ACORD 137 NJ (2014/12) - NEW JERSEY COMMERCIAL AUTO COVERAGES / LIMITS SECTION

ACORD 137 NJ (2014/12) - NEW JERSEY COMMERCIAL AUTO COVERAGES / LIMITS SECTION
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 Carriers 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 referred to as other than collision coverage.
* A state-specific fraud warning is included.
Form Page 1
Section Name
Field Name
Description
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g., agency or
brokerage).
IDENTIFICATION SECTION
Date
Enter date: The date on which the form is completed.
IDENTIFICATION SECTION
Agency
Enter text: The full name of the producer / agency.
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.
IDENTIFICATION SECTION
Effective Date:
Enter date: The effective date of the policy. The date that the terms and conditions of the policy
commence.
IDENTIFICATION SECTION
Named Insured(s)
Enter text: The named insured(s) as it / they will appear on the policy declarations page.
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.
IDENTIFICATION SECTION
NAIC Code
Enter code: The identification code assigned to the insurer by the NAIC.
BUSINESS AUTO
Liability 1
Check the box (if applicable): Indicates that any auto is covered.
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.
BUSINESS AUTO
Liability 4
Check the box (if applicable): Indicates that owned autos other than private passenger autos are
covered.
BUSINESS AUTO
Liability 7
Check the box (if applicable): Indicates that autos specified on the vehicle schedule are
covered.
BUSINESS AUTO
Liability 8
Check the box (if applicable): Indicates that hired autos are covered.
BUSINESS AUTO
Liability 9
Check the box (if applicable): Indicates that non-owned autos are covered.
BUSINESS AUTO
Liability Other
Check the box (if applicable): Indicates that a symbol other than those listed should be used.
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.
BUSINESS AUTO
Limits - CSL
Check the box (if applicable): Indicates if the limit shown is for combined single limit on the
coverage.
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.
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).
BUSINESS AUTO
BI Ea Accident ($)
Enter limit: The vehicle policy, bodily injury per accident limit amount. Any questions about
appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s).
BUSINESS AUTO
Property Damage ($)
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).
BUSINESS AUTO
Personal Injury Protection 5
Check the box (if applicable): Indicates that all owned autos which require no-fault coverage are
covered.
BUSINESS AUTO
Personal Injury Protection 7
Check the box (if applicable): Indicates that autos specified on the vehicle schedule are
covered.
BUSINESS AUTO
Personal Injury Protection
Other
Check the box (if applicable): Indicates that a symbol other than those listed should be used.
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.
BUSINESS AUTO
Lawsuit Threshold
Check the box (if applicable): Indicates the personal injury protection (PIP) has a lawsuit
threshold.
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.
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.
BUSINESS AUTO
Health Insurance Option No
Check the box (if applicable): Indicates the personal injury protection (PIP) health insurance
option has not been selected.
BUSINESS AUTO
Medical Expense Amount
Enter limit: The personal injury protection (PIP) medical expense limit amount.
BUSINESS AUTO
Deductible
Enter deductible: The deductible amount for personal injury protection (PIP) coverage.
BUSINESS AUTO
Ext Medical Expense Each
Person
Enter limit: The extended medical expense per person limit amount.
BUSINESS AUTO
Extra PIP Options Number
of Relatives
Enter number: The additional personal injury protection (APIP) number of additional relatives
being extended additional PIP.
BUSINESS AUTO
Uninsured / Underinsured
Motorists 2
Check the box (if applicable): Indicates that all owned autos are covered.
BUSINESS AUTO
Uninsured / Underinsured
Motorists 3
Check the box (if applicable): Indicates that owned private passenger autos are covered.
BUSINESS AUTO
Uninsured / Underinsured
Motorists 4
Check the box (if applicable): Indicates that owned autos other than private passenger autos are
covered.
BUSINESS AUTO
Uninsured / Underinsured
Motorists 6
Check the box (if applicable): Indicates that owned autos subject to compulsory uninsured
motorists law are covered.
BUSINESS AUTO
Uninsured / Underinsured
Motorists 7
Check the box (if applicable): Indicates that autos specified on the vehicle schedule are
covered.
BUSINESS AUTO
Uninsured / Underinsured
Motorists Other
Check the box (if applicable): Indicates that a symbol other than those listed should be used.
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.
BUSINESS AUTO
CSL (checkbox)
Check the box (if applicable): Indicates if the limit shown is for combined single limit on the
coverage.
