ACORD 81 (2014/12) - Personal Inland Marine Application

ACORD 81 (2014/12) - Personal Inland Marine Application
ACORD 81, Personal Inland Marine Application, can be used as a stand-alone application. Use ACORD 281 as a supplement to the Homeowner
Application (ACORD 80) or the Residential Section (ACORD 89) if scheduled personal property is being submitted as part of a homeowners
transaction.
Form Page 1
Section Name
Field Name
Description
IDENTIFICATION SECTION
Date
Enter date: The date on which the form is completed. (MM/DD/YYYY)
IDENTIFICATION SECTION
Agency
Enter text: The full name of the producer / agency.
IDENTIFICATION SECTION
Agency Address Line 1
Enter text: The mailing address line one of the producer / agency.
IDENTIFICATION SECTION
Agency Address Line 2
Enter text: The mailing address line two of the producer / agency.
IDENTIFICATION SECTION
Agency City
Enter text: The mailing address city name of the producer / agency.
IDENTIFICATION SECTION
Agency State
Enter code: The mailing address state or province code of the producer / agency.
IDENTIFICATION SECTION
Agency Zip
Enter code: The mailing address postal code of the producer / agency.
IDENTIFICATION SECTION
Contact Name
Enter text: The name of the individual at the producer's establishment that is the primary
contact.
IDENTIFICATION SECTION
Phone
Enter number: The producer's contact person's phone number. If applicable, include the area
code and extension.
IDENTIFICATION SECTION
Fax
Enter number: The fax number of the producer / agency.
IDENTIFICATION SECTION
E-Mail Address
Enter text: The producer's contact person's e-mail address.
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).
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
Plan
Enter code: The product code assigned by the insurer for the policy.
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IDENTIFICATION SECTION
Facility Code
Enter identifier: The identification code used by assigned risk plans, FAIR plans and other
associations (only applicable in a few states). When using this field, also enter the name of the
facility in the carrier or plan field.
IDENTIFICATION SECTION
Effective Date
Enter date: The effective date of the policy. The date that the terms and conditions of the policy
commence. (MM/DD/YYYY)
IDENTIFICATION SECTION
Expiration Date
Enter date: The date on which the terms and conditions of the policy will expire. (MM/DD/YYYY)
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's Name and
Mailing Address (Include
county & zip+4)
Enter text: The named insured(s) as it / they will appear on the policy declarations page.
IDENTIFICATION SECTION
Address Line 1
Enter text: The named insured's mailing address line one.
IDENTIFICATION SECTION
Address Line 2
Enter text: The named insured's mailing address line two.
IDENTIFICATION SECTION
City
Enter text: The named insured's mailing address city name.
IDENTIFICATION SECTION
County
Enter text: The named insured's physical address county name.
IDENTIFICATION SECTION
State
Enter code: The named insured's mailing address state or province code.
IDENTIFICATION SECTION
Zip + 4
Enter code: The named insured's mailing address postal code.
IDENTIFICATION SECTION
Date at Current Residence
Enter date: The date insured moved into their current residence. (MM/DD/YYYY)
IDENTIFICATION SECTION
Primary Phone #
Enter number: The named insured's primary phone number.
IDENTIFICATION SECTION
Home (checkbox)
Check the box (if applicable): Indicates the primary phone number is for a home phone.
IDENTIFICATION SECTION
Bus (checkbox)
Check the box (if applicable): Indicates the primary phone number is for a business phone.
IDENTIFICATION SECTION
Cell (checkbox)
Check the box (if applicable): Indicates the primary phone number is for a cell phone.
IDENTIFICATION SECTION
Secondary Phone #
Enter number: The named insured's secondary phone number.
IDENTIFICATION SECTION
Home (checkbox)
Check the box (if applicable): Indicates the secondary phone number is for a home phone.
IDENTIFICATION SECTION
Bus (checkbox)
Check the box (if applicable): Indicates the secondary phone number is for a business phone.
IDENTIFICATION SECTION
Cell (checkbox)
Check the box (if applicable): Indicates the secondary phone number is for a cell phone.
IDENTIFICATION SECTION
Primary E-Mail Address
Enter text: The named insured's primary e-mail address.
IDENTIFICATION SECTION
Secondary E-Mail Address
Enter text: The named insured's secondary e-mail address.
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IDENTIFICATION SECTION
Birth Date
Enter date: The date of birth of the insured. (MM/DD/YYYY)
IDENTIFICATION SECTION
Marital Status / Civil Union
Enter code: The insured's marital status. The applicable codes are:
* S Single
* M Married
* D Divorced
* F Fianc or Fiance
* P Separated
* W Widowed
* C Domestic Partner (unmarried)
* V Civil Union / Registered Domestic Partner
* U Unknown
* O Other
IDENTIFICATION SECTION
Applicant's Occupation
Enter text: The named insured's primary occupation or business activity.
IDENTIFICATION SECTION
Co-Applicant's Occupation
Enter text: The named insured's primary occupation or business activity.
LOCATION INFORMATION
Loc #
Enter number: The producer assigned number of the location.
LOCATION INFORMATION
Location of Property
Enter text: The first address line of the physical location.
LOCATION INFORMATION
Enter text: The city of the physical location.
LOCATION INFORMATION
Enter text: The county of the physical location.
LOCATION INFORMATION
Enter code: The state or province of the physical location.
LOCATION INFORMATION
Enter code: The postal code of the physical location.
LOCATION INFORMATION
Terr Code
Enter code: The industry or company specific code that identifies the rating territory for this item.
The source of this code is individual insurer, Insurance Services Office or State Insurance
Department manuals.
LOCATION INFORMATION
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
LOCATION INFORMATION
Dwelling Type
Enter text: The description of the type of residence (e.g., apartment, condominium, etc.).
LOCATION 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.
LOCATION INFORMATION
# Fam
Enter number: The number of separate family units in the dwelling.
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LOCATION INFORMATION
Fire District Name
Enter text: The property's fire district name.
LOCATION INFORMATION
Fire Dist Code
Enter code: The property's fire district code number which can be found in the individual states
manual pages.
LOCATION INFORMATION
Loc #
Enter number: The producer assigned number of the location.
LOCATION INFORMATION
Location of Property
Enter text: The first address line of the physical location.
LOCATION INFORMATION
Enter text: The city of the physical location.
LOCATION INFORMATION
Enter text: The county of the physical location.
LOCATION INFORMATION
Enter code: The state or province of the physical location.
LOCATION INFORMATION
Enter code: The postal code of the physical location.
LOCATION INFORMATION
Terr Code
Enter code: The industry or company specific code that identifies the rating territory for this item.
The source of this code is individual insurer, Insurance Services Office or State Insurance
Department manuals.
LOCATION INFORMATION
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
LOCATION INFORMATION
Dwelling Type
Enter text: The description of the type of residence (e.g., apartment, condominium, etc.).
LOCATION 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.
LOCATION INFORMATION
# Fam
Enter number: The number of separate family units in the dwelling.
LOCATION INFORMATION
Fire District Name
Enter text: The property's fire district name.
LOCATION INFORMATION
Fire Dist Code
Enter code: The property's fire district code number which can be found in the individual states
manual pages.
PROPERTY CLASS /
COVERAGE INFORMATION
Jewelry - Loc #
Enter number: The producer assigned number of the location.
PROPERTY CLASS /
COVERAGE INFORMATION
Jewelry - Loss Settlement
Enter code: The type of valuation used for this property class. The code values are ACV for
actual cash value or RC for replacement cost.
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PROPERTY CLASS /
COVERAGE INFORMATION
Jewelry - Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Jewelry - Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Jewelry - Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Jewelry - Professional /
Commercial Use
Enter Y for a Yes response. Input N for No response. Indicates if the property is used
professionally or commercially.
PROPERTY CLASS /
COVERAGE INFORMATION
Jewelry - Exhibited
Enter Y for a Yes response. Input N for No response. Indicates if the property is exhibited.
PROPERTY CLASS /
COVERAGE INFORMATION
Jewelry - In Vault
Enter Y for a Yes response. Input N for No response. Indicates if the property is stored in a
vault.
PROPERTY CLASS /
COVERAGE INFORMATION
Jewelry - Blanket Cov
Enter Y for a Yes response. Input N for No response. Indicates if blanket coverage applies.
PROPERTY CLASS /
COVERAGE INFORMATION
Jewelry - Deductible
Enter deductible: The deductible amount for scheduled personal property coverage.
PROPERTY CLASS /
COVERAGE INFORMATION
Jewelry - Amount of
Insurance
Enter amount: The total actual value amount for the jewelry class.
PROPERTY CLASS /
COVERAGE INFORMATION
Jewelry - Rate
Enter rate: The rate or factor used to calculate the premium for the jewelry class.
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PROPERTY CLASS /
COVERAGE INFORMATION
Jewelry - Premium
Enter amount: The total premium amount for the jewelry class.
