PROPERTY SECTION DATE (MM/DD/YYYY)
REMARKS (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) MINE SUBSIDENCE COVERAGE (Required in IL, IN, KY and WV) ACCEPT COVERAGE REJECT COVERAGE LIMIT: $ TYPE VALU- DED ATION SUBJECT OF INSURANCE AMOUNT COINS % CAUSES OF LOSSINFLATION GUARD % DED BLKT …
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COMMERCIAL GENERAL LIABILITY SECTION DATE …
www.colonialgeneral.comOTHER COVERAGES, RESTRICTIONS AND/OR ENDORSEMENTS (For hired/non-owned auto coverages attach the applicable state Business Auto Section, ACORD 137) IMPORTANT - If CLAIMS MADE is checked in the COVERAGE / LIMITS section below, this is an application for a claims-made policy. Read all provisions of the policy carefully. Attach to ACORD 125
COMMERCIAL INSURANCE APPLICATION DATE …
www.colonialgeneral.comapplicant information section commercial insurance application date (mm/dd/yyyy) underwriter underwriter office applicant information the acord name and logo are registered marks of acord ... coverages schedule additional premises apartment building supplement contractors supplement
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
www.colonialgeneral.comany proprietor/partner/executive officer/member excluded? insr ltr date (mm/dd/yyyy) insured policy effective date (mm/dd/yy) policy expiration type of insurance policy number date (mm/dd/yy) limits general liability automobile liability garage liability excess/umbrella liability workers compensation and employers' liability other
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