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ACORD Form 823 Additional Premises
Information Schedule Instructions

 

 
ACORD 823 (2003/09) rev. 03-31-2009 1 of 11
Section Name Field Name Field and/or Section Description
The title of the form. ACORD 823, Additional Premises Information Section, is used as an
TITLE Additional Premises Information attachment to ACORD 125, Commercial Insurance Application, when more space is
ACORD 823 (2009/03) Schedule required for additional premises.
Enter identifier: The customer's identification number assigned by the producer (e.g.
IDENTIFICATION SECTION Agency Customer ID agency or brokerage).
IDENTIFICATION SECTION Page # Enter number: The page number applicable to this page.
Enter number: The total number of pages applicable to this form (e.g., Page 1 of 4). If
IDENTIFICATION SECTION Of #of Pages only one page, indicate Page 1 of 1.
IDENTIFICATION SECTION Agency Enter text: The full name of the producer/agency.
IDENTIFICATION SECTION Named Insured(s) Enter text: The named insured(s) as it/they will appear on the policy declarations page.
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
IDENTIFICATION SECTION Policy Number required for self-insurance, the self-insured license or contract number.
Enter date: The effective date of the policy. The date that the terms and conditions of the
IDENTIFICATION SECTION Effective Date policy commence.
IDENTIFICATION SECTION Carrier Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name.
IDENTIFICATION SECTION NAIC Code Enter code: The identification code assigned to the insurer by the NAIC.
PREMISES INFORMATION Loc # One Enter number: The location number for the premises.
Enter number: The building number for the premises. Used when more than one building
PREMISES INFORMATION Bld # One exists at an individual location.
Street, City, County, State, Zip
PREMISES INFORMATION Code One Enter text: The first address line of the commercial structure.
PREMISES INFORMATION Enter text: The second address line of the commercial structure.
PREMISES INFORMATION Enter text: The city of the commercial structure.
PREMISES INFORMATION Enter text: The county of the commercial structure.
PREMISES INFORMATION Enter code: The state of the commercial structure.
PREMISES INFORMATION Enter code: The postal code of the commercial structure.
PREMISES INFORMATION City Limits Inside One Check the box (if applicable): Indicates if the building is within the city limits.
PREMISES INFORMATION City Limits Outside One Check the box (if applicable): Indicates if the building is outside the city limits.
ACORD 823 (2003/09) rev. 03-31-2009 2 of 11
Section Name Field Name Field and/or Section Description
PREMISES INFORMATION City Limits Other One Check the box (if applicable): Indicates if the building is not inside or outside city limits. For example, unincorporated.
PREMISES INFORMATION Other City Limits Description Enter text: The description of the risk location if not inside or outside the city limits.
PREMISES INFORMATION Interest Owner One Check the box (if applicable): Indicates the named insured's interest in the building is as its owner.
PREMISES INFORMATION Interest Tenant One Check the box (if applicable): Indicates the named insured's interest is the building is as its tenant.
PREMISES INFORMATION Other Interest One Check the box (if applicable): Indicates the named insured's interest is the building is other than as its owner or tenant.
PREMISES INFORMATION Other Interest Description One Enter text: The description of the insured's interest is the building when it is other than as its owner or tenant.
PREMISES INFORMATION Yr Built One 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.
PREMISES INFORMATION # Employees One Enter number: The total number of employee in this location.
PREMISES INFORMATION Annual Revenues One Enter amount: The annual revenue amount for this location.
PREMISES INFORMATION % Occupied One Enter percentage: The percentage of the building the named insured occupies.
PREMISES INFORMATION Loc # Two Enter number: The location number for the premises.
PREMISES INFORMATION Bld # Two Enter number: The building number for the premises. Used when more than one building exists at an individual location.
PREMISES INFORMATION Street, City, County, State, Zip Code Two Enter text: The first address line of the commercial structure.
PREMISES INFORMATION Enter text: The second address line of the commercial structure.
PREMISES INFORMATION Enter text: The city of the commercial structure.
PREMISES INFORMATION Enter text: The county of the commercial structure.
PREMISES INFORMATION Enter code: The state of the commercial structure.
PREMISES INFORMATION Enter code: The postal code of the commercial structure.
PREMISES INFORMATION City Limits Inside Two Check the box (if applicable): Indicates if the building is within the city limits.
PREMISES INFORMATION City Limits Outside Two Check the box (if applicable): Indicates if the building is outside the city limits.
PREMISES INFORMATION City Limits Other Two Check the box (if applicable): Indicates if the building is not inside or outside city limits. For example, unincorporated.
PREMISES INFORMATION Other City Limits Description Two Enter text: The description of the risk location if not inside or outside the city limits.
PREMISES INFORMATION Interest Owner Two Check the box (if applicable): Indicates the named insured's interest in the building is as its owner.