PROPERTY CLASS /
COVERAGE INFORMATION
Furs - Loc #
Enter number: The producer assigned number of the location.
PROPERTY CLASS /
COVERAGE INFORMATION
Furs - Loss Settlement
Enter code: The type of valuation used for this property class. The code values are ACV for
actual cash value or RC for replacement cost.
PROPERTY CLASS /
COVERAGE INFORMATION
Furs - Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Furs - Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Furs - Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Furs - Professional /
Commercial Use
Enter Y for a Yes response. Input N for No response. Indicates if the property is used
professionally or commercially.
PROPERTY CLASS /
COVERAGE INFORMATION
Furs - Exhibited
Enter Y for a Yes response. Input N for No response. Indicates if the property is exhibited.
PROPERTY CLASS /
COVERAGE INFORMATION
Furs - In Vault
Enter Y for a Yes response. Input N for No response. Indicates if the property is stored in a
vault.
PROPERTY CLASS /
COVERAGE INFORMATION
Furs - Blanket Cov
Enter Y for a Yes response. Input N for No response. Indicates if blanket coverage applies.
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PROPERTY CLASS /
COVERAGE INFORMATION
Furs - Deductible
Enter deductible: The deductible amount for scheduled personal property coverage.
PROPERTY CLASS /
COVERAGE INFORMATION
Furs - Amount of Insurance
Enter amount: The total actual value amount for the furs class.
PROPERTY CLASS /
COVERAGE INFORMATION
Furs - Rate
Enter rate: The rate or factor used to calculate the premium for the furs class.
PROPERTY CLASS /
COVERAGE INFORMATION
Furs - Premium
Enter amount: The total premium amount for the furs class.
PROPERTY CLASS /
COVERAGE INFORMATION
Fine Arts - Loc #
Enter number: The producer assigned number of the location.
PROPERTY CLASS /
COVERAGE INFORMATION
Fine Arts - Loss Settlement
Enter code: The type of valuation used for this property class. The code values are ACV for
actual cash value or RC for replacement cost.
PROPERTY CLASS /
COVERAGE INFORMATION
Fine Arts - Coverage
Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Fine Arts - Coverage
Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Fine Arts - Coverage
Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Fine Arts - Professional /
Commercial Use
Enter Y for a Yes response. Input N for No response. Indicates if the property is used
professionally or commercially.
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PROPERTY CLASS /
COVERAGE INFORMATION
Fine Arts - Exhibited
Enter Y for a Yes response. Input N for No response. Indicates if the property is exhibited.
PROPERTY CLASS /
COVERAGE INFORMATION
Fine Arts - In Vault
Enter Y for a Yes response. Input N for No response. Indicates if the property is stored in a
vault.
PROPERTY CLASS /
COVERAGE INFORMATION
Fine Arts - Blanket Cov
Enter Y for a Yes response. Input N for No response. Indicates if blanket coverage applies.
PROPERTY CLASS /
COVERAGE INFORMATION
Fine Arts - Deductible
Enter deductible: The deductible amount for scheduled personal property coverage.
PROPERTY CLASS /
COVERAGE INFORMATION
Fine Arts - Amount of
Insurance
Enter amount: The total actual value amount for the fine arts class.
PROPERTY CLASS /
COVERAGE INFORMATION
Fine Arts - Rate
Enter rate: The rate or factor used to calculate the premium for the fine arts class.
PROPERTY CLASS /
COVERAGE INFORMATION
Fine Arts - Premium
Enter amount: The total premium amount for the fine arts class.
PROPERTY CLASS /
COVERAGE INFORMATION
Cameras - Loc #
Enter number: The producer assigned number of the location.
PROPERTY CLASS /
COVERAGE INFORMATION
Cameras - Loss Settlement
Enter code: The type of valuation used for this property class. The code values are ACV for
actual cash value or RC for replacement cost.
PROPERTY CLASS /
COVERAGE INFORMATION
Cameras - Coverage
Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Cameras - Coverage
Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
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PROPERTY CLASS /
COVERAGE INFORMATION
Cameras - Coverage
Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Cameras - Professional /
Commercial Use
Enter Y for a Yes response. Input N for No response. Indicates if the property is used
professionally or commercially.
PROPERTY CLASS /
COVERAGE INFORMATION
Cameras - Exhibited
Enter Y for a Yes response. Input N for No response. Indicates if the property is exhibited.
PROPERTY CLASS /
COVERAGE INFORMATION
Cameras - In Vault
Enter Y for a Yes response. Input N for No response. Indicates if the property is stored in a
vault.
PROPERTY CLASS /
COVERAGE INFORMATION
Cameras - Blanket Cov
Enter Y for a Yes response. Input N for No response. Indicates if blanket coverage applies.
PROPERTY CLASS /
COVERAGE INFORMATION
Cameras - Deductible
Enter deductible: The deductible amount for scheduled personal property coverage.
PROPERTY CLASS /
COVERAGE INFORMATION
Cameras - Amount of
Insurance
Enter amount: The total actual value amount for the cameras class.
PROPERTY CLASS /
COVERAGE INFORMATION
Cameras - Rate
Enter rate: The rate or factor used to calculate the premium for the cameras class.
PROPERTY CLASS /
COVERAGE INFORMATION
Cameras - Premium
Enter amount: The total premium amount for the cameras class.
PROPERTY CLASS /
COVERAGE INFORMATION
Musical Instruments - Loc #
Enter number: The producer assigned number of the location.
PROPERTY CLASS /
COVERAGE INFORMATION
Musical Instruments - Loss
Settlement
Enter code: The type of valuation used for this property class. The code values are ACV for
actual cash value or RC for replacement cost.
PROPERTY CLASS /
COVERAGE INFORMATION
Musical Instruments -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
ACORD 81 (2014/12) rev. 04-29-2014
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PROPERTY CLASS /
COVERAGE INFORMATION
Musical Instruments -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Musical Instruments -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Musical Instruments -
Professional / Commercial
Use
Enter Y for a Yes response. Input N for No response. Indicates if the property is used
professionally or commercially.
PROPERTY CLASS /
COVERAGE INFORMATION
Musical Instruments -
Exhibited
Enter Y for a Yes response. Input N for No response. Indicates if the property is exhibited.
PROPERTY CLASS /
COVERAGE INFORMATION
Musical Instruments - In
Vault
Enter Y for a Yes response. Input N for No response. Indicates if the property is stored in a
vault.
PROPERTY CLASS /
COVERAGE INFORMATION
Musical Instruments -
Blanket Cov
Enter Y for a Yes response. Input N for No response. Indicates if blanket coverage applies.
PROPERTY CLASS /
COVERAGE INFORMATION
Musical Instruments -
Deductible
Enter deductible: The deductible amount for scheduled personal property coverage.
PROPERTY CLASS /
COVERAGE INFORMATION
Musical Instruments -
Amount of Insurance
Enter amount: The total actual value amount for the musical instruments class.
PROPERTY CLASS /
COVERAGE INFORMATION
Musical Instruments - Rate
Enter rate: The rate or factor used to calculate the premium for the musical instruments class.
PROPERTY CLASS /
COVERAGE INFORMATION
Musical Instruments -
Premium
Enter amount: The total premium amount for the musical instruments class.
PROPERTY CLASS /
COVERAGE INFORMATION
Silverware - Loc #
Enter number: The producer assigned number of the location.
PROPERTY CLASS /
COVERAGE INFORMATION
Silverware - Loss Settlement
Enter code: The type of valuation used for this property class. The code values are ACV for
actual cash value or RC for replacement cost.
ACORD 81 (2014/12) rev. 04-29-2014
Page 10 of 45
PROPERTY CLASS /
COVERAGE INFORMATION
Silverware - Coverage
Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Silverware - Coverage
Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Silverware - Coverage
Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Silverware - Professional /
Commercial Use
Enter Y for a Yes response. Input N for No response. Indicates if the property is used
professionally or commercially.
PROPERTY CLASS /
COVERAGE INFORMATION
Silverware - Exhibited
Enter Y for a Yes response. Input N for No response. Indicates if the property is exhibited.
PROPERTY CLASS /
COVERAGE INFORMATION
Silverware - In Vault
Enter Y for a Yes response. Input N for No response. Indicates if the property is stored in a
vault.
PROPERTY CLASS /
COVERAGE INFORMATION
Silverware - Blanket Cov
Enter Y for a Yes response. Input N for No response. Indicates if blanket coverage applies.
PROPERTY CLASS /
COVERAGE INFORMATION
Silverware - Deductible
Enter deductible: The deductible amount for scheduled personal property coverage.
PROPERTY CLASS /
COVERAGE INFORMATION
Silverware - Amount of
Insurance
Enter amount: The total actual value amount for the silverware class.
PROPERTY CLASS /
COVERAGE INFORMATION
Silverware - Rate
Enter rate: The rate or factor used to calculate the premium for the silverware class.
