Instructions ACORD 63 Fraud Statements

Instructions ACORD 63 Fraud Statements

BASIC INFORMATION

Instructions ACORD 63 Fraud Statements

AGENCY CUSTOMER ID

As with all ACORD forms with more than one page enter your agency customer ID so this page will be able to find the rest of this application if somewhere, somehow in that thing we call the business cycle they get separated from each other.

AGENCY

Enter your agency's name here.

CARRIER

The insurance company underwriting this policy. This is the company listed on the DEC page of the policy.

NAIC NUMBER

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/


POLICY NUMBER

Enter the policy number if one exists. If no policy number has been assigned yet enter TBD for to be determined. If you have a binder number enter that here.

EFFECTIVE DATE

This is the effective date of the policy to which this form is attached.


APPLICANT / NAMED INSURED

Enter the same as the Name on the preceding documents in this application.


FRAUD WARNINGS

Instructions ACORD 63

Familiarize yourself with each of these warnings - including the ones for states other than your home state.

If you have an insured with locations in more than one state the applicable law may be the law for that state.

You do not use this form with Loss Notices or with Workers Compensation applications.


SIGN AND DATE

How to complete the ACORD 63 Fraud Statements

APPLICANT'S SIGNATURE

Have you applicant or their legally authorized representative sign here.

DATE ( MM/DD/YYYY)

Enter the date this form is signed. Use the format month month / day day / year year year year - which looks like this for Oct first two thousand fourteen...

10/01/2014

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Instructions ACORD 61 CA Uninsured Motorists Property Damage Coverage Offer

Instructions ACORD 61 CA Uninsured Motorists Property Damage Coverage Offer

MANDATORY OFFER

Instructions ACORD 61 CA Uninsured Motorists Property Damage Coverage Offer

AGENCY CUSTOMER ID

As with all ACORD forms with more than one page enter your agency customer ID so this page will be able to find the rest of this application if somewhere, somehow in that thing we call the business cycle they get separated from each other.

MANDATORY UNINSURED MOTORISTS PROPERTY DAMAGE COVERAGE OFFER

The wording in this section provides a description of this coverage.

Note this coverage is only available...

1 - If you have not rejected Uninsured Motorists Bodily Injury Coverage, and

2 - For autos for which you have not purchased Collision Coverage.

If you already have Collision coverage on an auto, then Uninsured Motorists Property Damage Coverage is considered to be redundant. I do not quite agree with that because I am not aware if collision coverage would pay for loss of resale value to a repaired auto which has been in an accident, but that is because I do not know the answer to that.

SELECTION / REJECTION

Select or reject ACORD 61CA

Regardless of whether you are selecting or rejecting coverage, you need to have the applicant indicate that decision on this form.

If the coverage is being selected check the line to the left of that statement and then list the vehicles for which coverage is selected. If you have more than three vehicles, use another form.

If coverage is being completely rejected, check the line to the left of that statement.

If coverage is being rejected when specifically named individuals are operating the vehicle check the line to the left of that statement and list the named individuals being excluded.

SIGNATURES

APPLICANT's SIGNATURE

Have your applicant sign here.

DATE

Have the applicant enter the date of the signing.

EFFECTIVE DATE

Enter the effective date of this coverage. Normally this will be the policy effective date, however, this can be done by endorsement during a policy period. In that case the effective date would be the date of the endorsement.

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Instructions ACORD 61CA California Auto Supplement

Instructions ACORD 61CA California Auto Supplement

BASIC INFORMATION

Instructions ACORD 61CA California Auto Supplement

AGENCY CUSTOMER ID

As with all ACORD forms with more than one page enter your agency customer ID so this page will be able to find the rest of this application if somewhere, somehow in that thing we call the business cycle they get separated from each other.

AGENCY

Enter your agency's name here.

APPLICANT / NAMED INSURED

Enter the same as the Name on the preceding documents in this application.

