Acord 130 history
Name any employee who is a licensed pilot. Factored Premium Column The Factored Premium column is used to calculate the total estimated annual premium. For assigned risk business being submitted with the ACORD use the effective date on that form, following state mandated rules. The section should include enough detail to enable the underwriter to understand and classify each operation. Rate Manual Rate for the classification from the appropriate state manual. How many hours do they work? The average number is sufficient when the total number fluctuates during the year.
SimplyEasierACORDForms ACORD Workers Compensation Application Prior Carrier / Loss History
Refer to Florida Workers Compensation Application, ACORD FL. Either this section should be completed or a loss history report should be attached.
The ACORD name and logo are registered marks of ACORD. SPECIFY ACORD (/05) PRIOR CARRIER INFORMATION / LOSS HISTORY. ACORD (/09).
MONTHLY The ACORD name and logo are registered marks of ACORD. NAME PRIOR CARRIER INFORMATION / LOSS HISTORY.
This form may not be used in Florida. Are Certificates of Insurance required? If two or more classifications with different Minimum Premiums are included on one policy, the highest usually applies.
This field is related to the participating plan. Dividend Plan or Safety Group Identify the specific plan or safety group of which the applicant is a member.
Acord 130 history
|This field is related to the participating plan. For leasing employees indicate who you are leasing them to. One to three year plans may be available.
Duties Briefly identify the duties of the individual. Underwriters use this number to determine if the payroll estimates appear adequate.
Graphic FM Loss History
LOSS RUN ATTACHED: Notice in the top left hand corner. ACORD FL (/07). LOCATIONS ACORD CORPORATION.
All rights PRIOR CARRIER INFORMATION / LOSS HISTORY. PROVIDE. The ACORD is the industry standard form for workers' compensation cov- Prior Carrier Information/Loss. History.
If the applicant previously had cover.
If the risk was subject to experience rating, enter the Experience Modification in this column for the corresponding policy. Factored Premium Column The Factored Premium column is used to calculate the total estimated annual premium. For assigned risk business being submitted with the ACORD use the effective date on that form, following state mandated rules.
Minimum Premium Found on state rate sheets opposite the class code; they apply by policy.
The normal policy period effective date to expiration date is one year. Since the inclusion or exclusion affects coverage and premium, this section must be fully completed.
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Indicate who works at home and what their hours of operation are.
In AMS, information flows from the Policy > Loss History fields into this section on Page 2 of ACORD Loss History and Prior Carrier data for the policy.
ASSIGNED RISK (Attach ACORD ). DIRECT BILL ACORD (/08).
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PLEASE PRIOR CARRIER INFORMATION/LOSS HISTORY. NATURE OF.
Describe the safety program. Underwriters use this number to determine if the payroll estimates appear adequate. Total Estimated Annual Premium Amount resulting from applying all modifications, discounts, taxes and other rating criteria to the total estimated pre-modified premium.
Is a formal safety program in operation? Any work performed underground or above 15 feet? A separate FEIN may apply to each entity named as an insured.
ACORD Instructions – Simply Easier ACORD Forms
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|Audit Indicate the frequency with which audits should be undertaken for this policy.
How many employees? Remarks Add any additional rating information, comments or other items that will assist in the classification and rating of this risk. Explain his or her duties and describe the type of license.
Any employees under 16 or over 60 years of age? Describe the nature of the work and explain the circumstances under which physically handicapped workers are employed.