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ACORD Form 138 CT Connecticut Garage and Dealers Instructions

 

 
ACORD 138 CT (2005/11) 1 of 8
Universal wording updates to improve clarity and intent were made to all FIG text for this form on 10/30/2008.
Section Name Field Name Field and/or Section Description
TITLE ACORD 138 CT (2005/11) Connecticut Garage and Dealers, Coverages/Limits Section The title of the form. The ACORD 138 CT - Connecticut Garage and Dealers Coverages/Limits Section is used to collect the coverage and limit information necessary to write Garage and Dealers insurance in this state. Use this form with ACORD 128, Garage and Dealers Section. The following are the specific differences in this state. * Personal Injury Protection coverages reflects the optional coverages available. * Uninsured Motorists and Underinsured Motorists coverages are combined. * Uninsured Motorists Conversion coverage is added. This coverage can be purchased instead of Uninsured/Underinsured Motorists coverage.
IDENTIFICATION SECTION Date Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY)
IDENTIFICATION SECTION Agency Enter text: The full name of the producer/agency.
IDENTIFICATION SECTION Applicant (First Named Insured) Enter text: The named insured(s) as it/they will appear on the policy declarations page.
COVERAGES/LIMITS Liability 21 (checkbox) Check the box (if applicable): Indicates any auto is covered. As used here, Garage or Dealers policies use numeric symbols on the policy declarations to indicate the type(s) of vehicles for which coverage is in effect. Be sure to place an X in the appropriate box for each type of coverage. Only those symbols specified for a coverage may be used, symbols 21 through 26 provide fleet automatic coverage. symbol 21 includes Hired and Non-Owned auto coverage. if symbol 21 is not used and Hired Auto (symbol 28) or Non-Owned Auto (symbol 29) coverage is desired, those symbols must be checked. The symbols indicate the automobiles to which each coverage applies. The symbol ""triggers"" the coverage. For exact policy definitions of the symbols, please refer to the company's policy declarations page.
COVERAGES/LIMITS Liability 22 (checkbox) Check the box (if applicable): Indicates all owned autos are covered.
COVERAGES/LIMITS Liability 23 (checkbox) Check the box (if applicable): Indicates only owned private passengers autos are covered.

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Section Name Field Name Field and/or Section Description
COVERAGES/LIMITS Liability 24 (checkbox) Check the box (if applicable): Indicates owned autos other than private passenger autos are covered.
COVERAGES/LIMITS Liability 27 (checkbox) Check the box (if applicable): Indicates specifically described autos are covered.
COVERAGES/LIMITS Liability 28 (checkbox) Check the box (if applicable): Indicates only hired autos are covered.
COVERAGES/LIMITS Liability 29 (checkbox) Check the box (if applicable): Indicates non-owned autos used in garage business are covered.
COVERAGES/LIMITS EA Accident Auto Only ($) Enter limit: The liability each accident limit for garage operations auto only. For Dealers, use this field to enter the Policy Combined Single Limit.
COVERAGES/LIMITS EA Accident Other Than Auto Only ($) Enter limit: The liability each accident limit for garage operations other than auto only.
COVERAGES/LIMITS Aggregate ($) Enter limit: The liability aggregate limit for garage operations other than auto only.
COVERAGES/LIMITS Dealers Only Limited (checkbox) Check the box (if applicable): Indicates the liability coverage is limited for dealers.
COVERAGES/LIMITS Dealers Only Unlimited (checkbox) Check the box (if applicable): Indicates the liability coverage is unlimited for dealers.
COVERAGES/LIMITS Basic Reparations Benefits 25 (checkbox) Check the box (if applicable): Indicates owned autos subject to no-fault are covered.
COVERAGES/LIMITS Basic Reparations Benefits 27 (checkbox) Check the box (if applicable): Indicates specifically described autos are covered.
COVERAGES/LIMITS Basic Reparations Benefits Limit ($) Enter limit: The personal injury protection (PIP) basic reparations benefits limit amount. As used here, refer to applicable State Manual for options.
COVERAGES/LIMITS Basic Reparations Benefits Per Week ($) Enter limit: The personal injury protection (PIP) basic reparations benefits weekly limit amount for work loss and survivors loss.
COVERAGES/LIMITS Added Reparations Benefits 25 Check the box (if applicable): Indicates owned autos subject to no-fault are covered.
COVERAGES/LIMITS Added Reparations Benefits 27 Check the box (if applicable): Indicates specifically described autos are covered.
COVERAGES/LIMITS Added Reparations Benefits Limit ($) Enter limit: The additional personal injury protection (APIP) added reparations benefits increased limit amount. As used here, refer to applicable State Manual for options.
COVERAGES/LIMITS Added Reparations Benefits-($) Per Week Enter limit: The additional personal injury protection (APIP) added reparations benefits increased weekly limit amount for work loss and survivors loss. As used here, refer to applicable State Manual for options.
COVERAGES/LIMITS Medical Payments 21 Check the box (if applicable): Indicates any auto is covered.
COVERAGES/LIMITS Medical Payments 22 Check the box (if applicable): Indicates all owned autos are covered.
COVERAGES/LIMITS Medical Payments 23 Check the box (if applicable): Indicates only owned private passengers autos are covered.

