Enter date: The edition date of the form used by the company for personal and advertising injury
coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Personal & Advertising
Injury - Premium
Enter amount: The premium amount for personal and advertising injury coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Products & Completed
Operations - Total Amount
Enter limit: The general liability, products and completed operations aggregate limit amount.
Any questions about appropriate limits or applicable policy coverage(s) should be answered by
the issuing insurer(s).
LIABILITY COVERAGES -
POLICY LEVEL
Products & Completed
Operations - Deductible
Enter deductible: The deductible amount for products and completed operations coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Products & Completed
Operations - Included
Check the box (if applicable): Indicates products and completed operations coverage is included
in the policy.
LIABILITY COVERAGES -
POLICY LEVEL
Products & Completed
Operations - Form Number
Enter identifier: The form number used by the company for products and completed operations
coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Products & Completed
Operations - Form Date
Enter date: The edition date of the form used by the company for products and completed
operations coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Products & Completed
Operations - Premium
Enter amount: The premium amount for products and completed operations coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Professional Liability -
Employment Practices
Liability (EPLI) - Total
Amount
Enter limit: The limit amount for employment practices liability (EPLI) coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Professional Liability -
Employment Practices
Liability (EPLI) - Retroactive
Date
Enter date: The retroactive date requested for employment practices liability (EPLI) coverage.
(MM/DD/YYYY)
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LIABILITY COVERAGES -
POLICY LEVEL
Professional Liability -
Employment Practices
Liability (EPLI) - Deductible
Enter deductible: The deductible amount for employment practices liability (EPLI) coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Professional Liability -
Employment Practices
Liability (EPLI) - Included
Check the box (if applicable): Indicates employment practices liability (EPLI) coverage is
included in the policy.
LIABILITY COVERAGES -
POLICY LEVEL
Professional Liability -
Employment Practices
Liability (EPLI) - Form
Number
Enter identifier: The form number used by the company for employment practices liability (EPLI)
coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Professional Liability -
Employment Practices
Liability (EPLI) - Form Date
Enter date: The edition date of the form used by the company for employment practices liability
(EPLI) coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Professional Liability -
Employment Practices
Liability (EPLI) - Premium
Enter amount: The premium amount for employment practices liability (EPLI) coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Professional Liability -
Directors & Officers - Total
Amount
Enter limit: The limit amount for directors and officers (D&O) coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Professional Liability -
Directors & Officers -
Retroactive Date
Enter date: The retroactive date requested for Directors & Officers (D&O) coverage.
(MM/DD/YYYY)
LIABILITY COVERAGES -
POLICY LEVEL
Professional Liability -
Directors & Officers -
Deductible
Enter deductible: The deductible amount for directors and officers (D&O) coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Professional Liability -
Directors & Officers -
Included
Check the box (if applicable): Indicates directors and officers (D&O) coverage is 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 -
POLICY LEVEL
Professional Liability -
Directors & Officers - Form
Date
Enter date: The edition date of the form used by the company for directors and officers (D&O)
coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Professional Liability -
Directors & Officers -
Premium
Enter amount: The premium amount for directors and officers (D&O) coverage.
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LIABILITY COVERAGES -
POLICY LEVEL
Tenants Legal Liability -
Total Amount
Enter limit: The limit amount for tenants legal liability coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Tenants Legal Liability -
Deductible
Enter deductible: The deductible amount for tenants legal liability coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Tenants Legal Liability -
Included
Check the box (if applicable): Indicates tenants legal liability coverage is included in the policy.
LIABILITY COVERAGES -
POLICY LEVEL
Tenants Legal Liability -
Form Number
Enter identifier: The form number used by the company for tenants legal liability coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Tenants Legal Liability -
Form Date
Enter date: The edition date of the form used by the company for tenants legal liability coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Tenants Legal Liability -
Premium
Enter amount: The premium amount for tenants legal liability coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Auto - Hired Physical
Damage - Total Amount
Enter limit: The limit amount for hired auto physical damage coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Auto - Hired Physical
Damage - Deductible
Enter deductible: The deductible amount for hired auto physical damage coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Auto - Hired Physical
Damage - Included
Check the box (if applicable): Indicates hired auto physical damage coverage is 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 -
POLICY LEVEL
Auto - Hired Physical
Damage - Form Date
Enter date: The edition date of the form used by the company for hired auto physical damage
coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Auto - Hired Physical
Damage - Premium
Enter amount: The premium amount for hired auto physical damage coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Auto - Hired Liability -
Bodily Injury - Total Amount
Enter limit: The limit amount for hired auto bodily injury coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Auto - Hired Liability -
Bodily Injury - Deductible
Enter deductible: The deductible amount for hired auto bodily injury coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Auto - Hired Liability -
Bodily Injury - Included
Check the box (if applicable): Indicates hired auto bodily injury coverage is included in the policy.
LIABILITY COVERAGES -
POLICY LEVEL
Auto - Hired Liability -
Bodily Injury - Form Number
Enter identifier: The form number used by the company for hired auto bodily injury coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Auto - Hired Liability -
Bodily Injury - Form Date
Enter date: The edition date of the form used by the company for hired auto bodily injury
coverage.
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LIABILITY COVERAGES -
POLICY LEVEL
Auto - Hired Liability -
Bodily Injury - Premium
Enter amount: The premium amount for hired auto bodily injury coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Auto - Hired Liability -
Property Damage - Total
Amount
Enter limit: The limit amount for hired auto property damage coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Auto - Hired Liability -
Property Damage -
Deductible
Enter deductible: The deductible amount for hired auto property damage coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Auto - Hired Liability -
Property Damage - Included
Check the box (if applicable): Indicates hired auto property damage coverage is included in the
policy.
LIABILITY COVERAGES -
POLICY LEVEL
Auto - Hired Liability -
Property Damage - Form
Number
Enter identifier: The form number used by the company for hired auto property damage
coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Auto - Hired Liability -
Property Damage - Form
Date
Enter date: The edition date of the form used by the company for hired auto property damage
coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Auto - Hired Liability -
Property 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 -
POLICY LEVEL
Employee Benefits Liability -
Total Amount
Enter limit: The general liability employee benefits limit amount.
LIABILITY COVERAGES -
POLICY LEVEL
Employee Benefits Liability -
Retroactive Date
Enter date: The retroactive date that is the earliest date for which an occurrence could trigger
coverage under Employee Benefits coverage. (MM/DD/YYYY)
ACORD 160 (2014/12) rev. 04-29-2014
Page 11 of 70
LIABILITY COVERAGES -
POLICY LEVEL
Employee Benefits Liability -
Deductible
Enter deductible: The deductible per claim applicable to Employee Benefits Liability coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Employee Benefits Liability -
Included
Check the box (if applicable): Indicates employee benefits coverage is included in the policy.
LIABILITY COVERAGES -
POLICY LEVEL
Employee Benefits Liability -
Form 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 -
POLICY LEVEL
Employee Benefits Liability -
Premium
Enter amount: The premium amount for employee benefits coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Extended Employee
Dishonesty - Total Amount
Enter limit: The limit amount for extended employee dishonesty coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Extended Employee
Dishonesty - Deductible
Enter deductible: The deductible amount for extended employee dishonesty coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Extended Employee
Dishonesty - Included
Check the box (if applicable): Indicates extended employee dishonesty coverage is 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 -
POLICY LEVEL
Extended Employee
Dishonesty - Form Date
Enter date: The edition date of the form used by the company for extended employee
dishonesty coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Extended Employee
Dishonesty - Premium
Enter amount: The premium amount for extended employee dishonesty coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Freight or Passenger
Elevators Inspection Fee -
Total Amount
Enter limit: The limit amount for freight or passenger elevators inspection fee coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Freight or Passenger
Elevators Inspection Fee -
Deductible
Enter deductible: The deductible amount for freight or passenger elevators inspection fee
coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Freight or Passenger
Elevators Inspection Fee -
Included
Check the box (if applicable): Indicates freight or passenger elevators inspection fee coverage is
included in the policy.
LIABILITY COVERAGES -
POLICY LEVEL
Freight or Passenger
Elevators Inspection Fee -
Form Number
Enter identifier: The form number used by the company for freight or passenger elevators
inspection fee coverage.
ACORD 160 (2014/12) rev. 04-29-2014
Page 12 of 70
LIABILITY COVERAGES -
POLICY LEVEL
Freight or Passenger
Elevators Inspection Fee -
Form Date
Enter date: The edition date of the form used by the company for freight or passenger elevators
inspection fee coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Freight or Passenger
Elevators Inspection Fee -
Premium
Enter amount: The premium amount for freight or passenger elevators inspection fee coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Liquor Liability - General
Aggregate
Enter limit: The aggregate limit amount for liquor liability coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Liquor Liability - Per Person
Enter limit: The per person limit amount for liquor liability coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Liquor Liability - Other
Description
Enter text: The description of the other liquor liability coverage.
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 -
POLICY LEVEL
Medical Payments -
Included
Check the box (if applicable): Indicates medical payments coverage is included in the policy.
LIABILITY COVERAGES -
POLICY LEVEL
Medical Payments - Form
Number
Enter identifier: The form number used by the company for medical payments coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Medical Payments - Form
Date
Enter date: The edition date of the form used by the company for medical payments coverage.
ACORD 160 (2014/12) rev. 04-29-2014
Page 13 of 70
LIABILITY COVERAGES -
POLICY LEVEL
Medical Payments -
Premium
Enter amount: The premium amount for medical payments coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Mobile Equipment Subject
to Motor Vehicle Laws -
Total Amount
Enter limit: The limit amount for mobile equipment subject to motor vehicle laws coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Mobile Equipment Subject
to Motor Vehicle Laws -
Deductible
Enter deductible: The deductible amount for mobile equipment subject to motor vehicle laws
coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Mobile Equipment Subject
to Motor Vehicle Laws -
Included
Check the box (if applicable): Indicates mobile equipment subject to motor vehicle laws
coverage is included in the policy.
LIABILITY COVERAGES -
POLICY LEVEL
Mobile Equipment Subject
to Motor Vehicle Laws -
Form Number
Enter identifier: The form number used by the company for mobile equipment subject to motor
vehicle laws coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Mobile Equipment Subject
to Motor Vehicle Laws -
Form Date
Enter date: The edition date of the form used by the company for mobile equipment 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 COVERAGES -
POLICY LEVEL
Garage Physical Damage -
Collision - Total Amount
Enter limit: The limit amount for garage physical damage collision coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Garage Physical Damage -
Collision - Deductible
Enter deductible: The deductible amount for garage physical damage collision coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Garage Physical Damage -
Collision - Included
Check the box (if applicable): Indicates garage physical damage collision coverage is included in
the policy.
LIABILITY COVERAGES -
POLICY LEVEL
Garage Physical Damage -
Collision - Form Number
Enter identifier: The form number used by the company for garage physical damage collision
coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Garage Physical Damage -
Collision - Form Date
Enter date: The edition date of the form used by the company for garage physical damage
collision coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Garage Physical Damage -
Collision - Premium
Enter amount: The premium amount for garage physical damage collision coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Garage Physical Damage -
Comprehensive / OTC -
Total Amount
Enter limit: The limit amount for garage physical damage comprehensive / other than collision
coverage.
ACORD 160 (2014/12) rev. 04-29-2014
Page 14 of 70
LIABILITY COVERAGES -
POLICY LEVEL
Garage Physical Damage -
Comprehensive / OTC -
Deductible
Enter deductible: The deductible amount for garage physical damage comprehensive / other
than collision coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Garage Physical Damage -
Comprehensive / OTC -
Included
Check the box (if applicable): Indicates garage physical damage comprehensive / other than
collision coverage is included in the policy.
LIABILITY COVERAGES -
POLICY LEVEL
Garage Physical Damage -
Comprehensive / OTC -
Form Number
Enter identifier: The form number used by the company for garage physical damage
comprehensive / other than collision coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Garage Physical Damage -
Comprehensive / OTC -
Form Date
Enter date: The edition date of the form used by the company for garage physical damage
comprehensive / other than collision coverage.
LIABILITY COVERAGES -
POLICY LEVEL
Garage Physical Damage -
Comprehensive / OTC -
Premium
Enter amount: The premium amount for garage comprehensive / other than collision coverage.
GARAGE KEEPERS
Legal Liability (Checkbox)
Check the box (if applicable): Indicates the policy is to be written on a legal liability basis.
GARAGE KEEPERS
Direct Basis (Checkbox)
Check the box (if applicable): Indicates the policy is to be written on a direct basis.
GARAGE KEEPERS
Primary (Checkbox)
Check the box (if applicable): Indicates this policy is the primary coverage.
GARAGE KEEPERS
Excess (Checkbox)
Check the box (if applicable): Indicates this policy is for excess coverage.
GARAGE KEEPERS
Comp / OTC
Check the box (if applicable): Indicates the garage keepers coverage is comprehensive / other
than collision.
GARAGE KEEPERS
Specified Perils
Check the box (if applicable): Indicates the garage keepers coverage is for specified perils.
GARAGE KEEPERS
Perils option field
Enter text: The codes associated with specified perils coverage. The codes are: F - Fire, F&T -
Fire and Theft, FTW - Fire, Theft and Wind, LSP - Limited Specified Perils, SP - Specified
Perils.
GARAGE KEEPERS
Other Covered Auto Symbol
Check the box (if applicable): Indicates that a symbol other than those listed should be used.
GARAGE KEEPERS
Other Covered Auto Symbol
- Code
Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or
enter a company-unique symbol if applicable.