ACORD 823 (2003/09) rev. 03-31-2009 3 of 11

Section Name Field Name Field and/or Section Description
PREMISES INFORMATION Interest Tenant Two Check the box (if applicable): Indicates the named insured's interest is the building is as its tenant.
PREMISES INFORMATION Other Interest Two Check the box (if applicable): Indicates the named insured's interest is the building is other than as its owner or tenant.
PREMISES INFORMATION Other Interest Description Two Enter text: The description of the insured's interest is the building when it is other than as its owner or tenant.
PREMISES INFORMATION Yr Built Two 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.
PREMISES INFORMATION # Employees Two Enter number: The total number of employee in this location.
PREMISES INFORMATION Annual Revenues Two Enter amount: The annual revenue amount for this location.
PREMISES INFORMATION % Occupied Two Enter percentage: The percentage of the building the named insured occupies.
PREMISES INFORMATION Loc # Three Enter number: The location number for the premises.
PREMISES INFORMATION Bld # Three Enter number: The building number for the premises. Used when more than one building exists at an individual location.
PREMISES INFORMATION Street, City, County, State, Zip Code Three Enter text: The first address line of the commercial structure.
PREMISES INFORMATION Enter text: The second address line of the commercial structure.
PREMISES INFORMATION Enter text: The city of the commercial structure.
PREMISES INFORMATION Enter text: The county of the commercial structure.
PREMISES INFORMATION Enter code: The state of the commercial structure.
PREMISES INFORMATION Enter code: The postal code of the commercial structure.
PREMISES INFORMATION City Limits Inside Three Check the box (if applicable): Indicates if the building is within the city limits.
PREMISES INFORMATION City Limits Outside Three Check the box (if applicable): Indicates if the building is outside the city limits.
PREMISES INFORMATION City Limits Other Three Check the box (if applicable): Indicates if the building is not inside or outside city limits. For example, unincorporated.
PREMISES INFORMATION Other City Limits Description Three Enter text: The description of the risk location if not inside or outside the city limits.
PREMISES INFORMATION Interest Owner Three Check the box (if applicable): Indicates the named insured's interest in the building is as its owner.
PREMISES INFORMATION Interest Tenant Three Check the box (if applicable): Indicates the named insured's interest is the building is as its tenant.
PREMISES INFORMATION Other Interest Three Check the box (if applicable): Indicates the named insured's interest is the building is other than as its owner or tenant.
PREMISES INFORMATION Other Interest Description Three Enter text: The description of the insured's interest is the building when it is other than as its owner or tenant.

