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ACORD Form 126 Commercial General
Liability Section Instructions

 

 
ACORD 126 (2007/05) 1 of 18
Universal wording updates to improve clarity and intent were made to all FIG text for this form on 10/07/2008.
Section Name Field Name Field and/or Section Description
TITLE ACORD 126 (2007/05) Commercial General Liability Section The title of the form. The ACORD 126 - Commercial General Liability is a form of insurance designed to protect owners and operators of businesses from a wide variety of liability exposures. These exposures include liability for accidents resulting from the insured's operations or premises, products sold or operations completed by the insured, and contractual liability. The Coverage and Limits Section of the ACORD 126 was designed to follow the ISO Policy Simplification Program first initiated in 1986. The ACORD 126 was designed to be used in conjunction with the Commercial Insurance Application -Applicant Information Section (ACORD 125). Please refer to the chapter on the ACORD 125 for information on that form.
IDENTIFICATION SECTION Date Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY)
IDENTIFICATION SECTION Agency Enter text: The producer's full name.
IDENTIFICATION SECTION Enter text: The producer's mailing address line one.
IDENTIFICATION SECTION Enter text: The producer's mailing address line two.
IDENTIFICATION SECTION Enter text: The producer's mailing address city name.
IDENTIFICATION SECTION Enter code: The producer's mailing address state or province code.
IDENTIFICATION SECTION Enter code: The producer's mailing address postal code.
IDENTIFICATION SECTION Phone (A/C, No, Ext) Enter number: The producer's contact person's phone number.
IDENTIFICATION SECTION Fax (A/C, No) Enter number: The fax number of the producer.
IDENTIFICATION SECTION Code Enter code: The identification code assigned to the producer (e.g. agency or brokerage firm) by the insurer.
IDENTIFICATION SECTION Subcode Enter code: The identification code assigned by the insurer to the sub-producer (e.g. person) within a producer's office (e.g. agency or brokerage).

ACORD 126 (2007/05) 2 of 18

Section Name Field Name Field and/or Section Description
IDENTIFICATION SECTION Agency Customer ID Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage).
IDENTIFICATION SECTION Applicant (First Named Insured) Enter text: The named insuredís full name as it appears on the policy declarations page.
IDENTIFICATION SECTION Effective Date Enter date: The effective date of the policy.
IDENTIFICATION SECTION Expiration Date Enter date: The date on which the terms and conditions of the policy will expire.
IDENTIFICATION SECTION Billing Plan-Direct Bill checkbox Check the box (if applicable): Indicates if the policy is to be direct billed.
IDENTIFICATION SECTION Agency Bill checkbox Check the box (if applicable): Indicates if the policy is to be producer/agency billed.
IDENTIFICATION SECTION Payment Plan Enter code: The payment plan for the policy.
IDENTIFICATION SECTION Audit Enter code: The audit term for policies that are subject to periodic audit. If the audit period is known, enter the code; A - annual, S - semi-annual, Q - Quarterly, M - Monthly, O -Other.
IDENTIFICATION SECTION For Company Use Only Enter text: This area is to be completed by the insurer.
COVERAGES Commercial General Liability Check the box (if applicable): Indicates the claims made or occurrence option applies for the general liability policy.
COVERAGES Claims Made Check the box (if applicable): Indicates the "claims made" option applies on the general liability policy.
COVERAGES Occurrence Check the box (if applicable): Indicates the general liability policy, occurrence basis applies.
COVERAGES Owner's & Contractors Protective Check the box (if applicable): Indicates the owners and contractors protective option applies for the general liability policy.
COVERAGES Other checkbox Check the box (if applicable): Indicates other coverage not found on the form exists for the general liability policy.
COVERAGES Other Field Check the box (if applicable): Indicates the general liability policy, general aggregate limit applies per location.
COVERAGES Deductibles-Property Damage checkbox Check the box (if applicable): Indicates if a property damage deductible is requested.
COVERAGES Property Damage Enter amount: The deductible applicable to the Property Damage coverage.
COVERAGES Bodily Injury checkbox Check the box (if applicable): Indicates if a bodily injury deductible is requested.
COVERAGES Bodily Injury Enter amount: The deductible applicable to the Bodily Injury coverage.