POLICY NUMBER

Enter the policy number if one exists. If no policy number has been assigned yet enter TBD for to be determined. If you have a binder number enter that here.

CARRIER

The insurance company underwriting this policy. This is the company listed on the DEC page of the policy.

NAIC NUMBER

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/

MANDATORY UNINSURED MOTORISTS BODILY INJURY COVERAGE OFFER

Instructions ACORD 61 CA

The offer states that the insured may reject coverage completely or accept lower limits.

This statement also defines Uninsured and Underinsured Motorists Coverage.

REJECTION OF UNINSURED MOTORISTS BODILY INJURY COVERAGE

Rejection of Uninsured Motorists Coverage

This section allows the insurer or the applicant (the insured) to...

Completely Reject Coverage, or
Reject Coverage for specially named drivers when operating a vehicle insured under this policy.

Check the line to the left of the choice that is being made.

If you are not rejecting coverage, do not check anything here.

If you are rejecting coverage for specifically named drivers, enter the names of the excluded drivers here.


LOWER LIMITS for UNINSURED MOTORISTS BODILY INJURY COVERAGE

Accept Lower Limits for Uninsured Motorists Bodily Injury Coverage

The insurer and the insured may decide to accept a lower limit for Bodily Injury Uninsured Motorist.

If that is the decision, check the line to the left of the text stating that decision. Just after the dollar sign ($) enter the lower limits which have been accepted.

APPLICANT's SIGNATURE

Have your applicant sign here.

DATE

Have the applicant enter the date of the signing.

EFFECTIVE DATE

Enter the effective date of this coverage. Normally this will be the policy effective date, however, this can be done by endorsement during a policy period. In that case the effective date would be the date of the endorsement.


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Instructions ACORD 60US Terrorism Insurance Coverage

Instructions ACORD 60US Terrorism Insurance Coverage

BASIC INFORMATION

This form is attached to the ACORD 125 and/or many other forms depending on the type of insurance for which this applicant is applying.

Instructions ACORD 60 US Terrorism Insurance Coverage

AGENCY CUSTOMER ID

As with all ACORD forms with more than one page enter your agency customer ID so this page will be able to find the rest of this application if somewhere, somehow in that thing we call the business cycle they get separated from each other.

AGENCY

Enter your agency's name here.

APPLICANT / NAMED INSURED

Enter the same as the Name on the preceding documents in this application.

POLICY NUMBER

Enter the policy number if one exists. If no policy number has been assigned yet enter TBD for to be determined. If you have a binder number enter that here.

CARRIER

The insurance company underwriting this policy. This is the company listed on the DEC page of the policy.

NAIC NUMBER

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/


POLICYHOLDER DISCLOSURE

How to complete the ACORD 60 US

This section contains the actual coverage details. It references the Terrorism Risk Insurance ACT.

Here is a selection of very good, informative links about this act...

http://www.naic.org/cipr_topics/topic_tria.htm

http://www.treasury.gov/resource-center/fin-mkts/Pages/program.aspx

http://en.wikipedia.org/wiki/Terrorism_Risk_Insurance_Act

https://www.ncci.com/nccimain/industryinformation/terrorismwc/pages/tria-faq.aspx

You need to be familiar with this ACT. Notice the ACT does not cover all loses, only a percentage. The ACT also has a cap for all loses from a unique event. Once this cap is paid out your insured may have even more uncovered loses.


ACCEPTANCE OR REJECTION

Instructions ACORD 60US Terrorism Insurance Coverage

Check the first box to accept coverage.

Enter the premium amount for the policy period.

Check the second box to reject coverage.


SIGNATURES

ACORD 60US

Policyholder/Applicant's Signature - have the authorized representative or representatives sign.

Print Name - have the person who signed print their name.

Date - enter the date the person signed. It is best to have the signee enter the date.

Effective Date - enter the effective date of this coverage - it will normally be the same as the policy effective date.