ACORD 138 CT (2005/11) 3 of 8

Section Name Field Name Field and/or Section Description
COVERAGES/LIMITS Medical Payments 24 Check the box (if applicable): Indicates owned autos other than private passenger autos are covered.
COVERAGES/LIMITS Medical Payments 27 Check the box (if applicable): Indicates specifically described autos are covered.
COVERAGES/LIMITS Medical Payments 28 Check the box (if applicable): Indicates only hired autos are covered.
COVERAGES/LIMITS Medical Payments 29 Check the box (if applicable): Indicates non-owned autos used in garage business are covered.
COVERAGES/LIMITS Medical Payments ($) Enter limit: The medical payments per person limit.
COVERAGES/LIMITS Automobile (Checkbox) Check the box (if applicable): Indicates the medical payments coverage is for automobile.
COVERAGES/LIMITS Prem Operations (Checkbox) Check the box (if applicable): Indicates the medical payments coverage is for premises operations.
COVERAGES/LIMITS Uninsured Motorist 22 Check the box (if applicable): Indicates all owned autos are covered.
COVERAGES/LIMITS Uninsured Motorist 23 Check the box (if applicable): Indicates only owned private passengers autos are covered.
COVERAGES/LIMITS Uninsured Motorist 24 Check the box (if applicable): Indicates owned autos other than private passenger autos are covered.
COVERAGES/LIMITS Uninsured Motorist 26 Check the box (if applicable): Indicates owned autos subject to uninsured motorists law are covered.
COVERAGES/LIMITS Uninsured Motorist 27 Check the box (if applicable): Indicates specifically described autos are covered.
COVERAGES/LIMITS CSL (Checkbox) Check the box (if applicable): Indicates if the limit shown is for combined single limit on the coverage.
COVERAGES/LIMITS BI Ea Per (Checkbox) Check the box (if applicable): Indicates if the limit shown is the bodily injury each person limit on the coverage.
COVERAGES/LIMITS Amount ($) 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.
COVERAGES/LIMITS BI Ea 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.
COVERAGES/LIMITS UIM Standard Cov (Checkbox) Check the box (if applicable): Indicates uninsured/underinsured standard coverage has been selected.
COVERAGES/LIMITS UIM Conversion (Checkbox) Check the box (if applicable): Indicates uninsured/underinsured conversion coverage has been selected.
COVERAGES/LIMITS 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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Section Name Field Name Field and/or Section Description
COVERAGES/LIMITS Additional Coverage Covered Auto Symbols Enter text: The symbols that apply to the other coverage listed.
COVERAGES/LIMITS Additional Coverage Limit Enter limit: The limit amount of the other coverage.
PHYSICAL DAMAGE Comp / OTC (checkbox) Check the box (if applicable): Indicates the physical damage is comprehensive/other than collision.
PHYSICAL DAMAGE Specified Perils (checkbox) Check the box (if applicable): Indicates the physical damage coverage is for specified perils.
PHYSICAL DAMAGE List Specified Perils Enter text: The codes associated with specified perils coverage. The codes are: F - Fire, F&T - Fire and Theft, FTW - Fire, Theft and Wind, LSP - Limited Specified Perils, SP -Specified Perils.
PHYSICAL DAMAGE Specified Perils 22 Check the box (if applicable): Indicates all owned autos are covered.
PHYSICAL DAMAGE Specified Perils 23 Check the box (if applicable): Indicates only owned private passengers autos are covered.
PHYSICAL DAMAGE Specified Perils 24 Check the box (if applicable): Indicates owned autos other than private passenger autos are covered.
PHYSICAL DAMAGE Specified Perils 27 Check the box (if applicable): Indicates specifically described autos are covered.
PHYSICAL DAMAGE Specified Perils 28 Check the box (if applicable): Indicates only hired autos are covered.
PHYSICAL DAMAGE Specified Perils 31 Check the box (if applicable): Indicates autos on consignment and dealer autos are covered.
PHYSICAL DAMAGE LOC # One Enter number: The producer assigned number for the location.
PHYSICAL DAMAGE Enter the Limits for Each Location ($) One Enter limit: The physical damage comprehensive/other than collision or specified perils limit amount.
PHYSICAL DAMAGE Deductible Per Auto ($) One Enter deductible: The physical damage comprehensive/other than collision or specified perils per auto deductible amount.
PHYSICAL DAMAGE Maximum Deductible Per Loss ($) One Enter deductible: The physical damage comprehensive/other than collision or specified perils maximum deductible per loss amount.
PHYSICAL DAMAGE LOC # Two Enter number: The producer assigned number for the location.
PHYSICAL DAMAGE Enter the Limits for Each Location ($) Two Enter limit: The physical damage comprehensive/other than collision or specified perils limit amount.
PHYSICAL DAMAGE Deductible Per Auto ($) Two Enter deductible: The physical damage comprehensive/other than collision or specified perils per auto deductible amount.
PHYSICAL DAMAGE Maximum Deductible Per Loss ($) Two Enter deductible: The physical damage comprehensive/other than collision or specified perils maximum deductible per loss amount.
PHYSICAL DAMAGE LOC # Three Enter number: The producer assigned number for the location.
PHYSICAL DAMAGE Enter the Limits for Each Location ($) Three Enter limit: The physical damage comprehensive/other than collision or specified perils limit amount.

