Acord 130 Fillable 2020. This form must be attached to an acord this form along with an acord 130 workers compensation application constitute an application for the acord name and logo are registered marks of. ACORD Forms are now available in a variety of formats including printable PDF electronic fillable and eForms.
ACORD Forms increase your efficiency. The ACORD name and logo are registered marks of ACORD ACORD 140 201603 BLDG DESCRIPTION. Acord 130 fl 201502 page 1 of 3 locations -list all physical locations including other states whether coverage is requested or notif applicant is a professional employer organization peo employee leasing company list all client companies and their locations.
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POLICY NUMBER EFFECTIVE DATENAMED INSUREDS AGENCY CARRIER NAIC CODE AGENCY CUSTOMER ID. 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. OTHER COVERAGES RESTRICTIONS ANDOR ENDORSEMENTS For hirednon-owned auto coverages attach the applicable state Business Auto Section ACORD 137 IMPORTANT - If CLAIMS MADE is checked in the COVERAGE LIMITS section below this is an application for a claims-made policy. Acord 130 fl 201502 page 1 of 3 locations -list all physical locations including other states whether coverage is requested or notif applicant is a professional employer organization peo employee leasing company list all client companies and their locations.
