Transcription of COMMERCIAL INLAND MARINE SECTION - ACORD
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COMMERCIAL INLAND MARINE SECTION - ACORD
EFFECTIVE DATENAIC CODECARRIERPOLICY NUMBERAPPLICANT / FIRST NAMED INSUREDAGENCYAGENCY CUSTOMER ID: COMMERCIAL INLAND MARINE SECTIONDATE (MM/DD/YYYY)Attach to ACORD 125 The ACORD name and logo are registered marks of ACORDACORD 152 (2015/06) 2015 ACORD CORPORATION. All rights #BLD#$COVERAGES / CAUSES OF LOSSSUMMARY INFORMATIONSCH#12345678910 CLASSCODESUBCLASSCODEDESCRIPTIONSCHY / NNUMITEMSVALU-ATIONBLKT#MAX ITEM VALUE$$$$$$$$$% COINS%%%%%%%%%%COVERAGES / CAUSES OF LOSSSCH#POLLVLY / NCOVCODE% COINS%PREMIUM$OPTCODEDEDTYPEDED$LIMIT$LI MITAPPLIESTOLIMITAPPLIESTODESCRIPTIONLIM IT%$$%$$%$$%$$%$$%$$%$$%$$%$$%$$%$$%$$%$ $%$$%$$LOC#BLD#NUMMOS$$$$$$$$$MAXIMUM VALUEINSIDE$$$$$$$$$MAXIMUM VALUEOUTSIDETYPE OF SECURITYEQUIPMENT STORAGEPage 1 of 4$$$$$$$$%$$%$$%$$%$$$$$$$$$$$$$$$$$$$$$ ACORDs provided by Forms Boss. ; (c) Impressive Publishing 800-208-1977IS APPLICANT OPERATING EQUIPMENT NOT LISTED HERE? USED UNDERGROUND? WORK DONE AFLOAT? CUSTOMER ID:ITEM DESCRIPTION:INTERESTINTEREST IN ITEM NUMBERLOSS PAYEELIENHOLDERLOCATION:BUILDING:SCHEDUL E NUMBER: ACORD 45 AttachedADDITIONAL INTERESTLENDER'S LOSS PAYABLEREASON FOR INTEREST:LIEN AMOUNT:REFERENCE / LOAN #:PHONE (A/C, No, Ext):E-MAIL ADDRESS:INTEREST END DATE:SEND BILLPOLICYEVIDENCE:RANK:NAME AND ADDRESSCERTIFICATEITEM NUMBER: ACORD 152 (2015/06)Page 2 of 4 ITEM DESCRIPTION:INTERESTINTEREST IN ITEM NUMBERLOSS PAYEELIENHOLDERLOCATION:BUILDING:SCHEDUL E NUMBER:LENDER'S LOSS PAYABLEREASON FOR IN
effective date carrier naic code policy number applicant / first named insured agency agency customer id: commercial inland marine section date (mm/dd/yyyy) attach to acord 125
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