Member Reports - Acord

Forms
acord.org/Standards/forms
ACORD’s work began with forms – the original data collection and storage solution that continues to deliver
efficiency and consistency throughout the industry. We are committed to maintaining the forms collection in
line with industry evolution. We are also working to align form elements with other ACORD Standards.
AGENCY
PROPERTY LOSS NOTICE
INSURED LOCATION CODE
CARRIER
DATE (MM/DD/YYYY)
DATE OF LOSS AND TIME
AM
PM
PROPERTY / HOME POLICY
NAIC CODE
New Forms
ACORD developed several new forms this
year in response to user requests:
The Texas Association of School Boards
asked for ACORD’s help with insurance
certificates. Under new Texas law,
the boards are no longer able to issue
certificates since they are self-insured via
a risk pool. ACORD revamped its Liability
and Property Coverage Certificates to
make them legally compliant and available
for use by those school boards. This may
now serve as a model for a nationally
standardized risk pool form.
Dormitory Authority of
the State of New York
ACORD provided the Dormitory Authority
of the State of New York (DASNY) with a
specimen copy of an ACORD 25 Certificate of
Liability Insurance, to eliminate inefficiencies
when interacting with contractors. DASNY
provides information to producers who write
policies for parties that do business with them.
Forms Compliance
IN 2012 ACORD conducted a yearlong refresh of all
applications and application supplements to ensure state
fraud warnings and privacy notifications are up-to-date.
This means all forms users can be certain that ACORD
forms are compliant with state requirements in all states.
The compliance team also had dozens of conversations
with state insurance department personnel to make sure
ACORD’s current fraud warning and privacy language is
in accordance with current interpretations.
ACORD Forms may be revised for a variety of business or
regulatory reasons. When they are, the earlier versions are
no longer valid. ACORD offers several tools to help users
ensure they’re using the most current versions. You can
find them in the Forms area of the acord.org website.
New this year is the Vendor Forms Library which provides
information about the forms versions the vendors who
license ACORD Forms maintain in their systems.
The Forms Future
ACORD has been working with the National Conference
of Insurance Legislatures (NCOIL) and partner insurance
associations to try to resolve differences in their positions
on certificates for commercial property insurance. ACORD
plans to support all the parties involved in the development
of a form that works for everyone.
CONTACT
NAME:
PHONE
(A/C, No, Ext):
FAX
(A/C, No):
E-MAIL
ADDRESS:
CODE:
AGENCY CUSTOMER ID:
INSURED
NAME OF INSURED (First, Middle, Last)
PRIMARY
PHONE #
NAME OF SPOUSE (First, Middle, Last) (if applicable)
PRIMARY
PHONE #
CONTACT
NAME OF CONTACT (First, Middle, Last)
PRIMARY
PHONE #
DATE OF BIRTH
DATE OF BIRTH
WHEN TO CONTACT
HOME
HOME
HOME
BUS
BUS
BUS
CONTACT INSURED
CELL
SUBCODE:
FEIN (if applicable)
CELL
CELL
SECONDARY
PHONE #
FEIN (if applicable)
SECONDARY
PHONE #
SECONDARY
PHONE #
LOSS
LOCATION OF LOSS
STREET:
CITY, STATE, ZIP:
COUNTRY:
DESCRIBE LOCATION OF LOSS IF NOT AT SPECIFIC STREET ADDRESS:
KIND OF
LOSS
FIRE
LIGHTNING FLOOD
THEFT
HAIL
WIND
HOME
HOME
HOME
MARITAL STATUS
MARITAL STATUS
BUS
CELL
POLICY NUMBER
CARRIER
POLICY NUMBER
CARRIER
POLICY NUMBER
CONTACT'S MAILING ADDRESS
PRIMARY E-MAIL ADDRESS:
SECONDARY E-MAIL ADDRESS:
DESCRIPTION OF LOSS & DAMAGE (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
BUS
BUS
CELL
CELL
INSURED'S MAILING ADDRESS
PRIMARY E-MAIL ADDRESS:
SECONDARY E-MAIL ADDRESS:
SPOUSE'S MAILING ADDRESS (if applicable)
PRIMARY E-MAIL ADDRESS:
SECONDARY E-MAIL ADDRESS:
FLOOD POLICY
WIND POLICY
POLICE OR FIRE DEPARTMENT CONTACTED
REPORT NUMBER
PROBABLE AMOUNT ENTIRE LOSS
NAIC CODE
NAIC CODE
REPORTED BY
REPORTED TO
ACORD 1 (2011/07) Page 1 of 3 © 1988-2011 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
“PROVIDING SAMPLE CERTIFICATES OF INSURANCE TO OUR CONTRACTORS, CONSULTANTS AND VENDORS
SPEEDS THE PROCESS OF COMMUNICATING CONTRACTUAL INSURANCE REQUIREMENTS AND HELPS TO
ELIMINATE ERRORS AND OVERSIGHTS IN THE CONTRACTING PROCESS.”
-ANN DODSON, ASSISTANT DIRECTOR OF RISK MANAGEMENT & SAFETY
DASNY
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