ACORD 148 (2013/09)

Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 148 (2013/09)
Electronic Data Processing
Section
ACORD 148, Electronic Data Processing Section, has been designed
to handle the basic underwriting and rating needs for issuing an EDP policy.
Individual company manuals should be consulted for unique underwriting, rating, and other
information required by specific companies.
This form was designed to be used in conjunction with ACORD 125, Commercial
Insurance Application - Applicant Information Section. 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 business. Not completing this portion of the application makes it difficult to keep
track of the full account.
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
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.
IDENTIFICATION SECTION
Applicant / First Named Insured
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
PREMISES INFORMATION
Location Number
Enter number: The location number for the premises. As used here, the premises location
number as found in the premises information section on the ACORD 125. If the coverage
limits are blanketed, leave this section blank.
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Section Name
Field Name
Field and/or Section Description
PREMISES INFORMATION
Building Number
Enter number: The building number for the premises. Used when more than one building
exists at an individual location.
PREMISES INFORMATION
Equipment Owned Limit of
Insurance
Enter limit: The limit amount for electronic data processing equipment (hardware) owned.
If covering owned equipment (not leased), list the insurance limit, valuation type,
coinsurance percentage and forms and conditions. This is a separate limit from the leased
equipment.
PREMISES INFORMATION
Equipment Owned Valuation Type
ACV
Check the box (if applicable): Indicates the type of value used in determining the limit of
insurance is actual cash value.
PREMISES INFORMATION
Equipment Owned Valuation Type
RC
Check the box (if applicable): Indicates the type of value used in determining the limit of
insurance is replacement cost.
PREMISES INFORMATION
Equipment Owned Valuation Type
OTHER
Check the box (if applicable): Indicates the type of value used in determining the limit of
insurance is other than those listed. Enter the type in remarks.
PREMISES INFORMATION
Equipment Owned Coin %
Enter percentage: The coinsurance percentage used at the time of loss.
PREMISES INFORMATION
Equipment Owned Deductible
Enter deductible: The deductible amount for the coverage.
PREMISES INFORMATION
Equipment Owned Forms and
Conditions to Apply
Enter text: The description of all form numbers and special conditions applicable to the
coverage.
PREMISES INFORMATION
Equipment Leased Limit of
Insurance
Enter limit: The limit amount for electronic data processing equipment (hardware) leased.
List the Leased equipment limit separately from the Owned equipment limit. Attach a copy
of the lessor's contract for all leased equipment and also complete the Additional Insured
section for the lessors. If a coinsurance percentage applies to this coverage, this is the
coinsurance limit (e.g., $1 million of coverage written at 80 percent coinsurance is listed as
$800,000).
PREMISES INFORMATION
Equipment Leased Valuation Type
ACV
Check the box (if applicable): Indicates the type of value used in determining the limit of
insurance is actual cash value.
PREMISES INFORMATION
Equipment Leased Valuation Type
RC
Check the box (if applicable): Indicates the type of value used in determining the limit of
insurance is replacement cost.
PREMISES INFORMATION
Equipment Leased Coin %
Enter percentage: The coinsurance percentage used at the time of loss.
PREMISES INFORMATION
Equipment Leased Deductible
Enter deductible: The deductible amount for the coverage.
PREMISES INFORMATION
Equipment Leased Forms and
Conditions to Apply
Enter text: The description of all form numbers and special conditions applicable to the
coverage.
PREMISES INFORMATION
Equipment in Transit Limit of
Insurance
Enter limit: The limit amount for electronic data processing equipment (hardware) in transit.
If a coinsurance percentage applies to this coverage, this is the coinsurance limit (e.g., $1
million of coverage written at 80 percent coinsurance is listed as $800,000).
PREMISES INFORMATION
Equipment in Transit Valuation
Type ACV
Check the box (if applicable): Indicates the type of value used in determining the limit of
insurance is actual cash value.
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Section Name
Field Name
Field and/or Section Description
PREMISES INFORMATION
Equipment in Transit Valuation
Type RC
Check the box (if applicable): Indicates the type of value used in determining the limit of
insurance is replacement cost.
PREMISES INFORMATION
Equipment in Transit Coin %
Enter percentage: The coinsurance percentage used at the time of loss.
PREMISES INFORMATION
Equipment in Transit Deductible
Enter deductible: The deductible amount for the coverage.
PREMISES INFORMATION
Equipment in Transit Forms and
Conditions to Apply
Enter text: The description of all form numbers and special conditions applicable to the
coverage.
PREMISES INFORMATION
Media / Data Software Limit of
Insurance
Enter limit: The limit amount for electronic data processing media/data (software). Limit in
terms of the reproduction cost of the software programs, the insured's data and the disks
and tapes on which the data is stored. If a coinsurance percentage applies to this
coverage, this is the coinsurance limit (e.g., $1 million of coverage written at 80 percent
coinsurance is listed as $800,000).
PREMISES INFORMATION
Media / Data Software Valuation
Type Reproduction
Check the box (if applicable): Indicates the type of value used in determining the limit of
insurance is reproduction.
PREMISES INFORMATION
Media / Data Software Coin %
Enter percentage: The coinsurance percentage used at the time of loss.
PREMISES INFORMATION
Media / Data Software Deductible
Enter deductible: The deductible amount for the coverage.
PREMISES INFORMATION
Media / Data Software Forms and
Conditions to Apply
Enter text: The description of all form numbers and special conditions applicable to the
coverage.