ACORD 823 (2003/09) rev. 03-31-2009 4 of 11

Section Name Field Name Field and/or Section Description
PREMISES INFORMATION Yr Built Three 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.
PREMISES INFORMATION # Employees Three Enter number: The total number of employee in this location.
PREMISES INFORMATION Annual Revenues Three Enter amount: The annual revenue amount for this location.
PREMISES INFORMATION % Occupied Three Enter percentage: The percentage of the building the named insured occupies.
PREMISES INFORMATION Loc # Four Enter number: The location number for the premises.
PREMISES INFORMATION Bld # Four Enter number: The building number for the premises. Used when more than one building exists at an individual location.
PREMISES INFORMATION Street, City, County, State, Zip Code Four Enter text: The first address line of the commercial structure.
PREMISES INFORMATION Enter text: The second address line of the commercial structure.
PREMISES INFORMATION Enter text: The city of the commercial structure.
PREMISES INFORMATION Enter text: The county of the commercial structure.
PREMISES INFORMATION Enter code: The state of the commercial structure.
PREMISES INFORMATION Enter code: The postal code of the commercial structure.
PREMISES INFORMATION City Limits Inside Four Check the box (if applicable): Indicates if the building is within the city limits.
PREMISES INFORMATION City Limits Outside Four Check the box (if applicable): Indicates if the building is outside the city limits.
PREMISES INFORMATION City Limits Other Four Check the box (if applicable): Indicates if the building is not inside or outside city limits. For example, unincorporated.
PREMISES INFORMATION Other City Limits Description Four Enter text: The description of the risk location if not inside or outside the city limits.
PREMISES INFORMATION Interest Owner Four Check the box (if applicable): Indicates the named insured's interest in the building is as its owner.
PREMISES INFORMATION Interest Tenant Four Check the box (if applicable): Indicates the named insured's interest is the building is as its tenant.
PREMISES INFORMATION Other Interest Four Check the box (if applicable): Indicates the named insured's interest is the building is other than as its owner or tenant.
PREMISES INFORMATION Other Interest Description Four Enter text: The description of the insured's interest is the building when it is other than as its owner or tenant.
PREMISES INFORMATION Yr Built Four 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.
PREMISES INFORMATION # Employees Four Enter number: The total number of employee in this location.
PREMISES INFORMATION Annual Revenues Four Enter amount: The annual revenue amount for this location.
PREMISES INFORMATION % Occupied Four Enter percentage: The percentage of the building the named insured occupies.

ACORD 823 (2003/09) rev. 03-31-2009 5 of 11

Section Name Field Name Field and/or Section Description
PREMISES INFORMATION Loc # Five Enter number: The location number for the premises.
PREMISES INFORMATION Bld # Five Enter number: The building number for the premises. Used when more than one building exists at an individual location.
PREMISES INFORMATION Street, City, County, State, Zip Code Five Enter text: The first address line of the commercial structure.
PREMISES INFORMATION Enter text: The second address line of the commercial structure.
PREMISES INFORMATION Enter text: The city of the commercial structure.
PREMISES INFORMATION Enter text: The county of the commercial structure.
PREMISES INFORMATION Enter code: The state of the commercial structure.
PREMISES INFORMATION Enter code: The postal code of the commercial structure.
PREMISES INFORMATION City Limits Inside Five Check the box (if applicable): Indicates if the building is within the city limits.
PREMISES INFORMATION City Limits Outside Five Check the box (if applicable): Indicates if the building is outside the city limits.
PREMISES INFORMATION City Limits Other Five Check the box (if applicable): Indicates if the building is not inside or outside city limits. For example, unincorporated.
PREMISES INFORMATION Other City Limits Description Five Enter text: The description of the risk location if not inside or outside the city limits.
PREMISES INFORMATION Interest Owner Five Check the box (if applicable): Indicates the named insured's interest in the building is as its owner.
PREMISES INFORMATION Interest Tenant Five Check the box (if applicable): Indicates the named insured's interest is the building is as its tenant.
PREMISES INFORMATION Other Interest Five Check the box (if applicable): Indicates the named insured's interest is the building is other than as its owner or tenant.
PREMISES INFORMATION Other Interest Description Five Enter text: The description of the insured's interest is the building when it is other than as its owner or tenant.
PREMISES INFORMATION Yr Built Five 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.
PREMISES INFORMATION # Employees Five Enter number: The total number of employee in this location.
PREMISES INFORMATION Annual Revenues Five Enter amount: The annual revenue amount for this location.
PREMISES INFORMATION % Occupied Five Enter percentage: The percentage of the building the named insured occupies.
PREMISES INFORMATION Loc # Six Enter number: The location number for the premises.
PREMISES INFORMATION Bld # Six Enter number: The building number for the premises. Used when more than one building exists at an individual location.
PREMISES INFORMATION Street, City, County, State, Zip Code Six Enter text: The first address line of the commercial structure.
PREMISES INFORMATION Enter text: The second address line of the commercial structure.