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Instructions ACORD 137CA Endorsements, Remarks and Signatures Section

Instructions ACORD 137CA Endorsements, Remarks and Signatures Section

ENDORSEMENTS / REMARKS

Instructions ACORD 137CA Endorsements, Remarks and Signatures Section

ENDORSEMENTS

Use this space to enter any endorsements which are part of this policy. Include forms numbers and edition dates.

REMARKS

Use the space to add any remarks. If you need more space use the ACORD 101 Additional Remarks Section.



SIGNATURE

Instructions ACORD 137CA Endorsements, Remarks and Signatures Section

The very first box in the Signature section states that if an Insurer is not going to provide cover to a "GOOD DRIVER", the insurer must provide a written statement to the insured explaining why.

A "GOOD DRIVER" is a person with no more than one violation point or more than one at-fault accident resulting in only property damage in the past three years.

The second section speaks to Un-insured motorist coverage being offered.

The final section reminds the insured that the choices made in this application are permanent until actively changed.

APPLICANTS SIGNATURE - have your customer sign here.

DATE - The date the Applicant signs.

PRODUCER's SIGNATURE - The licensed producer - the agent writing this account - should sign here.

NATIONAL PRODUCER NUMBER - Enter your national producer number.

The National Insurance Producer Registry states "The National Producer Number is a unique NAIC identifier assigned through the licensing application process or the NAIC reporting systems to individuals and business entities (including, but not limited to producers, adjusters, and navigators) engaged in insurance related activities regulated by a state insurance department."

Here is a link to their web site...

http://www.nipr.com/

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Instructions ACORD 137CA Motor Carrier Trailer Interchange Section

Instructions ACORD 137CA Motor Carrier Trailer Interchange Section

TRAILER INTERCHANGE

The following discussion is taken directly from the JM Wilson Blog.

"The definition of trailer interchange is an agreement among common carriers whereby one trucker will transfer a trailer containing a shipment to a second trucker to transport the trailer to its destination or to a point of interchange with yet another trucker.  The arrangement continues until the cargo reaches its destination.  The effect of such an arrangement, which must be in writing, is that the trucker will be hauling trailers of others. (Northland Insurance Product News T-27R March 2007)

What this means is that trailer interchange is truly third party liability coverage, not first-party physical damage coverage.   Trailer interchange does not provide coverage to the average trucker who may be using a third party trailer while transporting goods."

"The main thing I try to point out to agents is that if no written agreement is in place, then non-owned trailer coverage is what the insured needs.  If the situation arises when the shipper is asking for non-owned trailer coverage and they do not have a written agreement in place, the situation can usually be handled by receiving a copy of the contract the insured has with the shipper and working it out with the company."

Thanks to Leon Hilaski for this article.

Instructions ACORD 137CA Motor Carrier Section Trailer Interchange

COMP / OTC

COMP means comprehensive coverage. Comprehensive insurance provides protection for your vehicle if it is damaged by something other than a collision with a vehicle or object, or if your vehicle is stolen.

OTC means other than collision coverage.

COVERED AUTO SYMBOLS - Look at the very last block in the Motor Carrier Section. On the far left it is titled "COVERED AUTO SYMBOLS.

These correspond to the check boxes in the Liability Section under Covered Auto Symbols. You will check any and all which apply for this policy.

The options are...

69 - Trailers in your possession  under a trailer interchange agreement.
70 - Your trailers in the possession of another trucker under a trailer interchange agreement.

# TRAILERS - Enter the maximum number of trailers operated by the insured under a trailer interchange agreement during this policy term.

FARTH ZONE - Farthest Zone where the trailer interchange agreement applies. Remember Zones from the ACORD 127

# DAYS - Enter the number of days during this policy period in which the insured will be pulling trailers under a trailer interchange agreement.

Radius - Enter the actual mileage radius - a number of miles - in which the insured will be pulling trailers under a trailer interchange agreement.