GARAGE KEEPERS
Other Covered Auto Symbol
Check the box (if applicable): Indicates that a symbol other than those listed should be used.
GARAGE KEEPERS
Other Covered Auto Symbol
- Code
Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or
enter a company-unique symbol if applicable.
GARAGE KEEPERS
LOC # - One
Enter number: The producer assigned number for the location. The location number for the
garage keepers coverages should correspond to a location number documented on the ACORD
125.
ACORD 160 (2014/12) rev. 04-29-2014
Page 15 of 70
GARAGE KEEPERS
Limit Per Location - One
Enter limit: The garage keepers comprehensive / other than collision or specified perils limit
amount.
GARAGE KEEPERS
# of Autos - One
Enter number: The number of vehicles located on the premises.
GARAGE KEEPERS
Deductible Per Auto - One
Enter deductible: The garage keepers comprehensive / other than collision or specified perils
per auto deductible amount.
GARAGE KEEPERS
Maximum Deductible Per
Loss - One
Enter deductible: The garage keepers comprehensive / other than collision or specified perils
maximum deductible per loss amount.
GARAGE KEEPERS
Premium - One
Enter amount: The garage keepers comprehensive / other than collision or specified perils
premium amount.
GARAGE KEEPERS
LOC # - Two
Enter number: The producer assigned number for the location. The location number for the
garage keepers coverages should correspond to a location number documented on the ACORD
125.
GARAGE KEEPERS
Limit Per Location - Two
Enter limit: The garage keepers comprehensive / other than collision or specified perils limit
amount.
GARAGE KEEPERS
# of Autos - Two
Enter number: The number of vehicles located on the premises.
GARAGE KEEPERS
Deductible Per Auto - Two
Enter deductible: The garage keepers comprehensive / other than collision or specified perils
per auto deductible amount.
GARAGE KEEPERS
Maximum Deductible Per
Loss - Two
Enter deductible: The garage keepers comprehensive / other than collision or specified perils
maximum deductible per loss amount.
GARAGE KEEPERS
Premium - Two
Enter amount: The garage keepers comprehensive / other than collision or specified perils
premium amount.
GARAGE KEEPERS
LOC # - Three
Enter number: The producer assigned number for the location. The location number for the
garage keepers coverages should correspond to a location number documented on the ACORD
125.
GARAGE KEEPERS
Limit Per Location - Three
Enter limit: The garage keepers comprehensive / other than collision or specified perils limit
amount.
GARAGE KEEPERS
# of Autos - Three
Enter number: The number of vehicles located on the premises.
GARAGE KEEPERS
Deductible Per Auto - Three
Enter deductible: The garage keepers comprehensive / other than collision or specified perils
per auto deductible amount.
GARAGE KEEPERS
Maximum Deductible Per
Loss - Three
Enter deductible: The garage keepers comprehensive / other than collision or specified perils
maximum deductible per loss amount.
GARAGE KEEPERS
Premium - Three
Enter amount: The garage keepers comprehensive / other than collision or specified perils
premium amount.
GARAGE KEEPERS
Other Covered Auto Symbol
Check the box (if applicable): Indicates that a symbol other than those listed should be used.
ACORD 160 (2014/12) rev. 04-29-2014
Page 16 of 70
GARAGE KEEPERS
Other Covered Auto Symbol
- Code
Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or
enter a company-unique symbol if applicable.
GARAGE KEEPERS
Other Covered Auto Symbol
Check the box (if applicable): Indicates that a symbol other than those listed should be used.
GARAGE KEEPERS
Other Covered Auto Symbol
- Code
Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or
enter a company-unique symbol if applicable.
GARAGE KEEPERS
LOC # - Four
Enter number: The producer assigned number for the location. The location number for the
garage keepers coverages should correspond to a location number documented on the ACORD
125.
GARAGE KEEPERS
Limit Per Location - Four
Enter limit: The garage keepers collision limit amount.
GARAGE KEEPERS
# of Autos - Four
Enter number: The number of vehicles located on the premises.
GARAGE KEEPERS
Deductible Per Auto - Four
Enter deductible: The garage keepers collision per auto deductible amount.
GARAGE KEEPERS
Premium - Four
Enter amount: The garage keepers collision premium amount.
GARAGE KEEPERS
LOC # - Five
Enter number: The producer assigned number for the location. The location number for the
garage keepers coverages should correspond to a location number documented on the ACORD
125.
GARAGE KEEPERS
Limit Per Location - Five
Enter limit: The garage keepers collision limit amount.
GARAGE KEEPERS
# of Autos - Five
Enter number: The number of vehicles located on the premises.
GARAGE KEEPERS
Deductible Per Auto - Five
Enter deductible: The garage keepers collision per auto deductible amount.
GARAGE KEEPERS
Premium - Five
Enter amount: The garage keepers collision premium amount.
GARAGE KEEPERS
LOC # - Six
Enter number: The producer assigned number for the location. The location number for the
garage keepers coverages should correspond to a location number documented on the ACORD
125.
GARAGE KEEPERS
Limit Per Location - Six
Enter limit: The garage keepers collision limit amount.
GARAGE KEEPERS
# of Autos - Six
Enter number: The number of vehicles located on the premises.
GARAGE KEEPERS
Deductible Per Auto - Six
Enter deductible: The garage keepers collision per auto deductible amount.
GARAGE KEEPERS
Premium - Six
Enter amount: The garage keepers collision premium amount.
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 (2014/12) rev. 04-29-2014
Page 17 of 70
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 deductible: 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.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL
Description of Credit /
Surcharge 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 (2014/12) rev. 04-29-2014
Page 18 of 70
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 deductible: 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 (2014/12) rev. 04-29-2014
Page 19 of 70
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL
Description of Credit /
Surcharge 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 deductible: 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 (2014/12) rev. 04-29-2014
Page 20 of 70
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.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL
Description of Credit /
Surcharge 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 deductible: 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 (2014/12) rev. 04-29-2014
Page 21 of 70
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.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL
Description of Credit /
Surcharge 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 (2014/12) rev. 04-29-2014
Page 22 of 70
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL
Deductible
Enter deductible: 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.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL
Description of Credit /
Surcharge 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).
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Page 23 of 70
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 deductible: 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.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL
Description of Credit /
Surcharge 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).
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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 deductible: 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.
LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL
Description of Credit /
Surcharge 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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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 deductible: 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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LIABILITY ADDITIONAL
COVERAGES - POLICY
LEVEL
Description of Credit /
Surcharge 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.
Form Page 3
Section Name
Field Name
Description
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g., agency or
brokerage).
IDENTIFICATION SECTION
Loc #
Enter number: The producer assigned number of the location.
IDENTIFICATION SECTION
Bldg #
Enter number: The building number for the premises. Used when more than one building exists
at an individual location.
PREMISES
Blanket Rate
Enter Y for a Yes response. Input N for No response. Indicates if a blanket rate is being
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.
PREMISES
Description of all
occupancies at this
premises
Enter text: The description of the building's occupancy.
PREMISES
Right Exposure
Enter text: The description of the buildings, structures, activities conducted, or use of the
adjacent property to the right of the insured premises.
PREMISES
Distance
Enter number: The distance to the adjacent exposure on the right of the insured premises in
linear feet.
PREMISES
Left Exposure
Enter text: The description of the buildings, structures, activities conducted, or use of the
adjacent property to the left of the insured premises.
PREMISES
Distance
Enter number: The distance to the adjacent exposure on the left of the insured premises in
linear feet.
PREMISES
Front Exposure
Enter text: The description of the buildings, structures, activities conducted, or use of the
adjacent property to the front of the insured premises.
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PREMISES
Distance
Enter number: The distance to the adjacent exposure in the front of the insured premises in
linear feet.
PREMISES
Rear Exposure
Enter text: The description of the buildings, structures, activities conducted, or use of the
adjacent property to the rear of the insured premises.
PREMISES
Distance
Enter number: The distance to the adjacent exposure in 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 Territory
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
BLDG - Blkt #
Enter number: The identifying number for the blanket under which this subject of insurance is
rated. Leave blank if the subject of insurance is not included under a blanket. As used here,
this information is for the building.
PROPERTY
Building Limit
Enter limit: The limit amount for building coverage.
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.
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Page 28 of 70
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.
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. If
other valuation basis applies, provide necessary information.
Example valuation methods are:
A - Actual Cash Value
R - Replacement Cost
V - Agreed Amount
M - 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 code indicating the type of deductible that is to apply to this subject of
insurance. Examples are percent, dollars and number of days. Number of days is used to
describe the waiting period (deductible) for business income. 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 code indicating the type of deductible that is to apply to this subject of
insurance. Examples are percent, dollars and number of days. Number of days is used to
describe the waiting period (deductible) for business income. 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
PROP PERS - Blkt #
Enter identifier: The blanket number assigned to the personal property. Leave blank if the
subject of insurance is not included under a blanket.
PROPERTY
Personal Property Limit
Enter limit: The limit amount for personal property coverage.
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.
ACORD 160 (2014/12) rev. 04-29-2014
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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.
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. If
other valuation basis applies, provide necessary information.
Example valuation methods are:
A - Actual Cash Value
R - Replacement Cost
V - Agreed Amount
M - 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 code indicating the type of deductible that is to apply to this subject of
insurance. Examples are percent, dollars and number of days. Number of days is used to
describe the waiting period (deductible) for business income. 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 code indicating the type of deductible that is to apply to this subject of
insurance. Examples are percent, dollars and number of days. Number of days is used to
describe the waiting period (deductible) for business income. 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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Page 30 of 70
PROPERTY
Construction Type
Enter code: The primary construction type of the premises. Common construction classifications
are:
* Frame
* Joisted Masonry
* Non-Combustible
* Masonry Non-Combustible
* Modified Fire Resistive
* Fire Resistive
PROPERTY
# Stories
Enter number: The number of stories or floors for this building not including any basement.
PROPERTY
% Sprink
Enter percentage: The percentage of the structure area covered by the sprinkler system.
PROPERTY
Basement Present? (Y / N)
Enter Y for a Yes response. Input N for No response. Indicates if there is a basement in the
structure.
PROPERTY
Is it finished? (Y / N)
Enter Y for a Yes response. Input N for No response. Indicates if the basement is finished.
PROPERTY
Wind Class - Resistive
Check the box (if applicable): Indicates the wind class is resistive.
PROPERTY
Wind Class - Semi-Resistive
Check the box (if applicable): Indicates the wind class is semi-resistive.
PROPERTY
Wind Class - Other
Check the box (if applicable): Indicates the wind class is other than those listed.
PROPERTY
Wind Class - Other
Description
Enter text: The description of the other wind class.
PROPERTY
Building Improvements -
Wiring Year
Enter year: The year the wiring improvements took place.
PROPERTY
Building Improvements -
Roofing Year
Enter year: The year the roofing improvements took place.
PROPERTY
Building Improvements -
Plumbing Year
Enter year: The year the plumbing improvements took place.
PROPERTY
Building Improvements -
Heating Year
Enter year: The year the heating improvements took place.
PROPERTY
Roof Type
Enter code: The material used to construct the roof. Examples include:
* Composition (fiberglass, asphalt, etc.)
* Metal
* Poured
* Slate
* Tile
* Wood Shake
(Please note this list is not all inclusive)
PROPERTY
Bldg. Code Grade
Enter code: The industry code used to collect the building code effectiveness grade code. The
source of this code list is public protection classification or individual insurer rating manuals.
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PROPERTY
Bldg. Code Grade -
Inspected (Y / N)
Enter Y for a Yes response. Input N for No response. Indicate if the structure has been
inspected specific to its Building Code effectiveness grade.
PROPERTY
Bldg. Code Grade -
Community
Check the box (if applicable): Indicates the building code effectiveness grade was established
for the community.
PROPERTY
Bldg. Code Grade - Specific
Property
Check the box (if applicable): Indicates the building code effectiveness grade was established
for this specific property.
PROPERTY
Tax Code
Enter code: The code which normally represents the location for which a surcharge is being
applied (city, county or state).
PROPERTY COVERAGES
Accounts Receivable - Pol
Level
Check the box (if applicable): Indicates accounts receivable coverage applies to the policy.
PROPERTY COVERAGES
Accounts Receivable - Prem
Level
Check the box (if applicable): Indicates accounts receivable coverage applies to a specific
premises.
PROPERTY COVERAGES
Accounts Receivable - Total
Amount
Enter limit: The total limit amount for accounts receivable coverage.
PROPERTY COVERAGES
Accounts Receivable -
Deductible
Enter deductible: The deductible amount for accounts receivable coverage.
PROPERTY COVERAGES
Accounts Receivable -
Included
Check the box (if applicable): Indicates accounts receivable coverage is included in the policy.
PROPERTY COVERAGES
Accounts Receivable - Form
Number
Enter identifier: The form number used by the company for accounts receivable coverage.
PROPERTY COVERAGES
Accounts Receivable - Form
Date
Enter date: The edition date of the form used by the company for accounts receivable coverage.
PROPERTY COVERAGES
Accounts Receivable -
Premium
Enter amount: The premium amount for accounts receivable coverage.
PROPERTY COVERAGES
Animal Coverage - Pol Level
Check the box (if applicable): Indicates animal coverage applies to the policy.
PROPERTY COVERAGES
Animal Coverage - Prem
Level
Check the box (if applicable): Indicates animal coverage applies to a specific premises.
PROPERTY COVERAGES
Animal Coverage - Total
Amount
Enter limit: The total limit amount for animal coverage.
PROPERTY COVERAGES
Animal Coverage -
Deductible
Enter deductible: The deductible amount for animal coverage.
