| Section Name |
Field Name |
Field and/or Section Description |
| TITLE ACORD 140 (2007/09) |
Property Section |
This guide provides the user with basic instructions for
completing the ACORD Property Section Application. The Property Section
has been designed to handle the basic underwriting and rating needs for
commercial property exposures. The Property Section accommodates two locations,
with coverage and rating information recorded separately for each
location. This form was designed to be used in conjunction with the Commercial
Insurance Application – Applicant Information Section (ACORD 125). |
| IDENTIFICATION SECTION |
|
Much of the information for the Identification Section should
match the data found within the Applicant Information Section of ACORD
125. Nevertheless, it is still important to complete it. Many companies
separate the applications by line of business for rating purposes. Not
completing this portion of the application
makes it difficult to keep track of the full account. |
| IDENTIFICATION SECTION |
Agency Customer ID |
Customer’s identification number assigned by the agency. |
| IDENTIFICATION SECTION |
Date |
Month/day/year (MM/DD/YYYY) on which the form is completed. |
| IDENTIFICATION SECTION |
Applicant (First Named Insured) |
First Named Insured as it appears on the ACORD 125. |
| IDENTIFICATION SECTION |
Policy Number |
Provide the policy number if a policy has already been issued. |
| IDENTIFICATION SECTION |
Carrier |
Name of the applicable insurance company. Do not use group
names; use the actual name of the company within the group in which you
wish to have the policy issued. |
| IDENTIFICATION SECTION |
NAIC Code |
Individual company code assigned by the NAIC. |
| IDENTIFICATION SECTION |
Effective Date Date |
Enter the Effective date on which the terms and conditions of
the policy will commence. It is important that the effective dates of
the underlying policies are concurrent with those of the Umbrella
policy when aggregate limits are involved. If the effective dates of
the underlying policies and the Umbrella are not concurrent, the full
underlying limits may not be available for losses that occur during the
policy period of the Umbrella and a coverage gap may occur. |
| IDENTIFICATION SECTION |
Expiration Date Date |
Enter the Expiration date on which the terms and conditions
of the policy will terminate unless renewed. |
| IDENTIFICATION SECTION |
Billing Plan check boxes |
Indicate whether the agency or the company (direct) will bill
the insured or other payor for the policy. |
| IDENTIFICATION SECTION |
Payment Plan |
Indicate the plan to be used to pay the company for the
policy. Use the company’s specific designation for the plan where
possible (e.g., Prepaid, Annual, Semi-annual, Bi-monthly, 40-30-30). |
| IDENTIFICATION SECTION |
Audit |
Use this field to indicate the audit term for policies that
are subject to periodic audit. If the audit period is known, enter the
code:A – annualS – semi-annual Q – quarterly M – monthly O – other |
| IDENTIFICATION SECTION |
For Company Use Only |
Blank space provided for carrier use. |
|
|
|
|
|
|
| PREMISES INFORMATION |
|
Complete the front of the form for a single building on a
premises, and the back of the form for a second building or a second
premises. Use additional forms for additional buildings or premises. |
| PREMISES INFORMATION |
Premises # |
Enter the premises location number as it appears on the ACORD
125 Premises Information Section. |
| PREMISES INFORMATION |
Street Address |
Enter the street address as shown on ACORD 125. |
| PREMISES INFORMATION |
Building # |
Enter the building number(s) associated with this location. |
| PREMISES INFORMATION |
Building Description |
Provide a description of the building at this location. |
| PREMISES INFORMATION |
Subject of Insurance |
Enter all units at risk/coverages that are to be insured at
this particular location number/building number combination. Examples:
* Building * Personal Property * Extra Expense * Business Income |
| PREMISES INFORMATION |
Amount |
Enter the amount of insurance required for the corresponding
subject of insurance. |
| PREMISES INFORMATION |
Coins % |
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. |
| PREMISES INFORMATION |
Valuation |
Indicate the method which will be used to determine the
amount paid on a claim. Valuation methods are: ACV- Actual Cash Value
RC- Replacement Cost AA- Agreed Amount MV- Market Value |
| PREMISES INFORMATION |
Causes of Loss |
Enter the causes of loss the subject of insurance is to be
covered for. Examples: * Basic * Broad * Special excluding theft *
Earthquake |
| PREMISES INFORMATION |
Inflation Guard % |
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). |
| PREMISES INFORMATION |
DED |
Enter the deductible amounts that are to apply
to this subject of insurance. |
| PREMISES INFORMATION |
Blkt # |
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. |
| PREMISES INFORMATION |
Forms and Conditions to Apply |
Enter all form numbers and special conditions that apply to
this subject of insurance. Also indicate here if coverage is blanket or
average rated. |
| PREMISES INFORMATION |
Additional Information – Business Income/Extra Expense/Value
Reporting Information |
Check the appropriate box for Business Income/Extra Expense
coverage and attach ACORD 810 supplement; or if Value Reporting
Information is to be reported, also attach ACORD 811 supplement. |
| PREMISES INFORMATION |
Additional Coverages, Options, Restrictions, Endorsements,
Rating Information |
Use this space to enter information on any endorsements or
options not provided for above. Also provide rating information
required for these options, or by individual company programs. Provide
any other coverage information that pertains to this location such as:
* Class Rate * Rate Reference * Sales * Earnings |
| PREMISES INFORMATION |
Spoilage Coverage |
Indicate by “Y” (YES) or “N” (NO) if spoilage coverage is
desired. If “YES”, complete adjacent fields. |
| PREMISES INFORMATION |
Description of Property Covered |
Describe the property to be covered for spoilage. |
| PREMISES INFORMATION |
Limit |
Limit applicable for this coverage. |
| PREMISES INFORMATION |
Deductible |
Enter the applicable deductible for this coverage. |
| PREMISES INFORMATION |
Refrigeration Maintenance Agreement |
Indicate by “Y” (YES) or “N” (NO) if a refrigeration
maintenance agreement exists. |
| PREMISES INFORMATION |
Options |
Enter any applicable optional coverages. |
| PREMISES INFORMATION |
# of Open Sides on Structure |
Indicate the number of open sides on the structure, if any. |
| PREMISES INFORMATION |
Construction Type |
Enter the construction of the premises. Common construction
classifications are: * Frame * Joisted Masonry * Non-Combustible *
Masonry Non-Combustible * Modified Fire Resistive * Fire Resistive |
| PREMISES INFORMATION |
Distance to Hydrant |
Distance (in ft.) from the nearest hydrant that supports the
protection class used. |
| PREMISES INFORMATION |
Distance to Fire Station |
Distance in miles from the nearest fire station that supports
the protection class used. |
| PREMISES INFORMATION |
Fire District/Code Number |
The property’s fire district name and corresponding code
number which can be found in the individual states manual pages. |
| PREMISES INFORMATION |
Prot Cl |
Enter the fire rating protection class for this location. |
| PREMISES INFORMATION |
# Stories |
Not including any basement, enter the number of stories for
this building. |
| PREMISES INFORMATION |
# Basm’ts |
Enter the number of basements. |
| PREMISES INFORMATION |
Yr Built |
Enter the year in which the building was first constructed. |
| PREMISES INFORMATION |
Total Area |
The number of square feet of the building or area occupied at
this location for which insurance is being requested. |
| PREMISES INFORMATION |
Building Improvements |
Indicate if any building improvements have been made since