PREMISES INFORMATION
Media / Data Software in Transit
Limit of Insurance
Enter limit: The limit amount for electronic data processing media/data (software) in transit.
Limit in terms of the reproduction cost of the software programs, the insured's data and the
disks and tapes on which the data is stored. If a coinsurance percentage applies to this
coverage, this is the coinsurance limit (e.g., $1 million of coverage written at 80 percent
coinsurance is listed as $800,000).
PREMISES INFORMATION
Media / Data Software in Transit
Valuation Type Reproduction
Check the box (if applicable): Indicates the type of value used in determining the limit of
insurance is reproduction.
PREMISES INFORMATION
Media / Data Software in Transit
Coin %
Enter percentage: The coinsurance percentage used at the time of loss.
PREMISES INFORMATION
Media / Data Software in Transit
Deductible
Enter deductible: The deductible amount for the coverage.
PREMISES INFORMATION
Media / Data Software in Transit
Forms and Conditions to Apply
Enter text: The description of all form numbers and special conditions applicable to the
coverage.
PREMISES INFORMATION
Extra Expense Limit of Insurance
Enter limit: The limit amount for electronic data processing extra expense. If a
coinsurance percentage applies to this coverage, this is the coinsurance limit (e.g., $1
million of coverage written at 80 percent coinsurance is listed as $800,000).
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Section Name
Field Name
Field and/or Section Description
PREMISES INFORMATION
Extra Expense Valuation Type
Period Of Restoration
Enter number: The period of restoration. The total number of days expected to be fully
operational after a total loss
PREMISES INFORMATION
Extra Expense Coin %
Enter percentage: The coinsurance percentage used at the time of loss.
PREMISES INFORMATION
Extra Expense Deductible
Enter deductible: The deductible amount for the coverage.
PREMISES INFORMATION
Extra Expense Forms and
Conditions to Apply
Enter text: The description of all form numbers and special conditions applicable to the
coverage.
PREMISES INFORMATION
Business Interruption Limit of
Insurance
Enter limit: The limit amount for electronic data processing business interruption. If a
coinsurance percentage applies to this coverage, this is the coinsurance limit (e.g., $1
million of coverage written at 80 percent coinsurance is listed as $800,000).
PREMISES INFORMATION
Business Interruption Valuation
Type Per Day LET
Enter limit: The per day limit amount for business interruption coverage.
PREMISES INFORMATION
Business Interruption Valuation
Type # Days
Enter number: The number of days of coverage.
PREMISES INFORMATION
Business Interruption Coin %
Enter percentage: The coinsurance percentage used at the time of loss.
PREMISES INFORMATION
Business Interruption Deductible
Dollar
Enter deductible: The deductible amount for the coverage.
PREMISES INFORMATION
Business Interruption Deductible
Waiting Period Hrs
Enter number: The number of hours to be applied before the deductible goes into effect
(waiting period hours).
PREMISES INFORMATION
Business Interruption Forms and
Conditions to Apply
Enter text: The description of all form numbers and special conditions applicable to the
coverage.
PREMISES INFORMATION
Mechanical Breakdown Yes
Check the box (if applicable): Indicates mechanical breakdown coverage is applicable.
PREMISES INFORMATION
Mechanical Breakdown No
Check the box (if applicable): Indicates mechanical breakdown coverage is not applicable.
PREMISES INFORMATION
Protection and Control System
Limit of Insurance
Enter limit: The limit amount for electronic data processing protection and control system.
If a coinsurance percentage applies to this coverage, this is the coinsurance limit (e.g., $1
million of coverage written at 80 percent coinsurance is listed as $800,000).
PREMISES INFORMATION
Protection and Control System
Valuation Type
Enter code: Indicates the type of value used in determining the limit of insurance.
PREMISES INFORMATION
Protection and Control System
Coin %
Enter percentage: The coinsurance percentage used at the time of loss.
PREMISES INFORMATION
Protection and Control System
Deductible
Enter deductible: The deductible amount for the coverage.
PREMISES INFORMATION
Protection and Control System
Forms and Conditions to Apply
Enter text: The description of all form numbers and special conditions applicable to the
coverage.
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Section Name
Field Name
Field and/or Section Description
PREMISES INFORMATION
Other Subject of Insurance
Description
Enter text: The description of the coverage.
PREMISES INFORMATION
Other Subject of Insurance Limit of
Insurance
Enter limit: The limit of the coverage. As used here, if a coinsurance percentage applies to
this coverage, this is the coinsurance limit (e.g., $1 million of coverage written at 80
percent coinsurance is listed as $80,000).
PREMISES INFORMATION
Other Subject of Insurance
Valuation Type
Enter code: Indicates the type of value used in determining the limit of insurance.
PREMISES INFORMATION
Other Subject of Insurance Coin %
Enter percentage: The coinsurance percentage used at the time of loss.
PREMISES INFORMATION
Other Subject of Insurance
Deductible
Enter deductible: The deductible of the coverage.
PREMISES INFORMATION
Other Subject of Insurance Forms
and Conditions to Apply
Enter text: The description of all form numbers and special conditions applicable to the
coverage.
PREMISES INFORMATION
Flood Coverage Yes
Check the box (if applicable): Indicates flood coverage applies to the policy.
PREMISES INFORMATION
Flood Coverage No
Check the box (if applicable): Indicates flood coverage does not apply to the policy.
PREMISES INFORMATION
Flood Coverage Zone
Enter code: The code indicating the flood zone the property is located in. The source of
this code list is the Flood Insurance Rate Map.
