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ACORD 137 NJ (2008/08) 1 of 24
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Universal wording updates to improve clarity and intent were made to all FIG text for this form on 04/24/2009. |
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Section Name |
Field Name |
Field and/or Section Description |
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TITLE ACORD 137 NJ (2008/08) |
New Jersey Commercial Auto, Coverages / Limits Section |
The title of the form. ACORD 137 NJ, New Jersey Commercial Auto Coverages/Limits Section, is used to collect the coverage and limit information necessary to write Business Auto, Truckers or Motor Carrier insurance in this state. Use this form with ACORD 127, Business Auto Section, or ACORD 132, Truckers/Motor Carrier Section. The following are the specific differences in this state. * Personal Injury Protection coverages have been revised to provide for unique New Jersey coverages. Refer to your state Manual. * Uninsured and Underinsured Motorists coverages are combined. * Comprehensive is known as "other than collision coverage". * The fraud statement on the back of the form is revised to comply with New Jersey law. * A statement has been added referencing the offer of Uninsured/Underinsured Motorists coverage up to the policy's BI limits. |
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IDENTIFICATION SECTION |
Agency Customer ID |
Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage). |
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IDENTIFICATION SECTION |
Date |
Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY) |
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IDENTIFICATION SECTION |
Agency |
Enter text: The full name of the producer/agency. |
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IDENTIFICATION SECTION |
Policy Number |
Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. |
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IDENTIFICATION SECTION |
Carrier |
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. |
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IDENTIFICATION SECTION |
NAIC Code |
Enter code: The identification code assigned to the insurer by the NAIC. |
ACORD 137 NJ (2008/08) 2 of 24
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Section Name |
Field Name |
Field and/or Section Description |
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IDENTIFICATION SECTION |
Named Insured(s) |
Enter text: The named insured(s) as it/they will appear on the policy declarations page. |
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IDENTIFICATION SECTION |
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Enter text: The named insured(s) as it/they will appear on the policy declarations page. |
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IDENTIFICATION SECTION |
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Enter text: The named insured(s) as it/they will appear on the policy declarations page. |
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IDENTIFICATION SECTION |
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Enter text: The named insured(s) as it/they will appear on the policy declarations page. |
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IDENTIFICATION SECTION |
Effective Date: |
Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. |
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BUSINESS AUTO |
Liability 1 |
Check the box (if applicable): Indicates that any auto is covered. |
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BUSINESS AUTO |
Liability 2 |
Check the box (if applicable): Indicates that all owned autos are covered. |
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BUSINESS AUTO |
Liability 3 |
Check the box (if applicable): Indicates that owned private passenger autos are covered. |
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BUSINESS AUTO |
Liability 4 |
Check the box (if applicable): Indicates that owned autos other than private passenger autos are covered. |
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BUSINESS AUTO |
Liability 7 |
Check the box (if applicable): Indicates that autos specified on the vehicle schedule are covered. |
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BUSINESS AUTO |
Liability 8 |
Check the box (if applicable): Indicates that hired autos are covered. |
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BUSINESS AUTO |
Liability 9 |
Check the box (if applicable): Indicates that non-owned autos are covered. |
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BUSINESS AUTO |
Liability Other |
Check the box (if applicable): Indicates that a symbol other than those listed should be used. |
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BUSINESS AUTO |
Liability Other Symbol |
Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable. |
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BUSINESS AUTO |
Limits - CSL |
Check the box (if applicable): Indicates if the limit shown is for combined single limit on the coverage. |
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BUSINESS AUTO |
Limits - BI Ea Per |
Check the box (if applicable): Indicates if the limit shown is the bodily injury each person limit on the coverage. |
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BUSINESS AUTO |
Limit Amount |
Enter limit: The vehicle policy, bodily injury per person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). |
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BUSINESS AUTO |
BI Ea Accident ($) |
Enter limit: The vehicle policy, bodily injury per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). |
ACORD 137 NJ (2008/08) 3 of 24
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Section Name |
Field Name |
Field and/or Section Description |
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BUSINESS AUTO |
Property Damage ($) |
Enter limit: The vehicle policy, property damage per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). |
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BUSINESS AUTO |
Personal Injury Protection 5 |
Check the box (if applicable): Indicates that all owned autos which require no-fault coverage are covered. |
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BUSINESS AUTO |
Personal Injury Protection 7 |
Check the box (if applicable): Indicates that autos specified on the vehicle schedule are covered. |
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BUSINESS AUTO |
Personal Injury Protection Other |
Check the box (if applicable): Indicates that a symbol other than those listed should be used. |
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BUSINESS AUTO |
Personal Injury Protection Other Symbol |
Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable. |
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BUSINESS AUTO |
Lawsuit Threshold |
Check the box (if applicable): Indicates the personal injury protection (PIP) has a lawsuit threshold. |
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BUSINESS AUTO |
No Threshold |
Check the box (if applicable): Indicates the personal injury protection (PIP) has no lawsuit threshold. |
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BUSINESS AUTO |
Medical Only |
Check the box (if applicable): Indicates the personal injury protection (PIP) medical expense only option has been selected. |
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BUSINESS AUTO |
Health Insurance Option Yes |
Check the box (if applicable): Indicates the personal injury protection (PIP) health insurance option has been selected. This indicates that PIP medical benefits are secondary. |
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BUSINESS AUTO |
Health Insurance Option No |
Check the box (if applicable): Indicates the personal injury protection (PIP) health insurance option has not been selected. |
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BUSINESS AUTO |
Medical Expense Amount |
Enter limit: The personal injury protection (PIP) medical expense limit amount. |
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BUSINESS AUTO |
Deductible |
Enter deductible: The deductible amount for personal injury protection (PIP) coverage. |
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BUSINESS AUTO |
Ext Medical Expense Each Person |
Enter limit: The extended medical expense per person limit amount. |
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BUSINESS AUTO |
Extra PIP Options Number of Relatives |
Enter number: The additional personal injury protection (APIP) number of additional relatives being extended additional PIP. |
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BUSINESS AUTO |
Uninsured / Underinsured Motorists 2 |
Check the box (if applicable): Indicates that all owned autos are covered. |
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BUSINESS AUTO |
Uninsured / Underinsured Motorists 3 |
Check the box (if applicable): Indicates that owned private passenger autos are covered. |
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BUSINESS AUTO |
Uninsured / Underinsured Motorists 4 |
Check the box (if applicable): Indicates that owned autos other than private passenger autos are covered. |