the original construction. Check all applicable improvements, and list
the year the improvement was made after the improvement name. |
| PREMISES INFORMATION |
Bldg Code Grade |
Enter the ISO Building Code Grade, if applicable. |
| PREMISES INFORMATION |
Tax Code |
Enter the city, county or state tax code, if required. |
| PREMISES INFORMATION |
Roof Type |
Enter the material used to construct the roof. Examples: *
Composition (fiberglass, asphalt, etc.) * Metal * Poured * Slate * Tile
* Wood Shake/Shingle |
| PREMISES INFORMATION |
Wind Class |
Check the applicable box. If another entity, describe. |
| PREMISES INFORMATION |
Other Occupancies |
List any other occupancies located in the building not
operated by the insured and not listed in the Description of Operations
section on the ACORD 125. If no other occupancy, enter None. |
| PREMISES INFORMATION |
Heating Boiler |
Indicate by “Y” (YES) or “N” (NO), if there is a heating
boiler on the premises. |
| PREMISES INFORMATION |
Heating Boiler |
If YES, indicate by “Y” (YES) or “N” (NO), if the insurance
is placed elsewhere. |
| PREMISES INFORMATION |
Right/Left/Front/Rear Exposure and Distance |
Describe the buildings, structures, activities conducted, or
use of property adjacent to the insured premises and provide the
distance from the insured premises. |
| PREMISES INFORMATION |
Burglar Alarm Type |
Describe any burglar alarm protecting the building or
contents. Descriptive terms such as safe, premises, perimeter, or
ultrasonic may be suitable. |
| PREMISES INFORMATION |
Certificate Number |
Enter the Underwriters Laboratories or other testing
organization Certificate Number, if applicable. Attach a copy of the
certificate to the application. |
| PREMISES INFORMATION |
Expiration Date |
Enter the expiration date of the Certificate. |
| PREMISES INFORMATION |
Central Station |
The burglar alarm rings at an alarm company or police
department. |
| PREMISES INFORMATION |
With Keys |
The alarm company, located off the insured’s premises, has
keys to the applicant’s property. |
| PREMISES INFORMATION |
Burglar Alarm Installed and Serviced by |
Enter the name of the alarm company. |
| PREMISES INFORMATION |
Extent |
Specify the designated extent of protection as described in
the ISO crime rating manual. |
| PREMISES INFORMATION |
Grade |
Enter the alarm grade as described in the ISO crime rating
manual (e.g., AA, A, B, C). |
| PREMISES INFORMATION |
# Guards/Watchmen |
Enter the number of guards and or watchmen employed or
contracted for by the insured. |
| PREMISES INFORMATION |
Clock Hourly/Other |
Check this box to indicate whether the guard/watchman is
required to make hourly rounds using a special time recording device or
in connection with the central station service. If other than hourly,
indicate the time interval in the Other box. |
| PREMISES INFORMATION |
Premises Fire Protection |
If the premises is sprinklered, indicate the percentage of
the area covered by the system, whether wet/dry system, if valve
monitors are included and if connected to central station. Cooking
facilities, or other special hazards, are often protected by automatic
carbon dioxide or chemical systems or other similar devices. Provide a
description. Indicate if the risk qualifies as a HPR (Highly Protected
Risk). Other devices would include smoke detectors. |
| PREMISES INFORMATION |
% Sprnk |
If the premises is sprinklered, indicate the percentage of
the area covered by the system. |
| PREMISES INFORMATION |
Fire Alarm Manufacturer |
Enter the name of the firm, and if it is UL listed. |
| PREMISES INFORMATION |
Central Station |
The fire alarm rings at an alarm company, police department
or fire department. |
| PREMISES INFORMATION |
Local Gong |
The fire alarm rings on an audible gong located outside of
the building. |
| IDENTIFICATION SECTION |
Agency Customer ID |
Customer’s identification number assigned by the agency. |
| ADDITIONAL PREMISES INFORMATION |
|