PREMISES INFORMATION
Location Of Equipment Above
Ground
Check the box (if applicable): Indicates the majority of the computer equipment is located
above ground level.
PREMISES INFORMATION
Location Of Equipment Below
Ground
Check the box (if applicable): Indicates the majority of the computer equipment is located
below ground level.
PREMISES INFORMATION
Location Of Equipment Ground
Level
Check the box (if applicable): Indicates the majority of the computer equipment is located
at ground level.
PREMISES INFORMATION
Earthquake Coverage Yes
Check the box (if applicable): Indicates earthquake coverage applies to the policy.
PREMISES INFORMATION
Earthquake Coverage No
Check the box (if applicable): Indicates earthquake coverage does not apply to the policy.
PREMISES INFORMATION
Earthquake Coverage Zone
Enter code: The code that defines a particular area for the sole purpose of rating
Earthquake Coverage. The source of this code list is the company or state/province
earthquake manuals.
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Section Name
Field Name
Field and/or Section Description
RATING INFORMATION
Building Construction Type
Enter code: The primary construction type of the premises. Common construction
classifications are:
* Frame
* Joisted Masonry
* Non-Combustible
* Masonry Non-Combustible
* Modified Fire Resistive
* Fire Resistive
RATING INFORMATION
Prot Class
Enter code: The fire rating protection class for this location. Note: some structures may be
located too far from the nearest hydrant, or too far from the nearest fire station, for the
protection class of the community to apply.
RATING INFORMATION
# of stories
Enter number: The number of stories for this building not including any basement.
RATING INFORMATION
Year Built
Enter year: The year the structure was built (YYYY).
SCHEDULE OF EQUIPMENT Loc. # One
Enter number: The location number for the premises. As used here, the location number
for the equipment as found on the ACORD 125.
SCHEDULE OF EQUIPMENT Bldg # One
Enter number: The building number for the premises. Used when more than one building
exists at an individual location. As used here, the building number for the equipment as
found on the ACORD 125.
SCHEDULE OF EQUIPMENT Item # One
Enter identifier: The producer assigned identifier for the item.
SCHEDULE OF EQUIPMENT Manufacturer One
Enter text: The name of the manufacturer of the item.
SCHEDULE OF EQUIPMENT Model One
Enter text: The manufacturer's model name or number for the item.
SCHEDULE OF EQUIPMENT Serial # One
Enter identifier: The identification number, serial number, or any other identifying symbol of
the item.
SCHEDULE OF EQUIPMENT Leased or Owned One
Enter code: Indicates the ownership status of the item as leased or owned.
SCHEDULE OF EQUIPMENT Current Full 100% Value One
Enter number: The amount it would currently cost to replace this piece of equipment with
the exact same model. As used here, due to the nature of computer equipment, this value
may be substantially less than the applicant's original purchase price
SCHEDULE OF EQUIPMENT One
Amount of Insur. (Coinsurance %)
Enter limit: Amount the piece of equipment is to be insured for at its coinsurance level and
requested valuation type.
SCHEDULE OF EQUIPMENT Loc. # Two
Enter number: The location number for the premises. As used here, the location number
for the equipment as found on the ACORD 125.
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Section Name
Field Name
Field and/or Section Description
SCHEDULE OF EQUIPMENT Bldg # Two
Enter number: The building number for the premises. Used when more than one building
exists at an individual location. As used here, the building number for the equipment as
found on the ACORD 125.
SCHEDULE OF EQUIPMENT Item # Two
Enter identifier: The producer assigned identifier for the item.
SCHEDULE OF EQUIPMENT Manufacturer Two
Enter text: The name of the manufacturer of the item.
SCHEDULE OF EQUIPMENT Model Two
Enter text: The manufacturer's model name or number for the item.
SCHEDULE OF EQUIPMENT Serial # Two
Enter identifier: The identification number, serial number, or any other identifying symbol of
the item.
SCHEDULE OF EQUIPMENT Leased or Owned Two
Enter code: Indicates the ownership status of the item as leased or owned.
SCHEDULE OF EQUIPMENT Current Full 100% Value Two
Enter number: The amount it would currently cost to replace this piece of equipment with
the exact same model. As used here, due to the nature of computer equipment, this value
may be substantially less than the applicant's original purchase price
SCHEDULE OF EQUIPMENT Two
Amount of Insur. (Coinsurance %)
Enter limit: Amount the piece of equipment is to be insured for at its coinsurance level and
requested valuation type.
SCHEDULE OF EQUIPMENT Loc. # Three
Enter number: The location number for the premises. As used here, the location number
for the equipment as found on the ACORD 125.
SCHEDULE OF EQUIPMENT Bldg # Three
Enter number: The building number for the premises. Used when more than one building
exists at an individual location. As used here, the building number for the equipment as
found on the ACORD 125.
SCHEDULE OF EQUIPMENT Item # Three
Enter identifier: The producer assigned identifier for the item.
SCHEDULE OF EQUIPMENT Manufacturer Three
Enter text: The name of the manufacturer of the item.
SCHEDULE OF EQUIPMENT Model Three
Enter text: The manufacturer's model name or number for the item.
SCHEDULE OF EQUIPMENT Serial # Three
Enter identifier: The identification number, serial number, or any other identifying symbol of
the item.
SCHEDULE OF EQUIPMENT Leased or Owned Three
Enter code: Indicates the ownership status of the item as leased or owned.
