ACORD 125 General Information Section

How to Complete the ACORD 125 General Information Section

From time to time the questions in this section change. I will discuss the questions present as of this writing on May 30, 2014.

First you should enter a Y for YES or an N for NO in the far right hand column of all questions.

If the answer to any question is NO, you do not need to worry about completing any of the rest of the questions in that section.

If the answer to any question is YES, you will need to complete the other questions in that section and offer some type of explanation in the remarks section on this page. If you need more space for remarks you should use the ACORD 101 form.

SUBSIDIARY

Question 1a and 1b ask if the applicant is a subsidiary or owns subsidiary companies. List the companies and the percentage of ownership.

SAFETY PROGRAM

Check each box which applies. Insurance underwriters love formal safety programs. You should give as much information as possible here. This information is very useful in convincing underwriters to consider credits to reduce your customer's premium.

EXPOSURE TO FLAMMABLES, EXPLOSIVES, CHEMICALS

List any used in the operation of the business.

ANY OTHER INSURANCE WITH THIS COMPANY

List the line of business and policy number of in force policies only.

It is always an excellent idea to place all lines of business possible with the same carrier. This eliminates arguments about which carrier should pay for any specific claim.

ANY POLICY OR COVERAGE DECLINED, CANCELLED, OR NON-RENEWED

The time period is over the past three years.

Check all the check boxes which apply.

This is a very bad sign. If the reason for any of these actions has been addressed and changed, it will be very important to explain that information here.

ANY PAST LOSSES OR CLAIMS RELATED TO SEXUAL ABUSE OR MOLESTATION ALLEGATIONS, DISCRIMINATION OR NEGLIGENT HIRING

If the causes of these actions has been effectively addressed it will be extremely important for you to explain those in detail.

INDICTED OR CONVICTED OF ANY DEGREE OF CRIME. ETC

This is one of those questions you, the agent signing this form, can go to jail for if you mis-represent these issues. You may want to run a background check if you have any reason to question this at all.

UNCORRECTED CODE VIOLATIONS

Explain in detail. If corrections are in progress, explain that process in detail.

FORECLOSURE, REPOSSESSION, BANKRUPTCY

Explain in detail, including any corrections made or in progress of being made.

JUDGEMENT OR LIEN

Explain in detail.

BUSINESS PLACED IN TRUST

This is not always a bad thing. It could be in a trust due to Estate issues. The positive thing to show is continuity in successful management.

FOREIGN OPERATIONS, FOREIGN PRODUCTS DISTRIBUTED IN USA, OR US PRODUCTS DISTRIBUTED IN FOREIGN COUNTRIES

How would you treat digital products or services? What if the servers hosting these services are in the US but the services are used in other countries? What if the servers hosting the digital products or services are hosted in foreign countries but the services or products are only used in the USA. What if the servers hosting the digital products or services are hosted who knows where when using services such as Amazon's cloud as a host?


DOES APPLICANT HAVE OTHER BUSINESS VENTURES FOR WHICH COVERAGE IS NOT REQUESTED

Even if these ventures are not insured elsewhere, you need to disclose those ventures here.


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ACORD 125 Additional Interest Section

How to Complete the Additional Interest Section of the ACORD 125

As the forms states, not all fields apply to all insureds. Only complete the ones which do apply. This is very important as any Additional Interest is given many of the rights of the Insured. You do not want to give these rights by error.

If you have more Additional Interests use the ACORD 45 form.

INTEREST

Check the box which applies for this specific business entity.

1. ADDITIONAL INSURED - Good Definition HERE
2. BREACH OF WARRANTY - Good Definition HERE
3. CO-OWNER - some one who is one of the owners of this insured business
4. EMPLOYEE AS LESSOR - If one of this business' employees is leasing property to this business
5. LEASEBACK OWNER - After purchasing an asset, the owner enters a long-term agreement by which the property is leased back to the seller at an agreed rate.
6. LIENHOLDER - a person who retains legal possession of a piece of property until the person to whom he/she has advanced money for use of the property has satisfactorily repaid the debt
7. LOSS PAYEE - Good Definition HERE
8. MORTGAGEE - Good Dicussion HERE
9. OWNER - The person or business which owns this business or item
10. REGISTRANT - This may be the person who registers a trademark, copyright or patent to be used by the insured. It could be the registrant of a web site URL being used by the insured.
11. TRUSTEE - A person appointed to manage the property of another.
12. OTHER - List your own here

NAME ADDRESS

Enter the full name and address as they need to be shown on a certificate of insurance.

RANK

Additional Interest can have a priority of rights. A rank of 1 would indicate this Additional Interest would receive protection from the policy prior to payments being made on behalf of lower ranked Additional Interests.

CHECK BOXES - EVIDENCE / CERTIFICATE / POLICY / SEND BILL

All can be checked.

Evidence means the Additional Interest requires an ACORD 27 or ACORD 28 Evidence of Insurance form to be issued.

Certificate means the Additional Interest requires a Certificate of Insurance to be issued.

Policy means the Additional Interest requires a copy of the actual policy.

Send Bill means the Additional Interest wants a copy of the bill.

REFERENCE  / LOAN #

Enter the loan number.

LIEN AMOUNT

Enter the amount of the original lien, not the current balance.

INTEREST END DATE

Enter the date the loan, lien, interest expires.

PHONE (A/C, No., EXT) 

Enter the phone number for the person at this Additional Interest who should be contacted with any issues related to their Additional Interest.

A/C is area code. No. is number - as in 7 digit phone number. EXT is the phone extension, if any, for this person.

E-MAIL ADDRESS

Enter the e-mail address for the person at this Additional Interest who should be contacted with any issues related to their Additional Interest.

FAX (A/C, No.)

Enter the FAX number for the person at this Additional Interest who should be contacted with any issues related to their Additional Interest.

