Transcription of ACORD PROPERTY SECTION DATE (MM/DD/YYYY)
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TMDATE (MM/DD/ yyyy )PHONEAGENCYAPPLICANT(A/C, No, Ext):(FirstFAXN amed(A/C, No):Insured)EFFECTIVE DATEEXPIRATION DATEPAYMENT PLANAUDITFORCOMPANYUSE ONLYCODE:SUB CODE:AGENCYCUSTOMER ID:PREMISES #:STREET ADDRESS:BUILDING #:BLDG DESCRIPTION:BLKTINFLATIONSUBJECT OF INSURANCEAMOUNTCOINS % VALUATIONCAUSES OF LOSSDEDUCTIBLEFORMS AND CONDITIONS TO APPLYCOVGUARD %ADDITIONAL INFORMATIONBUSINESS INCOME / EXTRA EXPENSEBUSINESS INCOME W/O EXTRA EXPENSEEXTRA EXPENSETYPE OF BUSINESSORDINARY PAYROLLPOWER/HEATEXT PERIODTUITION FEESOFF PREM POWERDEPEND PROPELEC MEDIAMO PERIODORD OR LAWMAX PERIODNAME AND ADDRESS(ES) FOR OFF PREM POWER OR DEPEND PROPADDITIONAL COVERAGES, OPTIONS, RESTRICTIONS, ENDORSEMENTS AND RATING INFORMATIONDISTANCE TOCONSTRUCTION TYPEFIRE DISTRICT/CODE NUMBERPROT CL# STORIES # BASM TSYR BUILTTOTAL AREAHYDRANTFIRE STATBLDG CODETAX CODEROOF TYPEOTHER OCCUPANCIESBUILDING IMPROVEMENTSGRADEWIND CLASSRIGHT EXPOSURE & DISTANCELEFT EXPOSURE & DISTANCEREAR EXPOSURE & DISTANCEBURGLAR ALARM TYPECERTIFICATE #EXPIRATION DATEEX
tm date (mm/dd/yyyy) agency phone applicant (a/c, no, ext): fax (first (a/c, no): named insured) effective date expiration date payment plan audit for
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