COMMERCIAL INSURANCE APPLICATION DATE …

CONDO ASSN BYLAWS (for D&O Coverage only)PROGRAM CODECOMPANY POLICY OR PROGRAM NAMEPOLICY NUMBERCARRIERNAIC CODEPMAMTIMEDATECHANGECANCELBOUND (Give Date and/or Attach Copy):ISSUE POLICYQUOTERENEWSTATUS OFTRANSACTIONE-MAILADDRESS:AGENCY CUSTOMER ID:CODE:SUBCODE:PHONE(A/C, No, Ext):CONTACTNAME:AGENCY(A/C, No):FAXAPPLICANT INFORMATION SECTIONCOMMERCIAL INSURANCE APPLICATIONDATE (MM/DD/YYYY)UNDERWRITERUNDERWRITER OFFICEAPPLICANT INFORMATIONThe ACORD name and logo are registered marks of ACORDPage 1 of 4 1993-2009 ACORD CORPORATION. All rights CARGODEALERSTRANSPORTATION /MOTOR TRUCK CARGOVALUABLE PAPERSACCOUNTS RECEIVABLE /INDICATE SECTIONS ATTACHEDPROPERTYGLASS AND SIGNCRIME / MISCELLANEOUS CRIMEGARAGE AND DEALERSBOILER & MACHINERYTRUCKERS / MOTOR CARRIERUMBRELLABUSINESS AUTOELECTRONIC DATA PROCINSTALLATION / BUILDERS RISKEQUIPMENT FLOATERBUSINESS OWNERSPREMIUMPREMIUMPREMIUM$$$$$$$$$$$$$ $$$$$$$ COMMERCIAL GENERAL LIABILITYSECTIONS ATTACHED$POLICY INFORMATIONPROPOSED EFF DATE PROPOSED EXP DATEAGENCYDIRECTBILLING PLANPAYMENT PLANAUDITPOLICY PREMIUMDEPOSIT$MINIMUMPREMIUMMETHOD OF PAYMENT$$ACORD 125 (2009/08)FEIN OR SOC SEC #GL CODESICWEBSITE ADDRESSLLCINDIVIDUALPARTNERSHI

AGENCY CUSTOMER ID: 12. ANY FOREIGN OPERATIONS, FOREIGN PRODUCTS DISTRIBUTED IN USA, OR US PRODUCTS SOLD/DISTRIBUTED IN FOREIGN COUNTRIES? (If "YES", attach ACORD 815 for Liability Exposure and/or ACORD 816 for Property Exposure)

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