INTEREST IN ITEM NUMBER

LOCATION, BUILDING, VEHICLE, BOAT, AIRPORT, AIRCRAFT, ITEM CLASS, ITEM

The number to enter here is the number referencing this at other places in this application. For instance, Location refers to the location number listed in the PREMISES INFORMATION section at the top of this page.

ITEM DESCRIPTION

If there is no other reference number in this form or other forms which are part of this application, enter a description.

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ACORD 125 Commercial Insurance Application - Nature of Business Section

How to Complete the ACORD 125 Nature of Business Section

Check Boxes

The Nature of Business Section starts with 11 check boxes. These are not mutually exclusive. Your customer could be in multiple businesses. Check all which apply.

The check box with no text beside it is for any other type of business your customer may operate. Check the box and write in the one or two word description of this other activity.

DATE BUSINESS STARTED (MM/DD/YYYY)

This is the date the business began. If it has been many years and/or a change of ownership, the month or date may not be available. You can always check the web site for the Secretary of State's office for the state your customer is incorporated in and find this information.

DESCRIPTION OF PRIMARY OPERATIONS

This is a free form entry area. This is where you sell your underwriter on this risk. Do not mislead, but be crisp and direct. If there is a specific way your insured does business that makes them a safer risk than others in this general business category, you should mention it here.

If you need more space use the ACORD 101 form.

RETAIL STORES OR SERVICE OPERATIONS

The row below the DESCRIPTION OF PRIMARY OPERATIONS is only required if you are insuring retail stores or service operations. If not, leave this blank.

INSTALLATION, SERVICE OR REPAIR WORK

Enter the percentage of total revenues- income - which are for installation, service or repair activity.

You determine the % by dividing the amount of sales from these specific activities by the total sales and then multiplying this amount by 100.

Example:  Total Sales $100,000.
                Sales from installation, service or repair activity   $30,000.

30,000 divided by 100,000 = .30

.30 times 100 = 30. Show as 30%.


OFF PREMISES INSTALLATION, SERVICE OR REPAIR WORK

Enter the percentage of sales that comes from these activities away from the business premise location.

This percentage can be equal to but not more than the percentage in the first question.

The math is done the same way as above.

DESCRIPTION OF OPERATIONS OF OTHER NAMED INSUREDS

Remember back on the bottom of Page 1 of this form you could enter two additional Named Insureds.

If you did this, enter the description of their business activities here. Be sure to indicate which description belongs to which specific OTHER NAMED INSURED.

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ACORD 125 Commerical Insurance Application Premises Information

How to Complete the ACORD 125 Premises Information

The Premises Information Section has room to list up to four locations.

Locations 2 through 4 are completed the same way as location 1.

If you have more than 4 locations use the ACORD 823 for those locations.

LOC# Location number. Starting with the first location assign this location number 1. Then follow with location number 2, etc. Or, if you are trying to irritate people, make the first location an "A" and the second location the number three, etc. I don't suggest this, but at least it still gives you and any other party looking at the application the same reference point.

STREET Enter the full street address of this location. For example - 3000 Computer Dr, Suite 200.

BLD# This is the building number for the building at this location. If the buildings actually have a building number displayed on the outside of the building, use this number. A location does not always include a building. For instance, your customer might own vacant land.

CITY The city for the physical street address.

STATE The two character abbreviation for the state in which this location exists. Example CA for California.

COUNTY The full county name for the location of this premise.

ZIP The 5 digit zip code plus the 4 digit extension if that is available.

CITY LIMITS There are three check boxes. You can only check one.

INSIDE means inside the city limits.

OUTSIDE means the premises is outside the city limits.

I assume the third is for any other municipal or county designation which applies in your state. Maybe INSIDE FIRE DISTRICT.

The importance of all this of course is the fire rates which will apply. Inside the city is always a lower fire rate than outside the city.

Some premises are located across city limit lines. As a general rule of thumb, it has been my experience that some structure must be on the land inside the city limit and then all other structures on the land will be responded to by the city fire department.

We once had an ice cream parlor put up a small metal shed in the corner of the property inside the city limit. Even though the main building was not connected, the main building received inside the city limits fire rates saving much more than the cost of the metal shed.

They also made the best banana pudding ice cream I have ever eaten.

INTEREST Three choices. You get to select one.

OWNER - The insured owns the premises. The ownership will have to be in the same legal name as one of the names in the Named Insured section on page one.

TENANT The insured rents or leases the premises.

OTHER - I ave no idea.

# FULL TIME EMPL The number of full time employees at this premises.Use numbers instead of letters.

# PART TIME EMPL The number of part time employees at this premises. Use numbers rather than letters. Where I live, part time is defined as less than 30 hours a week.

DESCRIPTION OF OPERATIONS A brief, because that is all the room you have, text description of what work is performed at this premises.

ANNUAL REVENUES: $ The estimated annual revenue generated for the business from activities at this premises location. Your customer may very well not be able to break this out by building or even location. That is not always normal accounting practice. If they do not have that information just leave this blank. My guess is this is one of those questions that is on the form only because the form was created by a committee. I suppose this one question is a gimme to the committee member that had no other question in the form.

OCCUPIED AREA List as a number of square feet. It may help at this point to know that an acre is 43,560 square feet. That will make your measurements easier than trying to do the math on oddly shaped property lines.

OPEN TO THE PUBLIC AREA List as a number of square feet.

TOTAL BUILDING AREA This is almost always on record at the county tax office.

ANY AREA LEASED TO OTHERS Y/N Input a "Y" or "N" if you are typing. If you are filling this form out by hand you could just circle the answer.

I hope this has helped you better understand how to complete the ACORD 125 commercial insurance application premises information section. I hope it also gave you some clever thoughts on how to lower your customers insurance premiums.

I believe a steady and regular amount of time spent learning about insurance and ACORD Forms makes you a better insurance professional.

