Legal Name of Business: Edition 01/15 General Appliion Garage Keepers Liability Information N/A *If more than 10 vehicles, please attach Auto Acord Schedule. *Cost New is required if Physical Damage Coverage is requested. *Gross Vehicle Weight is required.
Brownstone Agency Online Appliion
Larger schedules must be submitted on a Commercial Acord form! Water Damage Legal Liability WDLL Deductible: Commercial Crime Limit Any person who knowingly and with intent to defraud any insurance company or another person files an appliion for insurance or statement of claim containing any materially false information or conceals
Environmental Contractors - Westchester
Middle Market - Appliions Middle Market Binding - Commercial Lines 1-4 Family Dwelling Artisan Contractors erers Churches Commercial Specialty Tunnels, and Other Properties Builders Risk Communiions Risk Contractors Equipment Installation Floater Medical Equipment Warehouse Legal Liability.
COMPLETE EACH SECTION OF APPLIION AND ANSWER …
instructions complete each section of appliion and answer all questions as accurately as possible for each loion. if any question(s) does not apply, print or type “n/a” in the space provided this appliion must be signed and dated by an authorized owner, principal, …
General liability coverage is written for just that, general liabilities, and may not cover pollution conditions for which your business may be held responsible. These conditions could include a discharge of pollutants brought to the work site, or release of pre-existing pollutants at the site, amongst many others, and they can be sudden or
The back of the appliion is used for Motor Truck Cargo Legal Liability coverage. Expand the Motor Truck Cargo Legal Liability section and enter the following information. Limits of Liability. If loions are the same as shown on the Applicant Information Section (ACORD 125), use the same nuer. Average Value at Terminal.
Motor Carrier Questionnaire
This questionnaire is to be completed in conjunction with Acord 125, 132, and a state specific form 137. Complete Acord 126 if General Liability is requested. Complete Acord 194 if a filing is requested.
APPLIION FOR - Travelers
ACORD Appliions (Automobile Liability and Physical Damage Workers Compensation and/or Tribal Workers Comp Ordinance) Copy of the most recent audited financial statement. Five (5) Year Claim History. TPA or Carrier Loss Runs. Total Paid and Incurred. Separated by Line of coverage. PROFESSIONAL LINES ADDITIONAL INFORMATION
Avalon Risk Management General Agent for Miscellaneous
Please attach proof of both Cargo Legal Liability and Errors and Omissions Insurance coverage in the form of a Declarations Page, Acord form or policy. 5. Payment is required before the bond can be filed.
SECURITY GUARD AND PRIVATE INVESTIGATIVE …
and appropriate Acord appliions: General Liability SECURITY GUARD AND PRIVATE INVESTIGATIVE APPLIION COMMERCIAL GENERAL LIABILITY 1. Applicant (as it should appear on the policy): _ Industrial / Manufacturing Plants % % Warehouse / Utility Facilities % %
Avoiding Employment Practices Liability Claims . By: Tony Colucci Posted: October 17, 2019. One of the most common lawsuits a staffing firm may encounter are those triggering coverage under Employment Practices Liability Insurance (EPLI). There is exposure with internal office staff, as …
ACORD 143 Instructions – Simply Easier ACORD Forms
The section addresses the basic underwriting and rating needs for monoline or package policies with the Inland Marine coverages of Transportation and Motor Truck Cargo Legal Liability. This form is to be used in conjunction with the Commercial Insurance Appliion – Applicant Information Section (ACORD 125) and the Vehicle Schedule (ACORD 129).
Excess and Surplus Lines Insurance | E&S | Colony Specialty
Colony Specialty underwrites primary and excess casualty, property, and professional liability coverage for hard-to-place risks and/or distressed businesses. Colony Specialty provides coverage to a broad group of commercial enterprises, including contractors, manufacturers, distributors, property owners, retailers, restaurants and environmental
Products Overview - National Interstate
& ACORD appliions • 5 years loss runs • Vehicle schedule GKLL = Garage Keepers Legal Liability WC = Workers’ Compensation PL = Professional Liability • AL • PD • •GL Warehouse • Inland Marine • NIIC appliion • ACORD appliion 5 years loss runs
LEGAL LIABILITY COVERAGE FORM
the Legal Liability Coverage Schedule; or (ii) Use as a warehouse. The most we will pay as the result of any one accident for loss or damage to buildings covered under this Ex- tension is $250,000 at each building. (c) Personal property must be at a loca- tion: (i) That you own; or (ii) That is or comes under your care, custody or control;
Property, Casualty & Inland Marine Appliions | MJ Hall
Data Breach Loss to Insured and Electronic Media Appliion. Data Breach Quick Qualifier and Indiion Questionnaire. Day Nursery App. Demolition Contractor Annual App. Warehouse Operators Legal Liability App. Warehouse Program App. Warehouseman Liability Cold Storage IM Supplement. Warehouseman Liability IM App.
CRANE AND RIGGING SUPPLEMENTAL APPLIION
CRANE AND RIGGING SUPPLEMENTAL APPLIION Confientia an roprietar ea ron nerriters noration 9 Submission Requirements Inland Marine/General Liability Commercial Auto Urella/Excess Acord Sections Vehicle Schedule with Stated Amount Values Driver Schedule Motor Vehicle Reports - All Drivers Details On Any Filings Required Acord Sections
Builder’s Risk Product – New Construction Appliion
appliion for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.
Warehouseman’s Legal Liability Supplemental Appliion. TO BE USED WITH COMMERCIAL GENERAL LIABILITY APPLIION (ACORD 125) All questions must be answered in full. Appliion must be signed and dated by the applicant. Applicant’s Name Agent Applicant Mailing Address
Commercial General Liability: Loss of Income if my business stops operating due to fire or some event out of my control: Business Interruption Insurance: Protect goods you store for another: Warehouse Insurance - Bailee''s Legal
Contact IRMI. International Risk Management Institute, Inc. 12222 Merit Drive, Suite 1600 Dallas, TX 75251-2266 (972) 960-7693 (800) 827-4242
Pete’s Fresh Market New Vendor Appliion Form
Certifie of insurance (Acord Form 25) naming Pete''s Fresh Market, West Lawn Market, and GM Warehouse as additionally insured for general liability insurance. Please use the following corporate office address on the form: 3925 W. 43rd St., Chicago, IL 60632 Please allow 5 …
Aulance Supplemental Appliion 09-2016
Fire Damage Legal Liability $ Medical Payments $ Employee Benefits Liability $ *Retro Date: Please attach the ACORD Garagekeepers appliion Warehouse
WAREHOUSE LEGAL LIABILITY INSURANCE APPLIION
WAREHOUSE LEGAL LIABILITY INSURANCE APPLIION Applicant: Address: Applicant''s Website Address: Years in Business: Deductible Desired: Attach a copy of applicant''s standard warehouse receipt. B) Attach the liability and claims provisions of any special storage or …
Manufacturers make goods on a large scale with various operations divided among numerous workers. There are many manufacturing insurance risks in the supply chain process, including errors and omissions, equipment breakdown and employee injury.