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.
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 ($)
Enter limit: The uninsured / underinsured motorists bodily injury per accident limit (in some
states this may contain the uninsured / underinsured motorists combined single limit per
accident limit). The use of this limit varies by state.
BUSINESS AUTO
Property Damage ($)
Enter limit: The uninsured / underinsured property damage limit amount.
BUSINESS AUTO
Hired / Borrowed Liability
Yes
Check the box (if applicable): Indicates if hired / borrowed coverage applies.
BUSINESS AUTO
States
Enter code: Indicates a state where autos are hired or borrowed.
BUSINESS AUTO
Enter code: Indicates a state where autos are hired or borrowed.
BUSINESS AUTO
Enter code: Indicates a state where autos are hired or borrowed.
BUSINESS AUTO
Hired / Borrowed Liability
No
Check the box (if applicable): Indicates that hired / borrowed coverage does not apply.
BUSINESS AUTO
If any Basis (checkbox)
Enter amount: The estimated amount it will cost to hire the vehicles.
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.
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.
BUSINESS AUTO
States
Enter code: Indicates a state where autos are non-owned.
BUSINESS AUTO
Enter code: Indicates a state where autos are non-owned.
BUSINESS AUTO
Enter code: Indicates a state where autos are non-owned.
BUSINESS AUTO
Enter code: Indicates a state where autos are non-owned.
BUSINESS AUTO
Enter code: Indicates a state where autos are non-owned.
BUSINESS AUTO
Enter code: Indicates a state where autos are non-owned.
BUSINESS AUTO
Enter code: Indicates a state where autos are non-owned.
BUSINESS AUTO
Enter code: Indicates a state where autos are non-owned.
BUSINESS AUTO
Enter code: Indicates a state where autos are non-owned.
BUSINESS AUTO
Non-Owned Liability No
Check the box (if applicable): Indicates that non-owned coverage does not apply.
BUSINESS AUTO
Group Type - Employees
Check the box (if applicable): Indicates that non-owned liability coverage pertains to employees.
BUSINESS AUTO
Number of Employees
Enter number: The number of employees that use their own automobiles.
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.
BUSINESS AUTO
Partners
Check the box (if applicable): Indicates that non-owned liability coverage pertains to partners.
BUSINESS AUTO
Number of Partners
Enter number: The number of partners that use their own automobiles.
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).
BUSINESS AUTO
Additional Coverage
Covered Auto Symbols
Enter text: The symbols that apply to the other coverage listed.
BUSINESS AUTO
Additional Coverage Limit
Enter limit: The limit amount of the other coverage.
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).
BUSINESS AUTO
Additional Coverage
Covered Auto Symbols
Enter text: The symbols that apply to the other coverage listed.
BUSINESS AUTO
Additional Coverage Limit
Enter limit: The limit amount of the other coverage.
BUSINESS AUTO
Towing & Labor 3
Check the box (if applicable): Indicates that owned private passenger autos are covered.
BUSINESS AUTO
Towing & Labor 7
Check the box (if applicable): Indicates that autos specified on the vehicle schedule are
covered.
BUSINESS AUTO
Towing & Labor Other
Check the box (if applicable): Indicates that a symbol other than those listed should be used.
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.
BUSINESS AUTO
Limit ($)
Enter limit: The towing and labor limit amount.
BUSINESS AUTO
Other Than Collision (OTC)
2
Check the box (if applicable): Indicates that all owned autos are covered.
BUSINESS AUTO
Other Than Collision (OTC)
3
Check the box (if applicable): Indicates that owned private passenger autos are covered.
BUSINESS AUTO
Other Than Collision (OTC)
4
Check the box (if applicable): Indicates that owned autos other than private passenger autos are
covered.
BUSINESS AUTO
Other Than Collision (OTC)
7
Check the box (if applicable): Indicates that autos specified on the vehicle schedule are
covered.
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.
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.
BUSINESS AUTO
Specified Causes of Loss 2
Check the box (if applicable): Indicates that all owned autos are covered.
BUSINESS AUTO
Specified Causes of Loss 3
Check the box (if applicable): Indicates that owned private passenger autos are covered.
BUSINESS AUTO
Specified Causes of Loss 4
Check the box (if applicable): Indicates that owned autos other than private passenger autos are
covered.
