ACORD 811 (2014/12) - Value Reporting Information

ACORD 811 (2014/12) - Value Reporting Information
ACORD 811, Value Reporting Information, should be used as a supplement to ACORD 140, Property Section, when a reporting form is to be
included in the policy. This form can also be used to enter policy limits for business personal property at locations other than those included in the
declarations.
Form Page 1
Section Name
Field Name
Description
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g., agency or
brokerage).
IDENTIFICATION SECTION
Date
Enter date: The date on which the form is completed. (MM/DD/YYYY)
IDENTIFICATION SECTION
Agency
Enter text: The full name of the producer / agency.
IDENTIFICATION SECTION
Policy Number
Enter identifier: The identifier assigned by the insurer to the policy, or submission, being
referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for
self-insurance, the self-insured license or contract number.
IDENTIFICATION SECTION
Effective Date
Enter date: The effective date of the policy. The date that the terms and conditions of the policy
commence. (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 / First Named
Insured
Enter text: The named insured(s) as it / they will appear on the policy declarations page.
ACORD 811 (2014/12) rev. 05-29-2014
Page 1 of 26
REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
ACORD 811 (2014/12) rev. 05-29-2014
Page 2 of 26
REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
ACORD 811 (2014/12) rev. 05-29-2014
Page 3 of 26
REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
ACORD 811 (2014/12) rev. 05-29-2014
Page 4 of 26
REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
ACORD 811 (2014/12) rev. 05-29-2014
Page 5 of 26
REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
ACORD 811 (2014/12) rev. 05-29-2014
Page 6 of 26
REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
ACORD 811 (2014/12) rev. 05-29-2014
Page 7 of 26
REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
ACORD 811 (2014/12) rev. 05-29-2014
Page 8 of 26
REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
ACORD 811 (2014/12) rev. 05-29-2014
Page 9 of 26
REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
ACORD 811 (2014/12) rev. 05-29-2014
Page 10 of 26
REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
ACORD 811 (2014/12) rev. 05-29-2014
Page 11 of 26
REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
ACORD 811 (2014/12) rev. 05-29-2014
Page 12 of 26
REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
ACORD 811 (2014/12) rev. 05-29-2014
Page 13 of 26
REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
ACORD 811 (2014/12) rev. 05-29-2014
Page 14 of 26
REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
ACORD 811 (2014/12) rev. 05-29-2014
Page 15 of 26
REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
ACORD 811 (2014/12) rev. 05-29-2014
Page 16 of 26
REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
ACORD 811 (2014/12) rev. 05-29-2014
Page 17 of 26
REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
ACORD 811 (2014/12) rev. 05-29-2014
Page 18 of 26
REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
ACORD 811 (2014/12) rev. 05-29-2014
Page 19 of 26
REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
ACORD 811 (2014/12) rev. 05-29-2014
Page 20 of 26
REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
ACORD 811 (2014/12) rev. 05-29-2014
Page 21 of 26
REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
ACORD 811 (2014/12) rev. 05-29-2014
Page 22 of 26
REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
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REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
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REPORTING FORM
Subject of Insurance
Enter code: The code designating all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
REPORTING FORM
Premises / Building
Enter amount: If a reporting form is to be used, provide the average values for each premises
location for the prior twelve months.
REPORTING FORM
Any Other Location
Declared at Inception
Enter amount: The average amount of any other location declared at inception.
REPORTING FORM
Any Other Location
Acquired After Inception
Enter amount: The average amount of any other location acquired after inception.
REPORTING FORM
Premises Not Owned or
Acquired Limit
Enter limit: The limit for business personal property at locations not owned, leased or operated
by the insured, enter the premises location limit and aggregate amounts. Also referred to as
Incidental Locations.
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).
SIGNATURE
Producer's Signature
Sign here: Accommodates the signature of the authorized representative (e.g., producer, agent,
broker, etc.) of the company(ies) listed on the document. This is required in most states.
SIGNATURE
Producer's Name
Enter text: The name of the authorized representative of the producer, agency and/or broker
that signed the form.
SIGNATURE
State Producer License No
(Required in Florida)
Enter identifier: The State License Number of the producer.
SIGNATURE
Applicant's Signature
Sign here: Accommodates the signature of the applicant or named insured.
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SIGNATURE
Date
Enter date: The date the form was signed by the named insured. (MM/DD/YYYY)
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.
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