ACORD 137 NJ (2008/08) 4 of 24
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Section Name |
Field Name |
Field and/or Section Description |
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BUSINESS AUTO |
Uninsured / Underinsured Motorists 6 |
Check the box (if applicable): Indicates that owned autos subject to compulsory uninsured motorists law are covered. |
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BUSINESS AUTO |
Uninsured / Underinsured Motorists 7 |
Check the box (if applicable): Indicates that autos specified on the vehicle schedule are covered. |
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BUSINESS AUTO |
Uninsured / Underinsured Motorists Other |
Check the box (if applicable): Indicates that a symbol other than those listed should be used. |
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BUSINESS AUTO |
Uninsured / Underinsured Motorists Other Symbol |
Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable. |
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BUSINESS AUTO |
CSL (checkbox) |
Check the box (if applicable): Indicates if the limit shown is for combined single limit on the coverage. |
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BUSINESS AUTO |
BI Ea Per (checkbox) |
Check the box (if applicable): Indicates if the limit shown is the bodily injury each person limit on the coverage. |
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BUSINESS AUTO |
Amount |
Enter limit: The uninsured / underinsured motorists bodily injury per person limit. The use of this limit varies by state. On commercial policies, this may contain the combined single limit per accident amount. |
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BUSINESS AUTO |
BI Each Accident ($) |
Enter limit: The uninsured / underinsured motorists bodily injury per accident limit (in some states this may contain the uninsured / underinsured motorists combined single limit per accident limit). The use of this limit varies by state. |
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BUSINESS AUTO |
Property Damage ($) |
Enter limit: The uninsured / underinsured property damage limit amount. |
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BUSINESS AUTO |
Hired / Borrowed Liability Yes |
Check the box (if applicable): Indicates if hired / borrowed coverage applies. |
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BUSINESS AUTO |
States |
Enter code: Indicates a state where autos are hired or borrowed. |
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BUSINESS AUTO |
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Enter code: Indicates a state where autos are hired or borrowed. |
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BUSINESS AUTO |
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Enter code: Indicates a state where autos are hired or borrowed. |
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BUSINESS AUTO |
Hired / Borrowed Liability No |
Check the box (if applicable): Indicates that hired / borrowed coverage does not apply. |
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BUSINESS AUTO |
If any Basis (checkbox) |
Enter amount: The estimated amount it will cost to hire the vehicles. |
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BUSINESS AUTO |
Cost of Hire |
Check the box (if applicable): Indicates if the rating basis is "if any". Check this box if the exposure is minimal. The actual exposure is determined at the time of audit. |
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BUSINESS AUTO |
Non-Owned Liability Yes |
Check the box (if applicable): Indicates if non-owned coverage applies. As used here, enter state(s) where employees use their own autos in the operations of the applicant's business. |
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BUSINESS AUTO |
States |
Enter code: Indicates a state where autos are non-owned. |
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BUSINESS AUTO |
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Enter code: Indicates a state where autos are non-owned. |
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BUSINESS AUTO |
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Enter code: Indicates a state where autos are non-owned. |
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BUSINESS AUTO |
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Enter code: Indicates a state where autos are non-owned. |
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BUSINESS AUTO |
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Enter code: Indicates a state where autos are non-owned. |
ACORD 137 NJ (2008/08) 5 of 24
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Section Name |
Field Name |
Field and/or Section Description |
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BUSINESS AUTO |
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Enter code: Indicates a state where autos are non-owned. |
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BUSINESS AUTO |
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Enter code: Indicates a state where autos are non-owned. |
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BUSINESS AUTO |
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Enter code: Indicates a state where autos are non-owned. |
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BUSINESS AUTO |
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Enter code: Indicates a state where autos are non-owned. |
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BUSINESS AUTO |
Non-Owned Liability No |
Check the box (if applicable): Indicates that non-owned coverage does not apply. |
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BUSINESS AUTO |
Group Type - Employees |
Check the box (if applicable): Indicates that non-owned liability coverage pertains to employees. |
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BUSINESS AUTO |
Number of Employees |
Enter number: The number of employees that use their own automobiles. |
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BUSINESS AUTO |
Volunteers |
Check the box (if applicable): Indicates that non-owned liability coverage pertains to volunteers. |
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BUSINESS AUTO |
Number of Volunteers |
Enter number: The number of volunteers that use their own automobiles. |
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BUSINESS AUTO |
Partners |
Check the box (if applicable): Indicates that non-owned liability coverage pertains to partners. |
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BUSINESS AUTO |
Number of Partners |
Enter number: The number of partners that use their own automobiles. |
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BUSINESS AUTO |
Additional Coverage Description |
Enter text: The description of other coverage (not the limit) on the vehicle policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). |
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BUSINESS AUTO |
Additional Coverage Covered Auto Symbols |
Enter text: The symbols that apply to the other coverage listed. |
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BUSINESS AUTO |
Additional Coverage Limit |
Enter limit: The limit amount of the other coverage. |
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BUSINESS AUTO |
Additional Coverage Description |
Enter text: The description of other coverage (not the limit) on the vehicle policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). |
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BUSINESS AUTO |
Additional Coverage Covered Auto Symbols |
Enter text: The symbols that apply to the other coverage listed. |
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BUSINESS AUTO |
Additional Coverage Limit |
Enter limit: The limit amount of the other coverage. |
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BUSINESS AUTO |
Towing & Labor 3 |
Check the box (if applicable): Indicates that owned private passenger autos are covered. |
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BUSINESS AUTO |
Towing & Labor 7 |
Check the box (if applicable): Indicates that autos specified on the vehicle schedule are covered. |
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BUSINESS AUTO |
Towing & Labor Other |
Check the box (if applicable): Indicates that a symbol other than those listed should be used. |
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BUSINESS AUTO |
Towing & Labor Other Symbol |
Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable. |
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BUSINESS AUTO |
Limit ($) |
Enter limit: The towing and labor limit amount. |
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BUSINESS AUTO |
Other Than Collision (OTC) 2 |
Check the box (if applicable): Indicates that all owned autos are covered. |
ACORD 137 NJ (2008/08) 6 of 24
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Section Name |
Field Name |
Field and/or Section Description |
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BUSINESS AUTO |
Other Than Collision (OTC) 3 |
Check the box (if applicable): Indicates that owned private passenger autos are covered. |
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BUSINESS AUTO |
Other Than Collision (OTC) 4 |