PROPERTY COVERAGES
Animal Coverage - Included
Check the box (if applicable): Indicates animal coverage is included in the policy.
ACORD 160 (2014/12) rev. 04-29-2014
Page 32 of 70
PROPERTY COVERAGES
Animal Coverage - Form
Number
Enter identifier: The form number used by the company for animal coverage.
PROPERTY COVERAGES
Animal Coverage - Form
Date
Enter date: The edition date of the form used by the company for animal coverage.
PROPERTY COVERAGES
Animal Coverage - Premium
Enter amount: The premium amount for animal coverage.
PROPERTY COVERAGES
Bailees Liability - Pol Level
Check the box (if applicable): Indicates bailees coverage applies to the policy.
PROPERTY COVERAGES
Bailees Liability - Prem
Level
Check the box (if applicable): Indicates bailees coverage applies to a specific premises.
PROPERTY COVERAGES
Bailees Liability - Total
Amount
Enter limit: The total limit amount for bailees coverage.
PROPERTY COVERAGES
Bailees Liability - Deductible
Enter deductible: The deductible amount for bailees coverage.
PROPERTY COVERAGES
Bailees Liability - Included
Check the box (if applicable): Indicates bailees coverage is included in the policy.
PROPERTY COVERAGES
Bailees Liability - Form
Number
Enter identifier: The form number used by the company for bailees liability coverage.
PROPERTY COVERAGES
Bailees Liability - Form Date
Enter date: The edition date of the form used by the company for bailees liability coverage.
PROPERTY COVERAGES
Bailees Liability - Premium
Enter amount: The premium amount for bailees coverage.
PROPERTY COVERAGES
Builders Risk - Theft of Bldg
Materials - Pol Level
Check the box (if applicable): Indicates builders risk - theft of building materials coverage
applies to the policy.
PROPERTY COVERAGES
Builders Risk - Theft of Bldg
Materials - Prem Level
Check the box (if applicable): Indicates builders risk - theft of building materials coverage
applies to a specific premises.
PROPERTY COVERAGES
Builders Risk - Theft of Bldg
Materials - Total Amount
Enter limit: The total limit amount for builders risk - theft of building materials coverage.
PROPERTY COVERAGES
Builders Risk - Theft of Bldg
Materials - Deductible
Enter deductible: The deductible amount for builders risk - theft of building materials coverage.
PROPERTY COVERAGES
Builders Risk - Theft of Bldg
Materials - Included
Check the box (if applicable): Indicates builders risk - theft of building materials coverage is
included in the policy.
PROPERTY COVERAGES
Builders Risk - Theft of Bldg
Materials - Form Number
Enter identifier: The form number used by the company for builders risk - theft of building
materials coverage.
PROPERTY COVERAGES
Builders Risk - Theft of Bldg
Materials - Form Date
Enter date: The edition date of the form used by the company for builders risk - theft of building
materials coverage.
PROPERTY COVERAGES
Builders Risk - Theft of Bldg
Materials - Premium
Enter amount: The premium amount for builders risk - theft of building materials coverage.
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PROPERTY COVERAGES
Builders Risk - Collapse Due
to Hydro-Static Pressure -
Pol Level
Check the box (if applicable): Indicates builders risk - collapse due to hydro-static pressure
coverage applies to the policy.
PROPERTY COVERAGES
Builders Risk - Collapse Due
to Hydro-Static Pressure -
Prem Level
Check the box (if applicable): Indicates builders risk - collapse due to hydro-static pressure
coverage applies to a specific premises.
PROPERTY COVERAGES
Builders Risk - Collapse Due
to Hydro-Static Pressure -
Total Amount
Enter limit: The total limit amount for builders risk - collapse due to hydro-static pressure
coverage.
PROPERTY COVERAGES
Builders Risk - Collapse Due
to Hydro-Static Pressure -
Deductible
Enter deductible: The deductible amount for builders risk - collapse due to hydro-static pressure
coverage.
PROPERTY COVERAGES
Builders Risk - Collapse Due
to Hydro-Static Pressure -
Included
Check the box (if applicable): Indicates builders risk - collapse due to hydro-static pressure
coverage is included in the policy.
PROPERTY COVERAGES
Builders Risk - Collapse Due
to Hydro-Static Pressure -
Form Number
Enter identifier: The form number used by the company for builders risk - collapse due to
hydro-static pressure coverage.
PROPERTY COVERAGES
Builders Risk - Collapse Due
to Hydro-Static Pressure -
Form Date
Enter date: The edition date of the form used by the company for builders risk - collapse due to
hydro-static pressure coverage.
PROPERTY COVERAGES
Builders Risk - Collapse Due
to Hydro-Static Pressure -
Premium
Enter amount: The premium amount for builders risk - collapse due to hydro-static pressure
coverage.
PROPERTY COVERAGES
Business Income - Pol Level
Check the box (if applicable): Indicates business income coverage applies to the policy.
PROPERTY COVERAGES
Business Income - Prem
Level
Check the box (if applicable): Indicates business income coverage applies to a specific
premises.
PROPERTY COVERAGES
Business Income - Actual
Loss Sustained
Check the box (if applicable): Indicates the coverage is on an actual loss sustained basis.
PROPERTY COVERAGES
Business Income - Actual
Loss Sustained No. of
Months
Enter number: The number of months of coverage.
PROPERTY COVERAGES
Business Income - Business
Income Changes - Time
Period
Check the box (if applicable): Indicates business income changes - time period applies.
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Page 34 of 70
PROPERTY COVERAGES
Business Income - Total
Amount
Enter limit: The total limit amount for business income coverage.
PROPERTY COVERAGES
Business Income -
Deductible
Enter deductible: The deductible amount for business income coverage.
PROPERTY COVERAGES
Business Income - Included
Check the box (if applicable): Indicates business income coverage is included in the policy.
PROPERTY COVERAGES
Business Income - Form
Number
Enter identifier: The form number used by the company for business income coverage.
PROPERTY COVERAGES
Business Income - Form
Date
Enter date: The edition date of the form used by the company for business income coverage.
PROPERTY COVERAGES
Business Income - Premium
Enter amount: The premium amount for business income coverage.
PROPERTY COVERAGES
Business Income From
Dependent Properties - Pol
Level
Check the box (if applicable): Indicates business income from dependent properties coverage
applies to the policy.
PROPERTY COVERAGES
Business Income From
Dependent Properties -
Prem Level
Check the box (if applicable): Indicates business income from dependent properties coverage
applies to a specific premises.
PROPERTY COVERAGES
Business Income From
Dependent Properties -
Total Amount
Enter limit: The total limit amount for business income from dependent properties coverage.
PROPERTY COVERAGES
Business Income From
Dependent Properties -
Deductible
Enter deductible: The deductible amount for business income from dependent properties
coverage.
PROPERTY COVERAGES
Business Income From
Dependent Properties -
Included
Check the box (if applicable): Indicates business income from dependent properties coverage is
included in the policy.
PROPERTY COVERAGES
Business Income From
Dependent Properties -
Form Number
Enter identifier: The form number used by the company for business income from dependent
properties coverage.
PROPERTY COVERAGES
Business Income From
Dependent Properties -
Form Date
Enter date: The edition date of the form used by the company for business income from
dependent properties coverage.
PROPERTY COVERAGES
Business Income From
Dependent Properties -
Premium
Enter amount: The premium amount for business income from dependent properties coverage.
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PROPERTY COVERAGES
Business Income With Extra
Expense - Pol Level
Check the box (if applicable): Indicates business income with extra expense coverage applies to
the policy.
PROPERTY COVERAGES
Business Income With Extra
Expense - Prem Level
Check the box (if applicable): Indicates business income with extra expense coverage applies to
a specific premises.
PROPERTY COVERAGES
Business Income With Extra
Expense - Total Amount
Enter limit: The total limit amount for business income with extra expense coverage.
PROPERTY COVERAGES
Business Income With Extra
Expense - Deductible
Enter deductible: The deductible amount for business income with extra expense coverage.
PROPERTY COVERAGES
Business Income With Extra
Expense - Included
Check the box (if applicable): Indicates business income with extra expense coverage is
included in the policy.
PROPERTY COVERAGES
Business Income With Extra
Expense - Form Number
Enter identifier: The form number used by the company for business income with extra expense
coverage.
PROPERTY COVERAGES
Business Income With Extra
Expense - Form Date
Enter date: The edition date of the form used by the company for business income with extra
expense coverage.
PROPERTY COVERAGES
Business Income With Extra
Expense - Premium
Enter amount: The premium amount for business income with extra expense coverage.
PROPERTY COVERAGES
Combined Demolition Cost
and Increased Construction
Cost - Pol Level
Check the box (if applicable): Indicates combined demolition cost and increased construction
cost coverage applies to the policy.
PROPERTY COVERAGES
Combined Demolition Cost
and Increased Construction
Cost - Prem Level
Check the box (if applicable): Indicates combined demolition cost and increased construction
cost coverage applies to a specific premises.
PROPERTY COVERAGES
Combined Demolition Cost
and Increased Construction
Cost - Total Amount
Enter limit: The total limit amount for combined demolition cost and increased construction cost
coverage.
PROPERTY COVERAGES
Combined Demolition Cost
and Increased Construction
Cost - Deductible
Enter deductible: The deductible amount for combined demolition cost and increased
construction cost coverage.
PROPERTY COVERAGES
Combined Demolition Cost
and Increased Construction
Cost - Included
Check the box (if applicable): Indicates combined demolition cost and increased construction
cost coverage is included in the policy.
PROPERTY COVERAGES
Combined Demolition Cost
and Increased Construction
Cost - Form Number
Enter identifier: The form number used by the company for combined demolition cost and
increased construction cost coverage.
ACORD 160 (2014/12) rev. 04-29-2014
Page 36 of 70
PROPERTY COVERAGES
Combined Demolition Cost
and Increased Construction
Cost - Form Date
Enter date: The edition date of the form used by the company for combined demolition cost and
increased construction cost coverage.
PROPERTY COVERAGES
Combined Demolition Cost
and Increased Construction
Cost - Premium
Enter amount: The premium amount for combined demolition cost and increased construction
cost coverage.
PROPERTY COVERAGES
Debris Removal - Pol Level
Check the box (if applicable): Indicates debris removal coverage applies to the policy.
PROPERTY COVERAGES
Debris Removal - Prem
Level
Check the box (if applicable): Indicates debris removal coverage applies to a specific premises.
PROPERTY COVERAGES
Debris Removal - Total
Amount
Enter limit: The total limit amount for debris removal coverage.
PROPERTY COVERAGES
Debris Removal - Deductible
Enter deductible: The deductible amount for debris removal coverage.
PROPERTY COVERAGES
Debris Removal - Included
Check the box (if applicable): Indicates debris removal coverage is included in the policy.
PROPERTY COVERAGES
Debris Removal - Form
Number
Enter identifier: The form number used by the company for debris removal coverage.
PROPERTY COVERAGES
Debris Removal - Form Date
Enter date: The edition date of the form used by the company for debris removal coverage.
PROPERTY COVERAGES
Debris Removal - Premium
Enter amount: The premium amount for debris removal coverage.
PROPERTY COVERAGES
Condo Unit Owners -
Owners Loss Assessment -
Pol Level
Check the box (if applicable): Indicates condo unit owners - owners loss assessment coverage
applies to the policy.
PROPERTY COVERAGES
Condo Unit Owners -
Owners Loss Assessment -
Prem Level
Check the box (if applicable): Indicates condo unit owners - owners loss assessment coverage
applies to a specific premises.
PROPERTY COVERAGES
Condo Unit Owners -
Owners Loss Assessment -
Total Amount
Enter limit: The total limit amount for condo unit owners - owners loss assessment coverage.
PROPERTY COVERAGES
Condo Unit Owners -
Owners Loss Assessment -
Deductible
Enter deductible: The deductible amount for condo unit owners - owners loss assessment
coverage.
PROPERTY COVERAGES
Condo Unit Owners -
Owners Loss Assessment -
Included
Check the box (if applicable): Indicates condo unit owners - owners loss assessment coverage
is included in the policy.
ACORD 160 (2014/12) rev. 04-29-2014
Page 37 of 70
PROPERTY COVERAGES
Condo Unit Owners -
Owners Loss Assessment -
Form Number
Enter identifier: The form number used by the company for condo unit owners - owners loss
assessment coverage.
PROPERTY COVERAGES
Condo Unit Owners -
Owners Loss Assessment -
Form Date
Enter date: The edition date of the form used by the company for condo unit owners - owners
loss assessment coverage.
PROPERTY COVERAGES
Condo Unit Owners -
Owners Loss Assessment -
Premium
Enter amount: The premium amount for condo unit owners - owners loss assessment coverage.
PROPERTY COVERAGES
Condo Unit Owners -
Owners Miscellaneous Real
Property - Pol Level
Check the box (if applicable): Indicates condo unit owners - owners miscellaneous real property
coverage applies to the policy.
PROPERTY COVERAGES
Condo Unit Owners -
Owners Miscellaneous Real
Property - Prem Level
Check the box (if applicable): Indicates condo unit owners - owners miscellaneous real property
coverage applies to a specific premises.
PROPERTY COVERAGES
Condo Unit Owners -
Owners Miscellaneous Real
Property - Total Amount
Enter limit: The total limit amount for condo unit owners - owners miscellaneous real property
coverage.
PROPERTY COVERAGES
Condo Unit Owners -
Owners Miscellaneous Real
Property - Deductible
Enter deductible: The deductible amount for condo unit owners - owners miscellaneous real
property coverage.
