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ACORD INSTALLATION/BUILDERS RISK SECTION DATE …

ACORD 147 (2001/02)SPECIFIC JOB ON REVERSE SIDE ACORD CORPORATION 2001 FOR COMPANY USE ONLYINSTALLATIONBUILDERS RISKPROPOSED EFF. DATEPROPOSED EXP. DATEDIRECTAGENCYBILLING PLANPAYMENT PLANPREM. (A/C, No):FAX(A/C, No, Ext):PHONEPRODUCER%$$$COMMERCIAL%$$$RESI DENTIAL(% of Total)MATERIAL COSTAVERAGEMINIMUMMAXIMUMCOST OR VALUE OF EACH INSTALLATIONAVERAGEMAXIMUM# JOBS IN PROGRESSDURATIONNUMBERANNUALTYPEJOBS/VAL UESOPEN REPORTING FORMCOVERAGE$LIMITTRANSIT$LOCATIONLIMIT AT A TEMPORARY$DISASTERLIMIT PER$LOCATIONLIMIT AT ANY SINGLECAUSES OF LOSS & DEDUCTIBLEDEDUCTIBLESUB LIMITCAUSES OF LOSSEARTHQUAKE$FLOOD$$BASICBROADSPECIALT ERRITORYSPECIFY THE APPLICANTS OPERATING TERRITORY:RECEIPTSENTER THE GROSS INSTALLATION RECEIPTS.

date proposed exp. date direct agency billing plan payment planprem. adj. applicant (a/c, no): fax ... acordinstallation/builders risk section date (mm/dd/yyyy) insured's job number: job description describe the work to be performed acord 147 (2001/02) attach to applicant information section ... supplied property value of owner $ contract ...

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