ACORD Forms Notification Service January 2011 Bulletin

Transcription

1 ACORD Forms Notification Service January 2011 Bulletin ACORD P&C and Life/Annuity/Health Form Changes and Additions The following pages include both a List of recently Revised and New ACORD forms and an Explanation of the Changes made. Copies of the forms referenced in this announcement can be downloaded in the formats you need at To download forms, you will need to sign-in as an ACORD member with your user name and password. Once you are signed in, click on the Forms button, and then click on Download Forms to access the ones you need. If you need assistance, a sample of a form, or are an agent/broker who would like to join the Advantage Program, please call Member Services at (800) , Option 2 or us at memberservices@acord.org. If you do not wish to receive this notification, please send an to memberservices@acord.org requesting that we unsubscribe you to this Forms Notification Service. Form Enhancements This month, ACORD released several forms with new features and enhancements. Note: These are not new forms editions. The forms have not changed, nor have any fields been added or removed. The enhancements involve forms use and include: Field Parsing: Data fields such as Address are now separated into component parts (street, city, state, zip), to allow for more precise data capture and more accurate transmission. Improved FIGs: ACORD's Forms Instruction Guides are integrated into the forms to provide specific help for each field on screen, and are consistent across all forms. Each field is assigned a unique e-label Forms (By Number) for January NJ 65 NY FL NC 137 LA 137 ME 137 NC 137 NH 137 UT 137 VA 138 NC ACORD Forms Notification

2 ACORD Forms Release Form Number Replaces Title REVISIONS P&C - Countrywide 1 (2011/01) 2010/02 Property Loss Notice 2 (2011/01) 2010/01 Automobile Loss Notice 3 (2011/01) 2010/02 General Liability Notice of Occurrence / Claim 4 (2011/01) 2010/02 Workers Compensation First Report of Injury or Illness 5 (2011/01) 2010/02 Aircraft Loss Notice 140 (2010/12) 2010/05 Property Section P&C-State Specific 90 CT (2011/01) 2005/11 Connecticut Personal Auto Application 90 DC (2011/01) 2006/04 District of Columbia Personal Auto Application 133 FL (2011/01) 2010/01 Florida Workers Compensation Joint Underwriting Association, Inc. Addendum to ACORD 130 FL 137 CT (2011/01) 2005/11 Connecticut Commercial Auto Coverages / Limits Section 137 DC (2011/01) 2007/07 District of Columbia Commercial Auto Coverages / Limits Section 138 CT (2011/01) 2005/11 Connecticut Garage and Dealers Coverages / Limits Section 138 DC (2011/01) 2006/04 District of Columbia Garage and Dealers Coverages / Limits Section Life/Annuity/Health NONE NEW P&C - Countrywide 832 (2011/01) NEW Miscellaneous E&O Section P&C State Specific 290 CT (2011/01) NEW Connecticut Personal Auto Application Section 290 DC (2011/01) NEW District of Columbia Personal Auto Application Section Life/Annuity/Health NONE WITHDRAWN NONE 1 of 2 ACORD Forms Release

3 ACORD Forms Release E-FORMS / FIG REVISIONS / ENHANCEMENTS ONLY NJ 65 NY FL NC 137 LA 137 ME 137 NC 137 NH 137 UT 137 VA 138 NC Note: These are not new forms editions. The forms have not changed, nor have any fields been added or removed. The fields have been assigned unique e-labels. These forms are now available in both IBM and Adobe fillable formats. 2 of 2 ACORD Forms Release