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ACORD 125 How To Complete the Contact Information Section

ACORD 125 Commercial Insurance Application Contact Information Section

You or the insurance carrier may have many reasons to contact the insured. The names you list in the contact information section should anticipate these reasons...

1. General Information - the person you meet with, often the owner, to complete and review the application
2. Accounting Information - the bookkeeper, accountant, comptroller, etc. This would be the person an insurance company auditor would contact to get final payroll or sales numbers.
3. Physical Site Inspection - this would be the person the insurance carriers' safety engineers would contact to arrange an on-site visit.

CONTACT TYPE: Use the list above or add your own description of the type of contact to which this person will be best suited.

CONTACT NAME: The name of this contact. Use the name to which they normally answer. I have always called by brother Andy, but when I call his office nobody there knows him as Andy. They know him as Andrew or Mr. Williams. I would use Andrew Williams as the name for this space.

PRIMARY PHONE and SECONDARY PHONE:

Check the one box that applies - Home / Business / Cell

Some thoughts of mine on home and cell phones. I would never give out a customer's home or cell phone number without having a written permission to do so on file. Cell phones are more problematic than home phones because cell phones can receive texts. Text are a permanent record the same way an email is a permanent record. It is a dangerous legal idea to have a personal cell phone receive any business related text messages. It gets into all kinds of Privacy Law issues.

PRIMARY E-MAIL ADDRESS / SECONDARY E-MAIL ADDRESS

I would get written permission for my file before giving out their e-mail address. Of course, if the person whose email address you are listing here is also the person signing the application, then I think that is written permission.

I would worry about a secondary e-mail address being a personal e-mail address. I would worry about any e-mail address that was received on a personal - as opposed to business only - cell phone. As I understand it, if you have any business related data - texts, voice mails, e-mails - on your personal cell phone and you leave the employment of the business related to that data, then you are automatically at risk of being exposed to having committed a felony for possession of personal data.

SECOND CONTACT INFORMATION

These are exactly the same fields as listed above, just for a second contact.

I hope this has helped you learn how to complete the ACORD 125 commercial insurance application applicant information contact section.

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ACORD 125 How to Complete the Applicant Information Section

How to complete the Applicant Information Section of the ACORD 125

The Applicant Information section repeats itself three times at the bottom of the first page of the ACORD 125.

The second and third time are for any additional legal names for your customer. This would be likely to be the result of your customer owning subsidiary companies.

Please refer back to the information in this section for how to fill in the same named fields for a second or third legal entity.

I will work from the left to the right and from the top to the bottom.

NAME: Enter the full legal name and address as your customer will need it to be shown in a certificate of insurance.

Example;

Atlatl, Inc.
P.O. Box 2936
Durham, NC 27705-2936

GL CODE: This is the General Liability code. ISO - Insurance Services Office created these codes for use in rating general liability insurance.

Your carrier will have a list of all these codes. If you use a commercial lines rating software program, that program should have all these codes.

I have found two sources of these codes online at the following links...

https://www.faia.com/core/contentmanager/uploads/FIRL/Rapid%20Reference/Commercial%20General%20Liability%20Classifications%20%E2%80%93%20Numerical%20Listing.pdf


http://www.htbailey.com/tools/class_codes_listing.htm


SIC: Standard Industry Classification Code. You can find these at this link...

https://www.osha.gov/pls/imis/sicsearch.html


NAICS - The good old North American Industry Classification System codes. My Mother used to read these to me at bedtime. You can find them at this link...

https://www.census.gov/eos/www/naics/


FEIN or SOC SEC#: FEIN is the federal employer ID number. The Federal Tax ID number. Your customer will have this unless they are doing business as an individual. It will be on their federal tax returns if nowhere else.

SOC SEC# is the customers social security number. If they do not have a Federal Tax ID number because they are doing business as an individual, you need to use this number.

BUSINESS PHONE #: The main business phone number for your customers main office.

WEBSITE ADDRESS: This will be for the main website for your customer's business. Many businesses have more than one website. They may have websites for each individual product or service they sell. You should list these websites main addresses in the remarks section.

TYPE OF BUSINESS LEGAL ENTITY

Mark the ONE box which is the legal entity your customer has set up. Your customer will know this. If they do not, first I would worry about them. Second, I would go to Secretary of State's website for the state they are in and look them up by name. It will show the legal structure.

The choices are:

CORPORATION
INDIVIDUAL
JOINT VENTURE
LLC - this stands for Limited Liability Corporation. If they are an LLC you need to enter the number of members and managers.
NOT FOR PROFIT
PARTNERSHIP
SUBCHAPTER "S" CORPORATION
TRUST
OTHER - enter what other type the business is.


I hope this helps you learn how to complete the ACORD 125 commercial insurance application applicant information section.

Taking a few minutes on a regular basis is a proven way to increase your knowledge and professionalism.

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ACORD 125 Policy Information Section

How to Complete the ACORD 125 Policy Information Section

The Policy Information Section includes the following inputs:

PROPOSED EFF DATE: The proposed effective date of the policy or policies. The effective date is the date the policy coverage begins or "goes in force". If the policies your are requesting for this insured have multiple effective dates, you should complete a separate ACORD 125 for each policy with a different effective date.

Enter the dates in this numeric format - MM/DD/YYYY. Example: 07/01/2014 for July 1, 2014

PROPOSED EXP DATE: The proposed expiration date of the policy or policies. This is the date the policy ends and the coverage will need to be replaced by either a renewal policy with this carrier or a new policy with a different carrier.

Enter the dates in this numeric format - MM/DD/YYYY. Example: 07/01/2014 for July 1, 2014

BILLING PLAN: A policy cannot be both Direct Bill and Agency Bill.

DIRECT: This is direct bill. Direct bill is when the insurance carrier bills the customer directly. This means the carrier is responsible for collecting the premium payments, not the agency.