SCHEDULE OF EQUIPMENT Current Full 100% Value Three
Enter number: The amount it would currently cost to replace this piece of equipment with
the exact same model. As used here, due to the nature of computer equipment, this value
may be substantially less than the applicant's original purchase price
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Section Name
Field Name
Field and/or Section Description
SCHEDULE OF EQUIPMENT Three
Amount of Insur. (Coinsurance %)
Enter limit: Amount the piece of equipment is to be insured for at its coinsurance level and
requested valuation type.
SCHEDULE OF EQUIPMENT Loc. # Four
Enter number: The location number for the premises. As used here, the location number
for the equipment as found on the ACORD 125.
SCHEDULE OF EQUIPMENT Bldg # Four
Enter number: The building number for the premises. Used when more than one building
exists at an individual location. As used here, the building number for the equipment as
found on the ACORD 125.
SCHEDULE OF EQUIPMENT Item # Four
Enter identifier: The producer assigned identifier for the item.
SCHEDULE OF EQUIPMENT Manufacturer Four
Enter text: The name of the manufacturer of the item.
SCHEDULE OF EQUIPMENT Model Four
Enter text: The manufacturer's model name or number for the item.
SCHEDULE OF EQUIPMENT Serial # Four
Enter identifier: The identification number, serial number, or any other identifying symbol of
the item.
SCHEDULE OF EQUIPMENT Leased or Owned Four
Enter code: Indicates the ownership status of the item as leased or owned.
SCHEDULE OF EQUIPMENT Current Full 100% Value Four
Enter number: The amount it would currently cost to replace this piece of equipment with
the exact same model. As used here, due to the nature of computer equipment, this value
may be substantially less than the applicant's original purchase price
SCHEDULE OF EQUIPMENT Four
Amount of Insur. (Coinsurance %)
Enter limit: Amount the piece of equipment is to be insured for at its coinsurance level and
requested valuation type.
SCHEDULE OF EQUIPMENT Loc. # Five
Enter number: The location number for the premises. As used here, the location number
for the equipment as found on the ACORD 125.
SCHEDULE OF EQUIPMENT Bldg # Five
Enter number: The building number for the premises. Used when more than one building
exists at an individual location. As used here, the building number for the equipment as
found on the ACORD 125.
SCHEDULE OF EQUIPMENT Item # Five
Enter identifier: The producer assigned identifier for the item.
SCHEDULE OF EQUIPMENT Manufacturer Five
Enter text: The name of the manufacturer of the item.
SCHEDULE OF EQUIPMENT Model Five
Enter text: The manufacturer's model name or number for the item.
SCHEDULE OF EQUIPMENT Serial # Five
Enter identifier: The identification number, serial number, or any other identifying symbol of
the item.
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Section Name
Field Name
Field and/or Section Description
SCHEDULE OF EQUIPMENT Leased or Owned Five
Enter code: Indicates the ownership status of the item as leased or owned.
SCHEDULE OF EQUIPMENT Current Full 100% Value Five
Enter number: The amount it would currently cost to replace this piece of equipment with
the exact same model. As used here, due to the nature of computer equipment, this value
may be substantially less than the applicant's original purchase price
SCHEDULE OF EQUIPMENT Five
Amount of Insur. (Coinsurance %)
Enter limit: Amount the piece of equipment is to be insured for at its coinsurance level and
requested valuation type.
SCHEDULE OF EQUIPMENT Loc. # Six
Enter number: The location number for the premises. As used here, the location number
for the equipment as found on the ACORD 125.
SCHEDULE OF EQUIPMENT Bldg # Six
Enter number: The building number for the premises. Used when more than one building
exists at an individual location. As used here, the building number for the equipment as
found on the ACORD 125.
SCHEDULE OF EQUIPMENT Item # Six
Enter identifier: The producer assigned identifier for the item.
SCHEDULE OF EQUIPMENT Manufacturer Six
Enter text: The name of the manufacturer of the item.
SCHEDULE OF EQUIPMENT Model Six
Enter text: The manufacturer's model name or number for the item.
SCHEDULE OF EQUIPMENT Serial # Six
Enter identifier: The identification number, serial number, or any other identifying symbol of
the item.
SCHEDULE OF EQUIPMENT Leased or Owned Six
Enter code: Indicates the ownership status of the item as leased or owned.
SCHEDULE OF EQUIPMENT Current Full 100% Value Six
Enter number: The amount it would currently cost to replace this piece of equipment with
the exact same model. As used here, due to the nature of computer equipment, this value
may be substantially less than the applicant's original purchase price
SCHEDULE OF EQUIPMENT Six
Amount of Insur. (Coinsurance %)
Enter limit: Amount the piece of equipment is to be insured for at its coinsurance level and
requested valuation type.
SCHEDULE OF EQUIPMENT Totals Current Full Value
Enter amount: The total value of all of the scheduled items within the class / grouping.
SCHEDULE OF EQUIPMENT Totals Amount Of Insurance
Enter limit: The amount of insurance for the class / grouping. This is the total value of all
of the scheduled items within the class / grouping.
REMARKS
Remarks
Enter text: The general remarks associated with the commercial inland marine line of
business. Use this section to provide any additional information required for underwriting
or rating.
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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Section Name
Field Name
Field and/or Section Description
GENERAL INFORMATION
In the event of a major or total loss
could you return to operation
within one week? Yes
Check the box (if applicable): Indicates a Yes response to the question, In the event of a
major or total loss could you return to operation within one week?.
