Transcription of COMMERCIAL GENERAL LIABILITY SECTION DATE …
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Example: biology
COMMERCIAL GENERAL LIABILITY SECTION DATE …
SCHEDULE OF HAZARDSRATEPREM/OPSPRODUCTSPREMIUMPREM/O PSPRODUCTSRATING AND PREMIUM BASIS(S) GROSS SALES - PER $1,000/SALES(P) PAYROLL - PER $1,000/PAY(A) AREA - PER 1,000/SQ FT(C) TOTAL COST - PER $1,000/COST(M) ADMISSIONS - PER 1,000/ADM(U) UNIT - PER UNIT(T) OTHER#HAZEXPOSURETERRBASISPREMIUMCODECLA SSCLASSIFICATION#LOCCLAIMS MADE (Explain all "Yes" responses)1. PROPOSED RETROACTIVE DATE:2. ENTRY DATE INTO UNINTERRUPTED CLAIMS MADE COVERAGEEXPLAIN ALL "YES" RESPONSES3. HAS ANY PRODUCT, WORK, ACCIDENT, OR LOCATION BEEN EXCLUDED, UNINSURED OR SELF-INSURED FROM ANY PREVIOUS COVERAGE?4. WAS TAIL COVERAGE PURCHASED UNDER ANY PREVIOUS POLICY?Y / NThe acord name and logo are registered marks of ACORDACORD 126 (2007/05) acord CORPORATION 1993-2007. All rights 1 of 4 EMPLOYEE BENEFITS LIABILITY1. DEDUCTIBLE PER CLAIM:$2. NUMBER OF EMPLOYEES:3. NUMBER OF EMPLOYEES COVERED BY EMPLOYEE BENEFITS PLANS:4.
OTHER COVERAGES, RESTRICTIONS AND/OR ENDORSEMENTS (For hired/non-owned auto coverages attach the applicable state Business Auto Section, ACORD 137) DIRECT BILL AGENCY BILL CLAIMS MADE OCCURRENCE PROPERTY DAMAGE $ BODILY INJURY $ $ COVERAGES LIMITS COMMERCIAL GENERAL LIABILITY SECTION FAX (A/C, No): Named …
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