ACORD 823 (2003/09) rev. 03-31-2009 6 of 11

Section Name Field Name Field and/or Section Description
PREMISES INFORMATION Enter text: The city of the commercial structure.
PREMISES INFORMATION Enter text: The county of the commercial structure.
PREMISES INFORMATION Enter code: The state of the commercial structure.
PREMISES INFORMATION Enter code: The postal code of the commercial structure.
PREMISES INFORMATION City Limits Inside Six Check the box (if applicable): Indicates if the building is within the city limits.
PREMISES INFORMATION City Limits Outside Six Check the box (if applicable): Indicates if the building is outside the city limits.
PREMISES INFORMATION City Limits Other Six Check the box (if applicable): Indicates if the building is not inside or outside city limits. For example, unincorporated.
PREMISES INFORMATION Other City Limits Description Six Enter text: The description of the risk location if not inside or outside the city limits.
PREMISES INFORMATION Interest Owner Six Check the box (if applicable): Indicates the named insured's interest in the building is as its owner.
PREMISES INFORMATION Interest Tenant Six Check the box (if applicable): Indicates the named insured's interest is the building is as its tenant.
PREMISES INFORMATION Other Interest Six Check the box (if applicable): Indicates the named insured's interest is the building is other than as its owner or tenant.
PREMISES INFORMATION Other Interest Description Six Enter text: The description of the insured's interest is the building when it is other than as its owner or tenant.
PREMISES INFORMATION Yr Built Six 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.
PREMISES INFORMATION # Employees Six Enter number: The total number of employee in this location.
PREMISES INFORMATION Annual Revenues Six Enter amount: The annual revenue amount for this location.
PREMISES INFORMATION % Occupied Six Enter percentage: The percentage of the building the named insured occupies.
PREMISES INFORMATION Loc # Seven Enter number: The location number for the premises.
PREMISES INFORMATION Bld # Seven Enter number: The building number for the premises. Used when more than one building exists at an individual location.
PREMISES INFORMATION Street, City, County, State, Zip Code Seven Enter text: The first address line of the commercial structure.
PREMISES INFORMATION Enter text: The second address line of the commercial structure.
PREMISES INFORMATION Enter text: The city of the commercial structure.
PREMISES INFORMATION Enter text: The county of the commercial structure.
PREMISES INFORMATION Enter code: The state of the commercial structure.
PREMISES INFORMATION Enter code: The postal code of the commercial structure.
PREMISES INFORMATION City Limits Inside Seven Check the box (if applicable): Indicates if the building is within the city limits.
PREMISES INFORMATION City Limits Outside Seven Check the box (if applicable): Indicates if the building is outside the city limits.

