Search results with tag "Agency customer id"
UMBRELLA / EXCESS SECTION DATE (MM/DD/YYYY)
acords.comacord 131 (2013/12) agency customer id: page 3 of 5 incidental malpractice liability 17. is a hospital or first aid facility maintained? 18. are coverages provided for doctors / nurses?
PROPERTY LOSS NOTICE DATE (MM/DD/YYYY) AGENCY …
mckeerisk.comAGENCY CUSTOMER ID: It is a crime to knowingly provide false, incomplete, or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits. APPLICABLE IN NEW HAMPSHIRE APPLICABLE IN OHIO APPLICABLE IN WASHINGTON ACORD 1 (2009/02)
COMMERCIAL GENERAL LIABILITY SECTION DATE …
www.formsboss.comagency customer id: effective date carrier naic code policy number applicant / first named insured agency 4. retroactive date: 3. number of employees covered by …
INSURANCE BINDER DATE (MM/DD/YYYY) - Morstan
www.morstan.comAGENCY CUSTOMER ID: This Company binds the kind(s) of insurance stipulated on the reverse side. The Insurance is subject to the terms, conditions and limitations of the policy(ies) in current use by the Company.
AGENT/BROKER OF RECORD CHANGE - nstarco.com
www.nstarco.com(a/c, no, ext): phone (a/c, no): fax new agency code: subcode: agency customer id: e-mail address: © acord corporation 1996-2007. all rights reserved.
PROPERTY LOSS NOTICE DATE (MM/DD/YYYY)
www.cfins.comAGENCY CUSTOMER ID: Page 3 of 3 Applicable in Louisiana: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.
COMMERCIAL INSURANCE APPLICATION DATE …
www.mcneilandcompany.cominternational liability exposure supplement additional interest attachments contractors supplement condo assn bylaws (for d&o coverage only) apartment building supplement additional premises ... agency customer id: (not applicable in az, ca, de, ks, ma, mn, nd, ny, or, va, or wv.
COMMERCIAL INSURANCE APPLICATION DATE …
www.firstchoiceii.com(If "YES", attach ACORD 815 for Liability Exposure and/or ACORD 816 for Property Exposure) 12. AGENCY CUSTOMER ID: ACORD 125 (2016/03) Page 3 of 4 OCCUR DATEEXPLANATION RESOLUTION RESOLVE DATE OCCUR DATEEXPLANATION RESOLUTION RESOLVE DATE 14.DOES APPLICANT OWN / LEASE / OPERATE ANY DRONES? (If "YES", describe use)
PERSONAL AUTO POLICY CHANGE REQUEST DATE …
formservice3.fsc.wspage 3 of 3 agency customer id: if a vehicle is being added, answer questions 1- 3 and 9. if a driver is being added, answer questions 4- 9 y / n
AGENCY CUSTOMER ID: COMMERCIAL GENERAL LIABILITY …
acords.comattach to acord 125 agency customer id: effective date carrier naic code policy number applicant / first named insured agency 4. retroactive date: 3. number of employees covered by employee benefits plans:
AGENCY CUSTOMER ID: COMMERCIAL GENERAL LIABILITY …
www.graham-rogers.comagency customer id: effective date carrier naic code policy number applicant / first named insured agency 4. retroactive date: 3. number of employees covered by employee benefits plans:
AGENCY CUSTOMER ID: BUSINESS OWNERS SECTION
acords.comREMARKS (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
AGENCY CUSTOMER ID: CALIFORNIA COMMERCIAL AUTO …
ric-ins.comagency customer id: i understand that the coverage selection and limit choices indicated here or in any state supplement will apply to all future policy
AGENCY CUSTOMER ID: UMBRELLA / EXCESS SECTION DATE …
www.appliedsystems.comEXPLAIN ALL "YES" RESPONSES, PROVIDE OTHER INFORMATION REQUIRED Y / N 11. DESCRIBE TYPICAL JOBS PERFORMED (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
AGENCY CUSTOMER ID: INTERNATIONAL LIABILITY ... - …
www.appliedsystems.comother: remarks $ $ $ separate applications required for: kidnap and extortion property defense base act number of employees number of trips duration (average length of stay) employers medical and ad&d medical$ ad&d$ job functions performed numberu.s. nationals …
AGENCY CUSTOMER ID: COMMERCIAL GENERAL LIABILITY …
www.mcneilandcompany.comthe purpose of misleading information concerning any fact material thereto, may be committing a fraudulent insurance act, which may be a crime and may subject the person to criminal and civil penalties. in florida, any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an
AGENCY CUSTOMER ID: COMMERCIAL GENERAL ... - CMS Risk
www.cmsrisk.comacord 126 (2016/03) workers compensation coverage carried (y/n) lease from workers compensation coverage carried (y/n) lease to 17.do you lease employees to or from other employers?
AGENCY CUSTOMER ID: COMMERCIAL GENERAL LIABILITY ... …
www.appliedsystems.com10. does any named insured sell to other named insureds? 9. vendors coverage required? 8. products under label of others? 7. products of others sold or re-packaged under applicant label?
AGENCY CUSTOMER ID: BUSINESS AUTO SECTION
formservice3.fsc.wsbusiness auto section date (mm/dd/yyyy) broaden no-fault list all drivers, including family members that drive company vehicles, and employees who drive own vehicles on company business.
AGENCY CUSTOMER ID: NORTH CAROLINA …
www.firstchoiceii.comnorth carolina garage and dealers date (mm/dd/yyyy) coverages / limits section other $ $ $ $ $ $ collision 30 comp / otc* specified perils* 30 …
AGENCY CUSTOMER ID: BUSINESS AUTO SECTION
acords.comREMARKS (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ACORD 129 attached for additional vehicles Page 3 of 4
AGENCY CUSTOMER ID: COMMERCIAL GENERAL LIABILITY …
www.firstchoiceii.com4. RETROACTIVE DATE: OTHER COVERAGES, RESTRICTIONS AND/OR ENDORSEMENTS (For hired/non-owned auto coverages attach the applicable state Business Auto Section, ACORD 137)
AGENCY CUSTOMER ID: BUSINESS AUTO SECTION
www.mcneilandcompany.comacord 127 (2012/03) acord 129 attached for additional vehicles in kansas, any person who, knowingly and with intent to defraud, presents, causes to be presented or prepares with knowledge or
AGENCY CUSTOMER ID: BUSINESS AUTO SECTION
www.cmsrisk.comthe undersigned is an authorized representative of the applicant and represents that reasonable inquiry has been made to obtain the answers to questions on this application.
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