SPECIFIED CAUSES OF LOSS

This is an alternative to comprehensive coverage. Comprehensive coverage is more an All -Risk coverage. Losses are coverage unless specifically excluded. Specified Causes of Loss only covers losses caused by things specifically listed.

COVERED AUTO SYMBOLS - Look at the very last block in the Truckers Section. On the far left it is titled "COVERED AUTO SYMBOLS.

These correspond to the check boxes in the Liability Section under Covered Auto Symbols. You will check any and all which apply for this policy.

The options are...

69 - Trailers in your possession  under a trailer interchange agreement.
70 - Your trailers in the possession of another trucker under a trailer interchange agreement.

# TRAILERS - Enter the maximum number of trailers operated by the insured under a trailer interchange agreement during this policy term.

FARTH ZONE - Farthest Zone where the trailer interchange agreement applies. Remember Zones from the ACORD 127

# DAYS - Enter the number of days during this policy period in which the insured will be pulling trailers under a trailer interchange agreement.

Radius - Enter the actual mileage radius - a number of miles - in which the insured will be pulling trailers under a trailer interchange agreement.

COLLISION

Collision insurance provides protection for your vehicle if it is damaged in an accident. Collision insurance pays to repair or replace your vehicle if it collides with another object or overturns or rolls.

COVERED AUTO SYMBOLS - Look at the very last block in the Truckers Section. On the far left it is titled "COVERED AUTO SYMBOLS.

These correspond to the check boxes in the Liability Section under Covered Auto Symbols. You will check any and all which apply for this policy.

The options are...

69 - Trailers in your possession  under a trailer interchange agreement.
70 - Your trailers in the possession of another trucker under a trailer interchange agreement.

# TRAILERS - Enter the maximum number of trailers operated by the insured under a trailer interchange agreement during this policy term.

FARTH ZONE - Farthest Zone where the trailer interchange agreement applies. Remember Zones from the ACORD 127

# DAYS - Enter the number of days during this policy period in which the insured will be pulling trailers under a trailer interchange agreement.

Radius - Enter the actual mileage radius - a number of miles - in which the insured will be pulling trailers under a trailer interchange agreement.

WAIVER OF DEDUCTIBLE - check this box if your insured has selected this option.

A collision deductible waiver is a clause added as an option to some auto policies, which already include collision coverage, as a means of protecting the policyholder against under insured drivers.

DEDUCTIBLE - Enter the comprehensive or OTC deductible.

TRAILER VALUE - Enter the value assigned to the trailer in the trailer interchange agreement.


HIRED PHYSICAL DAMAGE

STATES - Enter the state codes - ex: NY for New York - for the states covered by the trailer interchange agreement.

# DAYS - This is used to rate this coverage. Enter the number of days during the policy period units will be pulled under the trailer interchange agreement.

# VEH - number of vehicles. This is also used for pricing this coverage. Enter the number of units which will be pulled under the trailer interchange agreement during this policy period.

COVERAGE IS: - check the box fro Primary or Secondary based on how you are having this policy set up.

PRIMARY - this coverage will pay damages before any other coverage.

SECONDARY - this coverage will pay only after other coverage has been completed used.


OTHER - Enter any other coverage description, Covered Auto Symbols and limits fro coverage provided under this policy.

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Instructions ACORD 137 Motor Carrier Physical Damage Section

Instructions ACORD 137 Motor Carrier Physical Damage Section

MOTOR CARRIERS PHYSICAL DAMAGE

Instructions ACORD 137 Motor Carriers Physical Section

COMP / OTC

COMP means comprehensive coverage. Comprehensive insurance provides protection for your vehicle if it is damaged by something other than a collision with a vehicle or object, or if your vehicle is stolen.

OTC means other than collision coverage.

COVERED AUTO SYMBOLS - Look at the very last block in the Motor Carriers Section. On the far left it is titled "COVERED AUTO SYMBOLS.

These correspond to the check boxes in the Liability Section under Covered Auto Symbols. You will check any and all which apply for this policy.