ACORD 126 (2007/05) 3 of 18

Section Name Field Name Field and/or Section Description
COVERAGES Other checkbox Check the box (if applicable): Indicates that a deductible is requested on the coverage other than Property Damage or Bodily Injury.
COVERAGES Other Field Enter text: The type of deductible being requested other than property damage and bodily injury.
COVERAGES Other Enter amount: The deductible applicable to the Other Coverage.
COVERAGES Per Claim checkbox Check the box (if applicable): Indicates that a per claim deductible applies to individual claims even if the claims are all related to the same occurrence or event.
COVERAGES Per Occurrence checkbox Check the box (if applicable): Indicates that a per occurrence deductible applies once to each occurrence no matter how many individual claims result from the occurrence or event.
LIMITS General Aggregate Enter limit: The commercial general liability policy, general aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIMITS Products & Completed Operations Aggregate $ Field Enter limit: The general liability policy, products and completed operations aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIMITS Personal & Advertising Injury Enter limit: The general liability policy, personal and advertising injury limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIMITS Each Occurrence Enter limit: The general liability policy, each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIMITS Damage to Rented Premises Enter limit: The general liability policy, damage to rented premises each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIMITS Medical Expense Enter limit: The commercial general liability policy, medical expense each person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
LIMITS Employee Benefits Enter limit: The general liability employee benefits limit amount.
LIMITS Premiums-Premises/Operations Enter amount: The premium for premises/operations coverage.
LIMITS Products Enter amount: The premium for products coverage.
LIMITS Other Enter amount: The premium for other general liability coverage.
LIMITS Total Enter amount: The total premium amount for the commercial general liability line of business.
LIMITS Other Coverages, Restrictions and/or Endorsements Enter text: The remarks associated with the general liability line of business.

ACORD 126 (2007/05) 4 of 18

Section Name Field Name Field and/or Section Description
SCHEDULE OF HAZARDS Location # Enter number: The producer assigned identifier for the location number of the risk's location as it appears on the Applicant Information Section of ACORD 125. All classifications should be grouped by location number.
SCHEDULE OF HAZARDS Hazard # Enter number: A unique (within location) number distinguishing this unit-at-risk from the others.
SCHEDULE OF HAZARDS Classification Enter text: The classification the applicant's liability exposures by location, using the ISO Classification Table or other industry organization rules. Enter the appropriate class description from the table in this field.
SCHEDULE OF HAZARDS Class Code Enter code: The general liability class code that corresponds to the classification description shown in the previous field.
SCHEDULE OF HAZARDS Premium Basis Enter code: An industry code designating the rating basis of the exposure amount.
SCHEDULE OF HAZARDS Exposure Enter amount: The amount of the exposure used for this class code in calculating the premium. The contents of this data element depends on the rating basis used. The full amount of exposure is contained.
SCHEDULE OF HAZARDS Terr. Enter code: The rating territory code based on location from the appropriate state exception page.
SCHEDULE OF HAZARDS Rate - Prem/Ops Enter rate: The separate Premises Operations manual rate applicable to the classification.
SCHEDULE OF HAZARDS Rate - Products Enter rate: The separate Products rate applicable to the classification.
SCHEDULE OF HAZARDS Premium - Prem/Ops Enter amount: The premium associated with the premises operations coverage.
SCHEDULE OF HAZARDS Premium - Products Enter amount: The premium associated with the products coverage.
SCHEDULE OF HAZARDS Location # Enter number: The producer assigned identifier for the location number of the risk's location as it appears on the Applicant Information Section of ACORD 125. All classifications should be grouped by location number.
SCHEDULE OF HAZARDS Hazard # Enter number: A unique (within location) number distinguishing this unit-at-risk from the others.
SCHEDULE OF HAZARDS Classification Enter text: The classification the applicant's liability exposures by location, using the ISO Classification Table or other industry organization rules. Enter the appropriate class description from the table in this field.
SCHEDULE OF HAZARDS Class Code Enter code: The general liability class code that corresponds to the classification description shown in the previous field.
SCHEDULE OF HAZARDS Premium Basis Enter code: An industry code designating the rating basis of the exposure amount.
SCHEDULE OF HAZARDS Exposure Enter amount: The amount of the exposure used for this class code in calculating the premium. The contents of this data element depends on the rating basis used. The full amount of exposure is contained.