AGENCY: This is agency bill. Agency bill is when the agency - you - are responsible for collecting the premiums on these policies.

Agency bill also means your agency has an account current with this insurance carrier. You collect the premiums and at some later date - maybe 30, 45 or 60 days later - your agency sends payment, less commission, to the insurance carrier.

PAYMENT PLAN: Some insurance carriers offer payment plan options such as quarterly billing or monthly billing. If you are asking your carrier to quote or issue the policy with one of these options enter that here.

METHOD OF PAYMENT: Will the customer be paying with check, electronic check, credit card, etc.  You will only need to enter this if the policy is Direct Bill. If the policy is agency bill the underwriter will not care about this.

AUDIT: Many commercial policies are audited by the insurance carrier after the end of the policy period. Since many policy premiums are based on sales estimates, this is done so the insurance carrier can end up charging for the actual exposure during the policy period. Audits can result in a refund or an additional premium due.

If your customer is growing fast or shrinking fast, it is a good idea for you to talk to your customer and adjust the estimated numbers during the policy period.

DEPOSIT: This is the dollar amount that you are sending to the insurance carrier so they will issue the policy.

This may be a space you leave blank until you have a quote.

MINIMUM PREMIUM: Most commercial policies have a minimum premium that is charged for small accounts. You will leave this blank. The underwriter giving you a quote will fill this in.

POLICY PREMIUM: This is also a space you will leave blank. Unless you are rating and issuing the policy yourself, the underwriter will fill this in when they provide a quote or issue the policy.

I hope this helps you learn how to complete the policy information section of the ACORD 125 commercial insurance application.

Taking a few minutes each day to learn is a great way to build your insurance knowledge over time.

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ACORD 125 Commercial Insurance Application - Attachments

How to Complete the Attachments Section of the ACORD 125

In the Attachments Section you continue your inventory of all the forms you are including with this application.

The value of this exercise is...

1 - a final checklist for you to be sure you are sending your underwriter all the forms needed to quote and issue this group of policies
2 - a checklist for your underwriter to be sure she has all the forms you sent

If you are using Cap Dat ACORD, you can combine all these forms into one single form. That way the attachments cannot get lost.

Here is a list of the corresponding ACORD form numbers for the items listed in this section as of this writing...

• Additional Interest - ACORD 145
• Additional Premises - ACORD 160 or ACORD 823
• Apartment Building Supplement - ACORD 105
• Condo Association By Laws - no ACORD form, the actual bylaws
• Contractors Supplement - ACORD 186
• Coverages Schedule - no ACORD form
• Driver Information Schedule - ACORD 163
• International Liability Exposure Supplement - ACORD 815
• International Property Supplement - ACORD 816
• Premium Payment Supplement - ACORD 610
• Professional Liability Supplement - ACORD 187
• Restaurant / Tavern Supplement - ACORD 185
• Statement / Schedule of Values - ACORD 139
• State Supplement (if applicable) - Various state forms
• Vacant Building Supplement - ACORD 106
• Vehicle Supplement - ACORD 129

The remaining 13 blank sections are for any other ACORD or company specific forms you are sending your underwriter as a part of the overall submission.

I hope this helps you learn how to complete the ACORD 125 commercial insurance application applicant section attachments sections.

Taking a few minutes each day is a wonderful way to steadily build your insurance knowledge.

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ACORD 125 Commercial Insurance Application Sections Attached

How to Complete the ACORD 125 Sections Attached Section

Put a check mark next to each additional ACORD forms attached to this application.

If you are using Cap Dat ACORD you can actually add each of these forms to the ACORD 125 form. This means your underwriter will not have to wonder if they have all the forms. They will be one large PDF.

Here is a listing of the ACORD Form numbers for each of the Sections listed as possible attachments.

• ACCOUNTS RECEIVABLE/VALUABLE PAPERS - ACORD 145
• BOILER & MACHINERY - ACORD 155BM
• BUSINESS AUTO - ACORD 127 followed by the ACORD 137 for each specific state where vehicles are garaged
• BUSINESS OWNERS - ACORD 160
• COMMERCIAL GENERAL LIABILITY - 126
• CRIME - ACORD 141
• DEALERS - ACORD 128
• ELECTRONIC DATA PROTECTION - ACORD 148
• EQUIPMENT FLOATER - ACORD 146
• GARAGE AND DEALERS - ACORD 128 followed by the ACORD 138 for each specific state where vehicles are garaged
• GLASS AND SIGN - ACORD 144
• INSTALLATION/BUILDERS RISK - ACORD 147
• OPEN CARGO - ACORD 193
• PROPERTY - ACORD 140
• TRANSPORTATION/MOTOR TRUCK CARGO - ACORD 143
• TRUCKERS/MOTOR CARRIERS - ACORD 132
• UMBRELLA - ACORD 131
• YACHT - ACORD 210

The remaining three blocks are for any form not listed above.

I hope this helps you learn how to complete the ACORD 125 commercial insurance application applicant information section / sections attached.

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ACORD 125 How to Complete the Carrier Information Section

ACORD 125 - Commercial Insurance Application Applicant Information Section - Carrier Info and Policy Status

Carrier Information

The Carrier - or insurance company - information is in the top right hand corner of the ACORD 125 form.

CARRIER: This is the name of the specific insurance carrier to whom you are sending the application.

NAIC stands for the National Association of Insurance Commissioners.

Here is their website home page...

http://www.naic.org/index.htm

They assign each insurance company a five digit code. You can search for any insurance company by name on their website at this page...

https://eapps.naic.org/cis/


COMPANY POLICY OR PROGRAM NAME: If your insurance carrier has a specific program or policy for the customer you are sending the application for, enter that name here.

Example: An insurance carrier might have a specific program for contractors called Clean Contractors 2020. You would enter that name.

PROGRAM CODE: If in addition to a program name, your carrier has a program code, enter that code in this box.

