COMMERCIAL INSURANCE APPLICATION DATE (MM/DD/YYYY) APPLICANT
commercial or personal insurance which such person knows to contain materially false information concerning any fact material thereto; or conceals, for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act
ACORD COMMERCIAL GENERAL LIABILITY SECTION DATE
acord commercial general liability section date producer (a/c, no, ext): phone code: sub code: customer id: agency applicant (first named insured) effective date expiration date direct bill agency bill payment plan audit for company use only coverages limits claims made occurrence owner's & contractor's protective commercial general liability
COMMERCIAL INLAND MARINE SECTION - acordscom
an insurance policy for personal or commercial insurance, or a claim for payment or other benefit pursuant to an insurance policy for commercial or personal insurance which such person knows to contain materially false information concerning any fact material thereto; or conceals, for the purpose of misleading,
COMMERCIAL INSURANCE APPLICATION DATE (MM/DD/YYYY) APPLICANT
commercial general liability sections attached $ policy information proposed eff date proposed exp date direct agency billing plan payment plan audit deposit policy premium $ minimum method of payment premium $ $ acord 125 (2009/08) gl code sic fein or soc sec # website address individual llc partnership corporation joint venture not for profit
COMMERCIAL INSURANCE APPLICATION DATE (MM/DD/YYYY) APPLICANT
commercial insurance application date (mm/dd/yyyy) applicant information section fax (a/c, no): agency name: contact (a/c, no, ext): phone code: subcode: agency customer id: address: e-mail status of transaction quote issue policy renew bound (give date and/or attach copy): cancel change date time am pm carrier naic code policy number
UMBRELLA / EXCESS SECTION DATE (MM/DD/YYYY)
ACORD 131 (2016/04) $ $ VOLUNTARY Attach to ACORD 125 IMPORTANT - If CLAIMS MADE is checked in the POLICY INFORMATION section below, this is an application for a claims-made policy
PROPERTY SECTION DATE (MM/DD/YYYY)
an insurance policy for personal or commercial insurance, or a claim for payment or other benefit pursuant to an insurance policy for commercial or personal insurance which such person knows to contain materially false information concerning any fact material thereto; or conceals, for the purpose of misleading,
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
commercial general liability general liability premises (ea occurrence) $ damage to rented each occurrence $ med exp (any one person) $ personal & adv injury $ general aggregate $ products - comp/op agg $ ded retention $ claims-made occur $ aggregate $ umbrella liab each occurrence $ excess liab
CANCELLATION REQUEST / POLICY RELEASE
The ACORD name and logo are registered marks of ACORD POLICY NUMBER CANCELLED POLICY INFORMATION EFFECTIVE DATE EXPIRATION DATE POLICY TERM EFFECTIVE DATE AND
COMMERCIAL POLICY CHANGE REQUEST DATE (MM/DD/YYYY)
commercial policy change request date (mm/dd/yyyy) $ cost new sym coll otc sym comp / total prem:$ otc fg reimb rent coll comp/ lsp ftw ft f c of l spec & labor towing motor undrins motor unins med pay fault add'l no-fault no-liab coverages for hirecheck service retail comm'l farm pleasure use work / school < 15 miles 15 miles + drive to
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