GENERAL INFORMATION
In the event of a major or total loss
could you return to operation
within one week? No
Check the box (if applicable): Indicates a No response to the question, In the event of a
major or total loss could you return to operation within one week?.
GENERAL INFORMATION
Do you have an arrangement for
the use of other equipment? Yes
Check the box (if applicable): Indicates a Yes response to the question, Do you have an
arrangement for the use of other equipment?.
GENERAL INFORMATION
Do you have an arrangement for
the use of other equipment? No
Check the box (if applicable): Indicates a No response to the question, Do you have an
arrangement for the use of other equipment?.
GENERAL INFORMATION
Is your equipment manufacturer in
a position to replace your
equipment promptly? Yes
Check the box (if applicable): Indicates a Yes response to the question, Is your
equipment manufacturer in a position to replace your equipment promptly?.
GENERAL INFORMATION
Is your equipment manufacturer in
a position to replace your
equipment promptly? No
Check the box (if applicable): Indicates a No response to the question, Is your
equipment manufacturer in a position to replace your equipment promptly?.
GENERAL INFORMATION
Is your equipment under
manufacturer's warranty? Yes
Check the box (if applicable): Indicates a Yes response to the question, Is your
equipment under manufacturer's warranty?.
GENERAL INFORMATION
Is your equipment under
manufacturer's warranty? No
Check the box (if applicable): Indicates a No response to the question, Is your
equipment under manufacturer's warranty?.
GENERAL INFORMATION
Do you have a service or
maintenance contract with a
manufacturer or other service
contractor? Yes
Check the box (if applicable): Indicates a Yes response to the question, Do you have a
service maintenance contract with a manufacturer or other service contractor?.
GENERAL INFORMATION
Do you have a service or
maintenance contract with a
manufacturer or other service
contractor? No
Check the box (if applicable): Indicates a No response to the question, Do you have a
service maintenance contract with a manufacturer or other service contractor?.
GENERAL INFORMATION
Is the equipment shipped by
common carrier? Yes
Check the box (if applicable): Indicates a Yes response to the question, Is the
equipment shipped by common carrier?.
GENERAL INFORMATION
Is the equipment shipped by
common carrier? No
Check the box (if applicable): Indicates a No response to the question, Is the equipment
shipped by common carrier?.
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Section Name
Field Name
Field and/or Section Description
GENERAL INFORMATION
Is the equipment shipped by
company vehicle? Yes
Check the box (if applicable): Indicates a Yes response to the question, Is the
equipment shipped by company vehicle?.
GENERAL INFORMATION
Is the equipment shipped by
company vehicle? No
Check the box (if applicable): Indicates a No response to the question, Is the equipment
shipped by company vehicle?.
GENERAL INFORMATION
Is the media/data shipped by
common carrier? Yes
Check the box (if applicable): Indicates a Yes response to the question, Is the
media/data shipped by common carrier?.
GENERAL INFORMATION
Is the media/data shipped by
common carrier? No
Check the box (if applicable): Indicates a No response to the question, Is the media/data
shipped by common carrier?.
GENERAL INFORMATION
Is the media/data shipped by
company vehicle? Yes
Check the box (if applicable): Indicates a Yes response to the question, Is the
media/data shipped by company vehicle?.
GENERAL INFORMATION
Is the media/data shipped by
company vehicle? No
Check the box (if applicable): Indicates a No response to the question, Is the media/data
shipped by company vehicle?.
GENERAL INFORMATION
Does the premises have a burglar
alarm? Yes
Check the box (if applicable): Indicates a Yes response to the question, Does the
premises have a burglar alarm?.
GENERAL INFORMATION
Does the premises have a burglar
alarm? No
Check the box (if applicable): Indicates a No response to the question, Does the
premises have a burglar alarm?.
GENERAL INFORMATION
Uninterruptible Power Source?
Yes
Check the box (if applicable): Indicates a Yes response to the question, Does the
applicant have an uninterruptible power source to protect the hardware from power line
problems?.
GENERAL INFORMATION
Uninterruptible Power Source? No
Check the box (if applicable): Indicates a No response to the question, Does the
applicant have an uninterruptible power source to protect the hardware from power line
problems?.
GENERAL INFORMATION
Line Conditioner? Yes
Check the box (if applicable): Indicates a Yes response to the question, Does the
applicant have a line conditioner to protect the hardware from power line problems?.
GENERAL INFORMATION
Line Conditioner? No
Check the box (if applicable): Indicates a No response to the question, Does the
applicant have a line conditioner to protect the hardware from power line problems?.
GENERAL INFORMATION
Power suppressor voltage
regulator? Yes
Check the box (if applicable): Indicates a Yes response to the question, Does the
applicant have a power suppressor voltage regulator to protect the hardware from power
line problems?.
GENERAL INFORMATION
Power suppressor voltage
regulator? No
Check the box (if applicable): Indicates a No response to the question, Does the
applicant have a power suppressor voltage regulator to protect the hardware from power
line problems?.
GENERAL INFORMATION
Dedicated Line? Yes
Check the box (if applicable): Indicates a Yes response to the question, Does the
applicant have a dedicated line to protect the hardware from power line problems?.
GENERAL INFORMATION
Dedicated Line? No
Check the box (if applicable): Indicates a No response to the question, Does the
applicant have a dedicated line to protect the hardware from power line problems?.