ACORD 126 (2007/05) 5 of 18

Section Name Field Name Field and/or Section Description
SCHEDULE OF HAZARDS Terr. Enter code: The rating territory code based on location from the appropriate state exception page.
SCHEDULE OF HAZARDS Rate - Prem/Ops Enter rate: The separate Premises Operations manual rate applicable to the classification.
SCHEDULE OF HAZARDS Rate - Products Enter rate: The separate Products rate applicable to the classification.
SCHEDULE OF HAZARDS Premium - Prem/Ops Enter amount: The premium associated with the premises operations coverage.
SCHEDULE OF HAZARDS Premium - Products Enter amount: The premium associated with the products coverage.
SCHEDULE OF HAZARDS Location # Enter number: The producer assigned identifier for the location number of the risk's location as it appears on the Applicant Information Section of ACORD 125. All classifications should be grouped by location number.
SCHEDULE OF HAZARDS Hazard # Enter number: A unique (within location) number distinguishing this unit-at-risk from the others.
SCHEDULE OF HAZARDS Classification Enter text: The classification the applicant's liability exposures by location, using the ISO Classification Table or other industry organization rules. Enter the appropriate class description from the table in this field.
SCHEDULE OF HAZARDS Class Code Enter code: The general liability class code that corresponds to the classification description shown in the previous field.
SCHEDULE OF HAZARDS Premium Basis Enter code: An industry code designating the rating basis of the exposure amount.
SCHEDULE OF HAZARDS Exposure Enter amount: The amount of the exposure used for this class code in calculating the premium. The contents of this data element depends on the rating basis used. The full amount of exposure is contained.
SCHEDULE OF HAZARDS Terr. Enter code: The rating territory code based on location from the appropriate state exception page.
SCHEDULE OF HAZARDS Rate - Prem/Ops Enter rate: The separate Premises Operations manual rate applicable to the classification.
SCHEDULE OF HAZARDS Rate - Products Enter rate: The separate Products rate applicable to the classification.
SCHEDULE OF HAZARDS Premium - Prem/Ops Enter amount: The premium associated with the premises operations coverage.
SCHEDULE OF HAZARDS Premium - Products Enter amount: The premium associated with the products coverage.
SCHEDULE OF HAZARDS Location # Enter number: The producer assigned identifier for the location number of the risk's location as it appears on the Applicant Information Section of ACORD 125. All classifications should be grouped by location number.
SCHEDULE OF HAZARDS Hazard # Enter number: A unique (within location) number distinguishing this unit-at-risk from the others.
SCHEDULE OF HAZARDS Classification Enter text: The classification the applicant's liability exposures by location, using the ISO Classification Table or other industry organization rules. Enter the appropriate class description from the table in this field.

ACORD 126 (2007/05) 6 of 18

Section Name Field Name Field and/or Section Description
SCHEDULE OF HAZARDS Class Code Enter code: The general liability class code that corresponds to the classification description shown in the previous field.
SCHEDULE OF HAZARDS Premium Basis Enter code: An industry code designating the rating basis of the exposure amount.
SCHEDULE OF HAZARDS Exposure Enter amount: The amount of the exposure used for this class code in calculating the premium. The contents of this data element depends on the rating basis used. The full amount of exposure is contained.
SCHEDULE OF HAZARDS Terr. Enter code: The rating territory code based on location from the appropriate state exception page.
SCHEDULE OF HAZARDS Rate - Prem/Ops Enter rate: The separate Premises Operations manual rate applicable to the classification.
SCHEDULE OF HAZARDS Rate - Products Enter rate: The separate Products rate applicable to the classification.
SCHEDULE OF HAZARDS Premium - Prem/Ops Enter amount: The premium associated with the premises operations coverage.
SCHEDULE OF HAZARDS Premium - Products Enter amount: The premium associated with the products coverage.
SCHEDULE OF HAZARDS Location # Enter number: The producer assigned identifier for the location number of the risk's location as it appears on the Applicant Information Section of ACORD 125. All classifications should be grouped by location number.
SCHEDULE OF HAZARDS Hazard # Enter number: A unique (within location) number distinguishing this unit-at-risk from the others.
SCHEDULE OF HAZARDS Classification Enter text: The classification the applicant's liability exposures by location, using the ISO Classification Table or other industry organization rules. Enter the appropriate class description from the table in this field.
SCHEDULE OF HAZARDS Class Code Enter code: The general liability class code that corresponds to the classification description shown in the previous field.
SCHEDULE OF HAZARDS Premium Basis Enter code: An industry code designating the rating basis of the exposure amount.
SCHEDULE OF HAZARDS Exposure Enter amount: The amount of the exposure used for this class code in calculating the premium. The contents of this data element depends on the rating basis used. The full amount of exposure is contained.
SCHEDULE OF HAZARDS Terr. Enter code: The rating territory code based on location from the appropriate state exception page.
SCHEDULE OF HAZARDS Rate - Prem/Ops Enter rate: The separate Premises Operations manual rate applicable to the classification.
SCHEDULE OF HAZARDS Rate - Products Enter rate: The separate Products rate applicable to the classification.
SCHEDULE OF HAZARDS Premium - Prem/Ops Enter amount: The premium associated with the premises operations coverage.
SCHEDULE OF HAZARDS Premium - Products Enter amount: The premium associated with the products coverage.