Check the box (if applicable): Indicates that owned autos other than private passenger autos are covered. |
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BUSINESS AUTO |
Other Than Collision (OTC) 7 |
Check the box (if applicable): Indicates that autos specified on the vehicle schedule are covered. |
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BUSINESS AUTO |
Other Than Collision (OTC) 8 |
Check the box (if applicable): Indicates that hired autos are covered. |
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BUSINESS AUTO |
Other Than Collision (OTC) Other |
Check the box (if applicable): Indicates that a symbol other than those listed should be used. |
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BUSINESS AUTO |
Other Than Collision (OTC) Other Symbol |
Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable. |
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BUSINESS AUTO |
Specified Causes of Loss 2 |
Check the box (if applicable): Indicates that all owned autos are covered. |
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BUSINESS AUTO |
Specified Causes of Loss 3 |
Check the box (if applicable): Indicates that owned private passenger autos are covered. |
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BUSINESS AUTO |
Specified Causes of Loss 4 |
Check the box (if applicable): Indicates that owned autos other than private passenger autos are covered. |
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BUSINESS AUTO |
Specified Causes of Loss 7 |
Check the box (if applicable): Indicates that autos specified on the vehicle schedule are covered. |
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BUSINESS AUTO |
Specified Causes of Loss 8 |
Check the box (if applicable): Indicates that hired autos are covered. |
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BUSINESS AUTO |
Specified Causes of Loss Other |
Check the box (if applicable): Indicates that a symbol other than those listed should be used. |
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BUSINESS AUTO |
Specified Causes of Loss Other Symbol |
Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable. |
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BUSINESS AUTO |
Collision 2 |
Check the box (if applicable): Indicates that all owned autos are covered. |
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BUSINESS AUTO |
Collision 3 |
Check the box (if applicable): Indicates that owned private passenger autos are covered. |
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BUSINESS AUTO |
Collision 4 |
Check the box (if applicable): Indicates that owned autos other than private passenger autos are covered. |
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BUSINESS AUTO |
Collision 7 |
Check the box (if applicable): Indicates that autos specified on the vehicle schedule are covered. |
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BUSINESS AUTO |
Collision 8 |
Check the box (if applicable): Indicates that hired autos are covered. |
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BUSINESS AUTO |
Collision Other |
Check the box (if applicable): Indicates that a symbol other than those listed should be used. |
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BUSINESS AUTO |
Collision Other Symbol |
Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable. |
ACORD 137 NJ (2008/08) 7 of 24
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Section Name |
Field Name |
Field and/or Section Description |
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BUSINESS AUTO |
Additional Coverage Description |
Enter text: The description of other coverage (not the limit) on the vehicle policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). |
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BUSINESS AUTO |
Additional Coverage Covered Auto Symbols |
Enter text: The symbols that apply to the other coverage listed. |
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BUSINESS AUTO |
Additional Coverage Limit |
Enter limit: The limit amount of the other coverage. |
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BUSINESS AUTO |
Additional Coverage Description |
Enter text: The description of other coverage (not the limit) on the vehicle policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). |
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BUSINESS AUTO |
Additional Coverage Covered Auto Symbols |
Enter text: The symbols that apply to the other coverage listed. |
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BUSINESS AUTO |
Additional Coverage Limit |
Enter limit: The limit amount of the other coverage. |
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BUSINESS AUTO |
Hired Physical Damage States |
Enter code: Indicates a state where autos are hired and have physical damage coverage. |
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BUSINESS AUTO |
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Enter code: Indicates a state where autos are hired and have physical damage coverage. |
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BUSINESS AUTO |
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Enter code: Indicates a state where autos are hired and have physical damage coverage. |
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BUSINESS AUTO |
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Enter code: Indicates a state where autos are hired and have physical damage coverage. |
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BUSINESS AUTO |
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Enter code: Indicates a state where autos are hired and have physical damage coverage. |
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BUSINESS AUTO |
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Enter code: Indicates a state where autos are hired and have physical damage coverage. |
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BUSINESS AUTO |
Hired Physical Damage # Days |
Enter number: The number of days needed to rate Hired Physical Damage Coverage. |
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BUSINESS AUTO |
Hired Physical Damage # Veh |
Enter number: The number of vehicles needed to rate Hired Physical Damage Coverage. |
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BUSINESS AUTO |
Coverage/Deductible Comp (checkbox) |
Check the box (if applicable): Indicates the deductible is for comprehensive or other than collision coverage. |
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BUSINESS AUTO |
Comp ($) |
Enter deductible: The comprehensive or other than collision deductible amount. |
ACORD 137 NJ (2008/08) 8 of 24
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Section Name |
Field Name |
Field and/or Section Description |
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Check the box (if applicable): Indicates the deductible is for specified causes of loss. The Specified Cause of Loss Codes are: |
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SCL Specified Cause of Loss F Fire |
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F&T Fire and Theft |
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BUSINESS AUTO |
Specified Causes of Loss (checkbox) |
F,T&W Fire, Theft and Wind LSP Limited Specified Perils SP Specified Perils |
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Enter deductible: The deductible associated with specified causes of loss coverage. As |
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BUSINESS AUTO |
Specified Causes of Loss ($) |
used here, enter the deductible only if it is applicable to all vehicles. |
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BUSINESS AUTO |
Coll (checkbox) |
Check the box (if applicable): Indicates the vehicle has collision coverage. |
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BUSINESS AUTO |
Coll ($) |
Enter deductible: The collision deductible amount. |
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BUSINESS AUTO |
Coverage is: Primary (Checkbox) |
Check the box (if applicable): Indicates if this coverage is on a primary basis. |
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Coverage is: Secondary |
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BUSINESS AUTO |
(Checkbox) |
Check the box (if applicable): Indicates if this coverage is on a secondary basis. |
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Enter text: The remarks associated with the commercial vehicle line of business. Enter |
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ENDORSEMENTS / REMARKS |
Endorsements / Remarks |
any endorsements that apply. Be sure to include the form numbers and the required information for attaching the endorsement. Attach ACORD 101, Additional Remarks Schedule, if more space is required. |
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SIGNATURE |
Applicant's Signature |
Sign here: Accommodates the signature of the applicant or named insured. |
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SIGNATURE |
Date |
Enter date: The date the form was signed by the named insured. |
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Sign here: Accommodates the signature of the authorized representative (e.g. producer, |
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SIGNATURE |