ACORD 81 (2014/12) rev. 04-29-2014
Page 11 of 45
PROPERTY CLASS /
COVERAGE INFORMATION
Silverware - Premium
Enter amount: The total premium amount for the silverware class.
PROPERTY CLASS /
COVERAGE INFORMATION
Stamps - Loc #
Enter number: The producer assigned number of the location.
PROPERTY CLASS /
COVERAGE INFORMATION
Stamps - Loss Settlement
Enter code: The type of valuation used for this property class. The code values are ACV for
actual cash value or RC for replacement cost.
PROPERTY CLASS /
COVERAGE INFORMATION
Stamps - Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Stamps - Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Stamps - Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Stamps - Professional /
Commercial Use
Enter Y for a Yes response. Input N for No response. Indicates if the property is used
professionally or commercially.
PROPERTY CLASS /
COVERAGE INFORMATION
Stamps - Exhibited
Enter Y for a Yes response. Input N for No response. Indicates if the property is exhibited.
PROPERTY CLASS /
COVERAGE INFORMATION
Stamps - In Vault
Enter Y for a Yes response. Input N for No response. Indicates if the property is stored in a
vault.
PROPERTY CLASS /
COVERAGE INFORMATION
Stamps - Blanket Cov
Enter Y for a Yes response. Input N for No response. Indicates if blanket coverage applies.
ACORD 81 (2014/12) rev. 04-29-2014
Page 12 of 45
PROPERTY CLASS /
COVERAGE INFORMATION
Stamps - Deductible
Enter deductible: The deductible amount for scheduled personal property coverage.
PROPERTY CLASS /
COVERAGE INFORMATION
Stamps - Amount of
Insurance
Enter amount: The total actual value amount for the stamps class.
PROPERTY CLASS /
COVERAGE INFORMATION
Stamps - Rate
Enter rate: The rate or factor used to calculate the premium for the stamps class.
PROPERTY CLASS /
COVERAGE INFORMATION
Stamps - Premium
Enter amount: The total premium amount for the stamps class.
PROPERTY CLASS /
COVERAGE INFORMATION
Coin Collections - Loc #
Enter number: The producer assigned number of the location.
PROPERTY CLASS /
COVERAGE INFORMATION
Coin Collections - Loss
Settlement
Enter code: The type of valuation used for this property class. The code values are ACV for
actual cash value or RC for replacement cost.
PROPERTY CLASS /
COVERAGE INFORMATION
Coin Collections - Coverage
Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Coin Collections - Coverage
Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Coin Collections - Coverage
Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Coin Collections -
Professional / Commercial
Use
Enter Y for a Yes response. Input N for No response. Indicates if the property is used
professionally or commercially.
ACORD 81 (2014/12) rev. 04-29-2014
Page 13 of 45
PROPERTY CLASS /
COVERAGE INFORMATION
Coin Collections - Exhibited
Enter Y for a Yes response. Input N for No response. Indicates if the property is exhibited.
PROPERTY CLASS /
COVERAGE INFORMATION
Coin Collections - In Vault
Enter Y for a Yes response. Input N for No response. Indicates if the property is stored in a
vault.
PROPERTY CLASS /
COVERAGE INFORMATION
Coin Collections - Blanket
Cov
Enter Y for a Yes response. Input N for No response. Indicates if blanket coverage applies.
PROPERTY CLASS /
COVERAGE INFORMATION
Coin Collections -
Deductible
Enter deductible: The deductible amount for scheduled personal property coverage.
PROPERTY CLASS /
COVERAGE INFORMATION
Coin Collections - Amount
of Insurance
Enter amount: The total actual value amount for the coin collections class.
PROPERTY CLASS /
COVERAGE INFORMATION
Coin Collections - Rate
Enter rate: The rate or factor used to calculate the premium for the coin collections class.
PROPERTY CLASS /
COVERAGE INFORMATION
Coin Collections - Premium
Enter amount: The total premium amount for the coin collections class.
PROPERTY CLASS /
COVERAGE INFORMATION
Golfer's Equipment - Loc #
Enter number: The producer assigned number of the location.
PROPERTY CLASS /
COVERAGE INFORMATION
Golfer's Equipment - Loss
Settlement
Enter code: The type of valuation used for this property class. The code values are ACV for
actual cash value or RC for replacement cost.
PROPERTY CLASS /
COVERAGE INFORMATION
Golfer's Equipment -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Golfer's Equipment -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
ACORD 81 (2014/12) rev. 04-29-2014
Page 14 of 45
PROPERTY CLASS /
COVERAGE INFORMATION
Golfer's Equipment -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Golfer's Equipment -
Professional / Commercial
Use
Enter Y for a Yes response. Input N for No response. Indicates if the property is used
professionally or commercially.
PROPERTY CLASS /
COVERAGE INFORMATION
Golfer's Equipment -
Exhibited
Enter Y for a Yes response. Input N for No response. Indicates if the property is exhibited.
PROPERTY CLASS /
COVERAGE INFORMATION
Golfer's Equipment - In
Vault
Enter Y for a Yes response. Input N for No response. Indicates if the property is stored in a
vault.
PROPERTY CLASS /
COVERAGE INFORMATION
Golfer's Equipment -
Blanket Cov
Enter Y for a Yes response. Input N for No response. Indicates if blanket coverage applies.
PROPERTY CLASS /
COVERAGE INFORMATION
Golfer's Equipment -
Deductible
Enter deductible: The deductible amount for scheduled personal property coverage.
PROPERTY CLASS /
COVERAGE INFORMATION
Golfer's Equipment -
Amount of Insurance
Enter amount: The total actual value amount for the golfer's equipment class.
PROPERTY CLASS /
COVERAGE INFORMATION
Golfer's Equipment - Rate
Enter rate: The rate or factor used to calculate the premium for the golfer's equipment class.
PROPERTY CLASS /
COVERAGE INFORMATION
Golfer's Equipment -
Premium
Enter amount: The total premium amount for the golfer's equipment class.
PROPERTY CLASS /
COVERAGE INFORMATION
Personal Computers - Loc #
Enter number: The producer assigned number of the location.
PROPERTY CLASS /
COVERAGE INFORMATION
Personal Computers - Loss
Settlement
Enter code: The type of valuation used for this property class. The code values are ACV for
actual cash value or RC for replacement cost.
PROPERTY CLASS /
COVERAGE INFORMATION
Personal Computers -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
ACORD 81 (2014/12) rev. 04-29-2014
Page 15 of 45
PROPERTY CLASS /
COVERAGE INFORMATION
Personal Computers -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Personal Computers -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Personal Computers -
Professional / Commercial
Use
Enter Y for a Yes response. Input N for No response. Indicates if the property is used
professionally or commercially.
PROPERTY CLASS /
COVERAGE INFORMATION
Personal Computers -
Exhibited
Enter Y for a Yes response. Input N for No response. Indicates if the property is exhibited.
PROPERTY CLASS /
COVERAGE INFORMATION
Personal Computers - In
Vault
Enter Y for a Yes response. Input N for No response. Indicates if the property is stored in a
vault.
PROPERTY CLASS /
COVERAGE INFORMATION
Personal Computers -
Blanket Cov
Enter Y for a Yes response. Input N for No response. Indicates if blanket coverage applies.
PROPERTY CLASS /
COVERAGE INFORMATION
Personal Computers -
Deductible
Enter deductible: The deductible amount for scheduled personal property coverage.
PROPERTY CLASS /
COVERAGE INFORMATION
Personal Computers -
Amount of Insurance
Enter amount: The total actual value amount for the personal computers class.
PROPERTY CLASS /
COVERAGE INFORMATION
Personal Computers - Rate
Enter rate: The rate or factor used to calculate the premium for the personal computers class.
PROPERTY CLASS /
COVERAGE INFORMATION
Personal Computers -
Premium
Enter amount: The total premium amount for the personal computers class.
PROPERTY CLASS /
COVERAGE INFORMATION
China / Crystal - Loc #
Enter number: The producer assigned number of the location.
PROPERTY CLASS /
COVERAGE INFORMATION
China / Crystal - Loss
Settlement
Enter code: The type of valuation used for this property class. The code values are ACV for
actual cash value or RC for replacement cost.
ACORD 81 (2014/12) rev. 04-29-2014
Page 16 of 45
PROPERTY CLASS /
COVERAGE INFORMATION
China / Crystal - Coverage
Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
China / Crystal - Coverage
Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
China / Crystal - Coverage
Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
China / Crystal -
Professional / Commercial
Use
Enter Y for a Yes response. Input N for No response. Indicates if the property is used
professionally or commercially.
PROPERTY CLASS /
COVERAGE INFORMATION
China / Crystal - Exhibited
Enter Y for a Yes response. Input N for No response. Indicates if the property is exhibited.
PROPERTY CLASS /
COVERAGE INFORMATION
China / Crystal - In Vault
Enter Y for a Yes response. Input N for No response. Indicates if the property is stored in a
vault.