POLICY NUMBER: If this is renewal application, or if for some other reason the policy number has already been assigned, enter the policy number here. If no policy number has been assigned, enter tbd - to be determined - or some other response to that effect.

UNDERWRITER: The name of the specific underwriter to whom you are sending this application.

UNDERWRITER OFFICE: Many insurance companies have regional offices. Some have everything run from one single home office. Enter the name - normally the city is used as the name - of the office location where the underwriter to whom you are sending this application works.

STATUS of TRANSACTION

The Status of transaction has 6 status options. You should put a mark in all that apply.

QUOTE: Check this box if you want the underwriter to send you a premium quotation. Usually this is done before the customer commits to the policy.

BOUND (Give Date and/or Attach Copy): When you as an agent "BIND" a policy, you are putting that policy in force. You are committing the insurance company to pay losses on this customer until the company can issue legal cancellation notice. Make absolutely certain you and/or your agency has legal binding authority for this action. You can always ask your underwriter about this.

There are many times when binding a policy is exactly the right thing to do.

When you bind the policy, you must enter the date and time you are taking this action. While policies normally begin at either midnight or noon, when you bind a policy you must enter the actual time you take this action.

Never back date a bound date without written instructions from the underwriter to do so.

CHANGE: Check this box if you are only asking for changes to the application you have already sent.

CANCEL: Check this box if you are asking to cancel.

I have never seen this used. I suppose if you wanted to withdraw the application you would send this in to cancel the request. But an email would document the same purpose. If you are asking to cancel a polciy you need to send the ACORD Request for Cancellation form.

ISSUE POLICY: This is telling your underwriter to go ahead and issue the policy even before they tell you the cost. If you show a policy status of BOUND, you should also check the ISSUE POLICY box.

RENEW: This is telling your underwriter to go ahead and issue the policy renewal.

DATE: Normally you should enter in numeric format MM/DD/YYYY. Example 10/15/2014 for Oct 15 2014.

TIME: Enter actual time and check whether you mean AM or PM.

I hope this has helped you learn how to complete the ACORD 125 commercial insurance application applicant information section.

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ACORD 125 - How to Complete the Commercial Insurance Application Agency Information Section

How to Complete the ACORD 125 Agency Information Section

The first section is so short, let's do two today.

Date of Application

This is the easy one. This is the date you are finished with the app and sending it to your underwriter.

Agency Information  Section

This is your agency name, agency address for mailing purposes.

In Cap Dat ACORD this information is auto-filled from your agency profile.

So I guess both are easy.

Below your Agency's Name and Address, you enter your personal information.

This is for you the agent, producer, sales rep, account executive - whatever your agency calls you. You are the person the underwriter will be contacting to get more information and to return a quote. That is the main purpose of this section.

CONTACT NAME: The agent to whom this account belongs.

PHONE: Your direct phone line, or main number if your agency has no individual direct lines.

FAX: Your agency fax number if for some reason your agency still uses a FAX machine.

E-MAIL ADDRESS: This should be your business email. Follow the logic of using your personal mobile device above and the same applies to personal email addresses. It is a terrible idea for both you and your employer.

CODE: This is your agency code with the specific carrier to whom you are sending this application.

SUB CODE: This means sub-producer code. This is your individual sub producer code with this specific carrier. The reason for entering this is to make paying you commissions easier for your agency.

AGENCY CUSTOMER ID: This is the ID number assigned by some back office system somewhere. Maybe your agency back office system or the carrier back office system. This is probably left blank most of the time.

If you are using Cap Dat ACORD all this information will pre-fill this section from your profile.

I hope this helps you learn how to complete the ACORD 125 commercial insurance application agency information section.

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ACORD 130 Workers Compensation Tutorials Table of Contents

Table of Contents for all Tutorials on How to Complete the ACORD 130 Workers Compensation Application

ACORD 130 Agency Information

http://simply-easier-acord-forms.blogspot.com/2014/04/acord-130-workers-compensation.html

ACORD 130 Agent Information

http://simply-easier-acord-forms.blogspot.com/2014/04/acord-130-workers-compensation-app.html

ACORD 130 Carrier and Applicant Information

http://simply-easier-acord-forms.blogspot.com/2014/04/acord-130-workers-compensation_24.html

ACORD 130 Status of Submission, Billing and Audit Section

http://simply-easier-acord-forms.blogspot.com/2014/04/acord-130-workers-compensation_25.html

ACORD 130 Locations Section

http://simply-easier-acord-forms.blogspot.com/2014/04/acord-130-workers-compensation_28.html

ACORD 130 Policy Information Section

http://simply-easier-acord-forms.blogspot.com/2014/04/acord-130-workers-compensation-section.html

ACORD 130 Total Estimated Premium Section

http://simply-easier-acord-forms.blogspot.com/2014/04/acord-130-workers-compensation_30.html

ACORD 130 Contact Information Section

http://simply-easier-acord-forms.blogspot.com/2014/05/acord-130-workers-compensation.html

ACORD 130 Individuals Included / Excluded Section

http://simply-easier-acord-forms.blogspot.com/2014/05/acord-130-workers-compensation.html

ACORD 130 Rating Information Section

http://simply-easier-acord-forms.blogspot.com/2014/05/acord-130-workers-compensation_5.html

ACORD 130 Premium Calculation Section

http://simply-easier-acord-forms.blogspot.com/2014/05/acord-130-workers-compensation_6.html

ACORD 130 Remarks Section

http://simply-easier-acord-forms.blogspot.com/2014/05/acord-130-workers-compensation_7.html

ACORD 130 Prior Carrier and Loss History Section

http://simply-easier-acord-forms.blogspot.com/2014/05/acord-130-workers-compensation_8.html

ACORD 130 Nature of Business / Description of Operations Section

http://simply-easier-acord-forms.blogspot.com/2014/05/acord-130-workers-compensation_9.html

ACORD 130 General Information Section

http://simply-easier-acord-forms.blogspot.com/2014/05/acord-130-workers-compensation_12.html

ACORD 130 Signatures and Notice of Information Practices

http://simply-easier-acord-forms.blogspot.com/2014/05/acord-130-workers-compensation_13.html

ACORD 130 Workers Compensation Application Signature Section

How to Complete the Signature Section of the Workers Compensation Application

At the top hand corner of the signature section of the ACORD 130 workers compensation application is a check box you need to check to state that you have given this insured a copy of the Notice of Information Practices form.