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Section Name Field Name Field and/or Section Description
PHYSICAL DAMAGE Deductible Per Auto ($) Three Enter deductible: The physical damage comprehensive/other than collision or specified perils per auto deductible amount.
PHYSICAL DAMAGE Maximum Deductible Per Loss ($) Three Enter deductible: The physical damage comprehensive/other than collision or specified perils maximum deductible per loss amount.
PHYSICAL DAMAGE Collision 22 (checkbox) Check the box (if applicable): Indicates all owned autos are covered.
PHYSICAL DAMAGE Collision 23 (checkbox) Check the box (if applicable): Indicates only owned private passengers autos are covered.
PHYSICAL DAMAGE Collision 24 (checkbox) Check the box (if applicable): Indicates owned autos other than private passenger autos are covered.
PHYSICAL DAMAGE Collision 27 (checkbox) Check the box (if applicable): Indicates specifically described autos are covered.
PHYSICAL DAMAGE Collision 28 (checkbox) Check the box (if applicable): Indicates only hired autos are covered.
PHYSICAL DAMAGE Collision 31 (checkbox) Check the box (if applicable): Indicates autos on consignment and dealer autos are covered.
PHYSICAL DAMAGE Collision Deductible ($) Enter deductible: The physical damage collision deductible amount.
PHYSICAL DAMAGE 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).
PHYSICAL DAMAGE Additional Coverage Covered Auto Symbols Enter text: The symbols that apply to the other coverage listed.
PHYSICAL DAMAGE Additional Coverage Limit Enter limit: The limit amount of the other coverage.
GARAGE KEEPERS Legal Liability (checkbox) Check the box (if applicable): Indicates the policy is to be written on a legal liability basis.
GARAGE KEEPERS Direct Basis (checkbox) Check the box (if applicable): Indicates the policy is to be written on a direct basis.
GARAGE KEEPERS Primary (checkbox) Check the box (if applicable): Indicates this policy is the primary coverage.
GARAGE KEEPERS Excess (checkbox) Check the box (if applicable): Indicates this policy is for excess coverage.
GARAGE KEEPERS COMP / OTC Check the box (if applicable): Indicates the garage keepers coverage is comprehensive/other than collision.
GARAGE KEEPERS Specified Perils Check the box (if applicable): Indicates the garage keepers coverage is for specified perils.
GARAGE KEEPERS List Specified Perils Enter text: The codes associated with specified perils coverage. The codes are: F - Fire, F&T - Fire and Theft, FTW - Fire, Theft and Wind, LSP - Limited Specified Perils, SP -Specified Perils.
GARAGE KEEPERS 30 (Checkbox) Check the box (if applicable): Indicates autos left for service, repairs and/or storage are covered.

