ACORD 126 FILLABLE PDF

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Commercial General Liability Section The title of the form. ACORD , Commercial General Liability Section, is a form of insurance designed to protect owners and operators of businesses from a wide variety of liability exposures.

If required for self-insurance, the self-insured license or contract number. The date that the terms and conditions of the policy commence. Use the actual name of the company within the group to which the policy has been issued. Any questions about appropriate limits or applicable policy coverage s should be answered by the issuing insurer s. LIMITS Other: check box Check the box if applicable : Indicates the general liability policy, general aggregate limit applies to code is other than those listed.

Use this section to provide any additional information required for underwriting or rating. All classifications should be grouped by location number. Enter the appropriate class description from the table in this field.

The contents of this data element depends on the rating basis used. The full amount of exposure is contained. Proposed Retroactive Date Enter date: The retroactive date you are requesting for the policy being applied for. If this is the first such policy, the date will be the same as the proposed retroactive date shown on the preceding field. If this is a renewal, it is the effective date of the first policy issued in the sequence of uninterrupted Claims Made policies.

Has any product, work, accident or location been excluded, uninsured or self-insured from any previous coverage? Was tail coverage purchased under any previous policy? Does applicant draw plans, designs, or specifications for others? Do any operations include blasting or utilize or store explosive material?

Do any operations include evacuation, tunneling, underground work or earth moving? Do your subcontractors carry coverages or limits less than yours? Are subcontractors allowed to work without providing you with Certificates of Insurance?

Does applicant lease equipment to others with or without operators? Does applicant install, service or demonstrate products? Foreign products sold, distributed, or used as components? Research and development conducted or new products planned? Guarantees, warranties, hold harmless agreements? Products recalled, discontinued, changed? Products under label of others? Does any named insured sell to any other named insured? Jewelry, Furs, Contractors Equipment, etc. 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. Any medical facilities provided or medical professionals employed or contracted? Do operations involve storing, treating, discharging, applying, disposing or transporting hazardous material? Any listed operations sold, acquired, or discontinued in the last five 5 years? Is any machinery or equipment loaned or rented to others?

Any watercraft, docks, floats owned, hired, or leased? Is a fee charged for parking? Are any recreational facilities provided?

Is there a swimming pool on the premises? Any sporting or social events sponsored? Any structural alterations contemplated? Any demolition exposure contemplated? Has applicant been active in or is currently active in joint ventures? Do you lease employees to or from others? Is there a labor interchange with any other business or subsidiaries? Are daycare facilities operated or controlled?

Have any crimes occurred or been attempted on your premises within the last three 3 years? Is there a formal, written safety and security policy in effect?

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