Producer's Signature |
agent, broker, etc.). by all companies to issue Certificates. This is required in most states. |
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Enter identifier: The National Producer Number (NPN) as defined in the National |
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Insurance Producer Registry (NIPR). Note: The NPN is not the same as the producer |
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SIGNATURE |
National Producer Number |
state license number. |
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Enter identifier: The customer's identification number assigned by the producer (e.g. |
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IDENTIFICATION SECTION |
Agency Customer ID |
agency or brokerage). |
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TRUCKERS |
Liability 41 |
Check the box (if applicable): Indicates that any auto is covered. |
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TRUCKERS |
Liability 42 |
Check the box (if applicable): Indicates that owned autos only are covered. |
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TRUCKERS |
Liability 43 |
Check the box (if applicable): Indicates that owned commercial autos only are covered. |
ACORD 137 NJ (2008/08) 9 of 24
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Section Name |
Field Name |
Field and/or Section Description |
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TRUCKERS |
Liability 46 |
Check the box (if applicable): Indicates that specifically described autos are covered. |
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TRUCKERS |
Liability 47 |
Check the box (if applicable): Indicates that hired autos only are covered. |
|
TRUCKERS |
Liability 50 |
Check the box (if applicable): Indicates that non-owned autos only are covered. |
|
TRUCKERS |
Liability Other |
Check the box (if applicable): Indicates that a symbol other than those listed should be used. |
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TRUCKERS |
Liability Other Symbol |
Enter code: The symbol code for the coverage. |
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TRUCKERS |
Limits - CSL |
Check the box (if applicable): Indicates if the limit shown is for combined single limit on the coverage. |
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TRUCKERS |
Limits - BI Ea Per |
Check the box (if applicable): Indicates if the limit shown is the bodily injury each person limit on the coverage. |
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TRUCKERS |
Limit Amount |
Enter limit: The vehicle policy, bodily injury per person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). |
|
TRUCKERS |
BI Ea Accident ($) |
Enter limit: The vehicle policy, bodily injury per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). |
|
TRUCKERS |
Property Damage ($) |
Enter limit: The vehicle policy, property damage per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). |
|
TRUCKERS |
Personal Injury Protection 44 |
Check the box (if applicable): Indicates that owned autos subject to no-fault are covered. |
|
TRUCKERS |
Personal Injury Protection 46 |
Check the box (if applicable): Indicates that specifically described autos are covered. |
|
TRUCKERS |
Personal Injury Protection Other |
Check the box (if applicable): Indicates that a symbol other than those listed should be used. |
|
TRUCKERS |
Personal Injury Protection Other Symbol |
Enter code: The symbol code for the coverage. |
|
TRUCKERS |
Lawsuit Threshold |
Check the box (if applicable): Indicates the personal injury protection (PIP) has a lawsuit threshold. |
|
TRUCKERS |
No Threshold |
Check the box (if applicable): Indicates the personal injury protection (PIP) has no lawsuit threshold. |
|
TRUCKERS |
Medical Only |
Check the box (if applicable): Indicates the personal injury protection (PIP) medical expense only option has been selected. |
ACORD 137 NJ (2008/08) 10 of 24
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Section Name |
Field Name |
Field and/or Section Description |
|
TRUCKERS |
Health Insurance Option Yes |
Check the box (if applicable): Indicates the personal injury protection (PIP) health insurance option has been selected. This indicates that PIP medical benefits are secondary. |
|
TRUCKERS |
Health Insurance Option No |
Check the box (if applicable): Indicates the personal injury protection (PIP) health insurance option has not been selected. |
|
TRUCKERS |
Medical Expense Amount |
Enter limit: The personal injury protection (PIP) medical expense limit amount. |
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TRUCKERS |
Deductible |
Enter deductible: The deductible amount for personal injury protection (PIP) coverage. |
|
TRUCKERS |
Ext Medical Expense Each Person |
Enter limit: The extended medical expense per person limit amount. |
|
TRUCKERS |
Extra PIP Options Number of Relatives |
Enter number: The additional personal injury protection (APIP) number of additional relatives being extended additional PIP. |
|
TRUCKERS |
Uninsured / Underinsured Motorists 42 |
Check the box (if applicable): Indicates that owned autos only are covered. |
|
TRUCKERS |
Uninsured / Underinsured Motorists 43 |
Check the box (if applicable): Indicates that owned commercial autos only are covered. |
|
TRUCKERS |
Uninsured / Underinsured Motorists 45 |
Check the box (if applicable): Indicates that owned autos subject to a compulsory uninsured motorist law are covered. |
|
TRUCKERS |
Uninsured / Underinsured Motorists 46 |
Check the box (if applicable): Indicates that specifically described autos are covered. |
|
TRUCKERS |
Uninsured / Underinsured Motorists Other |
Check the box (if applicable): Indicates that a symbol other than those listed should be used. |
|
TRUCKERS |
Uninsured / Underinsured Motorists Other Symbol |
Enter code: The symbol code for the coverage. |
|
TRUCKERS |
CSL (checkbox) |
Check the box (if applicable): Indicates if the limit shown is for combined single limit on the coverage. |
|
TRUCKERS |
BI Ea Per (checkbox) |
Check the box (if applicable): Indicates if the limit shown is the bodily injury each person limit on the coverage. |
|
TRUCKERS |
Amount |
Enter limit: The uninsured / underinsured motorists bodily injury per person limit. The use of this limit varies by state. On commercial policies, this may contain the combined single limit per accident amount. |
|
TRUCKERS |
BI Each Accident ($) |
Enter limit: The uninsured / underinsured motorists bodily injury per accident limit (in some states this may contain the uninsured / underinsured motorists combined single limit per accident limit). The use of this limit varies by state. |
|
TRUCKERS |
Property Damage ($) |
Enter limit: The uninsured / underinsured property damage limit amount. |
ACORD 137 NJ (2008/08) 11 of 24
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Section Name |
Field Name |
Field and/or Section Description |
|
TRUCKERS |
Non-Truckers Hired / Borrowed Liability Yes |
Check the box (if applicable): Indicates if hired / borrowed coverage applies. |
|
TRUCKERS |
Non-Truckers Hired / Borrowed Liability States |
Enter code: Indicates a state where autos are hired or borrowed. |
|
TRUCKERS |
|
Enter code: Indicates a state where autos are hired or borrowed. |
|
TRUCKERS |
|
Enter code: Indicates a state where autos are hired or borrowed. |
|
TRUCKERS |
Non-Truckers Hired / Borrowed Liability No |
Check the box (if applicable): Indicates that hired / borrowed coverage does not apply. |
|
TRUCKERS |
Cost of Hire |
Enter amount: The estimated amount it will cost to hire the vehicles. |
|
TRUCKERS |
If any Basis (checkbox) |
Check the box (if applicable): Indicates if the rating basis is "if any". Check this box if the exposure is minimal. The actual exposure is determined at the time of audit. |
|
TRUCKERS |
Truckers Hired / Borrowed Liability Yes |
Check the box (if applicable): Indicates if truckers hired / borrowed coverage applies. |
|
TRUCKERS |
Truckers Hired / Borrowed Liability States |
Enter code: Indicates a state where autos are hired or borrowed. |
|
TRUCKERS |
|
Enter code: Indicates a state where autos are hired or borrowed. |
|
TRUCKERS |
|
Enter code: Indicates a state where autos are hired or borrowed. |
|
TRUCKERS |
Truckers Hired / Borrowed Liability No |
Check the box (if applicable): Indicates that truckers hired / borrowed coverage does not apply. |
|
TRUCKERS |
Cost of Hire |
Enter amount: The estimated amount it will cost to hire the vehicles. |
|
TRUCKERS |
If any Basis (checkbox) |
Check the box (if applicable): Indicates if the rating basis is "if any". |
|
TRUCKERS |
Non-Owned Auto Liability Yes |
Check the box (if applicable): Indicates if non-owned coverage applies. |
|
TRUCKERS |
Non-Owned Auto Liability States |
Enter code: Indicates a state where autos are non-owned. |
|
TRUCKERS |
|
Enter code: Indicates a state where autos are non-owned. |
|
TRUCKERS |
|
Enter code: Indicates a state where autos are non-owned. |
|
TRUCKERS |
|
Enter code: Indicates a state where autos are non-owned. |
|
TRUCKERS |
|
Enter code: Indicates a state where autos are non-owned. |
|
TRUCKERS |
|
Enter code: Indicates a state where autos are non-owned. |
|
TRUCKERS |
|
Enter code: Indicates a state where autos are non-owned. |