ACORD 823 (2003/09) rev. 03-31-2009 7 of 11

Section Name Field Name Field and/or Section Description
Check the box (if applicable): Indicates if the building is not inside or outside city limits.
PREMISES INFORMATION City Limits Other Seven For example, unincorporated.
Other City Limits Description
PREMISES INFORMATION Seven Enter text: The description of the risk location if not inside or outside the city limits.
Check the box (if applicable): Indicates the named insured's interest in the building is as
PREMISES INFORMATION Interest Owner Seven its owner.
Check the box (if applicable): Indicates the named insured's interest is the building is as its
PREMISES INFORMATION Interest Tenant Seven tenant.
Check the box (if applicable): Indicates the named insured's interest is the building is other
PREMISES INFORMATION Other Interest Seven than as its owner or tenant.
Enter text: The description of the insured's interest is the building when it is other than as
PREMISES INFORMATION Other Interest Description Seven its owner or tenant.
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
PREMISES INFORMATION Yr Built Seven completed.
PREMISES INFORMATION # Employees Seven Enter number: The total number of employee in this location.
PREMISES INFORMATION Annual Revenues Seven Enter amount: The annual revenue amount for this location.
PREMISES INFORMATION % Occupied Seven Enter percentage: The percentage of the building the named insured occupies.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS BY
PREMISE(S) Loc # One Enter number: The producer assigned number of the location.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS BY Enter number: The building number for the premises. Used when more than one building
PREMISE(S) Bld # One exists at an individual location.
NATURE OF BUSINESS / DESCRIPTION OF OPERATIONS BY PREMISES Nature of Business / Description of Operations by Premise(s) One Enter text: The description of what business each applicant performs and the way it is conducted by premises. Operations which may not be apparent in a general description of operations may be segmented by location (e.g., location #1 is a sales office in Paris, France, location #2 is a warehouse in Berlin, Germany). Include number of leased and owned premises outside of the United States. The section should be completed in enough detail to enable the underwriter to understand and classify each operation. Do not use the classification wording from the Commercial Lines Manual or Workers Compensation Manual. They do not provide adequate detail. Example: a manufacturer of pulley wheels used in sewing machines should be described as such and not as "Metal Goods Mfg. N.O.C.".

ACORD 823 (2003/09) rev. 03-31-2009 8 of 11

Section Name Field Name Field and/or Section Description
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS BY
PREMISE(S) Loc # Two Enter number: The producer assigned number of the location.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS BY Enter number: The building number for the premises. Used when more than one building
PREMISE(S) Bld # Two exists at an individual location.
NATURE OF BUSINESS / DESCRIPTION OF OPERATIONS BY PREMISES Nature of Business / Description of Operations by Premise(s) Two Enter text: The description of what business each applicant performs and the way it is conducted by premises. Operations which may not be apparent in a general description of operations may be segmented by location (e.g., location #1 is a sales office in Paris, France, location #2 is a warehouse in Berlin, Germany). Include number of leased and owned premises outside of the United States. The section should be completed in enough detail to enable the underwriter to understand and classify each operation. Do not use the classification wording from the Commercial Lines Manual or Workers Compensation Manual. They do not provide adequate detail. Example: a manufacturer of pulley wheels used in sewing machines should be described as such and not as "Metal Goods Mfg. N.O.C.".
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS BY
PREMISE(S) Loc # Three Enter number: The producer assigned number of the location.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS BY Enter number: The building number for the premises. Used when more than one building
PREMISE(S) Bld # Three exists at an individual location.
NATURE OF BUSINESS / DESCRIPTION OF OPERATIONS BY PREMISES Nature of Business / Description of Operations by Premise(s) Three Enter text: The description of what business each applicant performs and the way it is conducted by premises. Operations which may not be apparent in a general description of operations may be segmented by location (e.g., location #1 is a sales office in Paris, France, location #2 is a warehouse in Berlin, Germany). Include number of leased and owned premises outside of the United States. The section should be completed in enough detail to enable the underwriter to understand and classify each operation. Do not use the classification wording from the Commercial Lines Manual or Workers Compensation Manual. They do not provide adequate detail. Example: a manufacturer of pulley wheels used in sewing machines should be described as such and not as "Metal Goods Mfg. N.O.C.".

