2/2/20049CF622A8-043B-406A-BDAD-96DBC2BF58883.68.1ACORD 140 (2007/01)Times New Roman10plain0application/vnd.xfdlapplication/vnd.xfdl140.xfdPureEdgeACORD Customer Service:
Telephone: (845) 620-1700 ex. 506
Address: New York Office (World Headquarters)
Two Blue Hill Plaza
3rd Floor
PO Box 1529
Pearl River, NY 10965-8529
USA1T-UGQV-69ZT-9L26-Z9TX-38CCoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffoffACORD 140 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u3XT//A4yUe5DYl7AAAAAElFTkSuQmCCZSG5c5sHAAA=Complete page 1 of this form for a single building on a premises, and page 2 of this form for a second building or a second premises. Use additional forms for additional buildings or premises.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). Please turn to the chapter on the ACORD 125 for information on that form.Month/day/year (MM/DD/YYYY) on which the form is completed.Agency's name and address.Agency's telephone number.Agency's facsimile number.Identification code assigned to the agency or brokerage firm by the insurance company receiving this form.If the agency uses a subcode identification system with the company, enter the appropriate code.Customer's identification number assigned by the agency.First Named Insured as it appears on the ACORD 125.Enter the Effective date on which the terms and conditions of the policy will commence.Enter the Expiration date on which the terms and conditions of the policy will terminate unless renewed.Indicate whether the agency or the company (direct) will bill the insured or other payor for the policy.Indicate whether the agency or the company (direct) will bill the insured or other payor for the policy.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).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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . annual
S . . . . . . . . . . . . . . . . . . . . . . . . . . . . semi-annual
Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . quarterly
M. . . . . . . . . . . . . . . . . . . . . . . . . . . . monthly
O . . . . . . . . . . . . . . . . . . . . . . . . . . . . otherEnter the premises location number as it appears on the ACORD 125 Premises Information Section.Enter the street address as shown on ACORD 125.Enter the building number(s) associated with this location.Provide a description of the building at this location.Enter the construction of the premises. Common construction classifications are:
* Frame
* Joisted Masonry
* Non-Combustible
* Masonry Non-Combustible
* Modified Fire Resistive
* Fire ResistiveDistance (in ft.) from the nearest hydrant that supports the protection class used.Distance in miles from the nearest fire station that supports the protection class used.The property's fire district name and corresponding code number which can be found in the individual states manual pages.Enter the fire rating protection class for this location.Not including any basement, enter the number of stories for this building.Enter the number of basements.Enter the year in which the building was first constructed.The number of square feet of the building or area occupied at this location for which insurance is being requested.List the year the improvement was made.List the year the improvement was made.List the year the improvement was made.List the year the improvement was made.List the year the improvement was made.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.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.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.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.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.Enter the ISO Building Code Grade, if applicable.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
* Tile
* Wood Shake/ShingleList 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.Check the applicable box.Check the applicable box.Check the applicable box.If there is a heating boiler on the premises, indicate if insurance is placed elsewhere.If there is a heating boiler on the premises, indicate if insurance is placed elsewhere.Describe the buildings, structures, activities conducted, or use of property adjacent to the insured premises and provide the distance from the insured premises.Describe the buildings, structures, activities conducted, or use of property adjacent to the insured premises and provide the distance from the insured premises.Describe the buildings, structures, activities conducted, or use of property adjacent to the insured premises and provide the distance from the insured premises.Describe any burglar alarm protecting the building or contents. Descriptive terms such as safe, premises, perimeter, or ultrasonic may be suitable.Enter the Underwriters Laboratories or other testing organization Certificate Number, if applicable. Attach a copy of the certificate to the application.Enter the expiration date of the Certificate.Specify the designated extent of protection as described in the ISO crime rating manual.Enter the alarm grade as described in the ISO crime rating manual (e.g., AA, A, B, C).The fire alarm rings at an alarm company, police department or fire department.The alarm company, located off the insured's premises, has keys to the applicant's property.Enter the name of the alarm company.Enter the number of guards and or watchmen employed or contracted for by the insured.Indicate the time interval.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.Check this box to indicate whether the guard/watchman is required to make other than hourly rounds using a special time recording device or in connection with the central station service. Indicate the time interval.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.If the premises is sprinklered, provide a description, 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). 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* Personal Property
