ACORD 60 LA (4/98) rev 01-15-2010

Section Name
Field Name
Field and/or Section Description
TITLE
ACORD 60 LA (4/98)
Louisiana Dwelling Supplement -
Loss Settlement - For use with
DWG 1
ACORD 60 LA, Louisiana Dwelling Supplement Loss Settlement -
For use with DWG 1, complies with Louisiana law which provides that, in cases of total
loss to inanimate, immovable property, the limit of insurance used to determine the
premium charge will be the amount used by the insurance company to calculate the loss
payment, without any deduction or offset, unless a different method is used in the
computation of loss. If a different method is used, both the policy and the application for
insurance must state the actual method of loss settlement.
The language in ACORD 60 LA is the language recommended by the Property Insurance
Association of Louisiana for use with applications for Dwelling 1 coverage. Use ACORD
60 LA with ACORD 89, Residential Section. ACORD 89 must be used in conjunction with
ACORD 88, Personal Insurance Application, Applicant Information Section.
Note this form is now mandatory when submitting applications for this type of coverage to
either the Louisiana Joint Reinsurance Plan or the Louisiana Insurance Underwriting Plan.
IDENTIFICATION SECTION
Enter text: The full name of the producer/agency.
IDENTIFICATION SECTION
Enter text: The mailing address line one of the producer/agency.
IDENTIFICATION SECTION
Enter text: The mailing address line two of the producer/agency.
IDENTIFICATION SECTION
Enter text: The mailing address city name of the producer/agency.
IDENTIFICATION SECTION
Enter code: The mailing address state or province code of the producer/agency.
IDENTIFICATION SECTION
Enter code: The mailing address postal code of the producer/agency.
IDENTIFICATION SECTION Code
Enter code: The identification code assigned to the producer (e.g. agency or brokerage
firm) by the insurer.
IDENTIFICATION SECTION Subcode
Enter code: The identification code assigned by the insurer to the sub-producer (e.g.
person) within a producer's office (e.g. agency or brokerage).
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
IDENTIFICATION SECTION Address
Applicant's Name and Mailing
Enter text: The named insured(s) as it/they will appear on the policy declarations page.
IDENTIFICATION SECTION
Enter text: The named insured's mailing address line one.
IDENTIFICATION SECTION
Enter text: The named insured's mailing address line two.
IDENTIFICATION SECTION
Enter text: The named insured's mailing address city name.
IDENTIFICATION SECTION
Enter text: The applicant's physical address county name.
IDENTIFICATION SECTION
Enter code: The named insured's mailing address state or province code.
IDENTIFICATION SECTION
Enter code: The named insured's mailing address postal code.
IDENTIFICATION SECTION FEIN or Social Security #
Enter identifier: The tax identifier of the named insured.
IDENTIFICATION SECTION Company
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 Account Number
Enter identifier: The account number to be used for billing purposes. This is the billing
number assigned by the billing entity. If agency bill, the agency assigns; if direct bill, the
insurer assigns. If the account already exists, the agent should provide the previously
assigned number.
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 New
Check the box (if applicable): Indicates the response expected from the company is a new
issued policy.
IDENTIFICATION SECTION Renewal
Check the box (if applicable): Indicates the response expected from the company is a
renewed policy.
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 Expiration Date
Enter date: The date on which the terms and conditions of the policy will expire.
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.
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Section Name
Field Name
Field and/or Section Description
SIGNATURE
Producer's Signature
Sign here: Accommodates the signature of the authorized representative (e.g. producer,
agent, broker, etc.). by all companies to issue Certificates. This is required in most states.
SIGNATURE
Date
Enter date: The date the producer signed the form.
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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