PROPERTY COVERAGES
Condo Unit Owners -
Owners Miscellaneous Real
Property - Included
Check the box (if applicable): Indicates condo unit owners - owners miscellaneous real property
coverage is included in the policy.
PROPERTY COVERAGES
Condo Unit Owners -
Owners Miscellaneous Real
Property - Form Number
Enter identifier: The form number used by the company for condo unit owners - owners
miscellaneous real property coverage.
PROPERTY COVERAGES
Condo Unit Owners -
Owners Miscellaneous Real
Property - Form Date
Enter date: The edition date of the form used by the company for condo unit owners - owners
miscellaneous real property coverage.
PROPERTY COVERAGES
Condo Unit Owners -
Owners Miscellaneous Real
Property - Premium
Enter amount: The premium amount for condo unit owners - owners miscellaneous real property
coverage.
PROPERTY COVERAGES
Crime - Employee
Dishonesty - Pol Level
Check the box (if applicable): Indicates employee dishonesty coverage applies to the policy.
ACORD 160 (2014/12) rev. 04-29-2014
Page 38 of 70
PROPERTY COVERAGES
Crime - Employee
Dishonesty - Prem Level
Check the box (if applicable): Indicates employee dishonesty coverage applies to a specific
premises.
PROPERTY COVERAGES
Crime - Employee
Dishonesty - Total Amount
Enter limit: The total limit amount for employee dishonesty coverage.
PROPERTY COVERAGES
Crime - Employee
Dishonesty - Deductible
Enter deductible: The deductible amount for employee dishonesty coverage.
PROPERTY COVERAGES
Crime - Employee
Dishonesty - Included
Check the box (if applicable): Indicates employee dishonesty coverage is included in the policy.
PROPERTY COVERAGES
Crime - Employee
Dishonesty - Form Number
Enter identifier: The form number used by the company for crime - employee dishonesty
coverage.
PROPERTY COVERAGES
Crime - Employee
Dishonesty - Form Date
Enter date: The edition date of the form used by the company for crime - employee dishonesty
coverage.
PROPERTY COVERAGES
Crime - Employee
Dishonesty - Premium
Enter amount: The premium amount for employee dishonesty coverage.
PROPERTY COVERAGES
Crime - Forgery or Alteration
- Pol Level
Check the box (if applicable): Indicates crime - forgery or alteration coverage applies to the
policy.
PROPERTY COVERAGES
Crime - Forgery or Alteration
- Prem Level
Check the box (if applicable): Indicates crime - forgery or alteration coverage applies to a
specific premises.
PROPERTY COVERAGES
Crime - Forgery or Alteration
- Total Amount
Enter limit: The total limit amount for crime - forgery or alteration coverage.
PROPERTY COVERAGES
Crime - Forgery or Alteration
- Deductible
Enter deductible: The deductible amount for crime - forgery or alteration coverage.
PROPERTY COVERAGES
Crime - Forgery or Alteration
- Included
Check the box (if applicable): Indicates crime - forgery or alteration coverage is included in the
policy.
PROPERTY COVERAGES
Crime - Forgery or Alteration
- Form Number
Enter identifier: The form number used by the company for crime - forgery or alteration
coverage.
PROPERTY COVERAGES
Crime - Forgery or Alteration
- Form Date
Enter date: The edition date of the form used by the company for crime - forgery or alteration
coverage.
PROPERTY COVERAGES
Crime - Forgery or Alteration
- Premium
Enter amount: The premium amount for crime - forgery or alteration coverage.
PROPERTY COVERAGES
Crime - Money & Securities
Inside - Pol Level
Check the box (if applicable): Indicates crime - money & securities inside coverage applies to
the policy.
PROPERTY COVERAGES
Crime - Money & Securities
Inside - Prem Level
Check the box (if applicable): Indicates crime - money & securities inside coverage applies to a
specific premises.
ACORD 160 (2014/12) rev. 04-29-2014
Page 39 of 70
PROPERTY COVERAGES
Crime - Money & Securities
Inside - Total Amount
Enter limit: The total limit amount for crime - money & securities inside coverage.
PROPERTY COVERAGES
Crime - Money & Securities
Inside - Deductible
Enter deductible: The deductible amount for crime - money & securities inside coverage.
PROPERTY COVERAGES
Crime - Money & Securities
Inside - Included
Check the box (if applicable): Indicates crime - money & securities inside coverage is included in
the policy.
PROPERTY COVERAGES
Crime - Money & Securities
Inside - Form Number
Enter identifier: The form number used by the company for crime - money & securities inside
coverage.
PROPERTY COVERAGES
Crime - Money & Securities
Inside - Form Date
Enter date: The edition date of the form used by the company for crime - money & securities
inside coverage.
PROPERTY COVERAGES
Crime - Money & Securities
Inside - Premium
Enter amount: The premium amount for crime - money & securities inside coverage.
PROPERTY COVERAGES
Crime - Money & Securities
Outside - Pol Level
Check the box (if applicable): Indicates crime - money & securities outside coverage applies to
the policy.
PROPERTY COVERAGES
Crime - Money & Securities
Outside - Prem Level
Check the box (if applicable): Indicates crime - money & securities outside coverage applies to a
specific premises.
PROPERTY COVERAGES
Crime - Money & Securities
Outside - Total Amount
Enter limit: The total limit amount for crime - money & securities outside coverage.
PROPERTY COVERAGES
Crime - Money & Securities
Outside - Deductible
Enter deductible: The deductible amount for crime - money & securities outside coverage.
PROPERTY COVERAGES
Crime - Money & Securities
Outside - Included
Check the box (if applicable): Indicates crime - money & securities outside coverage is included
in the policy.
PROPERTY COVERAGES
Crime - Money & Securities
Outside - Form Number
Enter identifier: The form number used by the company for crime - money & securities outside
coverage.
PROPERTY COVERAGES
Crime - Money & Securities
Outside - Form Date
Enter date: The edition date of the form used by the company for crime - money & securities
outside coverage.
PROPERTY COVERAGES
Crime - Money & Securities
Outside - Premium
Enter amount: The premium amount for crime - money & securities outside coverage.
PROPERTY COVERAGES
Crime - Welfare & Pension
Plan (ERISA) - Pol Level
Check the box (if applicable): Indicates crime - welfare & pension plan (ERISA) coverage
applies to the policy.
PROPERTY COVERAGES
Crime - Welfare & Pension
Plan (ERISA) - Prem Level
Check the box (if applicable): Indicates crime - welfare & pension plan (ERISA) coverage
applies to a specific premises.
PROPERTY COVERAGES
Crime - Welfare & Pension
Plan (ERISA) - Total Amount
Enter limit: The total limit amount for crime - welfare & pension plan (ERISA) coverage.
ACORD 160 (2014/12) rev. 04-29-2014
Page 40 of 70
PROPERTY COVERAGES
Crime - Welfare & Pension
Plan (ERISA) - Deductible
Enter deductible: The deductible amount for crime - welfare & pension plan (ERISA) coverage.
PROPERTY COVERAGES
Crime - Welfare & Pension
Plan (ERISA) - Included
Check the box (if applicable): Indicates crime - welfare & pension plan (ERISA) coverage is
included in the policy.
PROPERTY COVERAGES
Crime - Welfare & Pension
Plan (ERISA) - Form Number
Enter identifier: The form number used by the company for crime - welfare & pension plan
(ERISA) coverage.
PROPERTY COVERAGES
Crime - Welfare & Pension
Plan (ERISA) - Form Date
Enter date: The edition date of the form used by the company for crime - welfare & pension plan
(ERISA) coverage.
PROPERTY COVERAGES
Crime - Welfare & Pension
Plan (ERISA) - Premium
Enter amount: The premium amount for crime - welfare & pension plan (ERISA) coverage.
PROPERTY COVERAGES
Earthquake - Pol Level
Check the box (if applicable): Indicates earthquake coverage applies to the policy.
PROPERTY COVERAGES
Earthquake - Prem Level
Check the box (if applicable): Indicates earthquake coverage applies to a specific premises.
PROPERTY COVERAGES
Earthquake - Territory
Enter code: The earthquake zone (territory) associated with the coverage.
PROPERTY COVERAGES
Earthquake - Retrofit Type
Enter text: The type of earthquake retrofit for the building.
PROPERTY COVERAGES
Earthquake - Masonry
Veneer %
Enter percentage: The percentage of construction that is masonry veneer.
PROPERTY COVERAGES
Earthquake - Deductible
Amount
Enter deductible: The deductible amount for earthquake coverage.
PROPERTY COVERAGES
Earthquake - Deductible %
Enter percentage: The percentage deductible for earthquake coverage.
PROPERTY COVERAGES
Earthquake - Included
Check the box (if applicable): Indicates earthquake coverage is included in the policy.
PROPERTY COVERAGES
Earthquake - Form Number
Enter identifier: The form number used by the company for earthquake coverage.
PROPERTY COVERAGES
Earthquake - Form Date
Enter date: The edition date of the form used by the company for earthquake coverage.
PROPERTY COVERAGES
Earthquake - Premium
Enter amount: The premium amount for earthquake coverage.
PROPERTY COVERAGES
EDP - Equipment - Pol Level
Check the box (if applicable): Indicates EDP equipment coverage applies to the policy.
PROPERTY COVERAGES
EDP - Equipment - Prem
Level
Check the box (if applicable): Indicates EDP equipment coverage applies to a specific premises.
PROPERTY COVERAGES
EDP - Equipment - Total
Amount
Enter limit: The total limit amount for EDP equipment coverage.
PROPERTY COVERAGES
EDP - Equipment -
Deductible
Enter deductible: The deductible amount for EDP equipment coverage.
PROPERTY COVERAGES
EDP - Equipment - Included
Check the box (if applicable): Indicates EDP equipment coverage is included in the policy.
ACORD 160 (2014/12) rev. 04-29-2014
Page 41 of 70
PROPERTY COVERAGES
EDP - Equipment - Form
Number
Enter identifier: The form number used by the company for EDP equipment coverage.
PROPERTY COVERAGES
EDP - Equipment - Form
Date
Enter date: The edition date of the form used by the company for EDP equipment coverage.
PROPERTY COVERAGES
EDP - Equipment - Premium
Enter amount: The premium amount for EDP equipment coverage.
PROPERTY COVERAGES
EDP - Extra Expense - Pol
Level
Check the box (if applicable): Indicates EDP extra expense coverage applies to the policy.
PROPERTY COVERAGES
EDP - Extra Expense - Prem
Level
Check the box (if applicable): Indicates EDP extra expense coverage applies to a specific
premises.
PROPERTY COVERAGES
EDP - Extra Expense - Total
Amount
Enter limit: The total limit amount for EDP extra expense coverage.
PROPERTY COVERAGES
EDP - Extra Expense -
Deductible
Enter deductible: The deductible amount for EDP extra expense coverage.
PROPERTY COVERAGES
EDP - Extra Expense -
Included
Check the box (if applicable): Indicates EDP extra expense coverage is included in the policy.
PROPERTY COVERAGES
EDP - Extra Expense - Form
Number
Enter identifier: The form number used by the company for EDP extra expense coverage.
PROPERTY COVERAGES
EDP - Extra Expense - Form
Date
Enter date: The edition date of the form used by the company for EDP extra expense coverage.
PROPERTY COVERAGES
EDP - Extra Expense -
Premium
Enter amount: The premium amount for EDP extra expense coverage.
PROPERTY COVERAGES
EDP - Data / Media - Pol
Level
Check the box (if applicable): Indicates EDP data / media coverage applies to the policy.
PROPERTY COVERAGES
EDP - Data / Media - Prem
Level
Check the box (if applicable): Indicates EDP data / media coverage applies to a specific
premises.
PROPERTY COVERAGES
EDP - Data / Media - Total
Amount
Enter limit: The total limit amount for EDP data / media coverage.
PROPERTY COVERAGES
EDP - Data / Media -
Deductible
Enter deductible: The deductible amount for EDP data / media coverage.
PROPERTY COVERAGES
EDP - Data / Media -
Included
Check the box (if applicable): Indicates EDP data / media coverage is included in the policy.
PROPERTY COVERAGES
EDP - Data / Media - Form
Number
Enter identifier: The form number used by the company for EDP data / media coverage.
ACORD 160 (2014/12) rev. 04-29-2014
Page 42 of 70
PROPERTY COVERAGES
EDP - Data / Media - Form
Date
Enter date: The edition date of the form used by the company for EDP data / media coverage.
PROPERTY COVERAGES
EDP - Data / Media -
Premium
Enter amount: The premium amount for EDP data / media coverage.
PROPERTY COVERAGES
Equipment Breakdown -
Basic - Pol Level
Check the box (if applicable): Indicates basic equipment breakdown coverage applies to the
policy.
PROPERTY COVERAGES
Equipment Breakdown -
Basic - Prem Level
Check the box (if applicable): Indicates basic equipment breakdown coverage applies to a
specific premises.
PROPERTY COVERAGES
Equipment Breakdown -
Basic - Total Amount
Enter limit: The total limit amount for basic equipment breakdown coverage.
PROPERTY COVERAGES
Equipment Breakdown -
Basic - Deductible
Enter deductible: The deductible amount for basic equipment breakdown coverage.
PROPERTY COVERAGES
Equipment Breakdown -
Basic - Included
Check the box (if applicable): Indicates basic equipment breakdown coverage is included in the
policy.
PROPERTY COVERAGES
Equipment Breakdown -
Basic - Form Number
Enter identifier: The form number used by the company for basic equipment breakdown
coverage.
PROPERTY COVERAGES
Equipment Breakdown -
Basic - Form Date
Enter date: The edition date of the form used by the company for basic equipment breakdown
coverage.