|
TRUCKERS |
|
Enter code: Indicates a state where autos are non-owned. |
|
TRUCKERS |
|
Enter code: Indicates a state where autos are non-owned. |
|
TRUCKERS |
Non-Owned Auto Liability No |
Check the box (if applicable): Indicates that non-owned coverage does not apply. |
|
TRUCKERS |
Group Type - Employees |
Check the box (if applicable): Indicates that non-owned liability coverage pertains to employees. |
|
TRUCKERS |
Number of Employees |
Enter number: The number of employees that use their own automobiles. |
ACORD 137 NJ (2008/08) 12 of 24
|
Section Name |
Field Name |
Field and/or Section Description |
|
TRUCKERS |
Volunteers |
Check the box (if applicable): Indicates that non-owned liability coverage pertains to volunteers. |
|
TRUCKERS |
Number of Volunteers |
Enter number: The number of volunteers that use their own automobiles. |
|
TRUCKERS |
Partners |
Check the box (if applicable): Indicates that non-owned liability coverage pertains to partners. |
|
TRUCKERS |
Number of Partners |
Enter number: The number of partners that use their own automobiles. |
|
TRUCKERS |
Additional Coverage Description |
Enter text: The description of other coverage (not the limit) on the vehicle policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). |
|
TRUCKERS |
Additional Coverage Covered Auto Symbols |
Enter text: The symbols that apply to the other coverage listed. |
|
TRUCKERS |
Additional Coverage Limit |
Enter limit: The limit amount of the other coverage. |
|
TRUCKERS |
Additional Coverage Description |
Enter text: The description of other coverage (not the limit) on the vehicle policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). |
|
TRUCKERS |
Additional Coverage Covered Auto Symbols |
Enter text: The symbols that apply to the other coverage listed. |
|
TRUCKERS |
Additional Coverage Limit |
Enter limit: The limit amount of the other coverage. |
|
TRUCKERS |
Other Than Collision (OTC) 42 |
Check the box (if applicable): Indicates that owned autos only are covered. |
|
TRUCKERS |
Other Than Collision (OTC) 43 |
Check the box (if applicable): Indicates that owned commercial autos only are covered. |
|
TRUCKERS |
Other Than Collision (OTC) 46 |
Check the box (if applicable): Indicates that specifically described autos are covered. |
|
TRUCKERS |
Other Than Collision (OTC) 47 |
Check the box (if applicable): Indicates that hired autos only are covered. |
|
TRUCKERS |
Other Than Collision (OTC) Other |
Check the box (if applicable): Indicates that a symbol other than those listed should be used. |
|
TRUCKERS |
Other Than Collision (OTC) Other Symbol |
Enter code: The symbol code for the coverage. |
|
TRUCKERS |
Other Than Collision (OTC) Deductible |
Enter deductible: The comprehensive or other than collision deductible amount. |
|
TRUCKERS |
Specified Causes of Loss 42 |
Check the box (if applicable): Indicates that owned autos only are covered. |
|
TRUCKERS |
Specified Causes of Loss 43 |
Check the box (if applicable): Indicates that owned commercial autos only are covered. |
|
TRUCKERS |
Specified Causes of Loss 46 |
Check the box (if applicable): Indicates that specifically described autos are covered. |
|
TRUCKERS |
Specified Causes of Loss 47 |
Check the box (if applicable): Indicates that hired autos only are covered. |
ACORD 137 NJ (2008/08) 13 of 24
|
Section Name |
Field Name |
Field and/or Section Description |
|
TRUCKERS |
Specified Causes of Loss Other |
Check the box (if applicable): Indicates that a symbol other than those listed should be used. |
|
TRUCKERS |
Specified Causes of Loss Other Symbol |
Enter code: The symbol code for the coverage. |
|
TRUCKERS |
SCL |
Check the box (if applicable): Indicates the vehicle has specified cause of loss coverage. |
|
TRUCKERS |
F |
Check the box (if applicable): Indicates fire is a specified cause of loss on this vehicle. |
|
TRUCKERS |
FT |
Check the box (if applicable): Indicates fire and theft is a specified cause of loss on this vehicle. |
|
TRUCKERS |
FTW |
Check the box (if applicable): Indicates fire, theft and windstorm is a specified cause of loss on this vehicle. |
|
TRUCKERS |
LSP |
Check the box (if applicable): Indicates limited specified perils is a specified cause of loss on this vehicle. |
|
TRUCKERS |
Deductible ($) |
Enter deductible: The deductible associated with specified causes of loss coverage. |
|
TRUCKERS |
Collision 42 |
Check the box (if applicable): Indicates that owned autos only are covered. |
|
TRUCKERS |
Collision 43 |
Check the box (if applicable): Indicates that owned commercial autos only are covered. |
|
TRUCKERS |
Collision 46 |
Check the box (if applicable): Indicates that specifically described autos are covered. |
|
TRUCKERS |
Collision 47 |
Check the box (if applicable): Indicates that hired autos only are covered. |
|
TRUCKERS |
Collision Other |
Check the box (if applicable): Indicates that a symbol other than those listed should be used. |
|
TRUCKERS |
Collision Other Symbol |
Enter code: The symbol code for the coverage. |
|
TRUCKERS |
Collision Deductible |
Enter deductible: The collision deductible amount. |
|
TRUCKERS |
Towing & Labor 46 |
Check the box (if applicable): Indicates that specifically described autos are covered. |
|
TRUCKERS |
Towing & Labor Other |
Check the box (if applicable): Indicates that a symbol other than those listed should be used. |
|
TRUCKERS |
Towing & Labor Other Symbol |
Enter code: The symbol code for the coverage. |
|
TRUCKERS |
Towing & Labor Limit |
Enter limit: The towing and labor limit amount. |
|
TRUCKERS |
Other Than Collision (OTC) 48 |
Check the box (if applicable): Indicates that trailers in your possession under a trailer interchange agreement are covered. |
|
TRUCKERS |
Other Than Collision (OTC) 49 |
Check the box (if applicable): Indicates that your trailers in the possession of another trucker under a trailer interchange agreement are covered. |
ACORD 137 NJ (2008/08) 14 of 24
|
Section Name |
Field Name |
Field and/or Section Description |
|
TRUCKERS |
# Trailers |
Enter number: The number of trailers operated by the insured under a Trailer Interchange Agreement. |
|
TRUCKERS |
Farth Zone |
Enter code: The state of the farthest zone where trailer interchange coverage applies. |
|
TRUCKERS |
# Days |
Enter number: The number of days during one year in which this exposure exists; that is, the number of days in which the insured pulls trailers that are in his possession under a Trailer Interchange Agreement. |
|
TRUCKERS |
Radius |
Enter number: The radius in actual mileage within which trailers, covered by this policy, are pulled by other tractors. |
|
TRUCKERS |
Specified Causes of Loss 48 |
Check the box (if applicable): Indicates that trailers in your possession under a trailer interchange agreement are covered. |
|
TRUCKERS |
Specified Causes of Loss 49 |
Check the box (if applicable): Indicates that your trailers in the possession of another trucker under a trailer interchange agreement are covered. |
|
TRUCKERS |
# Trailers |
Enter number: The number of trailers operated by the insured under a Trailer Interchange Agreement. |
|
TRUCKERS |
Farth Zone |
Enter code: The state of the farthest zone where trailer interchange coverage applies. |
|
TRUCKERS |
# Days |
Enter number: The number of days during one year in which this exposure exists; that is, the number of days in which the insured pulls trailers that are in his possession under a Trailer Interchange Agreement. |
|
TRUCKERS |
Radius |
Enter number: The radius in actual mileage within which trailers, covered by this policy, are pulled by other tractors. |
|
TRUCKERS |
Collision 48 |
Check the box (if applicable): Indicates that trailers in your possession under a trailer interchange agreement are covered. |
|
TRUCKERS |
Collision 49 |
Check the box (if applicable): Indicates that your trailers in the possession of another trucker under a trailer interchange agreement are covered. |
|
TRUCKERS |
# Trailers |
Enter number: The number of trailers operated by the insured under a Trailer Interchange Agreement. |
|
TRUCKERS |
Farth Zone |
Enter code: The state of the farthest zone where trailer interchange coverage applies. |
|
TRUCKERS |
# Days |
Enter number: The number of days during one year in which this exposure exists; that is, the number of days in which the insured pulls trailers that are in his possession under a Trailer Interchange Agreement. |
|
TRUCKERS |
Radius |
Enter number: The radius in actual mileage within which trailers, covered by this policy, are pulled by other tractors. |
ACORD 137 NJ (2008/08) 15 of 24
|
Section Name |
Field Name |
Field and/or Section Description |
|
|
Enter deductible: The deductible amount applicable to trailer interchange collision |
|
TRUCKERS |
Deductible ($) |
coverage. |
|
TRUCKERS |
Hired Physical Damage States |
Enter code: Indicates a state where autos are hired and have physical damage coverage. |
|
TRUCKERS |
|
Enter code: Indicates a state where autos are hired and have physical damage coverage. |
|
TRUCKERS |
|
Enter code: Indicates a state where autos are hired and have physical damage coverage. |
|
TRUCKERS |
|
Enter code: Indicates a state where autos are hired and have physical damage coverage. |
|
TRUCKERS |
|
Enter code: Indicates a state where autos are hired and have physical damage coverage. |