* Extra Expense
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ACV . . . . . . . . . . . . . . . . . . . . . . . . . Actual Cash Value
RC. . . . . . . . . . . . . . . . . . . . . . . . . . .Replacement Cost
AA . . . . . . . . . . . . . . . . . . . . . . . . . . Agreed Amount
MV . . . . . . . . . . . . . . . . . . . . . . . . . . Market ValueEnter the causes of loss the subject of insurance is to be covered for. Examples:
* Basic
* Broad
* Special excluding theft
* EarthquakeThe 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).Enter the deductible amounts that are to apply to this subject of insurance.Enter the deductible amounts that are to apply to this subject of insurance.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.Enter all form numbers and special conditions that apply to this subject of insurance. Also indicate here if coverage is blanket or average rated.absolute11231extent9602Enter the additional interest.absolute263927extent50210Field BLDG_CODE_GRADEArial8plainwordwrapfixedleftHELP93FIELD13PLUMBING_YRabsolute0947extent9621Describe the improvement and list the year the improvement was made. absolute559316extent1501absolute559274extent1270absolute0544extent9621absolute0294extent9621absolute708274extent1270absolute634275extent1270absolute559357extent1501absolute559399extent1501absolute559441extent1501absolute559482extent1501absolute559523extent1501absolute-1462extent9621absolute-1504extent9621absolute0337extent9621absolute0378extent9621absolute-1419extent9621absolute404274extent1270absolute366274extent1270Indicate to what this deductible applies.Indicate the number of open sides on the structure, if any. absolute0827extent9621absolute185822extent371text/html140.htmFIGH4sIAAAAAAAAC+1de3PbOJL/+1KV74Dx1m6SK1uynec48VQptjzRrh37LGeyj9vagkhIwpoiNARl
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xJuAHLkBAAA=absolute941004extent626610Field EF47wordwrapfixedArial8plainHELP141CHECK7FIELD14List the additional interests' name and address.absolute383984extent178210Field REFERENCEArial8plainwordwrapfixedHELP142FIELD1CHECK7Indicate the additional interest's reference number for this applicant such as the loan or mortgage number.absolute40984extent51210Field REFERENCEArial8plainwordwrapfixedHELP140CB23CB24If there is more than one additional interest, indicate who is first mortgagee, second mortgagee, etc.absolute1991064extent760210Field REFERENCEArial8plainwordwrapfixedHELP149EF47FIELD15If 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.absolute7841004extent57210Field REFERENCEArial8plainwordwrapfixedHELP145FIELD14FIELD16For each building, enter the location number as shown on the application or change request that was used when the building was first insured.absolute9011004extent58210Field REFERENCEArial8plainwordwrapfixedHELP146FIELD15FIELD17For 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.absolute8691024extent90210Field REFERENCEArial8plainwordwrapfixedHELP147FIELD16FIELD18Enter the scheduled item number as shown on the application or change request that was used when the scheduled item was first insured.absolute7661044extent193210Field REFERENCEArial8plainwordwrapfixedHELP148EF111FIELD17Use this space to specify "other".This section should be used to collect information on any additional interest.List the item number corresponding with the application for the item of interest for this additional insured.wordwrapabsolute301065extent60210HELP2CB25REFERENCEArial8plainabsolute562984extent2121Check box CB23offArial18plainHELP143REFERENCEEF47Indicate if a Certificate of Property Insurance or an Evidence of Property Insurance is required.absolute11025extent2121Check box CB24offArial18plainHELP137FIELD19LOSS_PAYEECheck the appropriate box to indicate if the additional interest in the property is a loss payee or a mortgagee.absolute11045extent2121Check box LOSS_PAYEEoffArial18plainHELP138CB24CB25Check the appropriate box to indicate if the additional interest in the property is a loss payee or a mortgagee.absolute11065extent2121Check box CB25offArial18plainLOSS_PAYEEFIELD1HELP3Check the appropriate box to indicate if the additional interest in the property is a loss payee or a mortgagee.absolute0983extent9622absolute960983extent2103absolute01107extent9622absolute0983extent2103absolute01004extent911absolute3011004extent6611absolute7211024extent2411absolute7211044extent2411absolute911064extent8711absolute91983extent1103absolute301983extent121absolute721983extent181absolute8411004extent120Check this box if ACORD 811, VALUE REPORTING, Supplement to Property Section is attached.Enter the street address as shown on ACORD 125.Enter the premises location number as it appears on the ACORD 125 Premises Information Section.Enter the building number(s) associated with this location.Provide a description of the building at this location.Distance (in ft.) from the nearest hydrant that supports the protection class used.Distance in miles from the nearest fire station that supports the protection class used.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
