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AGENCY CUSTOMER ID: BUSINESS OWNERS SECTION

REMARKS (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)ACORD 160 (2014/12) AGENCY CUSTOMER ID:24 HOUR OPERATIONSEND TIME:START TIME:DOES THE OPERATION HAVE HOURS AFTER 9:00 AND/OR 24 HOUR OPERATIONS? EQUIPMENTSMALL TOOLSEQUIPMENTINSTRUCTION GIVEN (Y/N)LARGE EQUIPMENTSMALL TOOLSTYPE OF EQUIPMENTDO YOU RENT OR LOAN EQUIPMENT TO OTHERS? ADDITION TO YOUR PRIMARY NATURE OF BUSINESS , ARE YOU ALSO INVOLVED IN THE MIXING OF OTHERS PRODUCTS? ADDITION TO YOUR PRIMARY NATURE OF BUSINESS ARE YOU ALSO INVOLVED IN THE MANUFACTURE, RELABELING OR REPACKAGING OF OTHERSPRODUCTS? INTERESTTYPE OF BUSINESS OR LOCSTREET, CITY, STATE, ZIPDO YOU OWN OR OPERATE ANY OTHER BUSINESS ?

REMARKS (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ACORD 160 (2014/12) AGENCY CUSTOMER ID: START TIME: END TIME: 24 HOUR OPERATIONS

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  Business, Customer, Agency, Agency customer id

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