PROPERTY COVERAGES
Equipment Breakdown -
Basic - Premium
Enter amount: The premium amount for basic equipment breakdown coverage.
PROPERTY COVERAGES
Equipment Breakdown -
Broad - Pol Level
Check the box (if applicable): Indicates broad equipment breakdown coverage applies to the
policy.
PROPERTY COVERAGES
Equipment Breakdown -
Broad - Prem Level
Check the box (if applicable): Indicates broad equipment breakdown coverage applies to a
specific premises.
PROPERTY COVERAGES
Equipment Breakdown -
Broad - Total Amount
Enter limit: The total limit amount for broad equipment breakdown coverage.
PROPERTY COVERAGES
Equipment Breakdown -
Broad - Deductible
Enter deductible: The deductible amount for broad equipment breakdown coverage.
PROPERTY COVERAGES
Equipment Breakdown -
Broad - Included
Check the box (if applicable): Indicates broad equipment breakdown coverage is included in the
policy.
PROPERTY COVERAGES
Equipment Breakdown -
Broad - Form Number
Enter identifier: The form number used by the company for broad equipment breakdown
coverage.
PROPERTY COVERAGES
Equipment Breakdown -
Broad - Form Date
Enter date: The edition date of the form used by the company for broad equipment breakdown
coverage.
ACORD 160 (2014/12) rev. 04-29-2014
Page 43 of 70
PROPERTY COVERAGES
Equipment Breakdown -
Broad - Premium
Enter amount: The premium amount for broad equipment breakdown coverage.
PROPERTY COVERAGES
Equipment Breakdown -
Spoilage - Pol Level
Check the box (if applicable): Indicates equipment breakdown - spoilage coverage applies to the
policy.
PROPERTY COVERAGES
Equipment Breakdown -
Spoilage - Prem Level
Check the box (if applicable): Indicates equipment breakdown - spoilage coverage applies to a
specific premises.
PROPERTY COVERAGES
Equipment Breakdown -
Spoilage - Total Amount
Enter limit: The total limit amount for equipment breakdown - spoilage coverage.
PROPERTY COVERAGES
Equipment Breakdown -
Spoilage - Deductible
Enter deductible: The deductible amount for equipment breakdown - spoilage coverage.
PROPERTY COVERAGES
Equipment Breakdown -
Spoilage - Included
Check the box (if applicable): Indicates equipment breakdown - spoilage coverage is included in
the policy.
PROPERTY COVERAGES
Equipment Breakdown -
Spoilage - Form Number
Enter identifier: The form number used by the company for equipment breakdown - spoilage
coverage.
PROPERTY COVERAGES
Equipment Breakdown -
Spoilage - Form Date
Enter date: The edition date of the form used by the company for equipment breakdown -
spoilage coverage.
PROPERTY COVERAGES
Equipment Breakdown -
Spoilage - Premium
Enter amount: The premium amount for equipment breakdown - spoilage coverage.
Form Page 4
Section Name
Field Name
Description
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g., agency or
brokerage).
IDENTIFICATION SECTION
Loc #
Enter number: The producer assigned number of the location.
IDENTIFICATION SECTION
Bldg #
Enter number: The building number for the premises. Used when more than one building exists
at an individual location.
PROPERTY COVERAGES
Extra Expense - Pol Level
Check the box (if applicable): Indicates extra expense coverage applies to the policy.
PROPERTY COVERAGES
Extra Expense - Prem Level
Check the box (if applicable): Indicates extra expense coverage applies to a specific premises.
PROPERTY COVERAGES
Extra Expense - Actual Loss
Sustained
Check the box (if applicable): Indicates the coverage is on an actual loss sustained basis.
PROPERTY COVERAGES
Extra Expense - Actual Loss
Sustained No. of Months
Enter number: The number of months of coverage.
ACORD 160 (2014/12) rev. 04-29-2014
Page 44 of 70
PROPERTY COVERAGES
Extra Expense - Total
Amount
Enter limit: The total limit amount for extra expense coverage.
PROPERTY COVERAGES
Extra Expense - Deductible
Enter deductible: The deductible amount for extra expense coverage.
PROPERTY COVERAGES
Extra Expense - Included
Check the box (if applicable): Indicates extra expense coverage is included in the policy.
PROPERTY COVERAGES
Extra Expense - Form
Number
Enter identifier: The form number used by the company for extra expense coverage.
PROPERTY COVERAGES
Extra Expense - Form Date
Enter date: The edition date of the form used by the company for extra expense coverage.
PROPERTY COVERAGES
Extra Expense - Premium
Enter amount: The premium amount for extra expense coverage.
PROPERTY COVERAGES
Fine Arts - Pol Level
Check the box (if applicable): Indicates fine arts coverage applies to the policy.
PROPERTY COVERAGES
Fine Arts - Prem Level
Check the box (if applicable): Indicates fine arts coverage applies to a specific premises.
PROPERTY COVERAGES
Fine Arts - Total Amount
Enter limit: The total limit amount for fine arts coverage.
PROPERTY COVERAGES
Fine Arts - Deductible
Enter deductible: The deductible amount for fine arts coverage.
PROPERTY COVERAGES
Fine Arts - Included
Check the box (if applicable): Indicates fine arts coverage is included in the policy.
PROPERTY COVERAGES
Fine Arts - Form Number
Enter identifier: The form number used by the company for fine arts coverage.
PROPERTY COVERAGES
Fine Arts - Form Date
Enter date: The edition date of the form used by the company for fine arts coverage.
PROPERTY COVERAGES
Fine Arts - Premium
Enter amount: The premium amount for fine arts coverage.
PROPERTY COVERAGES
Floater - Contractor's
Equipment - Pol Level
Check the box (if applicable): Indicates contractor's equipment floater coverage applies to the
policy.
PROPERTY COVERAGES
Floater - Contractor's
Equipment - Prem Level
Check the box (if applicable): Indicates contractor's equipment floater coverage applies to a
specific premises.
PROPERTY COVERAGES
Floater - Contractor's
Equipment - Total Amount
Enter limit: The total limit amount for contractor's equipment floater coverage.
PROPERTY COVERAGES
Floater - Contractor's
Equipment - Deductible
Enter deductible: The deductible amount for contractor's equipment floater coverage.
PROPERTY COVERAGES
Floater - Contractor's
Equipment - Included
Check the box (if applicable): Indicates contractor's equipment floater coverage is included in
the policy.
PROPERTY COVERAGES
Floater - Contractor's
Equipment - Form Number
Enter identifier: The form number used by the company for contractor's equipment floater
coverage.
PROPERTY COVERAGES
Floater - Contractor's
Equipment - Form Date
Enter date: The edition date of the form used by the company for contractor's equipment floater
coverage.
ACORD 160 (2014/12) rev. 04-29-2014
Page 45 of 70
PROPERTY COVERAGES
Floater - Contractor's
Equipment - Premium
Enter amount: The premium amount for contractor's equipment floater coverage.
PROPERTY COVERAGES
Floater - Installation - Pol
Level
Check the box (if applicable): Indicates installation floater coverage applies to the policy.
PROPERTY COVERAGES
Floater - Installation - Prem
Level
Check the box (if applicable): Indicates installation floater coverage applies to a specific
premises.
PROPERTY COVERAGES
Floater - Installation - Total
Amount
Enter limit: The total limit amount for installation floater coverage.
PROPERTY COVERAGES
Floater - Installation -
Deductible
Enter deductible: The deductible amount for installation floater coverage.
PROPERTY COVERAGES
Floater - Installation -
Included
Check the box (if applicable): Indicates installation floater coverage is included in the policy.
PROPERTY COVERAGES
Floater - Installation - Form
Number
Enter identifier: The form number used by the company for installation floater coverage.
PROPERTY COVERAGES
Floater - Installation - Form
Date
Enter date: The edition date of the form used by the company for installation floater coverage.
PROPERTY COVERAGES
Floater - Installation -
Premium
Enter amount: The premium amount for installation floater coverage.
PROPERTY COVERAGES
Floater - Leased / Rented
Equipment - Pol Level
Check the box (if applicable): Indicates leased / rented equipment floater coverage applies to
the policy.
PROPERTY COVERAGES
Floater - Leased / Rented
Equipment - Prem Level
Check the box (if applicable): Indicates leased / rented equipment floater coverage applies to a
specific premises.
PROPERTY COVERAGES
Floater - Leased / Rented
Equipment - Total Amount
Enter limit: The total limit amount for leased / rented equipment floater coverage.
PROPERTY COVERAGES
Floater - Leased / Rented
Equipment - Deductible
Enter deductible: The deductible amount for leased / rented equipment floater coverage.
PROPERTY COVERAGES
Floater - Leased / Rented
Equipment - Included
Check the box (if applicable): Indicates leased / rented equipment floater coverage is included in
the policy.
PROPERTY COVERAGES
Floater - Leased / Rented
Equipment - Form Number
Enter identifier: The form number used by the company for leased / rented equipment floater
coverage.
PROPERTY COVERAGES
Floater - Leased / Rented
Equipment - Form Date
Enter date: The edition date of the form used by the company for leased / rented equipment
floater coverage.
PROPERTY COVERAGES
Floater - Leased / Rented
Equipment - Premium
Enter amount: The premium amount for leased / rented equipment floater coverage.
ACORD 160 (2014/12) rev. 04-29-2014
Page 46 of 70
PROPERTY COVERAGES
Flood - Building - Pol Level
Check the box (if applicable): Indicates flood building coverage applies to the policy.
PROPERTY COVERAGES
Flood - Building - Prem
Level
Check the box (if applicable): Indicates flood building coverage applies to a specific premises.
PROPERTY COVERAGES
Flood - Building - Total
Amount
Enter limit: The total limit amount for flood building coverage.
PROPERTY COVERAGES
Flood - Building - Deductible
Enter deductible: The deductible amount for flood building coverage.
PROPERTY COVERAGES
Flood - Building - Included
Check the box (if applicable): Indicates flood building coverage is included in the policy.
PROPERTY COVERAGES
Flood - Building - Form
Number
Enter identifier: The form number used by the company for flood building coverage.
PROPERTY COVERAGES
Flood - Building - Form Date
Enter date: The edition date of the form used by the company for flood building coverage.
PROPERTY COVERAGES
Flood - Building - Premium
Enter amount: The premium amount for flood building coverage.
PROPERTY COVERAGES
Flood - Contents - Pol Level
Check the box (if applicable): Indicates flood contents coverage applies to the policy.
PROPERTY COVERAGES
Flood - Contents - Prem
Level
Check the box (if applicable): Indicates flood contents coverage applies to a specific premises.
PROPERTY COVERAGES
Flood - Contents - Total
Amount
Enter limit: The total limit amount for flood contents coverage.
PROPERTY COVERAGES
Flood - Contents -
Deductible
Enter deductible: The deductible amount for flood contents coverage.
PROPERTY COVERAGES
Flood - Contents - Included
Check the box (if applicable): Indicates flood contents coverage is included in the policy.
PROPERTY COVERAGES
Flood - Contents - Form
Number
Enter identifier: The form number used by the company for flood contents coverage.
PROPERTY COVERAGES
Flood - Contents - Form
Date
Enter date: The edition date of the form used by the company for flood contents coverage.
PROPERTY COVERAGES
Flood - Contents - Premium
Enter amount: The premium amount for flood contents coverage.
PROPERTY COVERAGES
Fungi / Bacteria / Mold - Pol
Level
Check the box (if applicable): Indicates fungi / bacteria / mold coverage applies to the policy.
PROPERTY COVERAGES
Fungi / Bacteria / Mold -
Prem Level
Check the box (if applicable): Indicates fungi / bacteria / mold coverage applies to a specific
premises.
PROPERTY COVERAGES
Fungi / Bacteria / Mold -
Total Amount
Enter limit: The total limit amount for fungi / bacteria / mold coverage.
ACORD 160 (2014/12) rev. 04-29-2014
Page 47 of 70
PROPERTY COVERAGES
Fungi / Bacteria / Mold -
Deductible
Enter deductible: The deductible amount for fungi / bacteria / mold coverage.
PROPERTY COVERAGES
Fungi / Bacteria / Mold -
Included
Check the box (if applicable): Indicates fungi / bacteria / mold coverage is included in the policy.
PROPERTY COVERAGES
Fungi / Bacteria / Mold -
Form Number
Enter identifier: The form number used by the company for fungi / bacteria / mold coverage.
PROPERTY COVERAGES
Fungi / Bacteria / Mold -
Form Date
Enter date: The edition date of the form used by the company for fungi / bacteria / mold
coverage.
PROPERTY COVERAGES
Fungi / Bacteria / Mold -
Premium
Enter amount: The premium amount for fungi / bacteria / mold coverage.
PROPERTY COVERAGES
Hail Exclusion - Prem Level
Check the box (if applicable): Indicates hail exclusion applies to a specific premises.
PROPERTY COVERAGES
Hail Exclusion - Included
Check the box (if applicable): Indicates that hail exclusion option is included.
PROPERTY COVERAGES
Hail Exclusion - Form
Number
Enter number: The form number used by the company for hail exclusion.
PROPERTY COVERAGES
Hail Exclusion - Form Date
Enter date: The edition date of the form used by the company for hail exclusion.
PROPERTY COVERAGES
Hail Exclusion - Premium
Enter amount: The premium amount for hail exclusion.
PROPERTY COVERAGES
Mine Subsidence - Pol Level
Check the box (if applicable): Indicates mine subsidence coverage applies to the policy.