PROPERTY CLASS /
COVERAGE INFORMATION
China / Crystal - Blanket
Cov
Enter Y for a Yes response. Input N for No response. Indicates if blanket coverage applies.
PROPERTY CLASS /
COVERAGE INFORMATION
China / Crystal - Deductible
Enter deductible: The deductible amount for scheduled personal property coverage.
PROPERTY CLASS /
COVERAGE INFORMATION
China / Crystal - Amount of
Insurance
Enter amount: The total actual value amount for the china / crystal class.
PROPERTY CLASS /
COVERAGE INFORMATION
China / Crystal - Rate
Enter rate: The rate or factor used to calculate the premium for the china / crystal class.
ACORD 81 (2014/12) rev. 04-29-2014
Page 17 of 45
PROPERTY CLASS /
COVERAGE INFORMATION
China / Crystal - Premium
Enter amount: The total premium amount for the china / crystal class.
PROPERTY CLASS /
COVERAGE INFORMATION
Electronic Equipment - Loc
#
Enter number: The producer assigned number of the location.
PROPERTY CLASS /
COVERAGE INFORMATION
Electronic Equipment - Loss
Settlement
Enter code: The type of valuation used for this property class. The code values are ACV for
actual cash value or RC for replacement cost.
PROPERTY CLASS /
COVERAGE INFORMATION
Electronic Equipment -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Electronic Equipment -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Electronic Equipment -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Electronic Equipment -
Professional / Commercial
Use
Enter Y for a Yes response. Input N for No response. Indicates if the property is used
professionally or commercially.
PROPERTY CLASS /
COVERAGE INFORMATION
Electronic Equipment -
Exhibited
Enter Y for a Yes response. Input N for No response. Indicates if the property is exhibited.
PROPERTY CLASS /
COVERAGE INFORMATION
Electronic Equipment - In
Vault
Enter Y for a Yes response. Input N for No response. Indicates if the property is stored in a
vault.
PROPERTY CLASS /
COVERAGE INFORMATION
Electronic Equipment -
Blanket Cov
Enter Y for a Yes response. Input N for No response. Indicates if blanket coverage applies.
ACORD 81 (2014/12) rev. 04-29-2014
Page 18 of 45
PROPERTY CLASS /
COVERAGE INFORMATION
Electronic Equipment -
Deductible
Enter deductible: The deductible amount for scheduled personal property coverage.
PROPERTY CLASS /
COVERAGE INFORMATION
Electronic Equipment -
Amount of Insurance
Enter amount: The total actual value amount for the electronic equipment class.
PROPERTY CLASS /
COVERAGE INFORMATION
Electronic Equipment - Rate
Enter rate: The rate or factor used to calculate the premium for the electronic equipment class.
PROPERTY CLASS /
COVERAGE INFORMATION
Electronic Equipment -
Premium
Enter amount: The total premium amount for the electronic equipment class.
PROPERTY CLASS /
COVERAGE INFORMATION
Guns - Loc #
Enter number: The producer assigned number of the location.
PROPERTY CLASS /
COVERAGE INFORMATION
Guns - Loss Settlement
Enter code: The type of valuation used for this property class. The code values are ACV for
actual cash value or RC for replacement cost.
PROPERTY CLASS /
COVERAGE INFORMATION
Guns - Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Guns - Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Guns - Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Guns - Professional /
Commercial Use
Enter Y for a Yes response. Input N for No response. Indicates if the property is used
professionally or commercially.
ACORD 81 (2014/12) rev. 04-29-2014
Page 19 of 45
PROPERTY CLASS /
COVERAGE INFORMATION
Guns - Exhibited
Enter Y for a Yes response. Input N for No response. Indicates if the property is exhibited.
PROPERTY CLASS /
COVERAGE INFORMATION
Guns - In Vault
Enter Y for a Yes response. Input N for No response. Indicates if the property is stored in a
vault.
PROPERTY CLASS /
COVERAGE INFORMATION
Guns - Blanket Cov
Enter Y for a Yes response. Input N for No response. Indicates if blanket coverage applies.
PROPERTY CLASS /
COVERAGE INFORMATION
Guns - Deductible
Enter deductible: The deductible amount for scheduled personal property coverage.
PROPERTY CLASS /
COVERAGE INFORMATION
Guns - Amount of Insurance
Enter amount: The total actual value amount for the guns class.
PROPERTY CLASS /
COVERAGE INFORMATION
Guns - Rate
Enter rate: The rate or factor used to calculate the premium for the guns class.
PROPERTY CLASS /
COVERAGE INFORMATION
Guns - Premium
Enter amount: The total premium amount for the guns class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Code
Enter code: The code defining the class (group) of the inland marine items being described.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Description
Enter text: The description of the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Loc #
Enter number: The producer assigned number of the location.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Loss
Settlement
Enter code: The type of valuation used for this property class. The code values are ACV for
actual cash value or RC for replacement cost.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
ACORD 81 (2014/12) rev. 04-29-2014
Page 20 of 45
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Professional / Commercial
Use
Enter Y for a Yes response. Input N for No response. Indicates if the property is used
professionally or commercially.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Exhibited
Enter Y for a Yes response. Input N for No response. Indicates if the property is exhibited.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - In
Vault
Enter Y for a Yes response. Input N for No response. Indicates if the property is stored in a
vault.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Blanket Cov
Enter Y for a Yes response. Input N for No response. Indicates if blanket coverage applies.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Deductible
Enter deductible: The deductible amount for scheduled personal property coverage.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Amount Of Insurance
Enter amount: The total actual value amount for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Rate
Enter rate: The rate or factor used to calculate the premium for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Premium
Enter amount: The total premium amount for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Code
Enter code: The code defining the class (group) of the inland marine items being described.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Description
Enter text: The description of the property class.
ACORD 81 (2014/12) rev. 04-29-2014
Page 21 of 45
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Loc #
Enter number: The producer assigned number of the location.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Loss
Settlement
Enter code: The type of valuation used for this property class. The code values are ACV for
actual cash value or RC for replacement cost.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Professional / Commercial
Use
Enter Y for a Yes response. Input N for No response. Indicates if the property is used
professionally or commercially.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Exhibited
Enter Y for a Yes response. Input N for No response. Indicates if the property is exhibited.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - In
Vault
Enter Y for a Yes response. Input N for No response. Indicates if the property is stored in a
vault.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Blanket Cov
Enter Y for a Yes response. Input N for No response. Indicates if blanket coverage applies.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Deductible
Enter deductible: The deductible amount for scheduled personal property coverage.
ACORD 81 (2014/12) rev. 04-29-2014
Page 22 of 45
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Amount Of Insurance
Enter amount: The total actual value amount for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Rate
Enter rate: The rate or factor used to calculate the premium for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Premium
Enter amount: The total premium amount for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Code
Enter code: The code defining the class (group) of the inland marine items being described.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Description
Enter text: The description of the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Loc #
Enter number: The producer assigned number of the location.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Loss
Settlement
Enter code: The type of valuation used for this property class. The code values are ACV for
actual cash value or RC for replacement cost.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
ACORD 81 (2014/12) rev. 04-29-2014
Page 23 of 45
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Professional / Commercial
Use
Enter Y for a Yes response. Input N for No response. Indicates if the property is used
professionally or commercially.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Exhibited
Enter Y for a Yes response. Input N for No response. Indicates if the property is exhibited.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - In
Vault
Enter Y for a Yes response. Input N for No response. Indicates if the property is stored in a
vault.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Blanket Cov
Enter Y for a Yes response. Input N for No response. Indicates if blanket coverage applies.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Deductible
Enter deductible: The deductible amount for scheduled personal property coverage.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Amount Of Insurance
Enter amount: The total actual value amount for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Rate
Enter rate: The rate or factor used to calculate the premium for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Premium
Enter amount: The total premium amount for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Code
Enter code: The code defining the class (group) of the inland marine items being described.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Description
Enter text: The description of the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Loc #
Enter number: The producer assigned number of the location.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Loss
Settlement
Enter code: The type of valuation used for this property class. The code values are ACV for
actual cash value or RC for replacement cost.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
ACORD 81 (2014/12) rev. 04-29-2014
Page 24 of 45
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Professional / Commercial
Use
Enter Y for a Yes response. Input N for No response. Indicates if the property is used
professionally or commercially.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Exhibited
Enter Y for a Yes response. Input N for No response. Indicates if the property is exhibited.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - In
Vault
Enter Y for a Yes response. Input N for No response. Indicates if the property is stored in a
vault.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Blanket Cov
Enter Y for a Yes response. Input N for No response. Indicates if blanket coverage applies.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Deductible
Enter deductible: The deductible amount for scheduled personal property coverage.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Amount Of Insurance
Enter amount: The total actual value amount for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Rate
Enter rate: The rate or factor used to calculate the premium for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Premium
Enter amount: The total premium amount for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Code
Enter code: The code defining the class (group) of the inland marine items being described.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Description
Enter text: The description of the property class.