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Section Name
Field Name
Field and/or Section Description
COMPUTER ROOM
INFORMATION
Is the data processing equipment
located in a specifically designated
room? Yes
Check the box (if applicable): Indicates a Yes response to the question, Is the data
processing equipment located in a specifically designated room?.
COMPUTER ROOM
INFORMATION
Is the data processing equipment
located in a specifically designated
room? No
Check the box (if applicable): Indicates a No response to the question, Is the data
processing equipment located in a specifically designated room?.
COMPUTER ROOM
INFORMATION
Is access to the room restricted?
Yes
Check the box (if applicable): Indicates a Yes response to the question, Is access to the
room restricted?.
COMPUTER ROOM
INFORMATION
Is access to the room restricted?
No
Check the box (if applicable): Indicates a No response to the question, Is access to the
room restricted?.
COMPUTER ROOM
INFORMATION
Is the equipment controlled by a
master shutdown switch? Yes
Check the box (if applicable): Indicates a Yes response to the question, Is the
equipment controlled by a master shutdown switch?.
COMPUTER ROOM
INFORMATION
Is the equipment controlled by a
master shutdown switch? No
Check the box (if applicable): Indicates a No response to the question, Is the equipment
controlled by a master shutdown switch?.
COMPUTER ROOM
INFORMATION
Is there a separate air conditioning
system designed to specifically
protect the EDP equipment? Yes
Check the box (if applicable): Indicates a Yes response to the question, Is there a
separate air conditioning system designed to specifically protect the Electronic Data
Processing (EDP) equipment?.
COMPUTER ROOM
INFORMATION
Is there a separate air conditioning
system designed to specifically
protect the EDP equipment? No
Check the box (if applicable): Indicates a No response to the question, Is there a
separate air conditioning system designed to specifically protect the Electronic Data
Processing (EDP) equipment?.
COMPUTER ROOM
INFORMATION
The Computer Room is protected
by the following systems: None
Check the box (if applicable): Indicates there is no fire extinguishing system. As used here,
this is the protection on the computer room.
COMPUTER ROOM
INFORMATION
Wet Sprinkler
Check the box (if applicable): Indicates there is a wet sprinkler fire extinguishing system.
As used here, this is the protection on the computer room.
COMPUTER ROOM
INFORMATION
Dry Sprinkler System
Check the box (if applicable): Indicates there is a dry sprinkler fire extinguishing system.
As used here, this is the protection on the computer room.
COMPUTER ROOM
INFORMATION
Halon
Check the box (if applicable): Indicates there is a Halon fire extinguishing system. As used
here, this is the protection on the computer room.
COMPUTER ROOM
INFORMATION
CO2
Check the box (if applicable): Indicates there is a CO2 fire extinguishing system. As used
here, this is the protection on the computer room.
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Section Name
Field Name
Field and/or Section Description
COMPUTER ROOM
INFORMATION
Other (checkbox)
Check the box (if applicable): Indicates there is a fire extinguishing system other than
those listed. As used here, this is the protection on the computer room.
COMPUTER ROOM
INFORMATION
Other Description
Enter text: The description of the fire extinguishing system. As used here, this is the
protection on the computer room.
COMPUTER ROOM
INFORMATION
Does the computer room have a
raised pedestal floor? Yes
Check the box (if applicable): Indicates a Yes response to the question, Does the
computer room have a raised pedestal floor?.
COMPUTER ROOM
INFORMATION
Does the computer room have a
raised pedestal floor? No
Check the box (if applicable): Indicates a No response to the question, Does the
computer room have a raised pedestal floor?.
COMPUTER ROOM
INFORMATION
Floor Construction Type
Combustible
Check the box (if applicable): Indicates the floor construction type is combustible.
COMPUTER ROOM
INFORMATION
Floor Construction Type Non-
Combustible
Check the box (if applicable): Indicates the floor construction type is non-combustible.
COMPUTER ROOM
INFORMATION
Below Floor Protection Smoke
Detectors
Check the box (if applicable): Indicates a smoke detector is used for the computer room
below floor protection.
COMPUTER ROOM
INFORMATION
Below Floor Protection Halon
System/CO2 System
Check the box (if applicable): Indicates a Halon or CO2 system is used for the computer
room below floor protection.
COMPUTER ROOM
INFORMATION
Below Floor Protection Other
Check the box (if applicable): Indicates a computer room below floor protection system is
used other than those listed.
COMPUTER ROOM
INFORMATION
Computer Room Floor Protection
Description
Enter text: The description of the computer room below floor protection system.
COMPUTER ROOM
INFORMATION
Below Floor Protection None
Check the box (if applicable): Indicates there is no computer room below floor protection
system.
COMPUTER ROOM
INFORMATION
Alarm Type Local Temper.
Check the box (if applicable): Indicates the temperature alarm sounds or appears on the
premises.
COMPUTER ROOM
INFORMATION
Alarm Type Local Humidity
Check the box (if applicable): Indicates the humidity alarm sounds or appears on the
premises.
COMPUTER ROOM
INFORMATION
Alarm Type Local Smoke
Check the box (if applicable): Indicates that the smoke alarm sounds or appears on the
premises.
COMPUTER ROOM
INFORMATION
Alarm Type Local Fire
Check the box (if applicable): Indicates the fire alarm sounds or appears on the premises.
COMPUTER ROOM
INFORMATION
Alarm Type Central Temper.
Check the box (if applicable): Indicates the temperature alarm reports to an outside
service that in turn reports to the appropriate police or fire station.