The options are...

62 - Owned Autos Only - does not cover non-owned or hired
63 - Owned Private Passenger Autos Only - Does not cover Hired or Non-Owned Autos or Commercial Vehicles
64 - Owned Commercial Autos Only - Does not cover private passenger autos or hired or non-owned autos
67 - Specifically Described Autos - only autos listed in schedule as part of the policy
68 - Hired Autos Only - covers neither owned or non-owned autos

The check box without a number lets you manuscript your own symbol. Be sure you add a text description or no one other than you will understand what you mean.

You do not enter a limit for this row.

DEDUCTIBLE - Enter the comprehensive or OTC deductible.


SPECIFIED CAUSES OF LOSS

This is an alternative to comprehensive coverage. Comprehensive coverage is more an All -Risk coverage. Losses are coverage unless specifically excluded. Specified Causes of Loss only covers losses caused by things specifically listed.

COVERED AUTO SYMBOLS - Look at the very last block in the Truckers Section. On the far left it is titled "COVERED AUTO SYMBOLS.

These correspond to the check boxes in the Liability Section under Covered Auto Symbols. You will check any and all which apply for this policy.

The options are...

62 - Owned Autos Only - does not cover non-owned or hired
63 - Owned Private Passenger Autos Only - Does not cover Hired or Non-Owned Autos or Commercial Vehicles
64 - Owned Commercial Autos Only - Does not cover private passenger autos or hired or non-owned autos
67 - Specifically Described Autos - only autos listed in schedule as part of the policy
68 - Hired Autos Only - covers neither owned or non-owned autos

The check box without a number lets you manuscript your own symbol. Be sure you add a text description or no one other than you will understand what you mean.

Under Limits check the box for the specific coverages which  are being requested under this policy.

SCL - stands for Specified Cause of Loss
F - stands for Fire as the cause of loss
FT - stands for Fire and Theft as the cause of loss
FTW - stands for Fire, Theft and Windstorm as the cause of loss
LSP - stands for Limited Specified Perils as the cause of loss


DEDUCTIBLE - Enter the comprehensive or OTC deductible.


COLLISION

Collision insurance provides protection for your vehicle if it is damaged in an accident. Collision insurance pays to repair or replace your vehicle if it collides with another object or overturns or rolls.

COVERED AUTO SYMBOLS - Look at the very last block in the Truckers Section. On the far left it is titled "COVERED AUTO SYMBOLS.

These correspond to the check boxes in the Liability Section under Covered Auto Symbols. You will check any and all which apply for this policy.

The options are...

62 - Owned Autos Only - does not cover non-owned or hired
63 - Owned Private Passenger Autos Only - Does not cover Hired or Non-Owned Autos or Commercial Vehicles
64 - Owned Commercial Autos Only - Does not cover private passenger autos or hired or non-owned autos
67 - Specifically Described Autos - only autos listed in schedule as part of the policy
68 - Hired Autos Only - covers neither owned or non-owned autos

The check box without a number lets you manuscript your own symbol. Be sure you add a text description or no one other than you will understand what you mean.

You do not enter a limit for this row.


WAIVER OF DEDUCTIBLE - check this box if your insured has selected this option.

A collision deductible waiver is a clause added as an option to some auto policies, which already include collision coverage, as a means of protecting the policyholder against under insured drivers.

DEDUCTIBLE - Enter the comprehensive or OTC deductible.


TOWING & LABOR

COVERED AUTO SYMBOLS - Look at the very last block in the Truckers Section. On the far left it is titled "COVERED AUTO SYMBOLS.

These correspond to the check boxes in the Liability Section under Covered Auto Symbols. You will check any and all which apply for this policy.

The options are...

46 - Specifically Described Autos - only covers listed vehicles

The check box without a number lets you manuscript your own symbol. Be sure you add a text description or no one other than you will understand what you mean.

LIMIT - enter the dollar limit available under this policy.

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