Complete the front of the form for a single building on a
premises, and the back of the form for a second building or a second
premises. Use additional forms for additional buildings or premises. |
| ADDITIONAL PREMISES INFORMATION |
Premises # |
Enter the premises location number as it appears on the ACORD
125 Premises Information Section. |
| ADDITIONAL PREMISES INFORMATION |
Street Address |
Enter the street address as shown on ACORD 125. |
| ADDITIONAL PREMISES INFORMATION |
Building # |
Enter the building number(s) associated with this location. |
| ADDITIONAL PREMISES INFORMATION |
Building Description |
Provide a description of the building at this location. |
| ADDITIONAL PREMISES INFORMATION |
Subject of Insurance |
Enter all units at risk/coverages that are to be insured at
this particular location number/building number combination. Examples:
* Building * Personal Property * Extra Expense * Business Income |
| ADDITIONAL PREMISES INFORMATION |
Amount |
Enter the amount of insurance required for the corresponding
subject of insurance. |
| ADDITIONAL PREMISES INFORMATION |
Coins % |
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. |
| ADDITIONAL PREMISES INFORMATION |
Valuation |
Indicate the method which will be used to determine the
amount paid on a claim. Valuation methods are: ACV- Actual Cash Value
RC- Replacement CostAA- Agreed Amount MV- Market Value |
|
|
Enter the causes of loss the subject of insurance is to be
covered for. Examples: * Basic |
|
|
* Broad |
| ADDITIONAL PREMISES INFORMATION |
Causes of Loss |
* Special excluding theft * Earthquake |
|
|
The inflation guard percentage gives an automatic increase in
the amount of coverage |
| ADDITIONAL PREMISES |
|
based on a percentage over time. List both the percentage
amount and the period of time |
| INFORMATION |
Inflation Guard % |
during which it applies (e.g., 4% per year). |
| ADDITIONAL PREMISES |
|
|
| INFORMATION |
DED |
Enter the deductible amount that is to apply to this subject
of insurance. |
| ADDITIONAL PREMISES |
|
|
| INFORMATION |
Applies To |
Indicate to what this deductible applies. |
| ADDITIONAL PREMISES |
|
The identifying number for the blanket under which this
subject of insurance is rated. |
| INFORMATION |
Blkt # |
Leave blank if the subject of insurance is not included under
a blanket. |
| ADDITIONAL PREMISES |
|
Enter all form numbers and special conditions that apply to
this subject of insurance. Also |
| INFORMATION |
Forms and Conditions to Apply |
indicate here if coverage is blanket or average rated. |
| ADDITIONAL PREMISES INFORMATION |
Additional Information – Business Income/Extra Expense/Value
Reporting Information |
Check the appropriate box for Business Income/Extra Expense
coverage and attach ACORD 810 supplement; or if Value Reporting
Information is to be reported, also attach ACORD 811 supplement. |
|
|
Use this space to enter information on any endorsements or
options not provided for above. Also provide rating information
required for these options, or by individual |
|
|
company programs. |
|
Additional Coverages, Options, Restrictions, Endorsements, |
Provide any other coverage information that pertains to this
location such as: * Class Rate * Rate Reference |
| ADDITIONAL PREMISES INFORMATION |
Rating Information |
* Sales * Earnings |
| ADDITIONAL PREMISES |
|
Indicate by “Y” (YES) or “N” (NO) if spoilage coverage is
desired. If “YES”, complete |
| INFORMATION |
Spoilage Coverage |
adjacent fields. |
| ADDITIONAL PREMISES |
|
|
| INFORMATION |
Description of Property Covered |
Describe the property to be covered for spoilage. |
| ADDITIONAL PREMISES |
|
|
| INFORMATION |
Limit |
Limit applicable for this coverage. |
| ADDITIONAL PREMISES |
|
|
| INFORMATION |
Deductible |
Enter the applicable deductible for this coverage. |
| ADDITIONAL PREMISES |
Refrigeration Maintenance |
|
| INFORMATION |
Agreement |
Indicate by “Y” (YES) or “N” (NO) if a refrigeration
maintenance agreement exists. |