ACORD 126 (2007/05) 7 of 18

Section Name Field Name Field and/or Section Description
SCHEDULE OF HAZARDS Location # Enter number: The producer assigned identifier for the location number of the risk's location as it appears on the Applicant Information Section of ACORD 125. All classifications should be grouped by location number.
SCHEDULE OF HAZARDS Hazard # Enter number: A unique (within location) number distinguishing this unit-at-risk from the others.
SCHEDULE OF HAZARDS Classification Enter text: The classification the applicant's liability exposures by location, using the ISO Classification Table or other industry organization rules. Enter the appropriate class description from the table in this field.
SCHEDULE OF HAZARDS Class Code Enter code: The general liability class code that corresponds to the classification description shown in the previous field.
SCHEDULE OF HAZARDS Premium Basis Enter code: An industry code designating the rating basis of the exposure amount.
SCHEDULE OF HAZARDS Exposure Enter amount: The amount of the exposure used for this class code in calculating the premium. The contents of this data element depends on the rating basis used. The full amount of exposure is contained.
SCHEDULE OF HAZARDS Terr. Enter code: The rating territory code based on location from the appropriate state exception page.
SCHEDULE OF HAZARDS Rate - Prem/Ops Enter rate: The separate Premises Operations manual rate applicable to the classification.
SCHEDULE OF HAZARDS Rate - Products Enter rate: The separate Products rate applicable to the classification.
SCHEDULE OF HAZARDS Premium - Prem/Ops Enter amount: The premium associated with the premises operations coverage.
SCHEDULE OF HAZARDS Premium - Products Enter amount: The premium associated with the products coverage.
SCHEDULE OF HAZARDS Location # Enter number: The producer assigned identifier for the location number of the risk's location as it appears on the Applicant Information Section of ACORD 125. All classifications should be grouped by location number.
SCHEDULE OF HAZARDS Hazard # Enter number: A unique (within location) number distinguishing this unit-at-risk from the others.
SCHEDULE OF HAZARDS Classification Enter text: The classification the applicant's liability exposures by location, using the ISO Classification Table or other industry organization rules. Enter the appropriate class description from the table in this field.
SCHEDULE OF HAZARDS Class Code Enter code: The general liability class code that corresponds to the classification description shown in the previous field.
SCHEDULE OF HAZARDS Premium Basis Enter code: An industry code designating the rating basis of the exposure amount.
SCHEDULE OF HAZARDS Exposure Enter amount: The amount of the exposure used for this class code in calculating the premium. The contents of this data element depends on the rating basis used. The full amount of exposure is contained.

ACORD 126 (2007/05) 8 of 18

Section Name Field Name Field and/or Section Description
SCHEDULE OF HAZARDS Terr. Enter code: The rating territory code based on location from the appropriate state exception page.
SCHEDULE OF HAZARDS Rate - Prem/Ops Enter rate: The separate Premises Operations manual rate applicable to the classification.
SCHEDULE OF HAZARDS Rate - Products Enter rate: The separate Products rate applicable to the classification.
SCHEDULE OF HAZARDS Premium - Prem/Ops Enter amount: The premium associated with the premises operations coverage.
SCHEDULE OF HAZARDS Premium - Products Enter amount: The premium associated with the products coverage.
SCHEDULE OF HAZARDS Location # Enter number: The producer assigned identifier for the location number of the risk's location as it appears on the Applicant Information Section of ACORD 125. All classifications should be grouped by location number.
SCHEDULE OF HAZARDS Hazard # Enter number: A unique (within location) number distinguishing this unit-at-risk from the others.
SCHEDULE OF HAZARDS Classification Enter text: The classification the applicant's liability exposures by location, using the ISO Classification Table or other industry organization rules. Enter the appropriate class description from the table in this field.
SCHEDULE OF HAZARDS Class Code Enter code: The general liability class code that corresponds to the classification description shown in the previous field.
SCHEDULE OF HAZARDS Premium Basis Enter code: An industry code designating the rating basis of the exposure amount.
SCHEDULE OF HAZARDS Exposure Enter amount: The amount of the exposure used for this class code in calculating the premium. The contents of this data element depends on the rating basis used. The full amount of exposure is contained.
SCHEDULE OF HAZARDS Terr. Enter code: The rating territory code based on location from the appropriate state exception page.
SCHEDULE OF HAZARDS Rate - Prem/Ops Enter rate: The separate Premises Operations manual rate applicable to the classification.
SCHEDULE OF HAZARDS Rate - Products Enter rate: The separate Products rate applicable to the classification.
SCHEDULE OF HAZARDS Premium - Prem/Ops Enter amount: The premium associated with the premises operations coverage.
SCHEDULE OF HAZARDS Premium - Products Enter amount: The premium associated with the products coverage.
CLAIMS MADE 1. Proposed Retroactive Date Enter date: The retroactive date you are requesting for the policy being applied for. This is the proposed earliest date for which an occurrence could "trigger" coverage under a Claims Made policy.
CLAIMS MADE 2. Entry date into uninterrupted claims made coverage Enter date: The retroactive date shown on the applicant's first Claims Made policy. If this is the first such policy, the date will be the same as the proposed retroactive date shown on the preceding field. If this is a renewal, it is the effective date of the first policy issued in the sequence of uninterrupted Claims Made policies.