BUSINESS AUTO
Specified Causes of Loss 7
Check the box (if applicable): Indicates that autos specified on the vehicle schedule are
covered.
BUSINESS AUTO
Specified Causes of Loss 8
Check the box (if applicable): Indicates that hired autos are covered.
BUSINESS AUTO
Specified Causes of Loss
Other
Check the box (if applicable): Indicates that a symbol other than those listed should be used.
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.
BUSINESS AUTO
Collision 2
Check the box (if applicable): Indicates that all owned autos are covered.
BUSINESS AUTO
Collision 3
Check the box (if applicable): Indicates that owned private passenger autos are covered.
BUSINESS AUTO
Collision 4
Check the box (if applicable): Indicates that owned autos other than private passenger autos are
covered.
BUSINESS AUTO
Collision 7
Check the box (if applicable): Indicates that autos specified on the vehicle schedule are
covered.
BUSINESS AUTO
Collision 8
Check the box (if applicable): Indicates that hired autos are covered.
BUSINESS AUTO
Collision Other
Check the box (if applicable): Indicates that a symbol other than those listed should be used.
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.
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).
BUSINESS AUTO
Additional Coverage
Covered Auto Symbols
Enter text: The symbols that apply to the other coverage listed.
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).
BUSINESS AUTO
Additional Coverage
Covered Auto Symbols
Enter text: The symbols that apply to the other coverage listed.
BUSINESS AUTO
Additional Coverage Limit
Enter limit: The limit amount of the other coverage.
BUSINESS AUTO
Hired Physical Damage
States
Enter code: Indicates a state where autos are hired and have physical damage coverage.
BUSINESS AUTO
Enter code: Indicates a state where autos are hired and have physical damage coverage.
BUSINESS AUTO
Enter code: Indicates a state where autos are hired and have physical damage coverage.
BUSINESS AUTO
Enter code: Indicates a state where autos are hired and have physical damage coverage.
BUSINESS AUTO
Enter code: Indicates a state where autos are hired and have physical damage coverage.
BUSINESS AUTO
Enter code: Indicates a state where autos are hired and have physical damage coverage.
BUSINESS AUTO
Hired Physical Damage #
Days
Enter number: The number of days needed to rate Hired Physical Damage Coverage.
BUSINESS AUTO
Hired Physical Damage #
Veh
Enter number: The number of vehicles needed to rate Hired Physical Damage Coverage.
BUSINESS AUTO
Coverage / Deductible Comp
(checkbox)
Check the box (if applicable): Indicates the deductible is for comprehensive or other than
collision coverage.
BUSINESS AUTO
Other Than Collision (OTC)
Enter deductible: The comprehensive or other than collision deductible amount.
BUSINESS AUTO
Specified Causes of Loss
(checkbox)
Check the box (if applicable): Indicates the deductible is for specified causes of loss. The
Specified Cause of Loss Codes are:
SCL Specified Cause of Loss
F Fire
F&T Fire and Theft
F,T&W Fire, Theft and Wind
LSP Limited Specified Perils
SP Specified Perils
BUSINESS AUTO
Specified Causes of Loss ($)
Enter deductible: The deductible associated with specified causes of loss coverage. As used
here, enter the deductible only if it is applicable to all vehicles.
BUSINESS AUTO
Coll (checkbox)
Check the box (if applicable): Indicates the vehicle has collision coverage.
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.
BUSINESS AUTO
Coverage is: Secondary
(Checkbox)
Check the box (if applicable): Indicates if this coverage is on a secondary basis.
ENDORSEMENTS /
REMARKS
Endorsements / Remarks
Enter text: The remarks associated with the commercial vehicle line of business. Enter any
endorsements that apply. Be sure to include the form numbers and the required information for
attaching the endorsement. ACORD 101, Additional Remarks Schedule, may be attached 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.
SIGNATURE
Producer's Signature
Sign here: Accommodates the signature of the authorized representative (e.g., producer, agent,
broker, etc.) of the company(ies) listed on the document. 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.
Form Page 2
Section Name
Field Name
Description
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g., agency or
brokerage).
TRUCKERS
Liability 41
Check the box (if applicable): Indicates that any auto is covered.
TRUCKERS
Liability 42
Check the box (if applicable): Indicates that owned autos only are covered.
TRUCKERS
Liability 43
Check the box (if applicable): Indicates that owned commercial autos only are covered.