|
TRUCKERS |
|
Enter code: Indicates a state where autos are hired and have physical damage coverage. |
|
TRUCKERS |
Hired Physical Damage # Days |
Enter number: The number of days needed to rate Hired Physical Damage Coverage. |
|
TRUCKERS |
Hired Physical Damage # Veh |
Enter number: The number of vehicles needed to rate Hired Physical Damage Coverage. |
|
TRUCKERS |
Coverage is: Primary (Checkbox) |
Check the box (if applicable): Indicates if this coverage is on a primary basis. |
|
Coverage is: Secondary |
|
|
TRUCKERS |
(Checkbox) |
Check the box (if applicable): Indicates if this coverage is on a secondary basis. |
|
|
Enter text: The description of other coverage (not the limit) on the vehicle policy. Any |
|
|
questions about appropriate limits or applicable policy coverage(s) should be answered by |
|
TRUCKERS |
Additional Coverage Description |
the issuing insurer(s). |
|
Additional Coverage Covered Auto |
|
|
TRUCKERS |
Symbols |
Enter text: The symbols that apply to the other coverage listed. |
|
TRUCKERS |
Additional Coverage Limit |
Enter limit: The limit amount of the other coverage. |
|
|
Enter text: The remarks associated with the commercial vehicle line of business. Enter |
|
ENDORSEMENTS / REMARKS |
Endorsements / Remarks |
any endorsements that apply. Be sure to include the form numbers and the required information for attaching the endorsement. Attach ACORD 101, Additional Remarks Schedule, if more space is required. |
|
SIGNATURE |
Applicant's Signature |
Sign here: Accommodates the signature of the applicant or named insured. |
|
SIGNATURE |
Date |
Enter date: The date the form was signed by the named insured. |
ACORD 137 NJ (2008/08) 16 of 24
|
Section Name |
Field Name |
Field and/or Section Description |
|
SIGNATURE |
Producer's Signature |
Sign here: Accommodates the signature of the authorized representative (e.g. producer, agent, broker, etc.). by all companies to issue Certificates. This is required in most states. |
|
SIGNATURE |
National Producer Number |
Enter identifier: The National Producer Number (NPN) as defined in the National Insurance Producer Registry (NIPR). Note: The NPN is not the same as the producer state license number. |
|
IDENTIFICATION SECTION |
Agency Customer ID |
Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage). |
|
MOTOR CARRIER SECTION |
Liability 61 |
Check the box (if applicable): Indicates that any auto is covered. |
|
MOTOR CARRIER SECTION |
Liability 62 |
Check the box (if applicable): Indicates that owned autos only are covered. |
|
MOTOR CARRIER SECTION |
Liability 63 |
Check the box (if applicable): Indicates that owned private passenger autos only are covered. |
|
MOTOR CARRIER SECTION |
Liability 64 |
Check the box (if applicable): Indicates that owned commercial autos only are covered. |
|
MOTOR CARRIER SECTION |
Liability 67 |
Check the box (if applicable): Indicates that specifically described autos are covered. |
|
MOTOR CARRIER SECTION |
Liability 68 |
Check the box (if applicable): Indicates that hire autos only are covered. |
|
MOTOR CARRIER SECTION |
Liability 71 |
Check the box (if applicable): Indicates that non-owned autos only are covered. |
|
MOTOR CARRIER SECTION |
Liability Other |
Check the box (if applicable): Indicates that a symbol other than those listed should be used. |
|
MOTOR CARRIER SECTION |
Liability Other Symbol |
Enter code: The symbol code for the coverage. |
|
MOTOR CARRIER SECTION |
Limits - CSL |
Check the box (if applicable): Indicates if the limit shown is for combined single limit on the coverage. |
|
MOTOR CARRIER SECTION |
Limits - BI Ea Per |
Check the box (if applicable): Indicates if the limit shown is the bodily injury each person limit on the coverage. |
|
MOTOR CARRIER SECTION |
Limit Amount |
Enter limit: The vehicle policy, bodily injury per person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). |
|
MOTOR CARRIER SECTION |
BI Ea Accident ($) |
Enter limit: The vehicle policy, bodily injury per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). |
ACORD 137 NJ (2008/08) 17 of 24
|
Section Name |
Field Name |
Field and/or Section Description |
|
MOTOR CARRIER SECTION |
Property Damage ($) |
Enter limit: The vehicle policy, property damage per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). |
|
MOTOR CARRIER SECTION |
Personal Injury Protection 65 |
Check the box (if applicable): Indicates that owned autos subject to no-fault are covered. |
|
MOTOR CARRIER SECTION |
Personal Injury Protection 67 |
Check the box (if applicable): Indicates that specifically described autos are covered. |
|
MOTOR CARRIER SECTION |
Personal Injury Protection Other |
Check the box (if applicable): Indicates that a symbol other than those listed should be used. |
|
MOTOR CARRIER SECTION |
Personal Injury Protection Other Symbol |
Enter code: The symbol code for the coverage. |
|
MOTOR CARRIER SECTION |
Lawsuit Threshold |
Check the box (if applicable): Indicates the personal injury protection (PIP) has a lawsuit threshold. |
|
MOTOR CARRIER SECTION |
Medical Only |
Check the box (if applicable): Indicates the personal injury protection (PIP) medical expense only option has been selected. |
|
MOTOR CARRIER SECTION |
No Threshold |
Check the box (if applicable): Indicates the personal injury protection (PIP) has no lawsuit threshold. |
|
MOTOR CARRIER SECTION |
Health Insurance Option Yes |
Check the box (if applicable): Indicates the personal injury protection (PIP) health insurance option has been selected. This indicates that PIP medical benefits are secondary. |
|
MOTOR CARRIER SECTION |
Health Insurance Option NO |
Check the box (if applicable): Indicates the personal injury protection (PIP) health insurance option has not been selected. |
|
MOTOR CARRIER SECTION |
Medical Expense Amount |
Enter limit: The personal injury protection (PIP) medical expense limit amount. |
|
MOTOR CARRIER SECTION |
Deductible |
Enter deductible: The deductible amount for personal injury protection (PIP) coverage. |
|
MOTOR CARRIER SECTION |
Ext Medical Expense Each Person |
Enter limit: The extended medical expense per person limit amount. |
|
MOTOR CARRIER SECTION |
Extra PIP Options Number of Relatives |
Enter number: The additional personal injury protection (APIP) number of additional relatives being extended additional PIP. |
|
MOTOR CARRIER SECTION |
Uninsured / Underinsured Motorists 62 |
Check the box (if applicable): Indicates that owned autos only are covered. |
|
MOTOR CARRIER SECTION |
Uninsured / Underinsured Motorists 63 |
Check the box (if applicable): Indicates that owned private passenger autos only are covered. |
|
MOTOR CARRIER SECTION |
Uninsured / Underinsured Motorists 64 |
Check the box (if applicable): Indicates that owned commercial autos only are covered. |
ACORD 137 NJ (2008/08) 18 of 24
|
Section Name |
Field Name |
Field and/or Section Description |
|
MOTOR CARRIER SECTION |
Uninsured / Underinsured Motorists 66 |
Check the box (if applicable): Indicates that owned autos subject to a compulsory uninsured motorist law are covered. |
|
MOTOR CARRIER SECTION |
Uninsured / Underinsured Motorists 67 |
Check the box (if applicable): Indicates that specifically described autos are covered. |
|
MOTOR CARRIER SECTION |
Uninsured / Underinsured Motorists Other |
Check the box (if applicable): Indicates that a symbol other than those listed should be used. |
|
MOTOR CARRIER SECTION |
Uninsured / Underinsured Motorists Other Symbol |
Enter code: The symbol code for the coverage. |
|
MOTOR CARRIER SECTION |
CSL (checkbox) |
Check the box (if applicable): Indicates if the limit shown is for combined single limit on the coverage. |
|
MOTOR CARRIER SECTION |
BI Ea Per (checkbox) |
Check the box (if applicable): Indicates if the limit shown is the bodily injury each person limit on the coverage. |
|
MOTOR CARRIER SECTION |
Amount |
Enter limit: The uninsured / underinsured motorists bodily injury per person limit. The use of this limit varies by state. On commercial policies, this may contain the combined single limit per accident amount. |
|
MOTOR CARRIER SECTION |
BI Each Accident ($) |
Enter limit: The uninsured / underinsured motorists bodily injury per accident limit (in some states this may contain the uninsured / underinsured motorists combined single limit per accident limit). The use of this limit varies by state. |
|
MOTOR CARRIER SECTION |
Property Damage ($) |
Enter limit: The uninsured / underinsured property damage limit amount. |
|
MOTOR CARRIER SECTION |
Non-Truckers Hired / Borrowed Liability Yes |
Check the box (if applicable): Indicates if hired / borrowed coverage applies. |
|
MOTOR CARRIER SECTION |
Non-Truckers Hired / Borrowed Liability States |
Enter code: Indicates a state where autos are hired or borrowed. |
|
MOTOR CARRIER SECTION |
|
Enter code: Indicates a state where autos are hired or borrowed. |
|
MOTOR CARRIER SECTION |
|
Enter code: Indicates a state where autos are hired or borrowed. |
|
MOTOR CARRIER SECTION |
Non-Truckers Hired / Borrowed Liability No |
Check the box (if applicable): Indicates that hired / borrowed coverage does not apply. |
|
MOTOR CARRIER SECTION |
Cost of Hire |
Enter amount: The estimated amount it will cost to hire the vehicles. |
|
MOTOR CARRIER SECTION |