ACORD 126 (2007/05) 9 of 18

Section Name Field Name Field and/or Section Description
CLAIMS MADE 3. Has any product, work, accident or location been excluded, uninsured or self-insured from any previous coverage?-Yes checkbox Enter code: The response to the question, "Has any product, work, accident or location been excluded, uninsured or self-insured from any previous coverage?".
Enter text: An explanation of a response to a general information or underwriting question.
CLAIMS MADE Remarks Normally, "Yes" responses require an explanation.
4. Was tail coverage purchased
under any previous policy?-Yes Enter code: The response to the question, "Was tail coverage purchased under any
CLAIMS MADE checkbox previous policy?".
Enter text: An explanation of a response to a general information or underwriting question.
CLAIMS MADE Remarks Normally, "Yes" responses require an explanation.
EMPLOYEE BENEFITS LIABILITY Deductible Per Claim: Enter deductible: The deductible per claim applicable to Employee Benefits Liability coverage.
EMPLOYEE BENEFITS
LIABILITY Number of Employees: Enter number: The total number of employees.
EMPLOYEE BENEFITS Number of Employees Covered By
LIABILITY Employee Benefits Plan: Enter number: The total number of employees covered by employee benefits plans.
EMPLOYEE BENEFITS Enter date: The retroactive date that is the earliest date for which an occurrence could
LIABILITY Retroactive Date: "trigger" coverage under Employee Benefits coverage.
1. Does applicant draw plans,
designs, or specifications for Enter code: The response to the question, "Does applicant draw plans, designs or
CONTRACTORS others? Yes checkbox specifications for others?".
Enter text: An explanation of a response to a general information or underwriting question.
CONTRACTORS Remarks Normally, "Yes" responses require an explanation.
2. Do any operations include
blasting or utilize or store Enter code: The response to the question, "Do any operations include blasting or utilize, or
CONTRACTORS explosive material? Yes checkbox store explosive material?".
Enter text: An explanation of a response to a general information or underwriting question.
CONTRACTORS Remarks Normally, "Yes" responses require an explanation.
3. Do any operations include
evacuation, tunneling,
underground work or earth Enter code: The response to the question, "Does any operation involve excavation,
CONTRACTORS moving? Yes checkbox tunneling, underground work or earth moving?".

ACORD 126 (2007/05) 10 of 18

Section Name Field Name Field and/or Section Description
Enter text: An explanation of a response to a general information or underwriting question.
CONTRACTORS Remarks Normally, "Yes" responses require an explanation.
4. Do your subcontractors carry
coverages or limits less than Enter code: The response to the question, "Do subcontractors carry coverages or limits
CONTRACTORS yours? Yes checkbox less than applicant?".
Enter text: An explanation of a response to a general information or underwriting question.
CONTRACTORS Remarks Normally, "Yes" responses require an explanation.
5. Are subcontractors allowed to
work without providing you with
Certificates of Insurance? Yes Enter code: The response to the question, "Are subcontractors allowed to work without
CONTRACTORS checkbox providing you with a certificate of insurance?".
Enter text: An explanation of a response to a general information or underwriting question.
CONTRACTORS Remarks Normally, "Yes" responses require an explanation.
6. Does applicant lease equipment
to others with or without Enter code: The response to the question, "Does applicant lease equipment to others with
CONTRACTORS operators? Yes checkbox or without operators?".
Enter text: An explanation of a response to a general information or underwriting question.
CONTRACTORS Remarks Normally, "Yes" responses require an explanation.
CONTRACTORS $ Paid to Subcontractors Enter amount: The total dollar amount for work that the contractor pays to subcontractors.
Enter percentage: The percentage of the work described by the applicant as
CONTRACTORS % of Work Subcontracted subcontracted out.
CONTRACTORS # Full Time Staff Enter number: The number of individuals employed full time by the applicant.
CONTRACTORS # Part Time Staff Enter number: The number of individuals employed part time by the applicant.
Remarks/Describe the type of work Enter text: An explanation of a response to a general information or underwriting question.
CONTRACTORS & percentage subcontracted Normally, "Yes" responses require an explanation.
PRODUCTS/COMPLETED Enter text: The name used to identify the product manufactured or sold or service
OPERATIONS Products provided by the applicant.
PRODUCTS/COMPLETED Enter amount: The whole dollar estimate of the annual sales receipts realized by this
OPERATIONS Annual Gross Sales product or service.
PRODUCTS/COMPLETED
OPERATIONS # of Units Enter number: The number of units of this product manufactured and/or sold each year.
PRODUCTS/COMPLETED Enter number: The number of months the product or service has been marketed to the
OPERATIONS Time in Market public.