COMPUTER ROOM
INFORMATION
Alarm Type Central Humidity
Check the box (if applicable): Indicates the humidity alarm reports to an outside service
that in turn reports to the appropriate police or fire station.
COMPUTER ROOM
INFORMATION
Alarm Type Central Smoke
Check the box (if applicable): Indicates the smoke alarm notifies an outside service that in
turn reports to the appropriate police or fire station.
ACORD 148 (2013/09) rev. 06-28-2013
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Section Name
Field Name
Field and/or Section Description
COMPUTER ROOM
INFORMATION
Alarm Type Central Fire
Check the box (if applicable): Indicates the fire alarm reports to an outside service that in
turn reports to the appropriate police or fire station.
MEDIA AND DATA
(SOFTWARE)
INFORMATION
Are anti-viral safeguards in effect?
Yes
Check the box (if applicable): Indicates a Yes response to the question, Are anti-viral
safeguards in effect?.
MEDIA AND DATA
(SOFTWARE)
INFORMATION
Are anti-viral safeguards in effect?
No
Check the box (if applicable): Indicates a No response to the question, Are anti-viral
safeguards in effect?.
MEDIA AND DATA
(SOFTWARE)
INFORMATION
Are duplicates of software
maintained? Yes
Check the box (if applicable): Indicates a Yes response to the question, Are duplicates
of software maintained?.
MEDIA AND DATA
(SOFTWARE)
INFORMATION
Are duplicates of software
maintained? No
Check the box (if applicable): Indicates a No response to the question, Are duplicates of
software maintained?.
MEDIA AND DATA
(SOFTWARE)
INFORMATION
How often is data backed up?
Daily
Check the box (if applicable): Indicates data is backed up daily.
MEDIA AND DATA
(SOFTWARE)
INFORMATION
Weekly
Check the box (if applicable): Indicates data is backed up weekly.
MEDIA AND DATA
(SOFTWARE)
INFORMATION
Monthly
Check the box (if applicable): Indicates data is backed up monthly.
MEDIA AND DATA
(SOFTWARE)
INFORMATION
Quarterly
Check the box (if applicable): Indicates data is backed up quarterly.
MEDIA AND DATA
(SOFTWARE)
INFORMATION
Yearly
Check the box (if applicable): Indicates data is backed up yearly.
MEDIA AND DATA
(SOFTWARE)
INFORMATION
Other Backup Frequency
Check the box (if applicable): Indicates data is backed up other than those frequencies
listed.
MEDIA AND DATA
(SOFTWARE)
INFORMATION
Description Other Backup
Frequency
Enter text: The frequency that data is backed up.
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Section Name
Field Name
Field and/or Section Description
SOFTWARE DUPLICATES &
DATA BACKUP STORAGE
Duplicate Software On Premises
Check the box (if applicable): Indicates duplicate software is located on premises.
SOFTWARE DUPLICATES &
DATA BACKUP STORAGE
Duplicate Software Off Premises
Check the box (if applicable): Indicates duplicate software is located off premises.
SOFTWARE DUPLICATES &
DATA BACKUP STORAGE
Data Backups On Premises
Check the box (if applicable): Indicates data backups are located on premises.
SOFTWARE DUPLICATES &
DATA BACKUP STORAGE
Data Backups Off Premises
Check the box (if applicable): Indicates data backups are located off premises.
SOFTWARE DUPLICATES & On Premises Location Information
DATA BACKUP STORAGE
Safe
Check the box (if applicable): Indicates the on premises duplicate software and data
backups are kept in a safe.
SOFTWARE DUPLICATES & On Premises Location Information
DATA BACKUP STORAGE
Vault
Check the box (if applicable): Indicates the on premises duplicate software and data
backups are kept in a vault.
SOFTWARE DUPLICATES & On Premises Location Information
DATA BACKUP STORAGE
Computer Room
Check the box (if applicable): Indicates the on premises duplicate software and data
backups are kept in the computer room.
SOFTWARE DUPLICATES & On Premises Location Information
DATA BACKUP STORAGE
Other
Check the box (if applicable): Indicates the on premises duplicate software and data
backups are kept in a location other than those listed.
SOFTWARE DUPLICATES & On Premises Location Information
DATA BACKUP STORAGE
Other Description
Enter text: The storage location of on premises duplicate software and data backups.
SOFTWARE DUPLICATES & Name and Address of Off Premises
DATA BACKUP STORAGE
Storage Location
Enter text: The name of the duplicate records storage location.
SOFTWARE DUPLICATES &
DATA BACKUP STORAGE
Enter text: The first address line of the duplicate records storage location.
SOFTWARE DUPLICATES &
DATA BACKUP STORAGE
Enter text: The second address line of the duplicate records storage location.
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Section Name
Field Name
Field and/or Section Description
SOFTWARE DUPLICATES &
DATA BACKUP STORAGE
Enter text: The city of the duplicate records storage location.
SOFTWARE DUPLICATES &
DATA BACKUP STORAGE
Enter code: The state or province of the duplicate records storage location.
SOFTWARE DUPLICATES &
DATA BACKUP STORAGE
Enter code: The postal code of the duplicate records storage location.
ADDITIONAL INTEREST
ACORD 45 Attached (checkbox)
Check the box (if applicable): Indicates an ACORD 45, Additional Interest Schedule is
attached.
ADDITIONAL INTEREST
Interest - Additional Insured One
Check the box (if applicable): Indicates the interest type is an additional insured.