This is the ACORD 38 form for most states. The following states have their own form as of this writing...

ACORD 38AR - Arkansas

ACORD 38AZ - Arizona

ACORD 38CA - California

ACORD 38CT - Connecticut

ACORD 38DE - Delaware

ACORD 38GA - Georgia

ACORD 38IL - Illinois

ACORD 38MT - Montana

ACORD 38NH - New Hampshire

ACORD 38NJ - New Jersey

ACORD 38NV - Nevada

ACORD 38OR - Oregon

ACORD 38RI - Rhode Island

ACORD 38VA - Virginia

ACORD 38WA - Washington

Not all states require a notice. Check with an experienced agent at your agency or with your underwriter.

In the bottom left hand corner of the first section of the Signature section there is a place to get your insured to initial. Don't forget this.

At the very bottom of the 4th page is a place for the Applicant's Signature and next to it a space to have the insured date their signature.

Next to that is a spot for your - the agent's - signature.

Finally there is a box for your National Producer Number if your agency has one.

If you are using our Cap Dat ACORD services we have an electronic, or e-signature, feature available to you. You can add this to the signature box and email a link to the form to your insured. They can then review and sign the form on a tablet, smart phone or most current browsers. This gives you an extra level of legal documentation on the time and date of the signature. It can also save time.

I hope this group of posts have been helpful in your learning more about how to complete the ACORD 130 workers compensation application.

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ACORD 130 Workers Compensation Application General Information

How to Complete the General Information Section of ACORD 130 Workers Compensation App

This general information section continues on page 4 of the ACORD 130. This post will cover these questions on both pages.

As noted in the form, you will put a Y for yes or an N for no in the box in the far right hand column which matches the row which contains the question you are answering. Plain English, for the first question put a Y or N in the box at the end of the question on the right.

If you answer Yes to any of these questions you need to explain your answer in more detail. You will use the Remarks section on page 2 of this application, or the ACORD 130 form if you need more space to answer.

These questions have changed over time and will continue to change. So I will not go through each question individually.

I will point out that many of these questions should cause you to think about the coverage you are applying for. Example, if you say yes to any work preformed on barges, vessels, docks, bridge over water, should you be providing Longshoreman's  coverage?

If you are in Missouri, be certain you do not answer the question about prior coverage being declined.

I personally question the legality of the question about employees with physical handicaps.

Keep in mind these are underwriting questions which do not have an effect on the rate, but may have a significant effect on the discounts the underwriter is willing to apply.

I trust this has helped you learn how to complete the ACORD 130 workers compensation application.

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ACORD 130 Workers Compensation Application Nature of Business Seection

How to Complete the Nature of Business /Description of Operations Section of the ACORD 130

This is a large, free form entry section.

You need to be as inclusive as possible about what your customer does. This is where you can really sell your underwriter on this customer. It will also have an impact in how your underwriter decides to classify the payroll class codes.

Pay attention to the list in the top box above the free forms box and give descriptions and comments on:

Manufacturing:
Raw Materials
Processes
Product
Equipment

Contractor:
Type of Work
Sub-Contracts

Mercantile:
Merchandise
Customers
Deliveries

Service:
Type
Location

Farm:
Acreage
Animals
Machinery
Sub-Contract

I hope this helps you learn how to complete the nature of business and description of operations section of the ACORD 130 workers compensation application.

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ACORD 130 Workers Compensation Application Prior Carrier / Loss History

How to complete the ACORD 130 Prior Carrier Information and Loss History Section

LOSS RUN ATTACHED:  Notice in the top left hand corner of the very first row of this section is a small check box for Loss Run Attached. If you are including a separate document with prior carrier's loss run, check this box.

YEAR: Enter a 4 digit year for each row in this section. Your carrier will want five years history if the business has been in business for that long. This will give them enough information to determine if experience rating plans can apply.

CARRIER & POLICY NUMBER: For each of the five years of prior information, enter the insurance carrier name in the box labeled "CO:". Enter the Policy number in the box labeled "POL#". Include any prefixes and suffixes in the policy number. Example WC 989384-04.

ANNUAL PREMIUM: This should be the final audited premium, not the original estimated premium. Enter numerically as a dollar amount.

MOD: This is the Experience or Merit Modification. This will show on the declarations page of each previous policy.

#CLAIMS: Enter a numeric value for the total number of claims filed for this policy period.

AMOUNT PAID: Enter the total amount paid to date for the claims you listed in the #Claims box. Note, this is not the same as claims paid in this year. Some claims will occur in one policy year and have payments made for many years into the future. This space should show the payments related to claims filed in this year to the best of your ability.

RESERVE: This is the amount the carrier has set aside for future payments on claims already filed.

For instance, if a worker suffers a permanent disability from their work, the claim may include lifetime payments. The reserve amount will be the estimated amount to be paid during the lifetime of that worker.

As another example, the worker may not have a permanent disability, but medical treatment may not yet be complete. The reserve will be the estimate for the remaining treatment cost.

Do not confuse reserves with a maximum amount to be paid. Reserves may be increased or decreased as facts change. Reserves are an educated estimate.

I hope this is helpful in your process of learning how to complete the prior carrier information and loss history on the ACORD 130 workers compensation application.