PROPERTY COVERAGES
Mine Subsidence - Prem
Level
Check the box (if applicable): Indicates mine subsidence coverage applies to a specific
premises.
PROPERTY COVERAGES
Mine Subsidence - Limit
Enter limit: The total limit amount for mine subsidence coverage.
PROPERTY COVERAGES
Mine Subsidence -
Construction Material
Enter code: The type of construction material.
PROPERTY COVERAGES
Mine Subsidence - Property
Description
Enter text: The description of the property.
PROPERTY COVERAGES
Mine Subsidence -
Deductible
Enter deductible: The deductible amount for mine subsidence coverage.
PROPERTY COVERAGES
Mine Subsidence - Included
Check the box (if applicable): Indicates mine subsidence coverage is included in the policy.
PROPERTY COVERAGES
Mine Subsidence - Form
Number
Enter identifier: The form number used by the company for mine subsidence coverage.
PROPERTY COVERAGES
Mine Subsidence - Form
Date
Enter date: The edition date of the form used by the company for mine subsidence coverage.
ACORD 160 (2014/12) rev. 04-29-2014
Page 48 of 70
PROPERTY COVERAGES
Mine Subsidence - Premium
Enter amount: The premium amount for mine subsidence coverage.
PROPERTY COVERAGES
Newly Acquired Property -
Building - Pol Level
Check the box (if applicable): Indicates newly acquired property - building coverage applies to
the policy.
PROPERTY COVERAGES
Newly Acquired Property -
Building - Prem Level
Check the box (if applicable): Indicates newly acquired property - building coverage applies to a
specific premises.
PROPERTY COVERAGES
Newly Acquired Property -
Building - Total Amount
Enter limit: The total limit amount for newly acquired property - building coverage.
PROPERTY COVERAGES
Newly Acquired Property -
Building - Deductible
Enter deductible: The deductible amount for newly acquired property - building coverage.
PROPERTY COVERAGES
Newly Acquired Property -
Building - Included
Check the box (if applicable): Indicates newly acquired property - building coverage is included
in the policy.
PROPERTY COVERAGES
Newly Acquired Property -
Building - Form Number
Enter identifier: The form number used by the company for newly acquired property - building
coverage.
PROPERTY COVERAGES
Newly Acquired Property -
Building - Form Date
Enter date: The edition date of the form used by the company for newly acquired property -
building coverage.
PROPERTY COVERAGES
Newly Acquired Property -
Building - Premium
Enter amount: The premium amount for newly acquired property - building coverage.
PROPERTY COVERAGES
Newly Acquired Property -
Personal - Pol Level
Check the box (if applicable): Indicates newly acquired property - personal coverage applies to
the policy.
PROPERTY COVERAGES
Newly Acquired Property -
Personal - Prem Level
Check the box (if applicable): Indicates newly acquired property - personal coverage applies to a
specific premises.
PROPERTY COVERAGES
Newly Acquired Property -
Personal - Total Amount
Enter limit: The total limit amount for newly acquired property - personal coverage.
PROPERTY COVERAGES
Newly Acquired Property -
Personal - Deductible
Enter deductible: The deductible amount for newly acquired property - personal coverage.
PROPERTY COVERAGES
Newly Acquired Property -
Personal - Included
Check the box (if applicable): Indicates newly acquired property - personal coverage is included
in the policy.
PROPERTY COVERAGES
Newly Acquired Property -
Personal - Form Number
Enter identifier: The form number used by the company for newly acquired property - personal
coverage.
PROPERTY COVERAGES
Newly Acquired Property -
Personal - Form Date
Enter date: The edition date of the form used by the company for newly acquired property -
personal coverage.
PROPERTY COVERAGES
Newly Acquired Property -
Personal - Premium
Enter amount: The premium amount for newly acquired property - personal coverage.
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Page 49 of 70
PROPERTY COVERAGES
Ordinance - Building
Ordinance Or Law - Pol
Level
Check the box (if applicable): Indicates building ordinance or law coverage applies to the policy.
PROPERTY COVERAGES
Ordinance - Building
Ordinance Or Law - Prem
Level
Check the box (if applicable): Indicates building ordinance or law coverage applies to a specific
premises.
PROPERTY COVERAGES
Ordinance - Building
Ordinance Or Law -
Aggregate
Enter limit: The aggregate limit amount for building ordinance or law coverage.
PROPERTY COVERAGES
Ordinance - Building
Ordinance Or Law -
Increased
Enter limit: The increased limit amount for building ordinance or law coverage.
PROPERTY COVERAGES
Ordinance - Building
Ordinance Or Law - %
Rebuild
Enter percentage: The rebuild percentage for building ordinance or law coverage.
PROPERTY COVERAGES
Ordinance - Building
Ordinance Or Law -
Deductible
Enter deductible: The deductible amount for building ordinance or law coverage.
PROPERTY COVERAGES
Ordinance - Building
Ordinance Or Law - Included
Check the box (if applicable): Indicates building ordinance or law coverage is included in the
policy.
PROPERTY COVERAGES
Ordinance - Building
Ordinance Or Law - Form
Number
Enter identifier: The form number used by the company for building ordinance or law coverage.
PROPERTY COVERAGES
Ordinance - Building
Ordinance Or Law - Form
Date
Enter date: The edition date of the form used by the company for building ordinance or law
coverage.
PROPERTY COVERAGES
Ordinance - Building
Ordinance Or Law -
Premium
Enter amount: The premium amount for building ordinance or law coverage.
PROPERTY COVERAGES
Ordinance - Building
Ordinance Demolition Cost -
Pol Level
Check the box (if applicable): Indicates building ordinance demolition cost coverage applies to
the policy.
PROPERTY COVERAGES
Ordinance - Building
Ordinance Demolition Cost -
Prem Level
Check the box (if applicable): Indicates building ordinance demolition cost coverage applies to a
specific premises.
ACORD 160 (2014/12) rev. 04-29-2014
Page 50 of 70
PROPERTY COVERAGES
Ordinance - Building
Ordinance Demolition Cost -
Total Limit
Enter limit: The total limit amount for building ordinance demolition cost coverage.
PROPERTY COVERAGES
Ordinance - Building
Ordinance Demolition Cost -
Deductible
Enter deductible: The deductible amount for building ordinance demolition cost coverage.
PROPERTY COVERAGES
Ordinance - Building
Ordinance Demolition Cost -
Included
Check the box (if applicable): Indicates building ordinance demolition cost coverage is included
in the policy.
PROPERTY COVERAGES
Ordinance - Building
Ordinance Demolition Cost -
Form Number
Enter identifier: The form number used by the company for building ordinance demolition cost
coverage.
PROPERTY COVERAGES
Ordinance - Building
Ordinance Demolition Cost -
Form Date
Enter date: The edition date of the form used by the company for building ordinance demolition
cost coverage.
PROPERTY COVERAGES
Ordinance - Building
Ordinance Demolition Cost -
Premium
Enter amount: The premium amount for building ordinance demolition cost coverage.
PROPERTY COVERAGES
Ordinance - Building
Ordinance Increased
Construction Cost - Pol
Level
Check the box (if applicable): Indicates building ordinance increased construction cost coverage
applies to the policy.
PROPERTY COVERAGES
Ordinance - Building
Ordinance Increased
Construction Cost - Prem
Level
Check the box (if applicable): Indicates building ordinance increased construction cost coverage
applies to a specific premises.
PROPERTY COVERAGES
Ordinance - Building
Ordinance Increased
Construction Cost - Total
Amount
Enter limit: The total limit amount for building ordinance increased construction cost coverage.
PROPERTY COVERAGES
Ordinance - Building
Ordinance Increased
Construction Cost -
Deductible
Enter deductible: The deductible amount for building ordinance increased construction cost
coverage.
PROPERTY COVERAGES
Ordinance - Building
Ordinance Increased
Construction Cost -
Included
Check the box (if applicable): Indicates building ordinance increased construction cost coverage
is included in the policy.
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Page 51 of 70
PROPERTY COVERAGES
Ordinance - Building
Ordinance Increased
Construction Cost - Form
Number
Enter identifier: The form number used by the company for building ordinance increased
construction cost coverage.
PROPERTY COVERAGES
Ordinance - Building
Ordinance Increased
Construction Cost - Form
Date
Enter date: The edition date of the form used by the company for building ordinance increased
construction cost coverage.
PROPERTY COVERAGES
Ordinance - Building
Ordinance Increased
Construction Cost -
Premium
Enter amount: The premium amount for building ordinance increased construction cost
coverage.
PROPERTY COVERAGES
Outdoor Property - Pol Level
Check the box (if applicable): Indicates outdoor property coverage applies to the policy.
PROPERTY COVERAGES
Outdoor Property - Prem
Level
Check the box (if applicable): Indicates outdoor property coverage applies to a specific
premises.
PROPERTY COVERAGES
Outdoor Property - Total
Amount
Enter limit: The total limit amount for outdoor property coverage.
PROPERTY COVERAGES
Outdoor Property -
Deductible
Enter deductible: The deductible amount for outdoor property coverage.
PROPERTY COVERAGES
Outdoor Property - Included
Check the box (if applicable): Indicates outdoor property coverage is included in the policy.
PROPERTY COVERAGES
Outdoor Property - Form
Number
Enter identifier: The form number used by the company for outdoor property coverage.
PROPERTY COVERAGES
Outdoor Property - Form
Date
Enter date: The edition date of the form used by the company for outdoor property coverage.
PROPERTY COVERAGES
Outdoor Property - Premium
Enter amount: The premium amount for outdoor property coverage.
PROPERTY COVERAGES
Peak Season - Regular - Pol
Level
Check the box (if applicable): Indicates peak season - regular coverage applies to the policy.
PROPERTY COVERAGES
Peak Season - Regular -
Prem Level
Check the box (if applicable): Indicates peak season - regular coverage applies to a specific
premises.
PROPERTY COVERAGES
Peak Season - Regular -
Total Amount
Enter limit: The total limit amount for peak season - regular coverage.
PROPERTY COVERAGES
Peak Season - Regular -
Deductible
Enter deductible: The deductible amount for peak season - regular coverage.
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Page 52 of 70
PROPERTY COVERAGES
Peak Season - Regular -
Included
Check the box (if applicable): Indicates peak season - regular coverage is included in the policy.
PROPERTY COVERAGES
Peak Season - Regular -
Form Number
Enter identifier: The form number used by the company for peak season - regular coverage.
PROPERTY COVERAGES
Peak Season - Regular -
Form Date
Enter date: The edition date of the form used by the company for peak season - regular
coverage.
PROPERTY COVERAGES
Peak Season - Regular -
Premium
Enter amount: The premium amount for peak season - regular coverage.
PROPERTY COVERAGES
Peak Season - Additional -
Pol Level
Check the box (if applicable): Indicates peak season - additional coverage applies to the policy.
PROPERTY COVERAGES
Peak Season - Additional -
Prem Level
Check the box (if applicable): Indicates peak season - additional coverage applies to a specific
premises.
PROPERTY COVERAGES
Peak Season - Additional -
Total Amount
Enter limit: The total limit amount for peak season - additional coverage.
PROPERTY COVERAGES
Peak Season - Additional -
Deductible
Enter deductible: The deductible amount for peak season - additional coverage.
PROPERTY COVERAGES
Peak Season - Additional -
Included
Check the box (if applicable): Indicates peak season - additional coverage is included in the
policy.
PROPERTY COVERAGES
Peak Season - Additional -
Form Number
Enter identifier: The form number used by the company for peak season - additional coverage.
PROPERTY COVERAGES
Peak Season - Additional -
Form Date
Enter date: The edition date of the form used by the company for peak season - additional
coverage.
PROPERTY COVERAGES
Peak Season - Additional -
Premium
Enter amount: The premium amount for peak season - additional coverage.
PROPERTY COVERAGES
Property BPP -
Improvements &
Betterments / RC / ACV - Pol
Level
Check the box (if applicable): Indicates business personal property improvements & betterments
coverage applies to the policy.
PROPERTY COVERAGES
Property BPP -
Improvements &
Betterments / RC / ACV -
Prem Level
Check the box (if applicable): Indicates business personal property improvements & betterments
coverage applies to a specific premises.
ACORD 160 (2014/12) rev. 04-29-2014
Page 53 of 70
PROPERTY COVERAGES
Property BPP -
Improvements &
Betterments / RC / ACV -
Total Limit
Enter limit: The total limit amount for business personal property improvements & betterments
coverage.
PROPERTY COVERAGES
Property BPP -
Improvements &
Betterments / RC / ACV -
Deductible
Enter deductible: The deductible amount for business personal property improvements &
betterments coverage.
PROPERTY COVERAGES
Property BPP -
Improvements &
Betterments / RC / ACV -
Included
Check the box (if applicable): Indicates business personal property improvements & betterments
coverage is included in the policy.
PROPERTY COVERAGES
Property BPP -
Improvements &
Betterments / RC / ACV -
Form Number
Enter identifier: The form number used by the company for building personal property
improvements & betterments coverage.
PROPERTY COVERAGES
Property BPP -
Improvements &
Betterments / RC / ACV -
Form Date
Enter date: The edition date of the form used by the company for building personal property
improvements & betterments coverage.
PROPERTY COVERAGES
Property BPP -
Improvements &
Betterments / RC / ACV -
Premium
Enter amount: The premium amount for business personal property improvements &
betterments coverage.
PROPERTY COVERAGES
Sign - Pol Level
Check the box (if applicable): Indicates sign coverage applies to the policy.
PROPERTY COVERAGES
Sign - Prem Level
Check the box (if applicable): Indicates sign coverage applies to a specific premises.