ACORD 81 (2014/12) rev. 04-29-2014
Page 25 of 45
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Loc #
Enter number: The producer assigned number of the location.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Loss
Settlement
Enter code: The type of valuation used for this property class. The code values are ACV for
actual cash value or RC for replacement cost.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Professional / Commercial
Use
Enter Y for a Yes response. Input N for No response. Indicates if the property is used
professionally or commercially.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Exhibited
Enter Y for a Yes response. Input N for No response. Indicates if the property is exhibited.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - In
Vault
Enter Y for a Yes response. Input N for No response. Indicates if the property is stored in a
vault.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Blanket Cov
Enter Y for a Yes response. Input N for No response. Indicates if blanket coverage applies.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Deductible
Enter deductible: The deductible amount for scheduled personal property coverage.
ACORD 81 (2014/12) rev. 04-29-2014
Page 26 of 45
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Amount Of Insurance
Enter amount: The total actual value amount for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Rate
Enter rate: The rate or factor used to calculate the premium for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Premium
Enter amount: The total premium amount for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Code
Enter code: The code defining the class (group) of the inland marine items being described.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Description
Enter text: The description of the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Loc #
Enter number: The producer assigned number of the location.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Loss
Settlement
Enter code: The type of valuation used for this property class. The code values are ACV for
actual cash value or RC for replacement cost.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
ACORD 81 (2014/12) rev. 04-29-2014
Page 27 of 45
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Professional / Commercial
Use
Enter Y for a Yes response. Input N for No response. Indicates if the property is used
professionally or commercially.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Exhibited
Enter Y for a Yes response. Input N for No response. Indicates if the property is exhibited.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - In
Vault
Enter Y for a Yes response. Input N for No response. Indicates if the property is stored in a
vault.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Blanket Cov
Enter Y for a Yes response. Input N for No response. Indicates if blanket coverage applies.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Deductible
Enter deductible: The deductible amount for scheduled personal property coverage.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Amount Of Insurance
Enter amount: The total actual value amount for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Rate
Enter rate: The rate or factor used to calculate the premium for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Premium
Enter amount: The total premium amount for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Code
Enter code: The code defining the class (group) of the inland marine items being described.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Description
Enter text: The description of the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Loc #
Enter number: The producer assigned number of the location.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Loss
Settlement
Enter code: The type of valuation used for this property class. The code values are ACV for
actual cash value or RC for replacement cost.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
ACORD 81 (2014/12) rev. 04-29-2014
Page 28 of 45
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Professional / Commercial
Use
Enter Y for a Yes response. Input N for No response. Indicates if the property is used
professionally or commercially.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Exhibited
Enter Y for a Yes response. Input N for No response. Indicates if the property is exhibited.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - In
Vault
Enter Y for a Yes response. Input N for No response. Indicates if the property is stored in a
vault.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Blanket Cov
Enter Y for a Yes response. Input N for No response. Indicates if blanket coverage applies.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Deductible
Enter deductible: The deductible amount for scheduled personal property coverage.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Amount Of Insurance
Enter amount: The total actual value amount for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Rate
Enter rate: The rate or factor used to calculate the premium for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Premium
Enter amount: The total premium amount for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Code
Enter code: The code defining the class (group) of the inland marine items being described.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Description
Enter text: The description of the property class.
ACORD 81 (2014/12) rev. 04-29-2014
Page 29 of 45
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Loc #
Enter number: The producer assigned number of the location.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Loss
Settlement
Enter code: The type of valuation used for this property class. The code values are ACV for
actual cash value or RC for replacement cost.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Coverage Qualifier
Enter code: The code identifying the qualification to the coverage for this property class. The
code values are AR, All Risk (used for guns); BE, Breakage Exclusion Buy-Back; BF, Broad
Form Pair and Set; BR, Broad Form (used for guns); DP, Depreciated (used for furs); ED,
Limited Editions; LE, Laser Engraved; NO, Non-mobile Organ; NS, Non Standard; PO, Portable;
SB, Scheduled and Blanket Basis; SC, Safe Credit; SL, Scheduled Basis; T1, Tiered Rating 1;
T2, Tiered Rating 2; T3, Tiered Rating 3; T4, Tiered Rating 4; T5, Tiered Rating 5; T6, Tiered
Rating 6; T7, Tiered Rating 7; T8, Tiered Rating 8; T9, Tiered Rating 9; UA, Unattended
Automobile; VC, Vault Credit.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Professional / Commercial
Use
Enter Y for a Yes response. Input N for No response. Indicates if the property is used
professionally or commercially.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Exhibited
Enter Y for a Yes response. Input N for No response. Indicates if the property is exhibited.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - In
Vault
Enter Y for a Yes response. Input N for No response. Indicates if the property is stored in a
vault.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Blanket Cov
Enter Y for a Yes response. Input N for No response. Indicates if blanket coverage applies.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Deductible
Enter deductible: The deductible amount for scheduled personal property coverage.
ACORD 81 (2014/12) rev. 04-29-2014
Page 30 of 45
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Amount Of Insurance
Enter amount: The total actual value amount for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class - Rate
Enter rate: The rate or factor used to calculate the premium for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Other Property Class -
Premium
Enter amount: The total premium amount for the property class.
PROPERTY CLASS /
COVERAGE INFORMATION
Total
Enter amount: The total premium amount for the personal inland marine line of business.
SAFE / VAULT
INFORMATION
Bank Vault in Use ?
(checkbox)
Check the box (if applicable): Indicates the bank vault is in use.
SAFE / VAULT
INFORMATION
Bank Address Line 1
Enter text: The bank address line one.
SAFE / VAULT
INFORMATION
Bank Address City
Enter text: The bank address city.
SAFE / VAULT
INFORMATION
Bank Address State
Enter code: The bank's state or province code.
SAFE / VAULT
INFORMATION
Bank Address Zip
Enter code: The bank's postal code.
SAFE / VAULT
INFORMATION
Resident Vault in Use?
Check the box (if applicable): Indicates the residence vault is in use.
SAFE / VAULT
INFORMATION
Loc #
Enter number: The producer assigned number of the location.
SAFE / VAULT
INFORMATION
Manufacturer
Enter text: The safe or vault manufacturer's name.
SAFE / VAULT
INFORMATION
Model
Enter text: The model name of the safe or vault.
SAFE / VAULT
INFORMATION
Label UL
Check the box (if applicable): Indicates the rating is based on Underwriters Laboratories, Inc.
(UL).
SAFE / VAULT
INFORMATION
Label SMNA
Check the box (if applicable): Indicates the rating is based on Safe Manufacturers National
Association (SMNA).
SAFE / VAULT
INFORMATION
Class
Enter code: The construction classification representing the extent of burglary protection for this
safe or vault. Use the classification from the Burglary label and not the Fire label located on the
safe or vault. For industry definitions of the classifications, refer to the Commercial Lines
Manual.
ACORD 81 (2014/12) rev. 04-29-2014
Page 31 of 45
SAFE / VAULT
INFORMATION
Door Type Round
Check the box (if applicable): Indicates the door is round.
SAFE / VAULT
INFORMATION
Door Type Square
Check the box (if applicable): Indicates the door is square.
SAFE / VAULT
INFORMATION
Combination Locks Outer
Check the box (if applicable): Indicates if there are outer combination locks on the safe or vault.
SAFE / VAULT
INFORMATION
Combination Locks Inner
Check the box (if applicable): Indicates if there are inner combination locks on the safe or vault.
SAFE / VAULT
INFORMATION
Combination Locks Chest
Check the box (if applicable): Indicates if there are chest combination locks on the safe or vault.
SAFE / VAULT
INFORMATION
Thickness Door
Enter number: The door thickness in inches, excluding bolt work.
SAFE / VAULT
INFORMATION
Thickness Wall
Enter number: The wall thickness in inches.
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).
GENERAL INFORMATION
1. Any protective devices /
systems in use?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Any protective devices / systems in use?.
GENERAL INFORMATION
Explanation
Enter text: An explanation as to whether any protective devices / systems are in use.
GENERAL INFORMATION
2. Will any property be
exhibited?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Will any property be exhibited?.
GENERAL INFORMATION
Property
Enter text: The description of the property that will be exhibited.
GENERAL INFORMATION
Exhibit Location
Enter text: The description of the exhibit location.
GENERAL INFORMATION
Type of Exhibition
Enter text: The description of the type of exhibit.
GENERAL INFORMATION
Type of Security
Enter text: The type of security available at the exhibit.
GENERAL INFORMATION
Duration
Enter text: The duration of the exhibit.
GENERAL INFORMATION
3. Will any special
restriction / endorsements
apply?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Will any special restrictions / endorsements apply?.
ACORD 81 (2014/12) rev. 04-29-2014
Page 32 of 45
GENERAL INFORMATION
Explanation
Enter text: An explanation as to whether any restrictions or endorsements apply.