* EarningsEnter the construction of the premises. Common construction classifications are:
* Frame
* Joisted Masonry
* Non-Combustible
* Masonry Non-Combustible
* Modified Fire Resistive
* Fire ResistiveThe property's fire district name and corresponding code number which can be found in the individual states manual pages.Enter the fire rating protection class for this location.Not including any basement, enter the number of stories for this building.Enter the number of basements.Enter the year in which the building was first constructed.The number of square feet of the building or area occupied at this location for which insurance is being requested.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
* Tile
* Wood Shake/ShingleList 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.List the year the improvement was made.List the year the improvement was made.Enter the ISO Building Code Grade, if applicable.Describe the improvement and list the year the improvement was made. List the year the improvement was made.List the year the improvement was made.Describe the buildings, structures, activities conducted, or use of property adjacent to the insured premises and provide the distance from the insured premises.Describe the buildings, structures, activities conducted, or use of property adjacent to the insured premises and provide the distance from the insured premises.Describe the buildings, structures, activities conducted, or use of property adjacent to the insured premises and provide the distance from the insured premises.Describe any burglar alarm protecting the building or contents. Descriptive terms such as safe, premises, perimeter, or ultrasonic may be suitable.Enter the Underwriters Laboratories or other testing organization Certificate Number, if applicable. Attach a copy of the certificate to the application.Enter the expiration date of the Certificate.Specify the designated extent of protection as described in the ISO crime rating manual.Enter the alarm grade as described in the ISO crime rating manual (e.g., AA, A, B, C).Enter the name of the alarm company.Enter the number of guards and or watchmen employed or contracted for by the insured.Indicate the time interval.If the premises is sprinklered, provide a description, 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.If the premises is sprinklered, indicate the percentage of the area covered by the system.Enter the name of the firm, and if it is UL listed.Complete page 1 of this form for a single building on a premises, and page 2 of this form for a second building or a second premises. Use additional forms for additional buildings or premises.If there is a heating boiler on the premises, indicate if insurance is placed elsewhere.If there is a heating boiler on the premises, indicate if insurance is placed elsewhere.The fire alarm rings at an alarm company, police department or fire department.The alarm company, located off the insured's premises, has keys to the applicant's property.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.The fire alarm rings at an alarm company, police department or fire department.The fire alarm rings on an audible gong located outside of the building.Check this box if ACORD 810, BUSINESS INCOME / EXTRA EXPENSE / RENTAL VALUE, Supplement to Property Section is attached.Check the appropriate box for Spoilage Coverage. If "YES", complete adjacent fields.Check the appropriate box for Spoilage Coverage.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.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.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.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.Check the applicable box.Check the applicable box.Check the applicable box.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.The fire alarm rings at an alarm company, police department or fire department.The alarm company, located off the insured's premises, has keys to the applicant's property.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.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.The fire alarm rings at an alarm company, police department or fire department.The fire alarm rings on an audible gong located outside of the building.Check the appropriate box for a Refrigeration Maintenance Agreement.Check the appropriate box for a Refrigeration Maintenance Agreement.Check the appropriate box to indicate the additional interest in the property. Enter the additional interest.Check the appropriate box to indicate the additional interest in the property. 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