PROPERTY COVERAGES
Sign - Total Amount
Enter limit: The total limit amount for sign coverage.
PROPERTY COVERAGES
Sign - Deductible
Enter deductible: The deductible amount for sign coverage.
PROPERTY COVERAGES
Sign - Included
Check the box (if applicable): Indicates sign coverage is included in the policy.
PROPERTY COVERAGES
Sign - Form Number
Enter number: The form number used by the company for sign coverage.
PROPERTY COVERAGES
Sign - Form Date
Enter date: The edition date of the form used by the company for sign coverage.
PROPERTY COVERAGES
Sign - Premium
Enter amount: The premium amount for sign coverage.
PROPERTY COVERAGES
Terrorism - Domestic - Pol
Level
Check the box (if applicable): Indicates domestic terrorism coverage applies to the policy.
ACORD 160 (2014/12) rev. 04-29-2014
Page 54 of 70
PROPERTY COVERAGES
Terrorism - Domestic - Prem
Level
Check the box (if applicable): Indicates domestic terrorism coverage applies to a specific
premises.
PROPERTY COVERAGES
Terrorism - Domestic -
Included
Check the box (if applicable): Indicates domestic terrorism coverage is included in the policy.
PROPERTY COVERAGES
Terrorism - Domestic - Form
Number
Enter identifier: The form number used by the company for domestic terrorism coverage.
PROPERTY COVERAGES
Terrorism - Domestic - Form
Date
Enter date: The edition date of the form used by the company for domestic terrorism coverage.
PROPERTY COVERAGES
Terrorism - Domestic -
Premium
Enter amount: The premium amount for domestic terrorism.
PROPERTY COVERAGES
Terrorism - Foreign - Pol
Level
Check the box (if applicable): Indicates foreign terrorism coverage applies to the policy.
PROPERTY COVERAGES
Terrorism - Foreign - Prem
Level
Check the box (if applicable): Indicates foreign terrorism coverage applies to a specific
premises.
PROPERTY COVERAGES
Terrorism - Foreign - Accept
Check the box (if applicable): Indicates the named insured accepts foreign terrorism coverage.
PROPERTY COVERAGES
Terrorism - Foreign - Reject
Check the box (if applicable): Indicates the named insured rejects foreign terrorism coverage.
PROPERTY COVERAGES
Terrorism - Foreign -
Included
Check the box (if applicable): Indicates foreign terrorism coverage is included in the policy.
PROPERTY COVERAGES
Terrorism - Foreign - Form
Number
Enter identifier: The form number used by the company for foreign terrorism coverage.
PROPERTY COVERAGES
Terrorism - Foreign - Form
Date
Enter date: The edition date of the form used by the company for foreign terrorism coverage.
PROPERTY COVERAGES
Terrorism - Foreign -
Premium
Enter amount: The premium amount for foreign terrorism.
PROPERTY COVERAGES
Transit - Pol Level
Check the box (if applicable): Indicates transit coverage applies to the policy.
PROPERTY COVERAGES
Transit - Prem Level
Check the box (if applicable): Indicates transit coverage applies to a specific premises.
PROPERTY COVERAGES
Transit - Total Amount
Enter limit: The total limit amount for transit coverage.
PROPERTY COVERAGES
Transit - Deductible
Enter deductible: The deductible amount for transit coverage.
PROPERTY COVERAGES
Transit - Included
Check the box (if applicable): Indicates transit coverage is included in the policy.
PROPERTY COVERAGES
Transit - Form Number
Enter identifier: The form number used by the company for transit coverage.
PROPERTY COVERAGES
Transit - Form Date
Enter date: The edition date of the form used by the company for transit coverage.
ACORD 160 (2014/12) rev. 04-29-2014
Page 55 of 70
PROPERTY COVERAGES
Transit - Premium
Enter amount: The premium amount for transit coverage.
PROPERTY COVERAGES
Valuable Papers - Pol Level
Check the box (if applicable): Indicates valuable papers coverage applies to the policy.
PROPERTY COVERAGES
Valuable Papers - Prem
Level
Check the box (if applicable): Indicates valuable papers coverage applies to a specific premises.
PROPERTY COVERAGES
Valuable Papers - Total
Amount
Enter limit: The total limit amount for valuable papers coverage.
PROPERTY COVERAGES
Valuable Papers -
Deductible
Enter deductible: The deductible amount for valuable papers coverage.
PROPERTY COVERAGES
Valuable Papers - Included
Check the box (if applicable): Indicates valuable papers coverage is included in the policy.
PROPERTY COVERAGES
Valuable Papers - Form
Number
Enter identifier: The form number used by the company for valuable papers coverage.
PROPERTY COVERAGES
Valuable Papers - Form Date
Enter date: The edition date of the form used by the company for valuable papers coverage.
PROPERTY COVERAGES
Valuable Papers - Premium
Enter amount: The premium amount for valuable papers coverage.
PROPERTY COVERAGES
Wind Exclusion - Pol Level
Check the box (if applicable): Indicates wind exclusion applies to the policy.
PROPERTY COVERAGES
Wind Exclusion - Prem
Level
Check the box (if applicable): Indicates wind exclusion applies to a specific premises.
PROPERTY COVERAGES
Wind Exclusion - Included
Check the box (if applicable): Indicates wind exclusion is included in the policy.
PROPERTY COVERAGES
Wind Exclusion - Form
Number
Enter identifier: The form number used by the company for wind exclusion.
PROPERTY COVERAGES
Wind Exclusion - Form Date
Enter date: The edition date of the form used by the company for wind exclusion.
PROPERTY COVERAGES
Wind Exclusion - Premium
Enter amount: The premium amount for wind exclusion.
PROPERTY COVERAGES -
PREMISES LEVEL
Ground Floor Glass - #
Plates
Enter number: The number of plates of glass to be insured with the same dimensions and
description. As used here, this is ground floor glass.
PROPERTY COVERAGES -
PREMISES LEVEL
Ground Floor Glass - Area
Sq Ft
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). As used here, this is
ground floor glass.
PROPERTY COVERAGES -
PREMISES LEVEL
Ground Floor Glass - Length
Linear Ft
Enter number: The horizontal length, measured in feet, of the plates to be insured. As used
here, this is ground floor glass.
PROPERTY COVERAGES -
PREMISES LEVEL
Ground Floor Glass - Glass
Type
Enter code: The industry code identifying the class for the type of glass. The source of this code
is the Insurance Services Office CLM. As used here, this is ground floor glass.
ACORD 160 (2014/12) rev. 04-29-2014
Page 56 of 70
PROPERTY COVERAGES -
PREMISES LEVEL
Ground Floor Glass -
Interior
Check the box (if applicable): Indicates glass is located inside the building. As used here, this is
ground floor glass.
PROPERTY COVERAGES -
PREMISES LEVEL
Ground Floor Glass -
Tenants Exterior
Check the box (if applicable): Indicates glass is located outside a tenant area. As used here, this
is ground floor glass.
PROPERTY COVERAGES -
PREMISES LEVEL
Ground Floor Glass - Value
Enter amount: The actual value / cost per plate of glass. As used here, this is ground floor glass.
PROPERTY COVERAGES -
PREMISES LEVEL
Ground Floor Glass -
Deductible
Enter deductible: The deductible for the glass coverage. As used here, this is ground floor glass.
PROPERTY COVERAGES -
PREMISES LEVEL
Above Ground Floor Glass -
# Plates
Enter number: The number of plates of glass to be insured with the same dimensions and
description. As used here, this is above ground floor glass.
PROPERTY COVERAGES -
PREMISES LEVEL
Above Ground Floor Glass -
Area Sq Ft
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). As used here, this is
above ground floor glass.
PROPERTY COVERAGES -
PREMISES LEVEL
Above Ground Floor Glass -
Length Linear Ft
Enter number: The horizontal length, measured in feet, of the plates to be insured. As used
here, this is above ground floor glass.
PROPERTY COVERAGES -
PREMISES LEVEL
Above Ground Floor Glass -
Glass Type
Enter code: The industry code identifying the class for the type of glass. The source of this code
is the Insurance Services Office CLM. As used here, this is above ground floor glass.
PROPERTY COVERAGES -
PREMISES LEVEL
Above Ground Floor Glass -
Interior
Check the box (if applicable): Indicates glass is located inside the building. As used here, this is
above ground floor glass.
PROPERTY COVERAGES -
PREMISES LEVEL
Above Ground Floor Glass -
Tenants Exterior
Check the box (if applicable): Indicates glass is located outside a tenant area. As used here, this
is above ground floor glass.
PROPERTY COVERAGES -
PREMISES LEVEL
Above Ground Floor Glass -
Value
Enter amount: The actual value / cost per plate of glass. As used here, this is above ground
floor glass.
PROPERTY COVERAGES -
PREMISES LEVEL
Above Ground Floor Glass -
Deductible
Enter deductible: The deductible for the glass coverage. As used here, this is above ground
floor glass.
PROPERTY ADDITIONAL
COVERAGES
Coverage Code
Enter code: The code for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Coverage Description
Enter text: The description of the coverage.
PROPERTY ADDITIONAL
COVERAGES
Pol Level
Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL
COVERAGES
Blkt #
Enter identifier: The blanket number associated with the additional property coverage.
ACORD 160 (2014/12) rev. 04-29-2014
Page 57 of 70
PROPERTY ADDITIONAL
COVERAGES
Prem Level
Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL
COVERAGES
Total Amount
Enter limit: The total limit amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Included
Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL
COVERAGES
Form Number
Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Form Date
Enter date: The edition date of the form used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Premium
Enter amount: The premium amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Coverage Code
Enter code: The code for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Coverage Description
Enter text: The description of the coverage.
PROPERTY ADDITIONAL
COVERAGES
Pol Level
Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL
COVERAGES
Blkt #
Enter identifier: The blanket number associated with the additional property coverage.
PROPERTY ADDITIONAL
COVERAGES
Prem Level
Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL
COVERAGES
Total Amount
Enter limit: The total limit amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Included
Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL
COVERAGES
Form Number
Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Form Date
Enter date: The edition date of the form used by the company for the coverage.
ACORD 160 (2014/12) rev. 04-29-2014
Page 58 of 70
PROPERTY ADDITIONAL
COVERAGES
Premium
Enter amount: The premium amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Coverage Code
Enter code: The code for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Coverage Description
Enter text: The description of the coverage.
PROPERTY ADDITIONAL
COVERAGES
Pol Level
Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL
COVERAGES
Blkt #
Enter identifier: The blanket number associated with the additional property coverage.
PROPERTY ADDITIONAL
COVERAGES
Prem Level
Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL
COVERAGES
Total Amount
Enter limit: The total limit amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Included
Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL
COVERAGES
Form Number
Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Form Date
Enter date: The edition date of the form used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Premium
Enter amount: The premium amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Coverage Code
Enter code: The code for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Coverage Description
Enter text: The description of the coverage.
PROPERTY ADDITIONAL
COVERAGES
Pol Level
Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL
COVERAGES
Blkt #
Enter identifier: The blanket number associated with the additional property coverage.
PROPERTY ADDITIONAL
COVERAGES
Prem Level
Check the box (if applicable): Indicates the coverage applies at the premises level.
ACORD 160 (2014/12) rev. 04-29-2014
Page 59 of 70
PROPERTY ADDITIONAL
COVERAGES
Total Amount
Enter limit: The total limit amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Included
Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL
COVERAGES
Form Number
Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Form Date
Enter date: The edition date of the form used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Premium
Enter amount: The premium amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Coverage Code
Enter code: The code for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Coverage Description
Enter text: The description of the coverage.
PROPERTY ADDITIONAL
COVERAGES
Pol Level
Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL
COVERAGES
Blkt #
Enter identifier: The blanket number associated with the additional property coverage.
PROPERTY ADDITIONAL
COVERAGES
Prem Level
Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL
COVERAGES
Total Amount
Enter limit: The total limit amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Included
Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL
COVERAGES
Form Number
Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Form Date
Enter date: The edition date of the form used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Premium
Enter amount: The premium amount for the coverage.
ACORD 160 (2014/12) rev. 04-29-2014
Page 60 of 70
PROPERTY ADDITIONAL
COVERAGES
Coverage Code
Enter code: The code for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Coverage Description
Enter text: The description of the coverage.
PROPERTY ADDITIONAL
COVERAGES
Pol Level
Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL
COVERAGES
Blkt #
Enter identifier: The blanket number associated with the additional property coverage.
PROPERTY ADDITIONAL
COVERAGES
Prem Level
Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL
COVERAGES
Total Amount
Enter limit: The total limit amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Included
Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL
COVERAGES
Form Number
Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Form Date
Enter date: The edition date of the form used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Premium
Enter amount: The premium amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Coverage Code
Enter code: The code for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Coverage Description
Enter text: The description of the coverage.
PROPERTY ADDITIONAL
COVERAGES
Pol Level
Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL
COVERAGES
Blkt #
Enter identifier: The blanket number associated with the additional property coverage.
PROPERTY ADDITIONAL
COVERAGES
Prem Level
Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL
COVERAGES
Total Amount
Enter limit: The total limit amount for the coverage.
ACORD 160 (2014/12) rev. 04-29-2014
Page 61 of 70
PROPERTY ADDITIONAL
COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Included
Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL
COVERAGES
Form Number
Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Form Date
Enter date: The edition date of the form used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Premium
Enter amount: The premium amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Coverage Code
Enter code: The code for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Coverage Description
Enter text: The description of the coverage.
PROPERTY ADDITIONAL
COVERAGES
Pol Level
Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL
COVERAGES
Blkt #
Enter identifier: The blanket number associated with the additional property coverage.