GENERAL INFORMATION
4. Is any property used
professionally /
commercially?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Is any property used professionally / commercially?.
GENERAL INFORMATION
Explanation
Enter text: An explanation as to whether any property is used professionally / commercially.
GENERAL INFORMATION
5. Any other insurance with
this company?
Enter Y for a Yes response. Input N for No response. Indicates the answer to the question,
Any other insurance with this company?.
GENERAL INFORMATION
Line of Business
Enter code: The line of business of the other policy.
GENERAL INFORMATION
Policy Number
Enter identifier: The other policy number exactly as it appears on the policy, including prefix and
suffix symbols.
GENERAL INFORMATION
Line of Business
Enter code: The line of business of the other policy.
GENERAL INFORMATION
Policy Number
Enter identifier: The other policy number exactly as it appears on the policy, including prefix and
suffix symbols.
GENERAL INFORMATION
6. Has coverage been
declined, cancelled or
non-renewed during the last
three (3) years?
Enter Y for a Yes response. Input N for No response. Indicates the answer to the question,
Any coverage declined, cancelled or non-renewed during the mandated number of years
(Missouri Applicants - Do not answer this question)?.
GENERAL INFORMATION
Explanation
Enter text: An explanation of any coverage declined, cancelled or non-renewed within the last
specified number of years.
GENERAL INFORMATION
7. Has applicant had a
foreclosure, repossession,
bankruptcy or filed for
bankruptcy during the past
five (5) years?
Enter Y for a Yes response. Input N for No response. Indicates the answer to the question,
Has applicant had a foreclosure, repossession, bankruptcy or filed for bankruptcy during the
past specified number of years?.
GENERAL INFORMATION
Explanation
Enter text: An explanation of any foreclosures or bankruptcies in the last specified number of
years.
GENERAL INFORMATION
8. Has applicant had a
judgement or lien during the
past five (5) years?
Enter Y for a Yes response. Input N for No response. Indicates the answer to the question,
Has applicant had a judgement or lien during the past specified number of years?.
GENERAL INFORMATION
Explanation
Enter text: An explanation of any judgement or liens during the past five (5) years.
GENERAL INFORMATION
9. Has insurance been
transferred within the
agency?
Enter Y for a Yes response. Input N for No response. Indicates the answer to the question,
Has insurance been transferred within agency?.
GENERAL INFORMATION
Explanation
Enter text: An explanation of insurance transferred within the agency.
ACORD 81 (2014/12) rev. 04-29-2014
Page 33 of 45
GENERAL INFORMATION
10 During the last five (5)
years [ten (10) years in
Rhode Island], has any
applicant been indicted for
or convicted of any degree
of the crime of fraud,
bribery, arson or any other
arson-related crime in
connection with this or any
other property?
Enter Y for a Yes response. Input N for No response. Indicates the answer to the question,
During the last five (5) years [ten (10) years in Rhode Island], has any applicant been indicted
for or convicted of any degree of the crime of fraud, bribery, arson or any other arson related
crime in connection with this or any other property? (In RI, failure to disclose the existence of an
arson conviction is a misdemeanor punishable by a sentence of up to one (1) year of
imprisonment.).
GENERAL INFORMATION
Explanation
Enter text: An explanation as to whether any applicant has been convicted of fraud, bribery or
arson in the last specified number of years.
GENERAL INFORMATION
11. Prior Insurance?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
'Prior Insurance?.
GENERAL INFORMATION
Insurer Name
Enter text: The name of the previous insurer.
GENERAL INFORMATION
Policy Number
Enter identifier: The policy number of the previous coverage.
LOSS HISTORY
Any losses whether or not
paid by insurance, during
the last (enter number)
years, at this or any
location?
Enter number: The number of years of loss information required by the insurer.
LOSS HISTORY
Y / N
Enter Y for a Yes response. Input N for No response. Indicates if there have been any losses
at any location, whether paid or not paid by insurance, in the last mandated number of years.
LOSS HISTORY
Applicant's Initials
Initial here: The named insured's initials.
LOSS HISTORY
Loss Date
Enter date: The date when the accident or incident occurred that resulted in the filing of a claim.
(MM/DD/YYYY)
LOSS HISTORY
Loss Type
Enter code: The basic coverage provided, under which the loss was incurred.
LOSS HISTORY
Description of Loss
Enter text: A brief description of the loss.
LOSS HISTORY
Cat #
Enter identifier: The Catastrophe Number that is assigned by the Insurance Services Office
Property Claims Service in cases of multiple losses due to floods, hurricanes, earthquakes, and
similar major loss events.
LOSS HISTORY
Amount Paid
Enter amount: The amount that has been paid on this claim to date.
LOSS HISTORY
Entered by (A)gent
(C)ompany
Enter code: The code identifying who entered the loss (e.g. A - Agency, C - Company).
LOSS HISTORY
In dispute Y / N
Enter Y for a Yes response. Input N for No response. Indicates if the claim is in dispute.
ACORD 81 (2014/12) rev. 04-29-2014
Page 34 of 45
LOSS HISTORY
Loss Date
Enter date: The date when the accident or incident occurred that resulted in the filing of a claim.
(MM/DD/YYYY)
LOSS HISTORY
Loss Type
Enter code: The basic coverage provided, under which the loss was incurred.
LOSS HISTORY
Description of Loss
Enter text: A brief description of the loss.
LOSS HISTORY
Cat #
Enter identifier: The Catastrophe Number that is assigned by the Insurance Services Office
Property Claims Service in cases of multiple losses due to floods, hurricanes, earthquakes, and
similar major loss events.
LOSS HISTORY
Amount Paid
Enter amount: The amount that has been paid on this claim to date.
LOSS HISTORY
Entered by (A)gent
(C)ompany
Enter code: The code identifying who entered the loss (e.g. A - Agency, C - Company).
LOSS HISTORY
In dispute Y / N
Enter Y for a Yes response. Input N for No response. Indicates if the claim is in dispute.
LOSS HISTORY
Loss Date
Enter date: The date when the accident or incident occurred that resulted in the filing of a claim.
(MM/DD/YYYY)
LOSS HISTORY
Loss Type
Enter code: The basic coverage provided, under which the loss was incurred.
LOSS HISTORY
Description of Loss
Enter text: A brief description of the loss.
LOSS HISTORY
Cat #
Enter identifier: The Catastrophe Number that is assigned by the Insurance Services Office
Property Claims Service in cases of multiple losses due to floods, hurricanes, earthquakes, and
similar major loss events.
LOSS HISTORY
Amount Paid
Enter amount: The amount that has been paid on this claim to date.
LOSS HISTORY
Entered by (A)gent
(C)ompany
Enter code: The code identifying who entered the loss (e.g. A - Agency, C - Company).
LOSS HISTORY
In dispute Y / N
Enter Y for a Yes response. Input N for No response. Indicates if the claim is in dispute.
LOSS HISTORY
Loss Date
Enter date: The date when the accident or incident occurred that resulted in the filing of a claim.
(MM/DD/YYYY)
LOSS HISTORY
Loss Type
Enter code: The basic coverage provided, under which the loss was incurred.
LOSS HISTORY
Description of Loss
Enter text: A brief description of the loss.
LOSS HISTORY
Cat #
Enter identifier: The Catastrophe Number that is assigned by the Insurance Services Office
Property Claims Service in cases of multiple losses due to floods, hurricanes, earthquakes, and
similar major loss events.
LOSS HISTORY
Amount Paid
Enter amount: The amount that has been paid on this claim to date.
LOSS HISTORY
Entered by (A)gent
(C)ompany
Enter code: The code identifying who entered the loss (e.g. A - Agency, C - Company).
ACORD 81 (2014/12) rev. 04-29-2014
Page 35 of 45
LOSS HISTORY
In dispute Y / N
Enter Y for a Yes response. Input N for No response. Indicates if the claim is in dispute.
PAYMENT PLAN
Billing Account #
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.
PAYMENT PLAN
Deposit Amount
Enter amount: The amount of the premium received as a deposit.
PAYMENT PLAN
Est Total Premium
Enter amount: The estimated total cost amount of the policy.
PAYMENT PLAN
Billing - Direct Bill - Policy
(checkbox)
Check the box (if applicable): Indicates if the policy is to be direct billed.
PAYMENT PLAN
Direct Bill - Acct (checkbox)
Check the box (if applicable): Indicates if the account is to be direct billed.
PAYMENT PLAN
Agency Bill
Check the box (if applicable): Indicates if the policy is to be producer / agency billed.
PAYMENT PLAN
Payment Plan - Full Pay
(checkbox)
Check the box (if applicable): Indicates a full payment will be made on the policy.
PAYMENT PLAN
Annual (checkbox)
Check the box (if applicable): Indicates the policy will be paid annually.
PAYMENT PLAN
Semi-Annual (checkbox)
Check the box (if applicable): Indicates the policy will be paid semi-annually.