ACORD 823 (2003/09) rev. 03-31-2009 9 of 11

Section Name Field Name Field and/or Section Description
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS BY
PREMISE(S) Loc # Four Enter number: The producer assigned number of the location.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS BY Enter number: The building number for the premises. Used when more than one building
PREMISE(S) Bld # Four exists at an individual location.
NATURE OF BUSINESS / DESCRIPTION OF OPERATIONS BY PREMISES Nature of Business / Description of Operations by Premise(s) Four Enter text: The description of what business each applicant performs and the way it is conducted by premises. Operations which may not be apparent in a general description of operations may be segmented by location (e.g., location #1 is a sales office in Paris, France, location #2 is a warehouse in Berlin, Germany). Include number of leased and owned premises outside of the United States. The section should be completed in enough detail to enable the underwriter to understand and classify each operation. Do not use the classification wording from the Commercial Lines Manual or Workers Compensation Manual. They do not provide adequate detail. Example: a manufacturer of pulley wheels used in sewing machines should be described as such and not as "Metal Goods Mfg. N.O.C.".
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS BY
PREMISE(S) Loc # Five Enter number: The producer assigned number of the location.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS BY Enter number: The building number for the premises. Used when more than one building
PREMISE(S) Bld # Five exists at an individual location.
NATURE OF BUSINESS / DESCRIPTION OF OPERATIONS BY PREMISES Nature of Business / Description of Operations by Premise(s) Five Enter text: The description of what business each applicant performs and the way it is conducted by premises. Operations which may not be apparent in a general description of operations may be segmented by location (e.g., location #1 is a sales office in Paris, France, location #2 is a warehouse in Berlin, Germany). Include number of leased and owned premises outside of the United States. The section should be completed in enough detail to enable the underwriter to understand and classify each operation. Do not use the classification wording from the Commercial Lines Manual or Workers Compensation Manual. They do not provide adequate detail. Example: a manufacturer of pulley wheels used in sewing machines should be described as such and not as "Metal Goods Mfg. N.O.C.".

ACORD 823 (2003/09) rev. 03-31-2009 10 of 11

Section Name Field Name Field and/or Section Description
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS BY
PREMISE(S) Loc # Six Enter number: The producer assigned number of the location.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS BY Enter number: The building number for the premises. Used when more than one building
PREMISE(S) Bld # Six exists at an individual location.
NATURE OF BUSINESS / DESCRIPTION OF OPERATIONS BY PREMISES Nature of Business / Description of Operations by Premise(s) Six Enter text: The description of what business each applicant performs and the way it is conducted by premises. Operations which may not be apparent in a general description of operations may be segmented by location (e.g., location #1 is a sales office in Paris, France, location #2 is a warehouse in Berlin, Germany). Include number of leased and owned premises outside of the United States. The section should be completed in enough detail to enable the underwriter to understand and classify each operation. Do not use the classification wording from the Commercial Lines Manual or Workers Compensation Manual. They do not provide adequate detail. Example: a manufacturer of pulley wheels used in sewing machines should be described as such and not as "Metal Goods Mfg. N.O.C.".
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS BY
PREMISE(S) Loc # Seven Enter number: The producer assigned number of the location.
NATURE OF BUSINESS /
DESCRIPTION OF
OPERATIONS BY Enter number: The building number for the premises. Used when more than one building
PREMISE(S) Bld # Seven exists at an individual location.
NATURE OF BUSINESS / DESCRIPTION OF OPERATIONS BY PREMISES Nature of Business / Description of Operations by Premise(s) Seven Enter text: The description of what business each applicant performs and the way it is conducted by premises. Operations which may not be apparent in a general description of operations may be segmented by location (e.g., location #1 is a sales office in Paris, France, location #2 is a warehouse in Berlin, Germany). Include number of leased and owned premises outside of the United States. The section should be completed in enough detail to enable the underwriter to understand and classify each operation. Do not use the classification wording from the Commercial Lines Manual or Workers Compensation Manual. They do not provide adequate detail. Example: a manufacturer of pulley wheels used in sewing machines should be described as such and not as "Metal Goods Mfg. N.O.C.".
Section Name Field Name Field and/or Section Description
The edition identifier of the form including the form number and edition (the date is
Edition Date typically formatted YYYY/MM).

ACORD 823 (2003/09) rev. 03-31-2009 11 of 11