4 Countrywide Revised P&C FORMS 1 (2011/01) Property Loss Notice 1. Update ACORD copyright to Page 2 2. Move fraud statement for COLORADO from top of page 3 to the bottom of page 2 and reformat to fit Page 3 3. Insert fraud statement for KANSAS immediately below INDIANA 2 (2011/01) Automobile Loss Notice 1. Revise ACORD copyright to Page 3 2. Add fraud warning for KANSAS to bottom of page 3 3. Move MARYLAND and MINNESOTA fraud warnings to top of page 4 Page 4 4. Reformat page to accommodate MARYLAND and MINNESOTA fraud warnings from page 3 3 (2011/01) General Liability Notice of Occurrence / Claim 1. Revise ACORD copyright to Page 3 2. Move MARYLAND and MINNESOTA fraud warnings to top of page 4 3. Add fraud warning for KANSAS to bottom of page 3 Page 4 4. Reformat page to accommodate MARYLAND and MINNESOTA fraud warnings from page 3 4 (2011/01) Workers Compensation First Report of Injury or Illness 1. Revise ACORD copyright to: Page 3 2. Insert fraud warning for KANSAS, alphabetically below INDIANA notice 1 of 18 ACORD Explanation of Changes

5 5 (2011/01) Aircraft Loss Notice 1. Update ACORD copyright to Page 3 2. Move MARYLAND and MINNESOTA fraud warnings to top of page 4 3. Add fraud warning for KANSAS to bottom of page 3 Page 4 4. Reformat page to accommodate MARYLAND and MINNESOTA fraud warnings from page (2010/12) Property Section Please note: This form is now three pages 1. PREMISES INFORMATION section reformat: SPOILAGE COVERAGE check box, DESCRIPTION OF PROPERTY COVERED, LIMIT $, DEDUCTIBLE $ fields, REFRIG MAINT AGREEMENT (Y/N) check box 2. PREMISES INFORMATION section under Options, add check boxes for BREAKDOWN OR CONTAMINATION, POWER OUTAGE, SELLING PRICE, OTHER (Blank), and field for OTHER Description 3. PREMISES INFORMATION section add check box PROPERTY HAS BEEN DESIGNATED AN HISTORICAL LANDMARK to top left, reduced height of section, moved # OF OPEN SIDES ON STRUCTURE field from bottom left to top right. 4. PREMISES INFORMATION section change HEATING BOILER ON PREMISES TO HEATING SOURCE INCL WOODBURNING STOVE OR FIREPLACE INSERT and fields for DATE INSTALLED and MANUFACTURER. The Y/N box for IF BOILER, IS INSURANCE PLACED ELSEWHERE? moves down to PRIMARY HEAT and SECONDARY HEAT fields. 5. PREMISES INFORMATION section, add PRIMARY HEAT section with check boxes for BOILER, SOLID FUEL, OTHER (Blank), OTHER Description field, and Y/N box for IF BOILER, IS INSURANCE PLACED ELSEWHERE? 6. PREMISES INFORMATION section, add SECONDARY HEAT section with check boxes for BOILER, SOLID FUEL, OTHER (Blank), OTHER Description field, and Y/N box for IF BOILER, IS INSURANCE PLACED ELSEWHERE? 7. PREMISES INFORMATION section, BURGLAR ALARM TYPE row, add check box for LOCAL GONG Page 2 8. PREMISES INFORMATION section reformat SPOILAGE COVERAGE check box, DESCRIPTION OF PROPERTY COVERED, LIMIT $, DEDUCTIBLE $ fields, REFRIG MAINT AGREEMENT (Y/N) check box. 9. PREMISES INFORMATION section under Options, add check boxes for BREAKDOWN OR CONTAMINATION, POWER OUTAGE, SELLING PRICE, OTHER (Blank), and field for OTHER Description 2 of 18 ACORD Explanation of Changes