TRUCKERS
Liability 46
Check the box (if applicable): Indicates that specifically described autos are covered.
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.
TRUCKERS
Liability Other Symbol
Enter code: The symbol code for the coverage.
TRUCKERS
Limits - CSL
Check the box (if applicable): Indicates if the limit shown is for combined single limit on the
coverage.
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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Page 8 of 23
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.
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.
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.
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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.
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.
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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. Check this box if the
exposure is minimal. The actual exposure is determined at the time of audit.
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.
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.
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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 (2014/12) rev. 02-27-2014
Page 12 of 23
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.
TRUCKERS
# Trailers
Enter number: The number of trailers operated by the insured under a Trailer Interchange
Agreement.
ACORD 137 NJ (2014/12) rev. 02-27-2014
Page 13 of 23
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.
TRUCKERS
Deductible ($)
Enter deductible: The deductible amount applicable to trailer interchange collision coverage.
TRUCKERS
Trailer Value
Enter amount: The trailer value as assigned by the trailer interchange agreement.
TRUCKERS
Hired Physical Damage
States
Enter code: Indicates a state where autos are hired and have physical damage coverage.
ACORD 137 NJ (2014/12) rev. 02-27-2014
Page 14 of 23
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.
TRUCKERS
Coverage is: Secondary
(Checkbox)
Check the box (if applicable): Indicates if this coverage is on a secondary basis.
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.
ENDORSEMENTS /
REMARKS
Endorsements / Remarks
Enter text: The remarks associated with the commercial vehicle line of business. Enter any
endorsements that apply. Be sure to include the form numbers and the required information for
attaching the endorsement. ACORD 101, Additional Remarks Schedule, may be attached 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.
SIGNATURE
Producer's Signature
Sign here: Accommodates the signature of the authorized representative (e.g., producer, agent,
broker, etc.) of the company(ies) listed on the document. 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.
Form Page 3
Section Name
Field Name
Description
ACORD 137 NJ (2014/12) rev. 02-27-2014
Page 15 of 23
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 hired 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).
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.
ACORD 137 NJ (2014/12) rev. 02-27-2014
Page 16 of 23
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.
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.
ACORD 137 NJ (2014/12) rev. 02-27-2014
Page 17 of 23
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.
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. Check this box if the
exposure is minimal. The actual exposure is determined at the time of audit.
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.
ACORD 137 NJ (2014/12) rev. 02-27-2014
Page 18 of 23
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.
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.
ACORD 137 NJ (2014/12) rev. 02-27-2014
Page 19 of 23
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 hired 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.
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 hired 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.
MOTOR CARRIER SECTION
SCL
Check the box (if applicable): Indicates the vehicle has specified cause of loss coverage.
MOTOR CARRIER SECTION
F
Check the box (if applicable): Indicates fire is a specified cause of loss on this vehicle.
MOTOR CARRIER SECTION
FT
Check the box (if applicable): Indicates fire and theft is a specified cause of loss on this vehicle.
MOTOR CARRIER SECTION
FTW
Check the box (if applicable): Indicates fire, theft and windstorm is a specified cause of loss on
this vehicle.
MOTOR CARRIER SECTION
LSP
Check the box (if applicable): Indicates limited specified perils is a specified cause of loss on
this vehicle.
MOTOR CARRIER SECTION
Deductible ($)
Enter deductible: The deductible associated with specified causes of loss coverage.
MOTOR CARRIER SECTION
Collision 62
Check the box (if applicable): Indicates that owned autos only are covered.
MOTOR CARRIER SECTION
Collision 63
Check the box (if applicable): Indicates that owned private passenger autos only are covered.
MOTOR CARRIER SECTION
Collision 64
Check the box (if applicable): Indicates that owned commercial autos only are covered.
ACORD 137 NJ (2014/12) rev. 02-27-2014
Page 20 of 23
MOTOR CARRIER SECTION
Collision 67
Check the box (if applicable): Indicates that specifically described autos are covered.
MOTOR CARRIER SECTION
Collision 68
Check the box (if applicable): Indicates that hired autos only are covered.
MOTOR CARRIER SECTION
Collision Other
Check the box (if applicable): Indicates that a symbol other than those listed should be used.
MOTOR CARRIER SECTION
Collision Other Symbol
Enter code: The symbol code for the coverage.
MOTOR CARRIER SECTION
Collision Deductible
Enter deductible: The collision deductible amount.