ACORD 126 (2007/05) 11 of 18

Section Name Field Name Field and/or Section Description
PRODUCTS/COMPLETED OPERATIONS Expected Life Enter number: The anticipated number of months of useful life of the product or service.
PRODUCTS/COMPLETED OPERATIONS Intended Use Enter text: The intended use of the product.
PRODUCTS/COMPLETED OPERATIONS Principal Components Enter text: The principal components of the product.
PRODUCTS/COMPLETED OPERATIONS Products Enter text: The name used to identify the product manufactured or sold or service provided by the applicant.
PRODUCTS/COMPLETED OPERATIONS Annual Gross Sales Enter amount: The whole dollar estimate of the annual sales receipts realized by this product or service.
PRODUCTS/COMPLETED OPERATIONS # of Units Enter number: The number of units of this product manufactured and/or sold each year.
PRODUCTS/COMPLETED OPERATIONS Time in Market Enter number: The number of months the product or service has been marketed to the public.
PRODUCTS/COMPLETED OPERATIONS Expected Life Enter number: The anticipated number of months of useful life of the product or service.
PRODUCTS/COMPLETED OPERATIONS Intended Use Enter text: The intended use of the product.
PRODUCTS/COMPLETED OPERATIONS Principal Components Enter text: The principal components of the product.
PRODUCTS/COMPLETED OPERATIONS Products Enter text: The name used to identify the product manufactured or sold or service provided by the applicant.
PRODUCTS/COMPLETED OPERATIONS Annual Gross Sales Enter amount: The whole dollar estimate of the annual sales receipts realized by this product or service.
PRODUCTS/COMPLETED OPERATIONS # of Units Enter number: The number of units of this product manufactured and/or sold each year.
PRODUCTS/COMPLETED OPERATIONS Time in Market Enter number: The number of months the product or service has been marketed to the public.
PRODUCTS/COMPLETED OPERATIONS Expected Life Enter number: The anticipated number of months of useful life of the product or service.
PRODUCTS/COMPLETED OPERATIONS Intended Use Enter text: The intended use of the product.
PRODUCTS/COMPLETED OPERATIONS Principal Components Enter text: The principal components of the product.

ACORD 126 (2007/05) 12 of 18

Section Name Field Name Field and/or Section Description
1. Does applicant install, service or
PRODUCTS/COMPLETED demonstrate products? Yes Enter code: The response to the question, "Does applicant install, service or demonstrate
OPERATIONS checkbox products?".
PRODUCTS/COMPLETED Enter text: An explanation of a response to a general information or underwriting question.
OPERATIONS Remarks Normally, "Yes" responses require an explanation.
2. Foreign products sold,
PRODUCTS/COMPLETED distributed, or used as Enter code: The response to the question, "Foreign products, sold, distributed, used as
OPERATIONS components? Yes checkbox components?".
3. Research and development
PRODUCTS/COMPLETED conducted or new products Enter code: The response to the question, "Research and development conducted or new
OPERATIONS planned? Yes checkbox products planned?".
PRODUCTS/COMPLETED Enter text: An explanation of a response to a general information or underwriting question.
OPERATIONS Remarks Normally, "Yes" responses require an explanation.
4. Guarantees, warranties, hold
PRODUCTS/COMPLETED harmless agreements? Yes Enter code: The response to the question, "Guarantees, warrantees, hold harmless
OPERATIONS checkbox agreements?".
PRODUCTS/COMPLETED Enter text: An explanation of a response to a general information or underwriting question.
OPERATIONS Remarks Normally, "Yes" responses require an explanation.
5. Products related to
PRODUCTS/COMPLETED aircraft/space industry? Yes
OPERATIONS checkbox Enter code: The response to the question, "Products related to aircraft/space industry?".
PRODUCTS/COMPLETED Enter text: An explanation of a response to a general information or underwriting question.
OPERATIONS Remarks Normally, "Yes" responses require an explanation.
PRODUCTS/COMPLETED 6. Products recalled, discontinued,
OPERATIONS changed? Yes checkbox Enter code: The response to the question, "Products recalled, discontinued, changed?".
PRODUCTS/COMPLETED Enter text: An explanation of a response to a general information or underwriting question.
OPERATIONS Remarks Normally, "Yes" responses require an explanation.
7. Products of others sold or
PRODUCTS/COMPLETED repackaged under applicant's Enter code: The response to the question, "Products of others sold or repackaged under
OPERATIONS label? Yes checkbox applicant label?".
PRODUCTS/COMPLETED Enter text: An explanation of a response to a general information or underwriting question.
OPERATIONS Remarks Normally, "Yes" responses require an explanation.
PRODUCTS/COMPLETED 8. Products under label of others?
OPERATIONS Yes checkbox Enter code: The response to the question, "Products under label of others?".