6 140 (2010/12) Property Section (continued) 10. PREMISES INFORMATION section add check box PROPERTY HAS BEEN DESIGNATED AN HISTORICAL LANDMARK to top left, reduced height of section, moved # OF OPEN SIDES ON STRUCTURE field from bottom left to top right. 11. PREMISES INFORMATION section, revise HEATING BOILER ON PREMISES (Y/N) to HEATING SOURCE INCL WOODBURNING STOVE OR FIREPLACE INSERT and add fields for DATE INSTALLED and MANUFACTURER. Remove the IF BOILER, IS INSURANCE PLACED ELSEWHERE? checkbox. 12. PREMISES INFORMATION section add PRIMARY HEAT section with check boxes for BOILER, SOLID FUEL, OTHER (Blank), OTHER Description field, and add Y/N box for IF BOILER, IS INSURANCE PLACED ELSEWHERE? beneath the check boxes. 13. PREMISES INFORMATION section, add SECONDARY HEAT section with check boxes for BOILER, SOLID FUEL, OTHER (Blank), OTHER Description field, and add Y/N box for IF BOILER, IS INSURANCE PLACED ELSEWHERE? beneath the check boxes. 14. PREMISES INFORMATION section, BURGLAR ALARM TYPE row, add check box for LOCAL GONG 15. Add REMARKS section. 16. Move FRAUD NOTICES to top of page Revise page numbers in footer to Page 2 of 3. Page Add field for AGENCY CUSTOMER ID in upper right hand corner of page 19. FRAUD NOTICES, first paragraph, revise list of states in text in parentheses 20. FRAUD NOTICES, add a state specific fraud notice for Kansas immediately below Florida fraud warning 21. Add REMARKS section. 22. Add page numbers in footer to Page 3 of 3. 3 of 18 ACORD Explanation of Changes

7 State Specific Revised 90 CT (2011/01) Connecticut Personal Auto Application Please note: This form is now four pages 1. Font of title is 14 pt bold ariel 2. Redesign IDENTIFICATION section. Fields include: AGENCY, CONTACT NAME, PHONE, FAX, ADDRESS, CODE, SUBCODE, and AGENCY CUSTOMER ID 3. APPLICANT S NAME AND MAILING ADRESS sub-section, reformat and break out CO/PLAN field into two separate fields labeled CARRIER and PLAN 4. APPLICANT S NAME AND MAILING ADRESS sub-section, add a check box labeled INDICATE IF MAILING ADDRESS IS GARAGING ADDRESS 5. Revise RESIDENCE section immediately below the header. Fields now include YRS AT ADDR CURR, PREV, PREVIOUS STREET ADDRESS, CITY, STATE and ZIP Revise GARAGING ADDRESS section to ADDITIONAL GARAGING ADDRESS(ES) and redesign in tabular format. Fields now include LOC, STREET, CITY, COUNTY, STATE and ZIP VEHICLE DESCRIPTION / USE section, add extra spaces around slash (/) in section title 8. VEHICLE DESCRIPTION / USE section, add column labeled LOC to the right of VEH in first set of data 9. VEHICLE DESCRIPTION / USE section, create separate columns for MAKE, MODEL, BODY TYPE, VIN and REG STATE 10. VEHICLE / DESCRIPTION USE section, add two new columns to the right of SYMBOL AGE GRP column labeled COMP OTC SYM and COLL SYM, move remaining columns to the right. 11. VEHICLE / DESCRIPTION USE section, move CLASS column to the third row of data, two fields each to the right of both VEH column. Resize columns and reformat labels to fit. 12. VEHICLE / DESCRIPTION USE section, revise CREDITS/SURCHARGES to CREDITS AND SURCHARGES (two places) 13. COVERAGES / PREMIUMS section, add extra spaces around slash (/) in section title 14. COVERAGES / PREMIUMS section, COVERAGES column, add extra spaces around slash (/) in UNINSURED / UNDERINSURED MOTORISTS label 15. COVERAGES / PREMIUMS section, ACV UNLESS AMOUNT STATED row, delete dollar signs ($) in last four PREMIUM columns and replace with N / A 16. COVERAGES / PREMIUMS section, add extra spaces around slash (/) in TRANS EXP / RENTAL RE label 17. COVERAGES / PREMIUMS section, delete all rows below TRANS EXP / RENTAL RE row and add two new blank coverages rows. Retain ESTIMATED TOTAL, POLICY FEE and TOTAL PER VEHICLE fields 18. Move RESIDENT & DRIVER INFORMATION and ACCIDENTS / CONVICTIONS sections to page Revise PLEASE COMPLETE REVERSE SIDE to of Revise ACORD copyright to using standard format where years are the first item after the ACORD copyright and add All rights reserved. 4 of 18 ACORD Explanation of Changes