MOTOR CARRIER SECTION
Towing & Labor 63
Check the box (if applicable): Indicates that owned private passenger autos only are covered.
MOTOR CARRIER SECTION
Towing & Labor 67
Check the box (if applicable): Indicates that specifically described autos are covered.
MOTOR CARRIER SECTION
Towing & Labor Other
Check the box (if applicable): Indicates that a symbol other than those listed should be used.
MOTOR CARRIER SECTION
Towing & Labor Other
Symbol
Enter code: The symbol code for the coverage.
MOTOR CARRIER SECTION
Towing & Labor Limit Amt
Enter limit: The towing and labor limit amount.
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.
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.
MOTOR CARRIER SECTION
# Trailers
Enter number: The number of trailers operated by the insured under a Trailer Interchange
Agreement.
MOTOR CARRIER SECTION
Farth Zone
Enter code: The state of the farthest zone where trailer interchange coverage applies.
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.
MOTOR CARRIER SECTION
Radius
Enter number: The radius in actual mileage within which trailers, covered by this policy, are
pulled by other tractors.
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.
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.
MOTOR CARRIER SECTION
# Trailers
Enter number: The number of trailers operated by the insured under a Trailer Interchange
Agreement.
MOTOR CARRIER SECTION
Farth Zone
Enter code: The state of the farthest zone where trailer interchange coverage applies.
ACORD 137 NJ (2014/12) rev. 02-27-2014
Page 21 of 23
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.
MOTOR CARRIER SECTION
Radius
Enter number: The radius in actual mileage within which trailers, covered by this policy, are
pulled by other tractors.
MOTOR CARRIER SECTION
Collision 69
Check the box (if applicable): Indicates that trailers in your possession under a trailer
interchange agreement are covered.
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.
MOTOR CARRIER SECTION
# Trailers
Enter number: The number of trailers operated by the insured under a Trailer Interchange
Agreement.
MOTOR CARRIER SECTION
Farth Zone
Enter code: The state of the farthest zone where trailer interchange coverage applies.
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.
MOTOR CARRIER SECTION
Radius
Enter number: The radius in actual mileage within which trailers, covered by this policy, are
pulled by other tractors.
MOTOR CARRIER SECTION
Deductible ($)
Enter deductible: The deductible amount applicable to trailer interchange collision coverage.
MOTOR CARRIER
Trailer Value
Enter amount: The trailer value as assigned by the trailer interchange agreement.
MOTOR CARRIER SECTION
Hired Physical Damage
States
Enter code: Indicates a state where autos are hired and have physical damage coverage.
MOTOR CARRIER SECTION
Enter code: Indicates a state where autos are hired and have physical damage coverage.
MOTOR CARRIER SECTION
Enter code: Indicates a state where autos are hired and have physical damage coverage.
MOTOR CARRIER SECTION
Enter code: Indicates a state where autos are hired and have physical damage coverage.
MOTOR CARRIER SECTION
Enter code: Indicates a state where autos are hired and have physical damage coverage.
MOTOR CARRIER SECTION
Enter code: Indicates a state where autos are hired and have physical damage coverage.
MOTOR CARRIER SECTION
Hired Physical Damage #
Days
Enter number: The number of days needed to rate Hired Physical Damage Coverage.
MOTOR CARRIER SECTION
Hired Physical Damage #
Veh
Enter number: The number of vehicles needed to rate Hired Physical Damage Coverage.
MOTOR CARRIER SECTION
Coverage is: Primary
(Checkbox)
Check the box (if applicable): Indicates if this coverage is on a primary basis.
ACORD 137 NJ (2014/12) rev. 02-27-2014
Page 22 of 23
MOTOR CARRIER SECTION
Coverage is: Secondary
(Checkbox)
Check the box (if applicable): Indicates if this coverage is on a secondary basis.
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.
ENDORSEMENTS /
REMARKS
Endorsements / Remarks
Enter text: The remarks associated with the commercial vehicle line of business. Enter any
endorsements that apply. Be sure to include the form numbers and the required information for
attaching the endorsement. ACORD 101, Additional Remarks Schedule, may be attached 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.
SIGNATURE
Producer's Signature
Sign here: Accommodates the signature of the authorized representative (e.g., producer, agent,
broker, etc.) of the company(ies) listed on the document. 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.
ACORD 137 NJ (2014/12) rev. 02-27-2014
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