If any Basis (checkbox) |
Check the box (if applicable): Indicates if the rating basis is "if any". Check this box if the exposure is minimal. The actual exposure is determined at the time of audit. |
|
MOTOR CARRIER SECTION |
Truckers Hired / Borrowed Liability Yes |
Check the box (if applicable): Indicates if truckers hired / borrowed coverage applies. |
ACORD 137 NJ (2008/08) 19 of 24
|
Section Name |
Field Name |
Field and/or Section Description |
|
MOTOR CARRIER SECTION |
Truckers Hired / Borrowed Liability States |
Enter code: Indicates a state where autos are hired or borrowed. |
|
MOTOR CARRIER SECTION |
|
Enter code: Indicates a state where autos are hired or borrowed. |
|
MOTOR CARRIER SECTION |
|
Enter code: Indicates a state where autos are hired or borrowed. |
|
MOTOR CARRIER SECTION |
Truckers Hired / Borrowed Liability No |
Check the box (if applicable): Indicates that truckers hired / borrowed coverage does not apply. |
|
MOTOR CARRIER SECTION |
Cost of Hire |
Enter amount: The estimated amount it will cost to hire the vehicles. |
|
MOTOR CARRIER SECTION |
If any Basis (checkbox) |
Check the box (if applicable): Indicates if the rating basis is "if any". |
|
MOTOR CARRIER SECTION |
Non-Owned Auto Liability Yes |
Check the box (if applicable): Indicates if non-owned coverage applies. |
|
MOTOR CARRIER SECTION |
Non-Owned Auto Liability States |
Enter code: Indicates a state where autos are non-owned. |
|
MOTOR CARRIER SECTION |
|
Enter code: Indicates a state where autos are non-owned. |
|
MOTOR CARRIER SECTION |
|
Enter code: Indicates a state where autos are non-owned. |
|
MOTOR CARRIER SECTION |
|
Enter code: Indicates a state where autos are non-owned. |
|
MOTOR CARRIER SECTION |
|
Enter code: Indicates a state where autos are non-owned. |
|
MOTOR CARRIER SECTION |
|
Enter code: Indicates a state where autos are non-owned. |
|
MOTOR CARRIER SECTION |
|
Enter code: Indicates a state where autos are non-owned. |
|
MOTOR CARRIER SECTION |
|
Enter code: Indicates a state where autos are non-owned. |
|
MOTOR CARRIER SECTION |
|
Enter code: Indicates a state where autos are non-owned. |
|
MOTOR CARRIER SECTION |
Non-Owned Auto Liability No |
Check the box (if applicable): Indicates that non-owned coverage does not apply. |
|
MOTOR CARRIER SECTION |
Group Type Employees (checkbox) |
Check the box (if applicable): Indicates that non-owned liability coverage pertains to employees. |
ACORD 137 NJ (2008/08) 20 of 24
|
Section Name |
Field Name |
Field and/or Section Description |
|
MOTOR CARRIER SECTION |
Employees (#) |
Enter number: The number of employees that use their own automobiles. |
|
MOTOR CARRIER SECTION |
Volunteers (checkbox) |
Check the box (if applicable): Indicates that non-owned liability coverage pertains to volunteers. |
|
MOTOR CARRIER SECTION |
Volunteers (#) |
Enter number: The number of volunteers that use their own automobiles. |
|
MOTOR CARRIER SECTION |
Partners (checkbox) |
Check the box (if applicable): Indicates that non-owned liability coverage pertains to partners. |
|
MOTOR CARRIER SECTION |
Partners (#) |
Enter number: The number of partners that use their own automobiles. |
|
MOTOR CARRIER SECTION |
Additional Coverage Description |
Enter text: The description of other coverage (not the limit) on the vehicle policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). |
|
MOTOR CARRIER SECTION |
Additional Coverage Covered Auto Symbols |
Enter text: The symbols that apply to the other coverage listed. |
|
MOTOR CARRIER SECTION |
Additional Coverage Limit |
Enter limit: The limit amount of the other coverage. |
|
MOTOR CARRIER SECTION |
Other Than Collision (OTC) 62 |
Check the box (if applicable): Indicates that owned autos only are covered. |
|
MOTOR CARRIER SECTION |
Other Than Collision (OTC) 63 |
Check the box (if applicable): Indicates that owned private passenger autos only are covered. |
|
MOTOR CARRIER SECTION |
Other Than Collision (OTC) 64 |
Check the box (if applicable): Indicates that owned commercial autos only are covered. |
|
MOTOR CARRIER SECTION |
Other Than Collision (OTC) 67 |
Check the box (if applicable): Indicates that specifically described autos are covered. |
|
MOTOR CARRIER SECTION |
Other Than Collision (OTC) 68 |
Check the box (if applicable): Indicates that hire autos only are covered. |
|
MOTOR CARRIER SECTION |
Other Than Collision (OTC) Other |
Check the box (if applicable): Indicates that a symbol other than those listed should be used. |
|
MOTOR CARRIER SECTION |
Other Than Collision (OTC) Other Symbol |
Enter code: The symbol code for the coverage. |
|
MOTOR CARRIER SECTION |
Other Than Collision (OTC) Deductible |
Enter deductible: The comprehensive or other than collision deductible amount. |
|
MOTOR CARRIER SECTION |
Specified Causes of Loss 62 |
Check the box (if applicable): Indicates that owned autos only are covered. |
ACORD 137 NJ (2008/08) 21 of 24
|
Section Name |
Field Name |
Field and/or Section Description |
|
MOTOR CARRIER SECTION |
Specified Causes of Loss 63 |
Check the box (if applicable): Indicates that owned private passenger autos only are covered. |
|
MOTOR CARRIER SECTION |
Specified Causes of Loss 64 |
Check the box (if applicable): Indicates that owned commercial autos only are covered. |
|
MOTOR CARRIER SECTION |
Specified Causes of Loss 67 |
Check the box (if applicable): Indicates that specifically described autos are covered. |
|
MOTOR CARRIER SECTION |
Specified Causes of Loss 68 |
Check the box (if applicable): Indicates that hire autos only are covered. |
|
MOTOR CARRIER SECTION |
Specified Causes of Loss Other |
Check the box (if applicable): Indicates that a symbol other than those listed should be used. |
|
MOTOR CARRIER SECTION |
Specified Causes of Loss Other Symbol |
Enter code: The symbol code for the coverage. |
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MOTOR CARRIER SECTION |
SCL |
Check the box (if applicable): Indicates the vehicle has specified cause of loss coverage. |
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MOTOR CARRIER SECTION |
F |
Check the box (if applicable): Indicates fire is a specified cause of loss on this vehicle. |
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MOTOR CARRIER SECTION |
FT |
Check the box (if applicable): Indicates fire and theft is a specified cause of loss on this vehicle. |
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MOTOR CARRIER SECTION |
FTW |
Check the box (if applicable): Indicates fire, theft and windstorm is a specified cause of loss on this vehicle. |
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MOTOR CARRIER SECTION |
LSP |
Check the box (if applicable): Indicates limited specified perils is a specified cause of loss on this vehicle. |
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MOTOR CARRIER SECTION |
Deductible ($) |
Enter deductible: The deductible associated with specified causes of loss coverage. |
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MOTOR CARRIER SECTION |
Collision 62 |
Check the box (if applicable): Indicates that owned autos only are covered. |
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MOTOR CARRIER SECTION |
Collision 63 |
Check the box (if applicable): Indicates that owned private passenger autos only are covered. |
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MOTOR CARRIER SECTION |
Collision 64 |
Check the box (if applicable): Indicates that owned commercial autos only are covered. |
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MOTOR CARRIER SECTION |
Collision 67 |
Check the box (if applicable): Indicates that specifically described autos are covered. |
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MOTOR CARRIER SECTION |
Collision 68 |
Check the box (if applicable): Indicates that hire autos only are covered. |
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MOTOR CARRIER SECTION |
Collision Other |
Check the box (if applicable): Indicates that a symbol other than those listed should be used. |
ACORD 137 NJ (2008/08) 22 of 24
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Section Name |
Field Name |
Field and/or Section Description |
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MOTOR CARRIER SECTION |
Collision Other Symbol |
Enter code: The symbol code for the coverage. |
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MOTOR CARRIER SECTION |
Collision Deductible |
Enter deductible: The collision deductible amount. |
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MOTOR CARRIER SECTION |
Towing & Labor 63 |
Check the box (if applicable): Indicates that owned private passenger autos only are covered. |
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MOTOR CARRIER SECTION |
Towing & Labor 67 |
Check the box (if applicable): Indicates that specifically described autos are covered. |
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MOTOR CARRIER SECTION |
Towing & Labor Other |
Check the box (if applicable): Indicates that a symbol other than those listed should be used. |
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MOTOR CARRIER SECTION |
Towing & Labor Other Symbol |
Enter code: The symbol code for the coverage. |
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MOTOR CARRIER SECTION |
Towing & Labor Limit Amt |