8 90 CT (2011/01) Connecticut Personal Auto Application (continued) 21. Add The ACORD name and logo are registered marks of ACORD Page Add a field for AGENCY CUSTOMER ID to the right top of page 23. RESIDENT & DRIVERS INFORMATION section, redesign section to the same type of formatting as the VEHICLE DESCRIPTION / USE section. Data for one DRIVER will now be captured in two rows instead of one. Split out NAME (AS IT APPEARS ON LICENSE) fields into FIRST NAME, MIDDLE NAME and LAST NAME. Section now captures data for six drivers. 24. ACCIDENTS / CONVICTIONS section, add extra space around slash (/) in title and add and other insurers to text in parentheses 25. ACCIDENTS / CONVICTIONS section, add: Attach ACORD 99, Accidents / Convictions Schedule, if more space is required 26. ACCIDENTS / CONVICTIONS section, in text above the table, delete YES / NO check boxes and replace with a single field to capture a Y or N response, reformat text. Redesign BI OR DEATH column to a single column/field to capture a Y or N response. Section now captures data for five Accident / Convictions. 27. Redesign ADDITIONAL INTEREST and PRIOR COVERAGE sections 28. GENERAL INFORMATION section, reformat questions with space and/or table below to capture explanation. YES / NO checkboxes redesigned as a field to capture Y for a YES response or N for a NO response. 29. GENERAL INFORMATION section, revise Question 1 and add table with fields to capture VEH # and NAME OF OTHER OWNER 30. GENERAL INFORMATION section, revise Question 2 and add table with fields to capture VEH #, DESCRIPTION and COST $ 31. GENERAL INFORMATION section, Question 3, add table with fields to capture VEH # and DESCRIPTION 32. GENERAL INFORMATION section, revise Question 4 and add table with fields to capture DRV #, DESCRIPTION and COST $ 33. GENERAL INFORMATION section, Question 5, add table with fields to capture NAMED INSURED, YEAR, MAKE, MODEL, CARRIER, NAIC # and POLICY # 34. Move remaining questions to page Revise footer to Page 2 of 4 Page Add a field for AGENCY CUSTOMER ID to the right top of page 37. Create new section labeled GENERAL INFORMATION (continued) 38. GENERAL INFORMATION (continued) section, revise Question 6, and add fields labeled POLICY NUMBER and TYPE OF INSURANCE 39. GENERAL INFORMATION (continued) section, revise Question 7 and add table with fields to capture DRV #, BRANCH, RANK, BASE LOCATION and VEH AT BASE ( Y / N) 40. GENERAL INFORMATION (continued) section, Question 8, add table with fields to capture DRV #, SUSPENSION PERIOD (Start Date: and End Date:), EXPLANATION and REINSTATEMENT DATE 5 of 18 ACORD Explanation of Changes

