ACORD INSURANCE BINDER DATE - multi-line …

TMDATEPHONEPRODUCERCOMPANYBINDER #(A/C, No, Ext):FAX(A/C, No):EFFECTIVEEXPIRATIONDATETIMEDATETIMEC ODE:SUB CODE:AGENCYDESCRIPTION OF OPERATIONS/VEHICLES/PROPERTY (Including Location)CUSTOMER ID:INSUREDTYPE OF INSURANCECOVERAGE/FORMSDEDUCTIBLECOINS %AMOUNTPROPERTYGENERAL LIABILITYAUTOMOBILE LIABILITYAUTO PHYSICAL DAMAGEGARAGE LIABILITYEXCESS LIABILITYWORKER S COMPENSATIONANDEMPLOYER S LIABILITYSPECIALCONDITIONS/OTHERCOVERAGE SAUTHORIZED REPRESENTATIVEAM12:01 AMPMNOONTHIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANYPER EXPIRING POLICY #:CAUSES OF LOSSBASICBROADSPECEACH OCCURRENCE$DAMAGE TOCOMMERCIAL GENERAL LIABILITY$RENTED PREMISESCLAIMS MADEOCCURMED EXP (Any one person)$PERSONAL & ADV INJURY$GENERAL AGGREGATE$PRODUCTS - COMP/OP AGG$RETRO date FOR CLAIMS MADE:COMBINED SINGLE LIMIT$ANY AUTOBODILY INJURY (Per person)$ALL OWNED AUTOSBODILY INJURY (Per accident)$SCHEDULED AUTOSPROPERTY DAMAGE$HIRED AUTOSMEDICAL PAYMENTS$NON-OWNED AUTOSPERSONAL INJURY PROT$UNINSURED MOTORIST$$DEDUCTIBLEALL VEHICLESSCHEDULED VEHICLESACTUAL CASH VALUECOLLISION:STATED AMOUNT$OTHER THAN COL:OTHERAUTO ONLY - EA ACCIDENT$ANY AUTOOTHER THAN AUTO ONLY:EACH ACCIDENT$AGGREGATE$EACH OCCURRENCE$UMBRELLA FORMAGGREGATE$OTHER THAN UMBRELLA FORMR

ACORD 75 (2001/01) This Company binds the kind(s) of insurance stipulated on the reverse side. The Insurance is subject to the terms, conditions and limitations of the policy(ies) in current use by the Company.

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