Acord Insurance Form Pdf

Disease ea employee e l.

Acord insurance form pdf. This form is used to report coverages provided to a single specific vehicle or equipment. Acord forms are now available in a variety of formats including printable pdf electronic fillable and eforms. Description of operations locations vehicles attach acord 101 additional remarks schedule if more space is required insr ltr type of insurance policy number policy eff mm dd yyyy policy exp mm dd yyyy limits wc statu tory limits oth er e l. Since our first paper form was released in 1972 acord has provided the standard forms used by the insurance industry.

The acord name and logo are registered marks of acord applicant information underwriter underwriter office commercial insurance application date mm dd yyyy applicant information section fax a c no. This is evidence that insurance as identified below has been issued is in force and conveys all the rights and privileges afforded under the policy. When this form is used to provide insurance in the amount of one million dollars 1 000 000 or more the title of the form is changed from insurance binder to cover note. Surrender your registration certificate and plates before your insurance expires.

Using acord s standardized forms allows for increased efficiency accuracy and speed of information processing. Use acord 25 for that purpose. Type of insurance policy number date mm dd yy date mm dd yy limits. Disease policy limit any proprietor.

Description of operations locations vehicles acord 101 additional remarks schedule may be attached if more space is required insr ltr type of insurance policy number policy eff mm dd yyyy policy exp mm dd yyyy limits per statute oth er e l. Contact a c no ext. By law we must report the termination of auto insurance coverage to the department of motor vehicles. Do not use this form to report liability coverage provided to multiple vehicles under a single policy.

Ltr type of insurance policy number insr description of operations locations vehicles attach acord 101 additional remarks schedule if more space is required excess liab umbrella liab each occurrence aggregate occur claims made ded retention products comp op agg general aggregate personal adv injury med exp any one person. Except for auto insurance coverage no notice of cancellation or nonrenewal of a binder is required unless the duration of the binder exceeds 60 days. Disease ea employee e l. Remarks acord 101 additional remarks schedule may be attached if more space is required policy number effective date company subject to audit premium calculation.

Acord certificate of liability insurance. The policy is subject to the premiums forms and rules in effect for each policy period. The certificate of insurance on the reverse side of this form does not constitute a contract between the issuing insurer.