Indicate driver numbers, and provide number of years licensed to drive motorcycles 16. Any person who knowingly and with intent to defraud or solicit another to defraud the insurer by submitting an application containing a false statement as to any material fact may be violating state law. Commercial insurance application date mmddyyyy underwriter underwriter office applicant information the acord name and logo are registered marks of acord. Specific acord 38s are available for applicants in these states. Acord 126 fillable 2019 fill online, printable, fillable, blank. Acord forms are now available in a variety of formats, including printable pdf, electronic fillable, and eforms. Acord 807 2014 12 applicants name please print or type applicants title applicants signature date producers signature national producer number page 3 of 3 applicable in or. Acord 126 fillable fill out and sign printable pdf template. These exposures include liability for accidents resulting from the insureds operations or premises, products sold or. Fill out, securely sign, print or email your acord 126 fillable 20142020 form. The insurance is subject to the terms, conditions and limitations of the. Acord 126 200403 attach to applicant information section remarks remarks contractors explain all yes responses for past or present operations yes no explain all yes responses for past or present operations yes no 1.
The insurance is subject to the terms, conditions and limitations of the policyies in current use by the company. Attach to acord 125 and acord 126 important if claims made is checked in the policy information section below, this is an application for a claimsmade policy. Acord, 126, 201603, commercial general liability section. Acord 126 201404 commercial general liability acord 126, commercial general liability section, is a form of insurance designed to protect. The acord name and logo are registered marks of acord. Acord 90 ca 2007 04 page 3 of 4 explain all yes responses yn 15. Certificate of liability insurance 2014 acord 025 v04. Acord, 22, 201204, intermodal interchange certificate of insurance.
Acord 127 201412 business auto section acord 127, business auto section, of the acord commercial insurance application series, contains basic policy information as well as essential underwriting information for commercial auto accounts. Plan nj workers compensation and employers liability manual part 3, section 14. Get, create, make and sign printable acord form 126. Acord 80 2001 04 any person who knowingly and with intent to defraud any insurance company or another person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto.
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