PAYMENT PLAN
Quarterly (checkbox)
Check the box (if applicable): Indicates the policy will be paid quarterly.
PAYMENT PLAN
Bi-Monthly (checkbox)
Check the box (if applicable): Indicates the policy will be paid bi-monthly.
PAYMENT PLAN
Monthly (checkbox)
Check the box (if applicable): Indicates the policy will be paid monthly.
PAYMENT PLAN
Other (checkbox)
Check the box (if applicable): Indicates the policy will be paid in a frequency other than those
listed.
PAYMENT PLAN
Other Description
Enter code: The payment plan for the policy (i.e., AN - Annual, MO - Monthly, QT - Quarterly,
etc.).
PAYMENT PLAN
Payment Method - Cash
(checkbox)
Check the box (if applicable): Indicates the invoice will be paid in cash.
PAYMENT PLAN
Check (checkbox)
Check the box (if applicable): Indicates the invoice will be paid by check.
PAYMENT PLAN
Credit Card (checkbox)
Check the box (if applicable): Indicates the invoice will be paid by credit card.
PAYMENT PLAN
EFT (checkbox)
Check the box (if applicable): Indicates the invoice will be paid using electronic funds transfer
(EFT).
PAYMENT PLAN
Payroll Deduction
(checkbox)
Check the box (if applicable): Indicates the invoice will be paid by payroll deduction.
PAYMENT PLAN
Pre-Authorized Draft / Check
(PAC) (checkbox)
Check the box (if applicable): Indicates the invoice will be paid by a pre-authorized check or
draft.
ACORD 81 (2014/12) rev. 04-29-2014
Page 36 of 45
PAYMENT PLAN
Other (checkbox)
Check the box (if applicable): Indicates the invoice will be paid by a means other than those
listed.
PAYMENT PLAN
Other Description
Enter text: The method the invoice will be paid.
PAYMENT PLAN
Mail Policy to Agent
(checkbox)
Check the box (if applicable): Indicates if the policy paper should be sent to the producer.
PAYMENT PLAN
Insured (checkbox)
Check the box (if applicable): Indicates if the policy paper should be mailed directly to the
named insured.
PAYMENT PLAN
Other (checkbox)
Check the box (if applicable): Indicates if the policy paper should be mailed to other than the
agent or applicant.
PAYMENT PLAN
Other Description
Enter text: The description to whom the policy paper should be mailed.
PAYMENT PLAN
Payor - Insured (checkbox)
Check the box (if applicable): Indicates the payor of the policy is the insured.
PAYMENT PLAN
Mortgagee (checkbox)
Check the box (if applicable): Indicates the payor of the policy is the mortgagee.
PAYMENT PLAN
Other (checkbox)
Check the box (if applicable): Indicates the payor of the policy is other than those listed.
PAYMENT PLAN
Other Description
Enter text: The description of the payor of the policy.
ADDITIONAL INTEREST
Additional Insured
(checkbox)
Check the box (if applicable): Indicates the additional interest type is an additional insured.
ADDITIONAL INTEREST
Lienholder (checkbox)
Check the box (if applicable): Indicates the additional interest type is a lien holder.
ADDITIONAL INTEREST
Loss Payee (checkbox)
Check the box (if applicable): Indicates the additional interest type is a loss payee.
ADDITIONAL INTEREST
Mortgagee (checkbox)
Check the box (if applicable): Indicates the additional interest type is a mortgagee.
ADDITIONAL INTEREST
Trustee (checkbox)
Check the box (if applicable): Indicates the additional interest type is a trustee.
ADDITIONAL INTEREST
Other (checkbox)
Check the box (if applicable): Indicates the additional interest is other than those listed.
ADDITIONAL INTEREST
Other Description
Enter text: The description of the other type of additional interest.
ADDITIONAL INTEREST
Rank
Enter number: The ranking of 'this' additional interest when multiple additional interests are
associated with the same item.
ADDITIONAL INTEREST
Evidence - Certificate
(checkbox)
Check the box (if applicable): Indicates if the additional interest requires a Certificate of
Insurance.
ADDITIONAL INTEREST
Send Bill (checkbox)
Check the box (if applicable): Indicates the bill should be sent to the additional interest.
ADDITIONAL INTEREST
Name
Enter text: The additional interest's full name.
ADDITIONAL INTEREST
Address Line 1
Enter text: The additional interest's mailing address line one.
ADDITIONAL INTEREST
Address Line 2
Enter text: The additional interest's mailing address line two.
ACORD 81 (2014/12) rev. 04-29-2014
Page 37 of 45
ADDITIONAL INTEREST
City
Enter text: The additional interest's mailing address city name.
ADDITIONAL INTEREST
State
Enter code: The additional interest's mailing address state or province code.
ADDITIONAL INTEREST
Zip Code
Enter code: The additional interest's mailing address postal code.
ADDITIONAL INTEREST
Country
Enter code: The additional interest's country code.
ADDITIONAL INTEREST
Reference / Loan #
Enter identifier: The loan number, account number or other controlling number that the
additional interest may have assigned the insured.
ADDITIONAL INTEREST
Sched #
Enter number: The number associated with the property class (e.g., 1 - Jewelry, 2 - Furs). As
used here, which has an additional interest.
ADDITIONAL INTEREST
Item #
Enter number: The number assigned to the item by the producer. As used here, the item in
which there is an additional interest.
Form Page 3
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).
ATTACHMENTS
State Supplement(s)
Check the box (if applicable): Indicates that a state supplement is attached.
ATTACHMENTS
Photograph
Check the box (if applicable): Indicates that a photograph is attached.
ATTACHMENTS
Appraisal
Check the box (if applicable): Indicates that an appraisal is attached.
ATTACHMENTS
Bill of Sale
Check the box (if applicable): Indicates that a bill of sale is attached.
ATTACHMENTS
Protective Device Certificate
Check the box (if applicable): Indicates that a protective device certificate is attached.
ATTACHMENTS
Other Attachment
Check the box (if applicable): Indicates that there is an attachment other than those listed.
ATTACHMENTS
Other Attachment
Description
Enter text: The description of the attachment.
ATTACHMENTS
Other Attachment
Check the box (if applicable): Indicates that there is an attachment other than those listed.
ATTACHMENTS
Other Attachment
Description
Enter text: The description of the attachment.
ATTACHMENTS
Other Attachment
Check the box (if applicable): Indicates that there is an attachment other than those listed.
ATTACHMENTS
Other Attachment
Description
Enter text: The description of the attachment.
SCHEDULE OF PROPERTY
Schd #
Enter number: The number associated with the property class (e.g., 1 - Jewelry, 2 - Furs).
ACORD 81 (2014/12) rev. 04-29-2014
Page 38 of 45
SCHEDULE OF PROPERTY
Item #
Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY
Detail Description
Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY
Formal Appraisal
Enter Y for a Yes response. Input N for No response. Indicates if a formal appraisal has been
made on the item.
SCHEDULE OF PROPERTY
Valuation Date
Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY
Amount of Insurance
Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY
Schd #
Enter number: The number associated with the property class (e.g., 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY
Item #
Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY
Detail Description
Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY
Formal Appraisal
Enter Y for a Yes response. Input N for No response. Indicates if a formal appraisal has been
made on the item.
SCHEDULE OF PROPERTY
Valuation Date
Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY
Amount of Insurance
Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY
Schd #
Enter number: The number associated with the property class (e.g., 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY
Item #
Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY
Detail Description
Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY
Formal Appraisal
Enter Y for a Yes response. Input N for No response. Indicates if a formal appraisal has been
made on the item.
SCHEDULE OF PROPERTY
Valuation Date
Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY
Amount of Insurance
Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY
Schd #
Enter number: The number associated with the property class (e.g., 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY
Item #
Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY
Detail Description
Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY
Formal Appraisal
Enter Y for a Yes response. Input N for No response. Indicates if a formal appraisal has been
made on the item.
SCHEDULE OF PROPERTY
Valuation Date
Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY
Amount of Insurance
Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY
Schd #
Enter number: The number associated with the property class (e.g., 1 - Jewelry, 2 - Furs).
ACORD 81 (2014/12) rev. 04-29-2014
Page 39 of 45
SCHEDULE OF PROPERTY
Item #
Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY
Detail Description
Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY
Formal Appraisal
Enter Y for a Yes response. Input N for No response. Indicates if a formal appraisal has been
made on the item.
SCHEDULE OF PROPERTY
Valuation Date
Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY
Amount of Insurance
Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY
Schd #
Enter number: The number associated with the property class (e.g., 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY
Item #
Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY
Detail Description
Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY
Formal Appraisal
Enter Y for a Yes response. Input N for No response. Indicates if a formal appraisal has been
made on the item.