PROPERTY ADDITIONAL
COVERAGES
Prem Level
Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL
COVERAGES
Total Amount
Enter limit: The total limit amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Included
Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL
COVERAGES
Form Number
Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Form Date
Enter date: The edition date of the form used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Premium
Enter amount: The premium amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Coverage Code
Enter code: The code for the coverage.
ACORD 160 (2014/12) rev. 04-29-2014
Page 62 of 70
PROPERTY ADDITIONAL
COVERAGES
Coverage Description
Enter text: The description of the coverage.
PROPERTY ADDITIONAL
COVERAGES
Pol Level
Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL
COVERAGES
Blkt #
Enter identifier: The blanket number associated with the additional property coverage.
PROPERTY ADDITIONAL
COVERAGES
Prem Level
Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL
COVERAGES
Total Amount
Enter limit: The total limit amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Included
Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL
COVERAGES
Form Number
Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Form Date
Enter date: The edition date of the form used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Premium
Enter amount: The premium amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Coverage Code
Enter code: The code for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Coverage Description
Enter text: The description of the coverage.
PROPERTY ADDITIONAL
COVERAGES
Pol Level
Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL
COVERAGES
Blkt #
Enter identifier: The blanket number associated with the additional property coverage.
PROPERTY ADDITIONAL
COVERAGES
Prem Level
Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL
COVERAGES
Total Amount
Enter limit: The total limit amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
ACORD 160 (2014/12) rev. 04-29-2014
Page 63 of 70
PROPERTY ADDITIONAL
COVERAGES
Included
Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL
COVERAGES
Form Number
Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Form Date
Enter date: The edition date of the form used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Premium
Enter amount: The premium amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Coverage Code
Enter code: The code for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Coverage Description
Enter text: The description of the coverage.
PROPERTY ADDITIONAL
COVERAGES
Pol Level
Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL
COVERAGES
Blkt #
Enter identifier: The blanket number associated with the additional property coverage.
PROPERTY ADDITIONAL
COVERAGES
Prem Level
Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL
COVERAGES
Total Amount
Enter limit: The total limit amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Included
Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL
COVERAGES
Form Number
Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Form Date
Enter date: The edition date of the form used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Premium
Enter amount: The premium amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Coverage Code
Enter code: The code for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Coverage Description
Enter text: The description of the coverage.
ACORD 160 (2014/12) rev. 04-29-2014
Page 64 of 70
PROPERTY ADDITIONAL
COVERAGES
Pol Level
Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL
COVERAGES
Blkt #
Enter identifier: The blanket number associated with the additional property coverage.
PROPERTY ADDITIONAL
COVERAGES
Prem Level
Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL
COVERAGES
Total Amount
Enter limit: The total limit amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Included
Check the box (if applicable): Indicates the coverage is included in the policy.
PROPERTY ADDITIONAL
COVERAGES
Form Number
Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Form Date
Enter date: The edition date of the form used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Premium
Enter amount: The premium amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Coverage Code
Enter code: The code for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Coverage Description
Enter text: The description of the coverage.
PROPERTY ADDITIONAL
COVERAGES
Pol Level
Check the box (if applicable): Indicates the coverage applies at the policy level.
PROPERTY ADDITIONAL
COVERAGES
Blkt #
Enter identifier: The blanket number associated with the additional property coverage.
PROPERTY ADDITIONAL
COVERAGES
Prem Level
Check the box (if applicable): Indicates the coverage applies at the premises level.
PROPERTY ADDITIONAL
COVERAGES
Total Amount
Enter limit: The total limit amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Deductible
Enter deductible: The deductible amount for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Included
Check the box (if applicable): Indicates the coverage is included in the policy.
ACORD 160 (2014/12) rev. 04-29-2014
Page 65 of 70
PROPERTY ADDITIONAL
COVERAGES
Form Number
Enter identifier: The form number used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Form Date
Enter date: The edition date of the form used by the company for the coverage.
PROPERTY ADDITIONAL
COVERAGES
Premium
Enter amount: The premium amount for the coverage.
Form Page 5
Section Name
Field Name
Description
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g., agency or
brokerage).
IDENTIFICATION SECTION
Loc #
Enter number: The producer assigned number of the location.
IDENTIFICATION SECTION
Bldg #
Enter number: The building number for the premises. Used when more than one building exists
at an individual location.
PREMISES GENERAL
INFORMATION
1. Does applicant have a
heating or processing
boiler?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Does applicant have a heating or processing boiler?.
PREMISES GENERAL
INFORMATION
Date of Last Inspection
Enter date: The date of the last inspection.
PREMISES GENERAL
INFORMATION
Current Carrier for Boiler &
Machinery coverage:
Enter text: The insurer name on any other applicable insurance. As used here, this is the current
carrier for boiler and machinery coverage.
PREMISES GENERAL
INFORMATION
2. Any specialized
equipment, such as medical
equipment or other, valued
over $100,000?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Any specialized equipment, such as medical equipment or other, valued over $100,000?.
PREMISES GENERAL
INFORMATION
Remarks
Enter text: An explanation of an specialized equipment, such as medical equipment or other,
valued over $100,000.
PREMISES GENERAL
INFORMATION
3. Is all equipment
inspected annually and well
maintained?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Is all equipment inspected annually and well maintained?.
PREMISES GENERAL
INFORMATION
4. Is there a swimming pool
on the premises?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Is there a swimming pool on the premises?.
PREMISES GENERAL
INFORMATION
Approved Fence
Check the box (if applicable): Indicates the swimming pool is surrounded by a fence that is an
approved height.
ACORD 160 (2014/12) rev. 04-29-2014
Page 66 of 70
PREMISES GENERAL
INFORMATION
Limited Access
Check the box (if applicable): Indicates there is limited access to the swimming pool.
PREMISES GENERAL
INFORMATION
Diving Board
Check the box (if applicable): Indicates the swimming pool has a diving board.
PREMISES GENERAL
INFORMATION
Slide
Check the box (if applicable): Indicates the swimming pool has a slide.
PREMISES GENERAL
INFORMATION
Above Ground
Check the box (if applicable): Indicates the swimming pool is above ground.
PREMISES GENERAL
INFORMATION
In Ground
Check the box (if applicable): Indicates the swimming pool is in the ground.
PREMISES GENERAL
INFORMATION
Life Guard
Check the box (if applicable): Indicates there is life guard for the swimming pool.
PREMISES GENERAL
INFORMATION
5. Is the building under
construction?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Is the building under construction?.
PREMISES GENERAL
INFORMATION
Remarks
Enter text: An explanation as to whether the building is under construction.
APARTMENT AND
CONDOMINIUMS
1. Is there a playground on
premises?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Is there a playground on premises?.
APARTMENT AND
CONDOMINIUMS
Remarks
Enter text: An explanation as to whether there is a playground on premises.
APARTMENT AND
CONDOMINIUMS
2. Is aluminum wiring
used?
Enter Y for a Yes response. Input N for No response. Indicates if aluminum wiring is used in
the structure.
APARTMENT AND
CONDOMINIUMS
Installation Date
Enter date: The date the wiring was installed.
APARTMENT AND
CONDOMINIUMS
Description
Enter text: The description of any aluminum wire used.
APARTMENT AND
CONDOMINIUMS
3. Is developer or contractor
a board member?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Is developer or contractor a board member?.
APARTMENT AND
CONDOMINIUMS
4. Is a property manager
employed?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Is a property manager employed?.
APARTMENT AND
CONDOMINIUMS
Coverage Applies To Bare
Walls
Check the box (if applicable): Indicates coverage applies to bare walls.
APARTMENT AND
CONDOMINIUMS
Coverage Applies To
Finished Walls
Check the box (if applicable): Indicates coverage applies to finished walls.
ACORD 160 (2014/12) rev. 04-29-2014
Page 67 of 70
APARTMENT AND
CONDOMINIUMS
Smoke Detectors - None
Check the box (if applicable): Indicates there are no smoke detectors in each unit.
APARTMENT AND
CONDOMINIUMS
Smoke Detectors - Battery
Check the box (if applicable): Indicates the smoke detector is battery operated.
APARTMENT AND
CONDOMINIUMS
Smoke Detectors - Wired
Check the box (if applicable): Indicates the smoke detector is wired.
APARTMENT AND
CONDOMINIUMS
# of Fire Divisions
Enter number: The number of fire divisions in the building.
APARTMENT AND
CONDOMINIUMS
# Units Per Fire Division
Enter number: The number of units within a fire division.
APARTMENT AND
CONDOMINIUMS
# Units Owner Occupied
Enter number: The number of units that are owner occupied.
CRIME
Alarm Type - Hold Up
Check the box (if applicable): Indicates the alarm type is a hold-up alarm. A manual or
semiautomatic control which can transmit an alarm in the event of a hold-up. As used here,
complete this section in regards to the location and protection systems for this risk. Information
on the classification of safes, vaults and alarm systems can be found in the Crime Section of the
ISO Commercial Lines Manual.
CRIME
Alarm Type - Premises
Check the box (if applicable): Indicates the alarm type is a premises alarm. A sensing device
installed on premises which transmits an alarm in the event of unauthorized entry. The Premises
Extent must be completed for Premises Alarms.
CRIME
Alarm Type - Safe / Vault
Check the box (if applicable): Indicates the alarm type is a safe / vault alarm. A system that
protects the safe or vault and is connected to an outside central station, gong or siren. The
Extent of Protection for safe / vault must be completed.
CRIME
Alarm Type - Other
Check the box (if applicable): Indicates the alarm type is other than those listed.
CRIME
Alarm Type - Other
Description
Enter text: The description of the type of alarm.
CRIME
Alarm Description - Local
Gong
Check the box (if applicable): Indicates the burglar alarm sounds or appears outside the
premises.
CRIME
Alarm Description - Central
Station with Keys
Check the box (if applicable): Indicates the alarm company, located off the insured's premises,
has keys to the applicant's property.
CRIME
Alarm Description - Central
Station without Keys
Check the box (if applicable): Indicates the burglar alarm rings at an alarm company.
CRIME
Alarm Description - Police
Connect
Check the box (if applicable): Indicates if alarms (hold-up and burglar) are transmitted to police
headquarters rather than to a private control station
ACORD 160 (2014/12) rev. 04-29-2014
Page 68 of 70
CRIME
Grade
Enter code: The alarm grade as described in the Insurance Services Office crime rating manual
(e.g., AA, A, B, C) which indicates the time required to respond to a signal from the alarm
system.
CRIME
Extent of Protection for Safe
/ Vault - Partial
Check the box (if applicable): Indicates the extent of protection for the safe / vault is partial and
covers around the door only.
CRIME
Extent of Protection for Safe
/ Vault - Complete
Check the box (if applicable): Indicates the extent of protection for the safe / vault is complete
and covers the sides, top walls, floor and ceiling.
CRIME
Extent of Protection for
Premises - 1
Check the box (if applicable): Indicates the extent of protection for the premises is premises 1
as defined in the ISO Classification and Rating Manual.
CRIME
Extent of Protection for
Premises - 2
Check the box (if applicable): Indicates the extent of protection for the premises is premises 2
as defined in the ISO Classification and Rating Manual.
CRIME
Extent of Protection for
Premises - 3
Check the box (if applicable): Indicates the extent of protection for the premises is premises 3
as defined in the ISO Classification and Rating Manual.
CRIME
Certificate #
Enter identifier: The Underwriters Laboratories or other testing organization Certificate Number,
if applicable. Attach a copy of the certificate to the application.
CRIME
Expiration Date
Enter date: The expiration date of the certificate. (MM/DD/YYYY)
CRIME
Safe / Vault / Receptacle
Manufacturers Name
Enter text: The safe or vault manufacturer's name.
CRIME
Label - UL
Check the box (if applicable): Indicates the rating is based on Underwriters Laboratories, Inc.
(UL).
CRIME
Label - SMNA
Check the box (if applicable): Indicates the rating is based on Safe Manufacturers National
Association (SMNA).
CRIME
Class
Enter code: The construction classification representing the extent of burglary protection for this
safe or vault. Use the classification from the Burglary label and not the Fire label located on the
safe or vault. For industry definitions of the classifications, refer to the Commercial Lines
Manual.
CRIME
Maximum Cash on Premises
Enter amount: The maximum amount of cash kept on the premises during normal business
hours.
CRIME
Maximum Cash With
Messenger
Enter amount: The maximum amount of cash messengers are allowed to carry for the applicant.
CRIME
Money on Premises
Overnight
Enter amount: The maximum exposure amount for money overnight.
CRIME
Frequency of Deposits
Enter code: The frequency of deposits.
ACORD 160 (2014/12) rev. 04-29-2014
Page 69 of 70
CRIME
Deadbolt Cylinder Door
Locks
Enter Y for a Yes response. Input N for No response. Indicates the type of locks on the entry
doors of the insured premises are double cylinder deadbolt door locks.
CRIME
Safe Door Construction
Enter text: The construction of the safe, vault or other receptacle (e.g., 4-inch steel door, with
12-inch reinforced stone walls).
CRIME
Other Protection
Enter text: The description of other protective measures or devices (e.g., if windows have steel
grates and are connected to an alarm). Indicate if the building has skylights and if windows are
visible from the street.
REMARKS
Enter text: The description of any additional information required for underwriting or rating the
business owners line of business. ACORD 101, Additional Remarks Schedule, may be
attached if more space is required.
Form Page 6
Section Name
Field Name
Description
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g., agency or
brokerage).
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. (MM/DD/YYYY)
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.
ACORD 160 (2014/12) rev. 04-29-2014
Page 70 of 70