ADDITIONAL INTEREST
Interest - Loss Payee One
Check the box (if applicable): Indicates the additional interest type is a loss payee.
ADDITIONAL INTEREST
Interest - Mortgagee One
Check the box (if applicable): Indicates the additional interest type is a mortgagee.
ADDITIONAL INTEREST
Interest - Lienholder One
Check the box (if applicable): Indicates the additional interest type is a lien holder.
ADDITIONAL INTEREST
Interest Other One
Check the box (if applicable): Indicates the additional interest is not any of the types listed
on the form.
ADDITIONAL INTEREST
Interest Other Description One
Enter text: The description of the type of interest in the item.
ADDITIONAL INTEREST /
CERTIFICATE RECIPIENTS Rank One
Enter number: The ranking of 'this' additional interest when multiple additional interests are
associated with the same item.
ADDITIONAL INTEREST
Name and Address One
Enter text: The additional interest's full name.
ADDITIONAL INTEREST
Enter text: The additional interest's mailing address line one.
ADDITIONAL INTEREST
Enter text: The additional interest's mailing address line two.
ADDITIONAL INTEREST
Enter text: The additional interest's mailing address city name.
ADDITIONAL INTEREST
Enter code: The additional interest's mailing address state or province code.
ADDITIONAL INTEREST
Enter code: The additional interest's mailing address postal code.
ADDITIONAL INTEREST
Reference # One
Enter identifier: The loan number, account number or other controlling number that the
additional interest may have assigned the insured.
ADDITIONAL INTEREST
Certificate Required One
Check the box (if applicable): Indicates if the additional interest requires a Certificate of
Insurance,
ADDITIONAL INTEREST
Interest in Item Location # One
Enter number: The producer assigned number of the location which has an additional
interest.
ADDITIONAL INTEREST
Interest in Item Building # One
Enter number: The producer assigned number of the building which has an additional
interest.
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Section Name
Field Name
Field and/or Section Description
ADDITIONAL INTEREST
Interest in Item Item # One
Enter number: The producer assigned number of the scheduled item which has an
additional interest.
ADDITIONAL INTEREST
Interest in Item Other One
Enter text: The description of the item which has an additional interest.
ADDITIONAL INTEREST /
CERTIFICATE RECIPIENTS Item Description One
Enter text: The description of the item of interest if needed to further clarify. For a vehicle,
list the make, model and VIN number. For a scheduled item, list the description, such as
three carat diamond in six point setting.
ADDITIONAL INTEREST
Interest - Additional Insured Two
Check the box (if applicable): Indicates the interest type is an additional insured.
ADDITIONAL INTEREST
Interest - Loss Payee Two
Check the box (if applicable): Indicates the additional interest type is a loss payee.
ADDITIONAL INTEREST
Interest - Mortgagee Two
Check the box (if applicable): Indicates the additional interest type is a mortgagee.
ADDITIONAL INTEREST
Interest - Lienholder Two
Check the box (if applicable): Indicates the additional interest type is a lien holder.
ADDITIONAL INTEREST
Interest Other Two
Check the box (if applicable): Indicates the additional interest is not any of the types listed
on the form.
ADDITIONAL INTEREST
Interest Other Description Two
Enter text: The description of the type of interest in the item.
ADDITIONAL INTEREST /
CERTIFICATE RECIPIENTS Rank Two
Enter number: The ranking of 'this' additional interest when multiple additional interests are
associated with the same item.
ADDITIONAL INTEREST
Name and Address Two
Enter text: The additional interest's full name.
ADDITIONAL INTEREST
Enter text: The additional interest's mailing address line one.
ADDITIONAL INTEREST
Enter text: The additional interest's mailing address line two.
ADDITIONAL INTEREST
Enter text: The additional interest's mailing address city name.
ADDITIONAL INTEREST
Enter code: The additional interest's mailing address state or province code.
ADDITIONAL INTEREST
Enter code: The additional interest's mailing address postal code.
ADDITIONAL INTEREST
Reference # Two
Enter identifier: The loan number, account number or other controlling number that the
additional interest may have assigned the insured.
ADDITIONAL INTEREST
Certificate Required Two
Check the box (if applicable): Indicates if the additional interest requires a Certificate of
Insurance,
ADDITIONAL INTEREST
Interest in Item Location # Two
Enter number: The producer assigned number of the location which has an additional
interest.
ADDITIONAL INTEREST
Interest in Item Building # Two
Enter number: The producer assigned number of the building which has an additional
interest.
ADDITIONAL INTEREST
Interest in Item Item # Two
Enter number: The producer assigned number of the scheduled item which has an
additional interest.
ADDITIONAL INTEREST
Interest in Item Other Two
Enter text: The description of the item which has an additional interest.
ACORD 148 (2013/09) rev. 06-28-2013
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Section Name
Field Name
Field and/or Section Description
ADDITIONAL INTEREST /
CERTIFICATE RECIPIENTS Item Description Two
Enter text: The description of the item of interest if needed to further clarify. For a vehicle,
list the make, model and VIN number. For a scheduled item, list the description, such as
three carat diamond in six point setting.
REMARKS
Remarks
Enter text: The general remarks associated with the commercial inland marine line of
business. Use this section to provide any additional information required for underwriting
or rating.
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g.
agency or brokerage).
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
Producer's Name (Please Print)
Enter text: The name of the authorized representative of the producer, agency and/or
broker that signed the form.
SIGNATURE
State Producer License No
(Required in FL)
Enter identifier: The State License Number of the producer.
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
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.
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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