| ADDITIONAL PREMISES |
|
|
| INFORMATION |
Options |
Enter any applicable optional coverages. |
| PREMISES INFORMATION |
# of Open Sides on Structure |
Indicate the number of open sides on the structure, if any. |
|
|
Enter the construction of the premises. Common construction
classifications are: * Frame |
|
|
* Joisted Masonry * Non-Combustible |
| ADDITIONAL PREMISES |
|
* Masonry Non-Combustible * Modified Fire Resistive |
| INFORMATION |
Construction Type |
* Fire Resistive |
| ADDITIONAL PREMISES |
|
|
| INFORMATION |
Distance to Hydrant |
Distance (in ft.) from the nearest hydrant that supports the
protection class used. |
| ADDITIONAL PREMISES |
|
|
| INFORMATION |
Distance to Fire Station |
Distance in miles from the nearest fire station that supports
the protection class used. |
| ADDITIONAL PREMISES |
|
The property’s fire district name and corresponding code
number which can be found in |
| INFORMATION |
Fire District/Code Number |
the individual states manual pages. |
| ADDITIONAL PREMISES |
|
|
| INFORMATION |
Prot Cl |
Enter the fire rating protection class for this location. |
| ADDITIONAL PREMISES |
|
|
| INFORMATION |
# Stories |
Not including any basement, enter the number of stories for
this building. |
| ADDITIONAL PREMISES |
|
|
| INFORMATION |
# Basm’ts |
Enter the number of basements. |
| ADDITIONAL PREMISES |
|
|
| INFORMATION |
Yr Built |
Enter the year in which the building was first constructed. |
| ADDITIONAL PREMISES |
|
The number of square feet of the building or area occupied at
this location for which |
| INFORMATION |
Total Area |
insurance is being requested. |
|
|
Indicate if any building improvements have been made since
the original construction. |
| ADDITIONAL PREMISES |
|
Check all applicable improvements, and list the year the
improvement was made after the |
| INFORMATION |
Building Improvements |
improvement name. |
| ADDITIONAL PREMISES |
|
|
| INFORMATION |
Bldg Code Grade |
Enter the ISO Building Code Grade, if applicable. |
| ADDITIONAL PREMISES |
|
|
| INFORMATION |
Tax Code |
Enter the city, county or state tax code, if required. |
|
|
Enter the material used to construct the roof. Examples: *
Composition (fiberglass, asphalt, etc.) * Metal |
|
|
* Poured |
|
|
* Slate |
| ADDITIONAL PREMISES |
|
* Tile |
| INFORMATION |
Roof Type |
* Wood Shake/Shingle |
| ADDITIONAL PREMISES |
|
|
| INFORMATION |
Wind Class |
Check the applicable box. If another entity, describe. |
|
|
List any other occupancies located in the building not
operated by the insured and not |
| ADDITIONAL PREMISES |
|
listed in the Description of Operations section on the ACORD
125. If no other occupancy, |
| INFORMATION |
Other Occupancies |
enter None. |
| ADDITIONAL PREMISES |
|
|
| INFORMATION |
Heating Boiler |
Indicate by “Y” (YES) or “N” (NO), if there s a heating
boiler on the premises. |
| ADDITIONAL PREMISES |
|
|
| INFORMATION |
Heating Boiler |
If YES, indicate by “Y” (YES) or “N” (NO), if the insurance
is placed elsewhere. |
| ADDITIONAL PREMISES |
Right/Left/Front/Rear Exposure |
Describe the buildings, structures, activities conducted, or
use of property adjacent to the |
| INFORMATION |
and Distance |
insured premises and provide the distance from the insured
premises. |
| ADDITIONAL PREMISES |
|
Describe any burglar alarm protecting the building or
contents. Descriptive terms such as |
| INFORMATION |
Burglar Alarm Type |
safe, premises, perimeter, or ultrasonic may be suitable. |
| ADDITIONAL PREMISES |
|
Enter the Underwriters Laboratories or other testing
organization Certificate Number, if |
| INFORMATION |
Certificate Number |
applicable. Attach a copy of the certificate to the
application. |
| ADDITIONAL PREMISES |
|
|
| INFORMATION |
Expiration Date |
Enter the expiration date of the Certificate. |
| ADDITIONAL PREMISES |
|
|
| INFORMATION |
Central Station |
The burglar alarm rings at an alarm company or police
department. |
| ADDITIONAL PREMISES |
|
