Universal wording updates to improve clarity and intent were made to all FIG text for this form on 10/22/2008.
Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 60 NY (2008/03)
New York Homeowners
Supplement, Workers
Compensation Additional
Information
In New York, ISO Workers Compensation Endorsement HO 24 93
must be attached to all homeowners policies other than Forms HO 00 04 and HO 00 06,
when the policy covers owner-occupants of one through four family dwellings.
When the policy is issued with either HO 00 04 or HO 00 06, producers should use this
supplement to determine if HO 24 93 must be attached and to provide the insurance
company with necessary information not obtained by the Homeowners application. Refer
to the ISO manual for eligibility rules with respect to the use of HO 24 93.
IDENTIFICATION SECTION Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
IDENTIFICATION SECTION Agency
Enter text: The full name of the producer/agency.
IDENTIFICATION SECTION Applicant / Named Insured(s)
Enter text: The named insureds full name as it appears on the policy declarations page.
IDENTIFICATION SECTION Policy Number
Enter identifier: The identifier assigned by the insurer to the policy, or submission, being
referenced. If required for self-insurance, the self-insured license or contract number.
IDENTIFICATION SECTION Carrier
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy.
This is not the insurer's group name or trade name.
IDENTIFICATION SECTION NAIC Code
Enter code: The identification code assigned to the insurer by the NAIC.
HO 00 04
1A. Is the applicant a co-owner of
the dwelling, as well as an
occupant of an apartment in the
dwelling?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Is the applicant a co-owner of the dwelling, as well as an occupant of an
apartment in the dwelling?.
HO 00 04
1B. Is the other apartment
occupied by the other co-owner?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Is the other apartment occupied by the other co-owner?.
HO 00 04
1C. Are the living quarters
separate, with separate entrances?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Are living quarters separate, with separate entrances?.
HO 00 04
1D. Does the other co-owner have
a Homeowners policy that
provides building coverage?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Does the other co-owner have a homeowners policy that provides building
coverage?.
ACORD 60 NY (2008/03)
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Section Name
Field Name
Field and/or Section Description
HO 00 04
2A. Is the applicant an owner of
the dwelling who occupies an
apartment in the dwelling?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Is the applicant an owner of the dwelling who occupies an apartment in the
dwelling?.
HO 00 04
2B. Is the policy to include
premises liability coverage for the
entire property?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Is the policy to include premises liability coverage for the entire property?.
HO 00 04
3. Is the applicant a tenant of an
apartment in a dwelling that is also
occupied by an owner?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Is the applicant a tenant of an apartment in a dwelling that is also occupied by
an owner?.
HO 00 04
4. Is the applicant an owner of any
additional dwelling located in New
York state that is to be insured
under this policy?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Is the applicant an owner of any additional dwelling located in New York state
that is to be insured under this policy?.
HO 00 06
1. Is the applicant an owner-
occupant?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Is the applicant an owner-occupant?.
HO 00 06
2. Is the applicant an owner of any
additional location in New York?
Enter Y for a Yes response. Input N for No response. Indicates the response to the
question, Is the applicant an owner of any additional location in New York?.
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.
Edition
Date
The edition identifier of the form including the form number and edition (the date is
typically formatted YYYY/MM).
ACORD 60 NY (2008/03)
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