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ACORD 130 Workers Compensation Application Remarks Section

How to Complete the Remarks Section of the Workers Compensation Application

The Remarks Section is a free form place to enter all the additional information you did not have room to enter anywhere else in this application.

Several items on the first page specifically mention using the Remarks Section.

Under Policy Information it tells you to specify additional coverage or endorsements in Remarks.

While Locations does not mention it, if you have more than 3 locations, this is the place to list those additional locations.

The Individuals Included / Excluded mentions using the Remarks section if you have more than 4 people to list.

I have also seen it used for things that are not asked at all. Such as the fact that the insured is the brother-in-law of the agent. Who knew?

You may need even more room than the Remarks section provides. When that is the case, use the ACORD 101 Additional Remarks Schedule.

I hope this helps you learn how to complete the ACORD 130 workers compensation application remarks section.

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ACORD 130 Workers Compensation Applications - Premium Section

How to Complete the Premium Section of the ACORD 130 Workers Compensation Application

Before you get too worked up about this section, I advise this section is for the underwriter to complete. They are giving you the quote. Let them do their job.

If you are generating this form from a rating software product, all this information will be in the rating software. At worst you will be cutting and pasting.

It is to your benefit to understand how the premiums are created. The more you understand the details of how to create the premiums, the more you can keep your customer's premiums at the correct level. Fewer surprises at audit are always a good thing.

STATE: The state abbreviation for the locations this worksheet is covering.

COLUMNS in the WORKSHEET

FACTOR: There may be factors - numeric values which you will use to modify the premium up or down.

FACTORED PREMIUM: This will be the mathematical result of multiplying the Estimated Total Premium from the worksheet above this section by the Factor in the same row of the column labeled FACTOR.

EXAMPLE:

The first Row is TOTAL: This is the sum total of all the estimated annual manual premiums from the worksheet on this page.

The second row is increased limits. If you recall under the Policy Information Section on page one of the ACORD 130 form, Part 2 - Employer's Liability allowed you to have higher than basic limits of coverage. If you chose higher limits, there will an increase limits factor.

Let's say we have a Total Premium of $2,000. and an increased limits factor of 1.1.

You enter the $2,000 in the first row / third column.

You enter the increased limits factor of 1.10 in the second row, second column.

You multiply the premium in the first row by the factor in the second row to get the Factored Premium you put in the third column of the second row.

$2,000 times 1.1 = $2,200.

You repeat this process adjusted for the previous numbers throughout this section.

Now on to the terms used in this section.

INCREASED LIMITS: As described above, this is a factor that applies if you increase limits for Part 2 - Employer's Liability. This will increase the premium.

DEDUCTIBLE: If a state deductible is available and you chose to use it, enter the deductible factor here. This will reduce the premium.

EXPERIENCE OR MERIT MODIFICATION: If this business has had workers comp insurance for at least two years under the same ownership, and the business has had a workers comp premium both years that meets the state minimum for creating an experience or merit modification, you will enter that modification here. These modifications are based on losses versus premiums. It can result in either an increase or a decrease of the premium. It depends on loss history.

ASSIGNED RISK SURCHARGE: If this risk is being placed in a state Assigned Risk program, there will usually be a surcharge that applies. It will always increase the premium.

ARAP: This is the Assigned Risk Adjustment Program. If your state has this, enter that factor here.

SCHEDULE RATING: Scheduled rating is generally a factor that an individual carrier will develop on its own to more properly price a risk. Normally these are credits and reduce the premium.

CCPAP: Contracting Class Premium Adjustment Program. This provides a credit for construction industry employers who pay high hourly wages. It applies only to the construction class codes and not to the premium developed by other class codes on the same policy. For instance, it would not be applied to office workers.

You would normally expect these to apply only in major metropolitan ares, but I would ask about this if I were insuring a business in an area that was recovering from a significant natural disaster. Think New Orleans after Katrina or Staten Island after Sandy.

STANDARD PREMIUM: The unmodified premium. The premium from the Estimated Annual Manual Premium from the worksheet above.

PREMIUM DISCOUNT:  Large premium levels may create a premium discount. Sort of like a volume discount at a retail store.

EXPENSE CONSTANT: Generally there is a standard Expense Constant for most class codes in each state's workers compensation manual. Some class codes have a higher Expense Constant. These will be shown next to the rates when you look up the class codes and the rates. While each state will have rules about how you apply the Expense Constant if there is more than one, I believe I recall you only apply the one highest Expense Constant instead of adding them all together.

This is not a factor but a hard dollar amount. It will increase the premium. All workers comp policy have an Expense Constant.

TAXES AND ASSESSMENTS:  If you are writing this risk with a non-admitted carrier, you will need to add the premium taxes and other appropriate fees here.

TOTAL ESTIMATED ANNUAL PREMIUM:  This is the total after applying all the adjustments in this section to the estimated annual premium.

MINIMUM PREMIUM: Each class code will show a minimum premium next to the rates. If the Total Estimated Annual Premium is not higher than the Minimum Premium, you will charge the minimum premium.

If there is more than one class code, usually only the highest minimum premium applies.

DEPOSIT PREMIUM: The amount the insured must pay on or before the policy goes into effect.


Well, that is a lot. I hope it helps you understand workers compensation rating a little better.

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ACORD 130 Workers Compensation Application - Rating Information Section

How to Complete the Rating Information Section for the ACORD 130

The state rating worksheet rating information section of the worker compensation application is the heart and soul of the application.

STATE: Before you get into the main part of the section, enter the state for which this rating information applies.

LOC#: Location should track the location number listed in the LOCATIONS section on page 1.

CLASS CODE: This is a 4 digit code that corresponds to the type of work being done by the people whose payroll you are using to create the premiums.

The most common question we get is "Where do I find the Workers' Compensation Class Code?"

