ACORD INSURANCE BINDER DATE - multi-line …

1 TMDATEPHONEPRODUCERCOMPANYBINDER #(A/C, No, Ext):FAX(A/C, No):EFFECTIVEEXPIRATIONDATETIMEDATETIMEC ODE:SUB CODE:AGENCYDESCRIPTION OF OPERATIONS/VEHICLES/PROPERTY (Including Location)CUSTOMER ID:INSUREDTYPE OF INSURANCECOVERAGE/FORMSDEDUCTIBLECOINS %AMOUNTPROPERTYGENERAL LIABILITYAUTOMOBILE LIABILITYAUTO PHYSICAL DAMAGEGARAGE LIABILITYEXCESS LIABILITYWORKER S COMPENSATIONANDEMPLOYER S LIABILITYSPECIALCONDITIONS/OTHERCOVERAGE SAUTHORIZED REPRESENTATIVEAM12:01 AMPMNOONTHIS BINDER IS ISSUED TO EXTEND COVERAGE IN THE ABOVE NAMED COMPANYPER EXPIRING POLICY #:CAUSES OF LOSSBASICBROADSPECEACH OCCURRENCE$DAMAGE TOCOMMERCIAL GENERAL LIABILITY$RENTED PREMISESCLAIMS MADEOCCURMED EXP (Any one person)$PERSONAL & ADV INJURY$GENERAL AGGREGATE$PRODUCTS - COMP/OP AGG$RETRO date FOR CLAIMS MADE:COMBINED SINGLE LIMIT$ANY AUTOBODILY INJURY (Per person)$ALL OWNED AUTOSBODILY INJURY (Per accident)$SCHEDULED AUTOSPROPERTY DAMAGE$HIRED AUTOSMEDICAL PAYMENTS$NON-OWNED AUTOSPERSONAL INJURY PROT$UNINSURED MOTORIST$$DEDUCTIBLEALL VEHICLESSCHEDULED VEHICLESACTUAL CASH VALUECOLLISION:STATED AMOUNT$OTHER THAN COL:OTHERAUTO ONLY - EA ACCIDENT$ANY AUTOOTHER THAN AUTO ONLY:EACH ACCIDENT$AGGREGATE$EACH OCCURRENCE$UMBRELLA FORMAGGREGATE$OTHER THAN UMBRELLA FORMRETRO date FOR CLAIMS MADE:SELF-INSURED RETENTION$WC STATUTORY EACH ACCIDENT$ DISEASE - EA EMPLOYEE$ DISEASE - POLICY LIMIT$FEES$TAXES$ESTIMATED TOTAL PREMIUM$MORTGAGEEADDITIONAL INSUREDLOSS PAYEELOAN #THIS BINDER IS A TEMPORARY INSURANCE CONTRACT, SUBJECT TO THE CONDITIONS SHOWN ON THE REVERSE SIDE OF THIS & ADDRESSACORD 75 (2001/01)NOTE.

2 IMPORTANT STATE INFORMATION ON REVERSE SIDE ACORD CORPORATION 1993 ACORDINSURANCE BINDER 12:01 am STD X 30 days from Effective date X Homeowners Liability Limit $ Medical Limit $ Dwelling Private Structures Personal Property Loss of Use $ Hurricane: $ $ $ $ $ ACORD 75 (2001/01)This Company binds the kind(s) of INSURANCE stipulated on the reverse side. The INSURANCE is subject to theterms, conditions and limitations of the policy(ies) in current use by the BINDER may be cancelled by the Insured by surrender of this BINDER or by written notice to the Companystating when cancellation will be effective. This BINDER may be cancelled by the Company by notice to theInsured in accordance with the policy conditions.

3 This BINDER is cancelled when replaced by a policy. If thisbinder is not replaced by a policy, the Company is entitled to charge a premium for the BINDER according to theRules and Rates in use by the this form is used to provide INSURANCE in the amount of one million dollars ($1,000,000) or more, the titleof the form is changed from " INSURANCE BINDER " to "Cover Note".The mortgagee or Obligee of any mortgage or other instrument given for the purpose of creating a lien on realproperty shall accept as evidence of INSURANCE a written BINDER issued by an authorized insurer or its agent ifthe BINDER includes or is accompanied by: the name and address of the borrower; the name and address of thelender as loss payee; a description of the insured real property; a provision that the BINDER may not be canceledwithin the term of the BINDER unless the lender and the insured borrower receive written notice of the cancel-lation at least ten (10) days prior to the cancellation.

4 Except in the case of a renewal of a policy subsequent tothe closing of the loan, a paid receipt of the full amount of the applicable premium, and the amount ofinsurance 21 Title 25 Paragraph 2119 Except for Auto INSURANCE coverage, no notice of cancellation or nonrenewal of a BINDER is required unless theduration of the BINDER exceeds 60 days. For auto INSURANCE , the insurer must give 5 days prior notice, unlessthe BINDER is replaced by a policy or another BINDER in the same person who refuses to accept a BINDER which provides coverage of less than $1,000, when proof isrequired: (A) Shall be fined not more than $ , and (B) is liable to the party presenting the BINDER as proofof INSURANCE for actual damages sustained in CaliforniaApplicable in DelawareApplicable in FloridaApplicable in NevadaCONDITIONS