SCHEDULE OF PROPERTY
Valuation Date
Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY
Amount of Insurance
Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY
Schd #
Enter number: The number associated with the property class (e.g., 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY
Item #
Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY
Detail Description
Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY
Formal Appraisal
Enter Y for a Yes response. Input N for No response. Indicates if a formal appraisal has been
made on the item.
SCHEDULE OF PROPERTY
Valuation Date
Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY
Amount of Insurance
Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY
Schd #
Enter number: The number associated with the property class (e.g., 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY
Item #
Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY
Detail Description
Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY
Formal Appraisal
Enter Y for a Yes response. Input N for No response. Indicates if a formal appraisal has been
made on the item.
SCHEDULE OF PROPERTY
Valuation Date
Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY
Amount of Insurance
Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY
Schd #
Enter number: The number associated with the property class (e.g., 1 - Jewelry, 2 - Furs).
ACORD 81 (2014/12) rev. 04-29-2014
Page 40 of 45
SCHEDULE OF PROPERTY
Item #
Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY
Detail Description
Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY
Formal Appraisal
Enter Y for a Yes response. Input N for No response. Indicates if a formal appraisal has been
made on the item.
SCHEDULE OF PROPERTY
Valuation Date
Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY
Amount of Insurance
Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY
Schd #
Enter number: The number associated with the property class (e.g., 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY
Item #
Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY
Detail Description
Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY
Formal Appraisal
Enter Y for a Yes response. Input N for No response. Indicates if a formal appraisal has been
made on the item.
SCHEDULE OF PROPERTY
Valuation Date
Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY
Amount of Insurance
Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY
Schd #
Enter number: The number associated with the property class (e.g., 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY
Item #
Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY
Detail Description
Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY
Formal Appraisal
Enter Y for a Yes response. Input N for No response. Indicates if a formal appraisal has been
made on the item.
SCHEDULE OF PROPERTY
Valuation Date
Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY
Amount of Insurance
Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY
Schd #
Enter number: The number associated with the property class (e.g., 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY
Item #
Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY
Detail Description
Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY
Formal Appraisal
Enter Y for a Yes response. Input N for No response. Indicates if a formal appraisal has been
made on the item.
SCHEDULE OF PROPERTY
Valuation Date
Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY
Amount of Insurance
Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY
Schd #
Enter number: The number associated with the property class (e.g., 1 - Jewelry, 2 - Furs).
ACORD 81 (2014/12) rev. 04-29-2014
Page 41 of 45
SCHEDULE OF PROPERTY
Item #
Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY
Detail Description
Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY
Formal Appraisal
Enter Y for a Yes response. Input N for No response. Indicates if a formal appraisal has been
made on the item.
SCHEDULE OF PROPERTY
Valuation Date
Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY
Amount of Insurance
Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY
Schd #
Enter number: The number associated with the property class (e.g., 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY
Item #
Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY
Detail Description
Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY
Formal Appraisal
Enter Y for a Yes response. Input N for No response. Indicates if a formal appraisal has been
made on the item.
SCHEDULE OF PROPERTY
Valuation Date
Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY
Amount of Insurance
Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY
Schd #
Enter number: The number associated with the property class (e.g., 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY
Item #
Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY
Detail Description
Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY
Formal Appraisal
Enter Y for a Yes response. Input N for No response. Indicates if a formal appraisal has been
made on the item.
SCHEDULE OF PROPERTY
Valuation Date
Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY
Amount of Insurance
Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY
Schd #
Enter number: The number associated with the property class (e.g., 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY
Item #
Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY
Detail Description
Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY
Formal Appraisal
Enter Y for a Yes response. Input N for No response. Indicates if a formal appraisal has been
made on the item.
SCHEDULE OF PROPERTY
Valuation Date
Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY
Amount of Insurance
Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY
Schd #
Enter number: The number associated with the property class (e.g., 1 - Jewelry, 2 - Furs).
ACORD 81 (2014/12) rev. 04-29-2014
Page 42 of 45
SCHEDULE OF PROPERTY
Item #
Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY
Detail Description
Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY
Formal Appraisal
Enter Y for a Yes response. Input N for No response. Indicates if a formal appraisal has been
made on the item.
SCHEDULE OF PROPERTY
Valuation Date
Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY
Amount of Insurance
Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY
Schd #
Enter number: The number associated with the property class (e.g., 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY
Item #
Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY
Detail Description
Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY
Formal Appraisal
Enter Y for a Yes response. Input N for No response. Indicates if a formal appraisal has been
made on the item.
SCHEDULE OF PROPERTY
Valuation Date
Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY
Amount of Insurance
Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY
Schd #
Enter number: The number associated with the property class (e.g., 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY
Item #
Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY
Detail Description
Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY
Formal Appraisal
Enter Y for a Yes response. Input N for No response. Indicates if a formal appraisal has been
made on the item.
SCHEDULE OF PROPERTY
Valuation Date
Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY
Amount of Insurance
Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY
Schd #
Enter number: The number associated with the property class (e.g., 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY
Item #
Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY
Detail Description
Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY
Formal Appraisal
Enter Y for a Yes response. Input N for No response. Indicates if a formal appraisal has been
made on the item.
SCHEDULE OF PROPERTY
Valuation Date
Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY
Amount of Insurance
Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY
Schd #
Enter number: The number associated with the property class (e.g., 1 - Jewelry, 2 - Furs).
ACORD 81 (2014/12) rev. 04-29-2014
Page 43 of 45
SCHEDULE OF PROPERTY
Item #
Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY
Detail Description
Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY
Formal Appraisal
Enter Y for a Yes response. Input N for No response. Indicates if a formal appraisal has been
made on the item.
SCHEDULE OF PROPERTY
Valuation Date
Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY
Amount of Insurance
Enter amount: The value (limit of liability) of the item described.
SCHEDULE OF PROPERTY
Schd #
Enter number: The number associated with the property class (e.g., 1 - Jewelry, 2 - Furs).
SCHEDULE OF PROPERTY
Item #
Enter number: The number assigned to the item by the producer.
SCHEDULE OF PROPERTY
Detail Description
Enter text: The full description of the item including serial numbers, if applicable.
SCHEDULE OF PROPERTY
Formal Appraisal
Enter Y for a Yes response. Input N for No response. Indicates if a formal appraisal has been
made on the item.
SCHEDULE OF PROPERTY
Valuation Date
Enter date: The date on which the item described was either purchased or last appraised.
SCHEDULE OF PROPERTY
Amount of Insurance
Enter amount: The value (limit of liability) of the item described.
BINDER / NOTICE OF
INFORMATION PRACTICES
Effective Date
Enter date: The date on which the terms and conditions of the binder commenced. This date
normally coincides with the effective date of the policy or of an endorsement to the policy.
BINDER / NOTICE OF
INFORMATION PRACTICES
Time
Enter time: The time of day on the effective date in which the terms and conditions of the binder
will commence.
BINDER / NOTICE OF
INFORMATION PRACTICES
Expiration Date
Enter date: The date on which the terms and conditions of the policy will or have expired.
Certain state laws limit the terms of a binder, so this date may not coincide with the policy
expiration date.
BINDER / NOTICE OF
INFORMATION PRACTICES
12:01 am (checkbox)
Check the box (if applicable): Indicates the binder expires at 12:01 AM on the expiration date.
BINDER / NOTICE OF
INFORMATION PRACTICES
Noon (checkbox)
Check the box (if applicable): Indicates the binder expires at 12:00 noon on the expiration date.
BINDER / NOTICE OF
INFORMATION PRACTICES
Coverage is not bound
(checkbox)
Check the box (if applicable): Indicates the coverage has not been bound.
BINDER / NOTICE OF
INFORMATION PRACTICES
Applicant's Initials
Initial here: The named insured's initials.
ACORD 81 (2014/12) rev. 04-29-2014
Page 44 of 45
BINDER / NOTICE OF
INFORMATION PRACTICES
Copy of the Notice of
Information Practices
Privacy has been given to
the applicant. Not applicable
in all states, consult your
agent or broker for your
state's requirements.
Check the box (if applicable): Indicates that a copy of the Notice of Information Practices
(ACORD 38 or state specific ACORD 38) has been given to the applicant. State specific 38s
are available for applicants in AZ, DE, KS, MN, ND, NY, OR, VA, and WV. In addition, ACORD
38 contains CA and MA state specific language.
Form Page 4
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).
FRAUD STATEMENTS /
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.
FRAUD STATEMENTS /
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.
FRAUD STATEMENTS /
SIGNATURE
State Producer License No
(Required in FL)
Enter identifier: The State License Number of the producer.
FRAUD STATEMENTS /
SIGNATURE
Applicant's Signature
Sign here: Accommodates the signature of the applicant or named insured.
FRAUD STATEMENTS /
SIGNATURE
Date
Enter date: The date the form was signed by the named insured. (MM/DD/YYYY)
FRAUD STATEMENTS /
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 81 (2014/12) rev. 04-29-2014
Page 45 of 45