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ACORD INSTALLATION/BUILDERS RISK SECTION DATE …

ACORD 147 (2001/02)SPECIFIC JOB ON REVERSE SIDE ACORD CORPORATION 2001 FOR COMPANY USE ONLYINSTALLATIONBUILDERS RISKPROPOSED EFF. DATEPROPOSED EXP. DATEDIRECTAGENCYBILLING PLANPAYMENT PLANPREM. (A/C, No):FAX(A/C, No, Ext):PHONEPRODUCER%$$$COMMERCIAL%$$$RESI DENTIAL(% of Total)MATERIAL COSTAVERAGEMINIMUMMAXIMUMCOST OR VALUE OF EACH INSTALLATIONAVERAGEMAXIMUM# JOBS IN PROGRESSDURATIONNUMBERANNUALTYPEJOBS/VAL UESOPEN REPORTING FORMCOVERAGE$LIMITTRANSIT$LOCATIONLIMIT AT A TEMPORARY$DISASTERLIMIT PER$LOCATIONLIMIT AT ANY SINGLECAUSES OF LOSS & DEDUCTIBLEDEDUCTIBLESUB LIMITCAUSES OF LOSSEARTHQUAKE$FLOOD$$BASICBROADSPECIALT ERRITORYSPECIFY THE APPLICANTS OPERATING TERRITORY:RECEIPTSENTER THE GROSS INSTALLATION RECEIPTS.

date proposed exp. date direct agency billing plan payment planprem. adj. applicant (a/c, no): fax ... acordinstallation/builders risk section date (mm/dd/yyyy) insured's job number: job description describe the work to be performed acord 147 (2001/02) attach to applicant information section ... supplied property value of owner $ contract ...

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Transcription of ACORD INSTALLATION/BUILDERS RISK SECTION DATE …

1 ACORD 147 (2001/02)SPECIFIC JOB ON REVERSE SIDE ACORD CORPORATION 2001 FOR COMPANY USE ONLYINSTALLATIONBUILDERS RISKPROPOSED EFF. DATEPROPOSED EXP. DATEDIRECTAGENCYBILLING PLANPAYMENT PLANPREM. (A/C, No):FAX(A/C, No, Ext):PHONEPRODUCER%$$$COMMERCIAL%$$$RESI DENTIAL(% of Total)MATERIAL COSTAVERAGEMINIMUMMAXIMUMCOST OR VALUE OF EACH INSTALLATIONAVERAGEMAXIMUM# JOBS IN PROGRESSDURATIONNUMBERANNUALTYPEJOBS/VAL UESOPEN REPORTING FORMCOVERAGE$LIMITTRANSIT$LOCATIONLIMIT AT A TEMPORARY$DISASTERLIMIT PER$LOCATIONLIMIT AT ANY SINGLECAUSES OF LOSS & DEDUCTIBLEDEDUCTIBLESUB LIMITCAUSES OF LOSSEARTHQUAKE$FLOOD$$BASICBROADSPECIALT ERRITORYSPECIFY THE APPLICANTS OPERATING TERRITORY:RECEIPTSENTER THE GROSS INSTALLATION RECEIPTS.

2 $(ESTIMATE)NEXT 12 MONTHS$PAST 12 MONTHSNAME & ADDRESSINTERESTREQUIREDCERTIFICATIONNAME & ADDRESSINTERESTREQUIREDCERTIFICATIONNAME & ADDRESSINTERESTREQUIREDCERTIFICATIONNAME & ADDRESSINTERESTREQUIREDCERTIFICATIONADDI TIONAL INTERESTS (Attach a separate sheet if necessary)REMARKSTRANSPORTATION/SECURITY %SITE AT APPLICANT'S % OF VALUE OF MATERIAL SHIPPED TO JOBDESCRIBE JOB SITE SECURITYRIGGINGDESCRIBE ALL HOISTING OR OTHER OPERATIONS REQUIRING (MM/DD/ yyyy ) INSTALLATION/BUILDERS RISK SECTIONINSURED'S JOB NUMBER:JOB DESCRIPTIONDESCRIBE THE WORK TO BE PERFORMEDACORD 147 (2001/02)ATTACH TO APPLICANT INFORMATION SECTIONSPECIFIC JOBNAME & ADDRESSINTERESTREQUIREDCERTIFICATIONNAME & ADDRESSINTERESTREQUIREDCERTIFICATIONNAME & ADDRESSINTERESTREQUIREDCERTIFICATIONNAME & ADDRESSINTERESTREQUIREDCERTIFICATIONADDI TIONAL INTERESTS (Attach a separate sheet if necessary)

3 REMARKSCAUSES OF LOSS & DEDUCTIBLEDEDUCTIBLESUB LIMITCAUSES OF LOSSEARTHQUAKE$FLOOD$$BASICBROADSPECIALC OVERAGE$LOCATIONLIMIT AT A TEMPORARY$TRANSIT LIMIT$LIMIT AT LOCATIONJOB TERM/VALUES$SUPPLIED PROPERTYVALUE OF OWNER$CONTRACT AMOUNTCOMPLETIONCOMMENCEMENTJOB TERMSECURITYDESCRIBE JOB SITE SECURITYRIGGINGDESCRIBE ALL HOISTING OR OPERATIONS REQUIRING VALUES TO BE SHIPPED TO THIS JOB SITE AT APPLICANT'S INVOLVEDCONTRACT CARRIER% BY COMMON/%VEHICLES% FOR APPLICANT'S$AMOUNT SHIPPED

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