9 90 CT (2011/01) Connecticut Personal Auto Application (continued) 41. GENERAL INFORMATION (continued) section, Question 9 break out into two questions, Questions 9 and GENERAL INFORMATION (continued) section, revise Question 9 and add table with fields to capture DRV #, DESCRIPTION OF SPECIAL EQUIPMENT IN VEHICLE 43. GENERAL INFORMATION (continued) section, add new Question 10, with fields to capture DRV # and EXPLANATION. Renumber remaining questions 44. GENERAL INFORMATION section (continued), revise Question 11 and add table with fields to capture DRV #, REASON FOR FILING and FILING DATE 45. GENERAL INFORMATION (continued) section, Question 13, add table with fields to capture DRV #, REASON, DECLINED, CANCELLED OR NON-RENEWED 46. GENERAL INFORMATION (continued) section, Question 16, add a table to capture fields for DRV # and EXPLANATION 47. GENERAL INFORMATION (continued) section, add new Question 17, HAS ANY NAMED INSURED DRIVEN WITHOUT LIABILITY INSURANCE DURING ANY PART OF THE LAST SIX (6) MONTHS? 48. Revise REMARKS section to REMARKS / ATTACHMENTS section, add (Attach ACORD 101, Additional Remarks Schedule, if more space is required) to header and delete FOR COMPANY USE ONLY 49. Move BINDER / SIGNATURE section to new page Revise footer to page 3 of 4 Page Add AGENCY CUSTOMER ID field to upper right hand corner 52. Add REMARKS section 53. Add extra spaces around slash in BINDER / SIGNATURE section title 54. Increase font size of all text in binder section to 9 pt 55. Add Page 4 of 4 to footer 90 DC (2011/01) District of Columbia Personal Auto Application Please note: This form is now four pages 1. Font of title is 14 pt bold ariel 2. Redesign IDENTIFICATION section. Fields include: AGENCY, CONTACT NAME, PHONE, FAX, ADDRESS, CODE, SUBCODE, and AGENCY CUSTOMER ID 3. APPLICANT S NAME AND MAILING ADRESS sub-section, reformat and break out CO/PLAN field into two separate fields labeled CARRIER and PLAN 4. APPLICANT S NAME AND MAILING ADRESS sub-section, add a check box labeled INDICATE IF MAILING ADDRESS IS GARAGING ADDRESS 5. Revise RESIDENCE section immediately below the header. Fields now include YRS AT ADDR CURR, PREV, PREVIOUS STREET ADDRESS, CITY, STATE and ZIP of 18 ACORD Explanation of Changes

10 90 DC (2011/01) District of Columbia Personal Auto Application (continued) 6. Revise GARAGING ADDRESS section to ADDITIONAL GARAGING ADDRESS(ES) and redesign in tabular format. Fields now include LOC, STREET, CITY, COUNTY, STATE and ZIP VEHICLE DESCRIPTION / USE section, add extra spaces around slash (/) in section title 8. VEHICLE DESCRIPTION / USE section, add column labeled LOC to the right of VEH in first set of data 9. VEHICLE DESCRIPTION / USE section, create separate columns for MAKE, MODEL, BODY TYPE, VIN and REG STATE 10. VEHICLE / DESCRIPTION USE section, add two new columns to the right of SYMBOL AGE GRP column labeled COMP OTC SYM and COLL SYM, move remaining columns to the right. 11. VEHICLE / DESCRIPTION USE section, move CLASS column to the third row of data, two fields each to the right of both VEH column. Resize columns and reformat labels to fit. 12. COVERAGES / PREMIUMS section, add extra spaces around slash (/) in section title 13. COVERAGES / PREMIUMS section, ACV UNLESS AMOUNT STATED row, delete dollar signs ($) in last four PREMIUM columns and replace with N / A 14. COVERAGES / PREMIUMS section, add extra spaces around slash (/) in TRANS EXP / RENTAL RE label 15. COVERAGES / PREMIUMS section, delete all rows below TRANS EXP / RENTAL RE row and add two new blank coverages rows. Retain ESTIMATED TOTAL, POLICY FEE and TOTAL PER VEHICLE fields 16. Move RESIDENT & DRIVER INFORMATION section to page Revise of 3 to of Revise ACORD copyright to using standard format where years are the first item after the ACORD copyright and add All rights reserved. 19. Add The ACORD name and logo are registered marks of ACORD Page Add a field for AGENCY CUSTOMER ID to the right top of page 21. RESIDENT & DRIVERS INFORMATION section, redesign section to the same type of formatting as the VEHICLE DESCRIPTION / USE section. Data for one DRIVER will now be captured in two rows instead of one. Split out NAME (AS IT APPEARS ON LICENSE) fields into FIRST NAME, MIDDLE NAME and LAST NAME. Section now captures data for six drivers. 22. ACCIDENTS / CONVICTIONS section, add extra space around slash (/) in title 23. ACCIDENTS / CONVICTIONS section, add: Attach ACORD 99, Accidents / Convictions Schedule, if more space is required 24. ACCIDENTS / CONVICTIONS section, in text above the table, delete YES / NO check boxes and replace with a single field to capture a Y or N response, reformat text. Add extra spaces around slash in ACCIDENT / CONVICTION colum headers (two places). Redesign BI OR DEATH column to a single column/field to capture a Y or N response. Section now captures data for five Accident / Convictions. 25. GENERAL INFORMATION section, reformat questions across entire page with space and/or table below to capture explanation. YES / NO checkboxes redesigned as a field to capture Y for a YES response or N for a NO response. 7 of 18 ACORD Explanation of Changes