ACORD 126 (2007/05) 13 of 18

Section Name Field Name Field and/or Section Description
PRODUCTS/COMPLETED Enter text: An explanation of a response to a general information or underwriting question.
OPERATIONS Remarks Normally, "Yes" responses require an explanation.
PRODUCTS/COMPLETED 9. Vendor's coverage required?
OPERATIONS Yes checkbox Enter code: The response to the question, "Vendors coverage required?".
PRODUCTS/COMPLETED Enter text: An explanation of a response to a general information or underwriting question.
OPERATIONS Remarks Normally, "Yes" responses require an explanation.
10. Does any named insured sell to
PRODUCTS/COMPLETED any other named insured? Yes Enter code: The response to the question, "Does any named insured sell to other named
OPERATIONS checkbox insured?".
PRODUCTS/COMPLETED Enter text: An explanation of a response to a general information or underwriting question.
OPERATIONS Remarks Normally, "Yes" responses require an explanation.
ADDITIONAL
INTERESTS/CERTIFICATE ACORD 45 attached for additional Check the box (if applicable): Indicates that further additional interests appear on the
RECIPIENTS names checkbox attached ACORD 45.
ADDITIONAL
INTERESTS/CERTIFICATE
RECIPIENTS Interest-Additional Insured Check the box (if applicable): Indicates the additional interest type is an additional insured.
ADDITIONAL
INTERESTS/CERTIFICATE
RECIPIENTS Loss payee Check the box (if applicable): Indicates the additional interest type is a loss payee.
ADDITIONAL
INTERESTS/CERTIFICATE
RECIPIENTS Mortgagee Check the box (if applicable): Indicates the additional interest type is a mortgagee.
ADDITIONAL
INTERESTS/CERTIFICATE
RECIPIENTS Lienholder Check the box (if applicable): Indicates the additional interest type is a lien holder.
ADDITIONAL
INTERESTS/CERTIFICATE Check the box (if applicable): Indicates the additional interest type is an employee as
RECIPIENTS Employee as Lessor lessor.
ADDITIONAL
INTERESTS/CERTIFICATE Check the box (if applicable): Indicates the additional interest is not any of the types listed
RECIPIENTS Other checkbox on the form.
ADDITIONAL
INTERESTS/CERTIFICATE
RECIPIENTS Other Field Enter text: The description of the type of interest in the item.

ACORD 126 (2007/05) 14 of 18

Section Name Field Name Field and/or Section Description
ADDITIONAL INTERESTS/CERTIFICATE RECIPIENTS Rank Enter number: The ranking of 'this' additional interest when multiple additional interests are associated with the same item.
ADDITIONAL INTERESTS/CERTIFICATE RECIPIENTS Name Enter text: The additional interest's full name.
ADDITIONAL INTERESTS/CERTIFICATE RECIPIENTS Address Enter text: The additional interest's mailing address line one.
ADDITIONAL INTERESTS/CERTIFICATE RECIPIENTS Address Enter text: The additional interest's mailing address line two.
ADDITIONAL INTERESTS/CERTIFICATE RECIPIENTS Address Enter text: The additional interest's mailing address city name.
ADDITIONAL INTERESTS/CERTIFICATE RECIPIENTS Address Enter code: The additional interest's mailing address state or province code.
ADDITIONAL INTERESTS/CERTIFICATE RECIPIENTS Address Enter code: The additional interest's mailing address postal code.
ADDITIONAL INTERESTS/CERTIFICATE RECIPIENTS Reference # Enter identifier: The account number (loan number).
ADDITIONAL INTERESTS/CERTIFICATE RECIPIENTS Certificate Required Checkbox Check the box (if applicable): Indicates if the additional interest requires a Certificate of Insurance,
ADDITIONAL INTERESTS/CERTIFICATE RECIPIENTS Interest in Item Number - Location: Enter number: The producer assigned number of the location which has an additional interest.
ADDITIONAL INTERESTS/CERTIFICATE RECIPIENTS Building: Enter number: The producer assigned number of the building which has an additional interest.
ADDITIONAL INTERESTS/CERTIFICATE RECIPIENTS Vehicle: Enter number: The producer assigned number of the vehicle which has an additional interest.

