Transcription of ACORD UMBRELLA SECTION - chamberagent.com
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ACORD UMBRELLA SECTION - chamberagent.com
UMBRELLA SECTIONPOLICY INFORMATIONPRIMARY LOCATION & SUBSIDIARIES ( ACORD 125)UNDERLYING INSURANCEACORD 131 (1/96)cOACORD CORPORATION 1991 ATTACH TO APPLICANT INFORMATION AND commercial LIABILITY SECTIONSDATE (MM/DD/YY)PRODUCERPHONE(A/C, No, Ext):APPLICANT(FirstNamedInsured)EFFECTI VE DATEEXPIRATION DATEPAYMENT PLANAUDITFORCOMPANYUSE ONLYCODE:SUBCODE:AGENCYCUSTOMER ID:TRANSACTION TYPELIMIT OF LIABILITYRETAINED LIMITPROPOSED RETROACTIVE DATEEXPIRING POL #:CURRENT RETROACTIVE DATE:FIRST DOLLAR DEFENSE#NAME AND LOCATION OF PRIMARY AND ALL SUBSIDIARY COMPANIES (Describe Operations)ANNUAL PAYROLLANN GROSS SALESFOREIGN GROSS SALES # EMPLTYPECARRIER/POLICY NUMBERPOLICY EFF DATEPOLICY EXP DATELIMITSANNUAL RENEWALPREMIUM+ -RATINGMODUNDERLYING GENERAL LIABILITY INFORMATION (Explain all "YES" responses)CHECK IF APPROPRIATECOVERAGEEXPOSURECOVERAGEEXPOS URECOVERAGEEXPOSURE123456 ARE DEFENSE COSTS:WITHIN AGGREGATE LIMITS?
umbrella section policy information primary location & subsidiaries (acord 125) underlying insurance acord 131 (1/96) attach to applicant information and commercial liability sections oc acord corporation 1991
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