Here are some links to these codes...

https://www.wcrb.org/wcrb/classcode/main.asp

http://www.wcirb.com/content/classification-information

http://www.workerscompensationshop.com/workers_compensation_class_codes.htm

http://www.tdi.texas.gov/wc/regulation/

This used to be the hardest question to answer. I love Google. Just enter the phrase "workers compensation code" and then the name of the state you need the codes for, and you will get that information toute suite.

CATEGORIES, DUTIES, CLASSIFICATIONS: In the process of finding the class code, you will also have found the text to enter here.

Example: Code 8810 - Clerical Office Employees NOC. The NOC stand for not otherwise classified. They might work in an office but be some other classification such as Inside Sales, etc.

# EMPLOYEES: Enter a numeric value for the number of Full Time and the number of Part Time Employees classified under this code for this state.

SIC: Standard Industry Classification Code. You can find these at this link...

https://www.osha.gov/pls/imis/sicsearch.html

NAICS: The good old North American Industry Classification System codes. My Mother used to read these to me at bedtime. You can find them at these links...

https://www.census.gov/eos/www/naics/

https://www.census.gov/eos/www/naics/

ESTIMATED ANNUAL REMUNERATION / PAYROLL: Why ask for anything other than payroll? Sometimes room and board is considered remuneration and the carrier can include that when they audit the risk at the end of the policy term.

This is the total payroll for this classification adjusted for maximum payrolls for Executive Officers, Partners and Owners, for this classification for this state.

RATE: When you look up the Class code on a state specific or company specific site, you should see the rate for that class code listed. The rate is a dollar amount such as $0.52 or $3.14.

ESTIMATED ANNUAL MANUAL PREMIUM: The rate applies per $100.00 of payroll. So multiple the rate times the Payroll and divide by 100 to get this number..

Example:

Your Annual Payroll is $100,000.

Your Rate for this Class Code is $0.52

Multiple 100,000 times .52 = $52,000.

Divide $52,000 by 100 = $520.


I hope this helps you learn how to complete the State Rating Worksheet for the ACORD 130 Workers Compensation application.

We all learn for the first time some time.

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ACORD 130 Workers Compensation Application - Individuals Included / Excluded Section

How to Complete the Workers Compensation Individuals Included / Excluded Section

The last section on page 1 of the ACORD 130.

INDIVIDUALS INCLUDE / EXCLUDED

Some States allow Partners and/or Officers of a business to be excluded from workers compensation coverage. This saves the company money on the cost of the workers compensation policy in some cases.

In some other States you need to specifically include Partners and Officers. Note - they must actually be employed by the business to be included.

Check with an experienced agent in your office or your carrier underwriter to find out the details for a specific state.

For each individual you wish to include or exclude, you need to list the following information in this section of the application. If you need more space for more than four individuals use the Remarks Section at the bottom of page 2, or attached the ACORD 101 form.

STATE: The state in which this person would be employed.

LOC#: This would track the location number listed in the LOCATIONS section higher up on this first page of the ACORD 130.

NAME: The person's full name.

DATE OF BIRTH: The person's full date of birth.

TITLE / RELATIONSHIP: The title the person has at the business or relationship. Example, President, or Owner.

OWNER-SHIP %: The percentage of ownership this person has. Your customer will be able to provide this information.

DUTIES: The actual job this person does for this company. (I can't help it. I watched too many episodes of the Simpsons with my son. I laugh every time I hear the word duty. I flash to Bart saying "He said duty")

INC/EXC: Include or exclude from coverage. Enter the letters INC to include coverage for this person. Enter the letters EXC to exclude coverage for this person.

CLASS CODE: This is the workers compensation class code this person's job would fall under. I will discuss class codes in the very next post.

REMUNERATION/PAYROLL: Each state has a maximum payroll limitation for Officers, Directors and Owners. So this may not be this person's actual payroll. You need to check with an experienced agent in your office or your carrier underwriter to learn the limitations for your states.

When I was a young workers comp underwriter, back when Jesus was in grade school, the limit was $15,600. You would not want the premium to be computed on the $1,000,000 annual salary we all know our bosses secretly make. That would run the premium up way too high. We would then not be competitive with other agents quoting this account and therefor not get this business. A bad thing.


I hope this helps you learn how to complete the ACORD 130 workers compensation application.

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ACORD 130 Workers Compensation Application - Contact Information Section

How to Complete the ACORD 130 Contact Information Section

This section is the next to the last one on page one of the ACORD 130.

Contact Information

This is information on the people to contact at your customer's office for the following:

INSPECTION: This would be for the carrier to schedule a physical safety inspection of the insured's premises or operations away from the premises. One of the valuable services many insurance providers of workers compensation offer is safety inspections to give your insured's ideas on how to change their processes to reduce the risk of worker's injuries. A win for everyone.

ACCTING: Accounting.  This would be your customer's bookkeeper, accountant, or whoever would be able to provide the actual payroll information. In a smaller business this might be the owner.

Remember, the workers compensation policy can be adjusted after the policy period to change the premium to reflect the actual payroll during the policy period. This can result in a refund, if the actual payroll was less than the estimate, or an additional charge if the actual payroll was more than the estimate.

If you are aware that your customer is either growing dramatically or shrinking dramatically, you will be doing them a favor to suggest updating the estimate during the policy period.

CLAIMS INFO: Claims information. This would be the person at your customer's business that would keep the record of all First Reports of Claims. The carrier's claims adjuster would co-ordinate with this person.

For each of the above contacts provide the following:

NAME:

OFFICE PHONE: Include personal extension if there is one.

MOBILE PHONE: If the person has a business mobile phone, this would be that number. Only provide the person's personal mobile phone number if you get their permission in writing to do so. This is both a courtesy and a legal protection for you and your agency.

E-Mail: The person's business email, not personal email. Again, only provide personal email with written permission to do so.

I hope this helps you learn how to complete the ACORD 130 workers compensation application.

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