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Section Name Field Name Field and/or Section Description
GARAGE KEEPERS LOC # One Enter number: The producer assigned number for the location. 'The location number for the physical damage coverages should correspond to a location number documented on the ACORD 125.
GARAGE KEEPERS Enter the Limits for Each Location ($) One Enter limit: The garage keepers comprehensive/other than collision or specified perils limit amount.
GARAGE KEEPERS # of Autos One Enter number: The number of vehicles located on the premises.
GARAGE KEEPERS Deductible Per Auto ($) One Enter deductible: The garage keepers comprehensive/other than collision or specified perils per auto deductible amount.
GARAGE KEEPERS Maximum Deductible Per Loss ($) One Enter deductible: The garage keepers comprehensive/other than collision or specified perils maximum deductible per loss amount.
GARAGE KEEPERS LOC # Two Enter number: The producer assigned number for the location. 'The location number for the physical damage coverages should correspond to a location number documented on the ACORD 125.
GARAGE KEEPERS Enter the Limits for Each Location ($) Two Enter limit: The garage keepers comprehensive/other than collision or specified perils limit amount.
GARAGE KEEPERS # of Autos Two Enter number: The number of vehicles located on the premises.
GARAGE KEEPERS Deductible Per Auto ($) Two Enter deductible: The garage keepers comprehensive/other than collision or specified perils per auto deductible amount.
GARAGE KEEPERS Maximum Deductible Per Loss ($) Two Enter deductible: The garage keepers comprehensive/other than collision or specified perils maximum deductible per loss amount.
GARAGE KEEPERS LOC # Three Enter number: The producer assigned number for the location. 'The location number for the physical damage coverages should correspond to a location number documented on the ACORD 125.
GARAGE KEEPERS Enter the Limits for Each Location ($) Three Enter limit: The garage keepers comprehensive/other than collision or specified perils limit amount.
GARAGE KEEPERS # of Autos Three Enter number: The number of vehicles located on the premises.
GARAGE KEEPERS Deductible Per Auto ($) Three Enter deductible: The garage keepers comprehensive/other than collision or specified perils per auto deductible amount.
GARAGE KEEPERS Maximum Deductible Per Loss ($) Three Enter deductible: The garage keepers comprehensive/other than collision or specified perils maximum deductible per loss amount.
GARAGE KEEPERS 30 (checkbox) Check the box (if applicable): Indicates autos left for service, repairs and/or storage are covered.
GARAGE KEEPERS LOC # Four Enter number: The producer assigned number for the location. The location number for the garage keepers coverages should correspond to a location number documented on the ACORD 125.

ACORD 138 CT (2005/11) 7 of 8

Section Name Field Name Field and/or Section Description
GARAGE KEEPERS Enter the Limits for Each Location ($) Four Enter limit: The garage keepers collision limit amount.
GARAGE KEEPERS # of Autos Four Enter number: The number of vehicles located on the premises.
GARAGE KEEPERS Deductible Per Auto ($) Four Enter deductible: The garage keepers collision per auto deductible amount.
GARAGE KEEPERS LOC # Five Enter number: The producer assigned number for the location. The location number for the garage keepers coverages should correspond to a location number documented on the ACORD 125.
GARAGE KEEPERS Enter the Limits for Each Location ($) Five Enter limit: The garage keepers collision limit amount.
GARAGE KEEPERS # of Autos Five Enter number: The number of vehicles located on the premises.
GARAGE KEEPERS Deductible Per Auto ($) Five Enter deductible: The garage keepers collision per auto deductible amount.
GARAGE KEEPERS LOC # Six Enter number: The producer assigned number for the location. The location number for the garage keepers coverages should correspond to a location number documented on the ACORD 125.
GARAGE KEEPERS Enter the Limits for Each Location ($) Six Enter limit: The garage keepers collision limit amount.
GARAGE KEEPERS # of Autos Six Enter number: The number of vehicles located on the premises.
GARAGE KEEPERS Deductible Per Auto ($) Six Enter deductible: The garage keepers collision per auto deductible amount.
GARAGE KEEPERS 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).
GARAGE KEEPERS Additional Coverage Covered Auto Symbols Enter text: The symbols that apply to the other coverage listed.
GARAGE KEEPERS Additional Coverage Limit Enter limit: The limit amount of the other coverage.
GARAGE KEEPERS Physical Damage Reporting Period Enter text: The timing of the reporting period if the policy will be on a Reporting basis. Examples: Monthly, Quarterly, Semi-Annual.
GARAGE KEEPERS Non-Reporting (Checkbox) Check the box (if applicable): Indicates the policy is on a non-reporting basis.
GARAGE KEEPERS # Dealer Plates/Repairer Plates Enter number: The total number of sets of dealer or repairer plates issued to the named insured.
GARAGE KEEPERS # Transportation Plates Enter number: The total number of sets of transportation plates issued to the applicant.
GARAGE KEEPERS # Hoists Enter number: The total number of hoists located on the premises.
GARAGE KEEPERS Temporary Location Limit Enter limit: The limit for covered autos stored temporarily off premises.
GARAGE KEEPERS Transit Limit Enter limit: The limit for covered autos in transit.
Section Name Field Name Field and/or Section Description
ENDORSEMENTS Endorsements/Remarks Enter text: The remarks associated with the Garage and Dealers line of business. Enter any endorsements that apply. Be sure to include the form numbers and the required information for attaching the endorsement.
ENDORSEMENTS Applicant's Signature Sign here: Accommodates the signature of the applicant or named insured.
ENDORSEMENTS Date Enter date: The date the form was signed by the named insured.
ENDORSEMENTS 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.
ENDORSEMENTS National Producer Number Enter identifier: The National Producer Number (NPN) as defined in the National Insurance Producer Registry (NIPR).
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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