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ACORD Form 155 BM Boiler and Machinery Section 2002 Instructions
 

 
Section Name Field Name Field and/or Section Description
The following provides basic instructions for completing the ACORD 155 BM, Boiler & Machinery 2002 Section. This form has been designed to address basic underwriting and rating needs for the issuance of Boiler and Machinery policies under the ISO 2002 rules.
TITLE ACORD 155 BM (2004/12) Boiler & Machinery Section 2002 ACORD 155 BM (2004/12) This form was designed to be used in conjunction with the Commercial Insurance Application - Applicant Information Section (ACORD 125). Refer to ACORD 125 for information on that form.
Most information for the Identification Section should match the data found within the
Applicant Information Section of ACORD 125. However it is still important to complete the
section. Many companies, for rating purposes, separate the applications by line of
IDENTIFICATION SECTION business. Not completing this portion of the application impedes tracking the full account.
IDENTIFICATION SECTION Date Month/day/year (MM/DD/YYYY) on which the form is completed.
IDENTIFICATION SECTION Agency Agency's name and address.
IDENTIFICATION SECTION Phone No. Agency's telephone number. Incluse area code and extension (if applicable).
IDENTIFICATION SECTION Fax No. Agency's fax number. Include area code
Identification code assigned to the agency or brokerage firm by the insurance company
IDENTIFICATION SECTION Code receiving this form.
If the agency uses a sub-code identification system with the company, enter the
IDENTIFICATION SECTION Sub Code appropriate code.
IDENTIFICATION SECTION Agency Customer ID Customer's identification number assigned by the agency.
IDENTIFICATION SECTION Applicant (First Named Insured) First Named Insured as it appears on the ACORD 125.
IDENTIFICATION SECTION Policy Number Number exactly as it appears on the policy, including prefix and suffix symbols.
IDENTIFICATION SECTION Proposed Eff. Date Effective date on which the terms and conditions of the policy will commence.
Expiration date on which the terms and conditions of the policy will terminate unless
IDENTIFICATION SECTION Proposed Exp. Date renewed.

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Section Name Field Name Field and/or Section Description
Indicate whether the agency or the company (direct) will bill the insured or other payor for
IDENTIFICATION SECTION Billing Plan the policy.
Indicate the plan to be used to pay the company for the policy. Use the company's specific
designation for the plan where possible (e.g., Prepaid, Annual, Semi-annual, Bi-monthly,
IDENTIFICATION SECTION Payment Plan 40-30-30).
IDENTIFICATION SECTION Inspection Contact Indicate the name of the individual to be contacted for inspection of the equipment.
IDENTIFICATION SECTION Inspection Contact Phone # Indicate the telephone number of the inspection contact.
Age of Oldest Machinery and
IDENTIFICATION SECTION Equipment Indicate the age of the oldest piece of machinery and equipment.
PREMISES INFORMATION Premises # Premises location number as stated in the Applicant Information Section (ACORD 125).
Building location number as stated in the Applicant Information Section (ACORD 125).
PREMISES INFORMATION Building #
Provide the policy limits, applicable deductibles, and other necessary information for each
PREMISES INFORMATION Policy Limit of the coverages selected.
Provide the policy limits, applicable deductibles, and other necessary information for each
PREMISES INFORMATION Deductible of the coverages selected.
COVERAGE LIMITATIONS Enter the policy limits for each coverage limitation selected.
CONDITIONS OR
OPTIONAL COVERAGES Complete the fields in this section if coverage for Business Income is selected.
REMARKS Use this section to provide any additional information required for underwriting or rating.
Use this section to collect information on any additional interest or receiver of Certificates
ADDITIONAL INTERESTS of Insurance.
ADDITIONAL INTERESTS Prem # Premises location number as stated in the Applicant Information Section (ACORD 125).
ADDITIONAL INTERESTS Bldg # Building location number as stated in the Applicant Information Section (ACORD 125).
ADDITIONAL INTERESTS Name and Address List the Additional Interest's name and mailing address.
ADDITIONAL INTERESTS Certificate Required If a Certificate of Insurance is required, check this box.
Section Name Field Name Field and/or Section Description
ADDITIONAL INTERESTS Interest List the type of interest of the additional interest. Examples: * Mortgagee * Loss Payee * Additional Insured
GENERAL INFORMATION 1. Are equipment maintenance, overhaul, monitoring, disassembly and repair conducted according to manufacturers' instructions? If "NO", explain in Remarks.
2. Is all equipment accessible with respect to repair or replacement? If "NO", explain in Remarks.
3. Are all equipment instrumentation and controls in accordance with manufacturers' specifications? If "NO", explain in Remarks.
4. Are chlorofluorocarbon (CFC) refrigerants used in the machinery to cool any part of the premises or process? If "YES", explain in Remarks.
5. Is all machinery and equipment in good condition? If "NO", explain in Remarks.
REMARKS Remarks Use this section to provide any additional information required for underwriting or rating.