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Section Name Field Name Field and/or Section Description
ADDITIONAL
INTERESTS/CERTIFICATE Enter number: The producer assigned number of the boat which has an additional
RECIPIENTS Boat: interest.
ADDITIONAL
INTERESTS/CERTIFICATE Enter number: The producer assigned number of the scheduled item which has an
RECIPIENTS Scheduled Item Number: additional interest.
ADDITIONAL
INTERESTS/CERTIFICATE
RECIPIENTS Other Field Enter text: The description of the item which has an additional interest.
ADDITIONAL INTERESTS/CERTIFICATE RECIPIENTS Item Description Enter text: The description of the item of interest if needed to further clarify. For a vehicle, list the make, model and VIN number. For a scheduled item, list the description, such as three carat diamond in six point setting.
GENERAL INFORMATION 1. Any medical facilities provided or medical professionals employed or contracted? Yes checkbox Enter code: The response to the question, "Any medical facilities provided or medical professionals employed or contracted?".
Enter text: An explanation of a response to a general information or underwriting question.
GENERAL INFORMATION Remarks Normally, "Yes" responses require an explanation.
2. Any exposure to
radioactive/nuclear materials? Yes Enter code: The response to the question, "Any exposure to radioactive/nuclear
GENERAL INFORMATION checkbox materials?".
Enter text: An explanation of a response to a general information or underwriting question.
GENERAL INFORMATION Remarks Normally, "Yes" responses require an explanation.
GENERAL INFORMATION 3. Do operations involve storing, treating, discharging, applying, disposing or transporting hazardous material? Yes checkbox Enter code: The response to the question, "Do/have past, present or discontinued operations involve(d) storing, treating, discharging, applying, disposing, or transporting of hazardous material?".
Enter text: An explanation of a response to a general information or underwriting question.
GENERAL INFORMATION Remarks Normally, "Yes" responses require an explanation.
4. Any listed operations sold,
acquired, or discontinued in the Enter code: The response to the question, "Any operations sold, acquired or discontinued
GENERAL INFORMATION last five (5) years? Yes checkbox in the last specified number of years?".
Enter text: An explanation of a response to a general information or underwriting question.
GENERAL INFORMATION Remarks Normally, "Yes" responses require an explanation.

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Section Name Field Name Field and/or Section Description
GENERAL INFORMATION 5. Is any machinery or equipment loaned or rented to others? Yes checkbox Enter code: The response to the question, "Machinery or equipment loaned or rented to others?".
GENERAL INFORMATION Remarks Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION 6. Any watercraft, docks, floats owned, hired, or leased? Yes checkbox Enter code: The response to the question, "Any watercraft, docks, floats owned, hired or leased?".
GENERAL INFORMATION Remarks Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION 7. Any parking facilities owned/ rented? Yes checkbox Enter code: The response to the question, "Any parking facilities owned/rented?".
GENERAL INFORMATION Remarks Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION 8. Is a fee charged for parking? Yes checkbox Enter code: The response to the question, "Is a fee charged for parking?".
GENERAL INFORMATION Remarks Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION 9. Are any recreational facilities provided? Yes checkbox Enter code: The response to the question, "Recreation facilities provided?".
GENERAL INFORMATION Remarks Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION 10. Is there a swimming pool on the premises? Yes checkbox Enter code: The response to the question, "Is there a swimming pool on the premises?".
GENERAL INFORMATION Remarks Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION 11. Any sporting or social events sponsored? Yes checkbox Enter code: The response to the question, "Sporting or social events sponsored?".
GENERAL INFORMATION Remarks Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION 12. Any structural alterations contemplated? Yes checkbox Enter code: The response to the question, "Any structural alterations contemplated?".
GENERAL INFORMATION Remarks Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.

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Section Name Field Name Field and/or Section Description
GENERAL INFORMATION 13. Any demolition exposure contemplated? Yes checkbox Enter code: The response to the question, "Any demolition exposure contemplated?".
GENERAL INFORMATION Remarks Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION 14. Has applicant been active in or is currently active in joint ventures? Yes checkbox Enter code: The response to the question, "Has applicant been active in or is currently active in joint ventures?".
GENERAL INFORMATION Remarks Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION 15. Do you lease employees to or from others? Yes checkbox Enter code: The response to the question, "Do you lease employees to or from other employers?".
GENERAL INFORMATION Remarks Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION 16. Is there a labor interchange with any other business or subsidiaries? Yes checkbox Enter code: The response to the question, "Is there a labor interchange with any other business or subsidiaries?".
GENERAL INFORMATION Remarks Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION 17. Are daycare facilities operated or controlled? Yes checkbox Enter code: The response to the question, "Are day care facilities operated or controlled?".
GENERAL INFORMATION Remarks Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION 18. Have any crimes occurred or been attempted on your premises within the last three (3) years? Yes checkbox Enter code: The response to the question, "Have any crimes occurred or been attempted on your premises within the last specified number of years?".
GENERAL INFORMATION Remarks Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION 19. Is there a formal, written safety and security policy in effect? Yes checkbox Enter code: The response to the question, "Is there a formal, written safety and security policy in effect?".
GENERAL INFORMATION Remarks Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
Section Name Field Name Field and/or Section Description
GENERAL INFORMATION 20. Does the businesses' promotional literature make any representations about the safety or security of the premises? Yes checkbox Enter code: The response to the question, "Does the business' promotional literature make any representation about the safety or security of the premises?".
GENERAL INFORMATION Remarks Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION REMARKS Enter text: The remarks associated with the general liability line of business.
Edition Date The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM).

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