Enter limit: The towing and labor limit amount. |
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MOTOR CARRIER SECTION |
Other Than Collision (OTC) 69 |
Check the box (if applicable): Indicates that trailers in your possession under a trailer interchange agreement are covered. |
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MOTOR CARRIER SECTION |
Other Than Collision (OTC) 70 |
Check the box (if applicable): Indicates that your trailers in the possession of another trucker under a trailer interchange agreement are covered. |
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MOTOR CARRIER SECTION |
# Trailers |
Enter number: The number of trailers operated by the insured under a Trailer Interchange Agreement. |
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MOTOR CARRIER SECTION |
Farth Zone |
Enter code: The state of the farthest zone where trailer interchange coverage applies. |
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MOTOR CARRIER SECTION |
# Days |
Enter number: The number of days during one year in which this exposure exists; that is, the number of days in which the insured pulls trailers that are in his possession under a Trailer Interchange Agreement. |
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MOTOR CARRIER SECTION |
Radius |
Enter number: The radius in actual mileage within which trailers, covered by this policy, are pulled by other tractors. |
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MOTOR CARRIER SECTION |
Specified Causes of Loss 69 |
Check the box (if applicable): Indicates that trailers in your possession under a trailer interchange agreement are covered. |
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MOTOR CARRIER SECTION |
Specified Causes of Loss 70 |
Check the box (if applicable): Indicates that your trailers in the possession of another trucker under a trailer interchange agreement are covered. |
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MOTOR CARRIER SECTION |
# Trailers |
Enter number: The number of trailers operated by the insured under a Trailer Interchange Agreement. |
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MOTOR CARRIER SECTION |
Farth Zone |
Enter code: The state of the farthest zone where trailer interchange coverage applies. |
ACORD 137 NJ (2008/08) 23 of 24
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Section Name |
Field Name |
Field and/or Section Description |
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MOTOR CARRIER SECTION |
# Days |
Enter number: The number of days during one year in which this exposure exists; that is, the number of days in which the insured pulls trailers that are in his possession under a Trailer Interchange Agreement. |
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MOTOR CARRIER SECTION |
Radius |
Enter number: The radius in actual mileage within which trailers, covered by this policy, are pulled by other tractors. |
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MOTOR CARRIER SECTION |
Collision 69 |
Check the box (if applicable): Indicates that trailers in your possession under a trailer interchange agreement are covered. |
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MOTOR CARRIER SECTION |
Collision 70 |
Check the box (if applicable): Indicates that your trailers in the possession of another trucker under a trailer interchange agreement are covered. |
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MOTOR CARRIER SECTION |
# Trailers |
Enter number: The number of trailers operated by the insured under a Trailer Interchange Agreement. |
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MOTOR CARRIER SECTION |
Farth Zone |
Enter code: The state of the farthest zone where trailer interchange coverage applies. |
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MOTOR CARRIER SECTION |
# Days |
Enter number: The number of days during one year in which this exposure exists; that is, the number of days in which the insured pulls trailers that are in his possession under a Trailer Interchange Agreement. |
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MOTOR CARRIER SECTION |
Radius |
Enter number: The radius in actual mileage within which trailers, covered by this policy, are pulled by other tractors. |
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MOTOR CARRIER SECTION |
Deductible ($) |
Enter deductible: The deductible amount applicable to trailer interchange collision coverage. |
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MOTOR CARRIER SECTION |
Hired Physical Damage States |
Enter code: Indicates a state where autos are hired and have physical damage coverage. |
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MOTOR CARRIER SECTION |
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Enter code: Indicates a state where autos are hired and have physical damage coverage. |
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MOTOR CARRIER SECTION |
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Enter code: Indicates a state where autos are hired and have physical damage coverage. |
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MOTOR CARRIER SECTION |
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Enter code: Indicates a state where autos are hired and have physical damage coverage. |
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MOTOR CARRIER SECTION |
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Enter code: Indicates a state where autos are hired and have physical damage coverage. |
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MOTOR CARRIER SECTION |
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Enter code: Indicates a state where autos are hired and have physical damage coverage. |
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MOTOR CARRIER SECTION |
Hired Physical Damage # Days |
Enter number: The number of days needed to rate Hired Physical Damage Coverage. |
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MOTOR CARRIER SECTION |
Hired Physical Damage # Veh |
Enter number: The number of vehicles needed to rate Hired Physical Damage Coverage. |
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Section Name |
Field Name |
Field and/or Section Description |
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MOTOR CARRIER SECTION |
Coverage is: Primary (Checkbox) |
Check the box (if applicable): Indicates if this coverage is on a primary basis. |
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Coverage is: Secondary |
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MOTOR CARRIER SECTION |
(Checkbox) |
Check the box (if applicable): Indicates if this coverage is on a secondary basis. |
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Enter text: The description of other coverage (not the limit) on the vehicle policy. Any |
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questions about appropriate limits or applicable policy coverage(s) should be answered by |
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MOTOR CARRIER SECTION |
Additional Coverage Description |
the issuing insurer(s). |
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Additional Coverage Covered Auto |
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MOTOR CARRIER SECTION |
Symbols |
Enter text: The symbols that apply to the other coverage listed. |
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MOTOR CARRIER SECTION |
Additional Coverage Limit |
Enter limit: The limit amount of the other coverage. |
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Enter text: The remarks associated with the commercial vehicle line of business. Enter |
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ENDORSEMENTS / REMARKS |
Endorsements / Remarks |
any endorsements that apply. Be sure to include the form numbers and the required information for attaching the endorsement. Attach ACORD 101, Additional Remarks Schedule, if more space is required. |
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SIGNATURE |
Applicant's Signature |
Sign here: Accommodates the signature of the applicant or named insured. |
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SIGNATURE |
Date |
Enter date: The date the form was signed by the named insured. |
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Sign here: Accommodates the signature of the authorized representative (e.g. producer, |
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SIGNATURE |
Producer's Signature |
agent, broker, etc.). by all companies to issue Certificates. This is required in most states. |
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Enter identifier: The National Producer Number (NPN) as defined in the National |
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Insurance Producer Registry (NIPR). Note: The NPN is not the same as the producer |
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SIGNATURE |
National Producer Number |
state license number. |
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The edition identifier of the form including the form number and edition (the date is |
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Edition |
Date |
typically formatted YYYY/MM). |
ACORD 137 NJ (2008/08) 24 of 24
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