The alarm company, located off the insured’s premises, has
keys to the applicant’s |
| INFORMATION |
With Keys |
property. |
| ADDITIONAL PREMISES |
Burglar Alarm Installed and |
|
| INFORMATION |
Serviced by |
Enter the name of the alarm company. |
| ADDITIONAL PREMISES |
|
|
| INFORMATION |
Extent |
Specify the designated extent of protection as described in
the ISO crime rating manual. |
| ADDITIONAL PREMISES |
|
|
| INFORMATION |
Grade |
Enter the alarm grade as described in the ISO crime rating
manual (e.g., AA, A, B, C). |
| ADDITIONAL PREMISES INFORMATION |
# Guards/Watchmen |
Enter the number of guards and or watchmen employed or
contracted for by the insured. |
| ADDITIONAL PREMISES INFORMATION |
Clock Hourly/Other |
Place an “X” in the box to indicate whether the
guard/watchman is required to make hourly rounds using a special time
recording device or in connection with the central station service. If
other than hourly, indicate the time interval in the Other box. |
| ADDITIONAL PREMISES INFORMATION |
Premises Fire Protection |
If the premises is sprinklered, indicate the percentage of
the area covered by the system, whether wet/dry system, if valve
monitors are included and if connected to central station. Cooking
facilities, or other special hazards, are often protected by automatic
carbon dioxide or chemical systems or other similar devices. Provide a
description. Indicate if the risk qualifies as a HPR (Highly Protected
Risk). Other devices would include smoke detectors. |
| ADDITIONAL PREMISES INFORMATION |
% Sprnk |
If the premises is sprinklered, indicate the percentage of
the area covered by the system. |
| ADDITIONAL PREMISES INFORMATION |
Fire Alarm Manufacturer |
Enter the name of the firm, and if it is UL listed. |
| ADDITIONAL PREMISES INFORMATION |
Central Station |
The fire alarm rings at an alarm company, police department
or fire department. |
| ADDITIONAL PREMISES INFORMATION |
Local Gong |
The fire alarm rings on an audible gong located outside of
the building. |
| ADDITIONAL INTEREST |
|
This section should be used to collect information on any
additional interest. |
| ADDITIONAL INTEREST |
Interest |
Check the appropriate box to indicate if the additional
interest in the property is a loss payee or a mortgagee. |
| ADDITIONAL INTEREST |
Rank |
If there is more than one additional interest, indicate who
is first mortgagee, second mortgagee, etc. |
| ADDITIONAL INTEREST |
Name and Address |
List the additional interests’ name and address. |
| ADDITIONAL INTEREST |
Reference # |
Indicate the additional interest’s reference number for this
applicant such as the loan or mortgage number. |
| ADDITIONAL INTEREST |
Evidence/Certificate Required |
Indicate if a Certificate of Property Insurance or an
Evidence of Property Insurance is required. |
| ADDITIONAL INTEREST |
Interest in Item Number |
List the item number corresponding with the application for
the item of interest for this additional insured. |
| ADDITIONAL INTEREST |
Location |
For each building, enter the location number as shown on the
application or change request that was used when the building was first
insured. |
| ADDITIONAL INTEREST |
Building |
For each building, enter the building number as shown on the
application or change request that was used when the building was first
insured. Provide a description of the property where necessary. Use
more than one line if additional space is required. |
| ADDITIONAL INTEREST |
Scheduled Item Number |
Enter the scheduled item number as shown on the application
or change request that was used when the scheduled item was first
insured. |
| ADDITIONAL INTEREST |
Other |
Use this space to specify “other”. |
| ADDITIONAL INTEREST |
Item Description |
If needed, further clarify the item of interest in this
field. For a vehicle, list the make, model and VIN number. For a
scheduled item, list the description, such as three carat diamond in
six point setting. |
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