ACORD PROPERTY SECTION - advancede-s.com

1 PROPERTY SECTIONPREMISES INFORMATIONADDITIONAL INTERESTSVALUE REPORTING INFORMATIONACORD 140 (1/98)cOACORD CORPORATION 1985 ATTACH TO APPLICANT INFORMATION SECTIONDATEPRODUCERPHONE(A/C, No, Ext):CODE:SUB CODE:AGENCYCUSTOMER ID:APPLICANT(FirstNamedInsured)EFFECTIVE DATEEXPIRATION DATEDIRECT BILLAGENCY BILLPAYMENT PLANAUDITFORCOMPANYUSE ONLYPREMISES #:BUILDING #:STREET ADDRESS:SUBJECT OF INSURANCEAMOUNTCOINS % VALUATIONCAUSES OF LOSSINFLATIONGUARD %DEDUCTIBLEFORMS AND CONDITIONS TO APPLYADDITIONAL INFORMATION - BUSINESS INCOME/EXTRA EXPENSEBUSINESS INCOME W/O EXTRA EXPENSEEXTRA EXPENSEADDITIONAL COVERAGES, OPTIONS, RESTRICTIONS, ENDORSEMENTS AND RATING INFORMATIONCONSTRUCTION TYPEDISTANCE TOHYDRANTFIRE STATFTMIFIRE DISTRICT/CODE NUMBERPROT CL# STORIES # BASM TSYR BUILTTOTAL AREABUILDING IMPROVEMENTSBLDG CODEGRADETAX CODEROOF TYPEOTHER OCCUPANCIESWIND CLASSHEATING BOILER ON PREMISES?

2 YESNOIF YES, IS INSURANCE PLACED ELSEWHERE?YESNORIGHT EXPOSURE & DISTANCELEFT EXPOSURE & DISTANCEREAR EXPOSURE & DISTANCEBURGLAR ALARM TYPECERTIFICATE #EXPIRATION DATEEXTENTGRADEBURGLAR ALARM INSTALLED AND SERVICED BY# GUARDS/WATCHMENPREMISES FIRE PROTECTION (Sprinklers, Standpipes, CO2/Chemical Systems)% SPRNKFIRE ALARM MANUFACTURERWIRING, YR:ROOFING, YR:OTHER:PLUMBING, YR:HEATING, YR:RESISTIVESEMI-RESISTIVEOTHERCENTRAL STATIONWITH KEYSCLOCK HOURLYCENTRAL STATIONLOCAL GONGTYPE OF BUSINESSNON MFGMFGMINING% COINSORDINARY PAYROLLEXCLINCL90 DAYS180 DAYS$POWER/HEAT$DEDELEC MEDIADAYSORD OR LAWDAYSEXT PERIODDAYSMO PERIOD$LIMITMAX PERIODTUITION FEES$STUDENTS$OTHER EDSERV/INCOFF PREM POWERPOWERWATERCOMM(DESCR BELOW)DEPEND PROP% COINCONT LOCREC LOCMFG LOCLDR LOC (DESC BELOW)EXTRAEXPENSEDAYS PERIOD RESTLIMIT LOSS PAY%%%%NAME AND ADDRESS(ES) FOR OFF PREM POWER OR DEPEND PROPRANK:RANK:NAME AND ADDRESSNAME AND ADDRESSEVIDENCEEVIDENCEINTERESTINTERESTL OSSPAYEEMORT-GAGEELOSSPAYEEMORT-GAGEECER TIF-ICATEPOLICYCERTIF-ICATEPOLICYREPORTI NG FORM.

3 PROVIDE AVERAGE VALUES FOR PAST 12 MONTHSSUBJECT OF INSURANCEPREMISES/BUILDINGANY OTHER LOCA-TION DECLAREDAT INCEPTIONANY OTHER LOCA-TION ACQUIREDAFTER INCEPTIONPREMISES NOT OWNEDOR ACQUIREDLIMITACORDTMPREMISES INFORMATIONADDITIONAL INTERESTSVALUE REPORTING INFORMATIONREMARKSACORD 140 (1/98)PREMISES #:BUILDING #:STREET ADDRESS:SUBJECT OF INSURANCEAMOUNTCOINS % VALUATIONCAUSES OF LOSSINFLATIONGUARD %DEDUCTIBLEFORMS AND CONDITIONS TO APPLYADDITIONAL INFORMATION - BUSINESS INCOME/EXTRA EXPENSEBUSINESS INCOME W/O EXTRA EXPENSEEXTRA EXPENSEADDITIONAL COVERAGES, OPTIONS, RESTRICTIONS, ENDORSEMENTS AND RATING INFORMATIONCONSTRUCTION TYPEDISTANCE TOHYDRANTFIRE STATFTMIFIRE DISTRICT/CODE NUMBERPROT CL# STORIES # BASM TSYR BUILTTOTAL AREABUILDING IMPROVEMENTSBLDG CODEGRADETAX CODEROOF TYPEOTHER OCCUPANCIESWIND CLASSHEATING BOILER ON PREMISES?

4 YESNOIF YES, IS INSURANCE PLACED ELSEWHERE?YESNORIGHT EXPOSURE & DISTANCELEFT EXPOSURE & DISTANCEREAR EXPOSURE & DISTANCEBURGLAR ALARM TYPECERTIFICATE #EXPIRATION DATEEXTENTGRADEBURGLAR ALARM INSTALLED AND SERVICED BY# GUARDS/WATCHMENPREMISES FIRE PROTECTION (Sprinklers, Standpipes, CO2/Chemical Systems)% SPRNKFIRE ALARM MANUFACTURERWIRING, YR:ROOFING, YR:OTHER:PLUMBING, YR:HEATING, YR:RESISTIVESEMI-RESISTIVEOTHERCENTRAL STATIONWITH KEYSCLOCK HOURLYCENTRAL STATIONLOCAL GONGTYPE OF BUSINESSNON MFGMFGMINING% COINSORDINARY PAYROLLEXCLINCL90 DAYS180 DAYS$POWER/HEAT$DEDELEC MEDIADAYSORD OR LAWDAYSEXT PERIODDAYSMO PERIOD$LIMITMAX PERIODTUITION FEES$STUDENTS$OTHER EDSERV/INCOFF PREM POWERPOWERWATERCOMM(DESCR BELOW)DEPEND PROP% COINCONT LOCREC LOCMFG LOCLDR LOC (DESC BELOW)EXTRAEXPENSEDAYS PERIOD RESTLIMIT LOSS PAY%%%%NAME AND ADDRESS(ES) FOR OFF PREM POWER OR DEPEND PROPRANK:RANK:NAME AND ADDRESSNAME AND ADDRESSEVIDENCEEVIDENCEINTERESTINTERESTL OSSPAYEEMORT-GAGEELOSSPAYEEMORT-GAGEECER TIF-ICATEPOLICYCERTIF-ICATEPOLICYREPORTI NG FORM.

5 PROVIDE AVERAGE VALUES FOR PAST 12 MONTHSSUBJECT OF INSURANCEPREMISES/BUILDINGANY OTHER LOCA-TION DECLAREDAT INCEPTIONANY OTHER LOCA-TION ACQUIREDAFTER INCEPTIONPREMISES NOT OWNEDOR ACQUIREDLIMIT