11 90 DC (2011/01) District of Columbia Personal Auto Application (continued) 26. GENERAL INFORMATION section, revise Question 1 and add table with fields to capture VEH # and NAME OF OTHER OWNER 27. GENERAL INFORMATION section, revise Question 2 and add table with fields to capture VEH #, DESCRIPTION and COST $ 28. GENERAL INFORMATION section, Question 3, add table with fields to capture VEH # and DESCRIPTION 29. GENERAL INFORMATION section, revise Question 4 and add table with fields to capture DRV #, DESCRIPTION and COST $ 30. GENERAL INFORMATION section, Question 5, add table with fields to capture NAMED INSURED, YEAR, MAKE, MODEL, CARRIER, NAIC # and POLICY # 31. Move remaining questions to page Revise footer to Page 2 of 4 Page Add a field for AGENCY CUSTOMER ID to the right top of page 34. Create new section labeled GENERAL INFORMATION (continued) 35. GENERAL INFORMATION (continued) section, revise Question 6, and add fields labeled POLICY NUMBER and TYPE OF INSURANCE 36. GENERAL INFORMATION (continued) section, revise Question 7 and add table with fields to capture DRV #, BRANCH, RANK, BASE LOCATION and VEH AT BASE ( Y / N) 37. GENERAL INFORMATION (continued) section, Question 8, add table with fields to capture DRV #, SUSPENSION PERIOD (Start Date: and End Date:), EXPLANATION and REINSTATEMENT DATE 38. GENERAL INFORMATION (continued) section, Question 9 break out into two questions, Questions 9 and GENERAL INFORMATION (continued) section, revise Question 9 and add table with fields to capture DRV #, DESCRIPTION OF SPECIAL EQUIPMENT IN VEHICLE 40. GENERAL INFORMATION (continued) section, add new Question 10, with fields to capture DRV # and EXPLANATION. Renumber remaining questions 41. GENERAL INFORMATION section (continued), revise Question 11 and add table with fields to capture DRV #, REASON FOR FILING and FILING DATE 42. GENERAL INFORMATION section (continued), delete Question 12 and renumber remaining questions 43. GENERAL INFORMATION (continued) section, revise Question 15 and add table to capture fields for DRV # and EXPLANATION 44. GENERAL INFORMATION (continued) section, add new Question 16, HAS ANY NAMED INSURED DRIVEN WITHOUT LIABILITY INSURANCE DURING ANY PART OF THE LAST SIX (6) MONTHS? 45. Revise REMARKS section to REMARKS / ATTACHMENTS section, add (Attach ACORD 101, Additional Remarks Schedule, if more space is required) to header and delete FOR COMPANY USE ONLY 46. Move BINDER / SIGNATURE section to new page Revise footer to page 3 of 4 8 of 18 ACORD Explanation of Changes

12 90 DC (2011/01) District of Columbia Personal Auto Application (continued) Page Add AGENCY CUSTOMER ID field to upper right hand corner 49. Add REMARKS section 50. Add extra spaces around slash in BINDER / SIGNATURE section title 51. BINDER / SIGNATURE section, correct spelling of the word ADDITION in the fraud warning 52. Add Page 4 of 4 to footer 133 FL (2011/01) Florida Workers Compensation Joint Underwriting Association, Inc. Addendum to ACORD 130 FL 1. REQUEST FOR ADDITIONAL INFORMATION section, revise questions 1 and 8 2. REQUEST FOR ADDITIONAL INFORMATION section, item 10, delete last sentence in Options 1 and 2 3. Move OPTION 3 (header and first two sentences from page 2) immediately below OPTION 2 4. Revise ACORD copyright to Page 2 5. Add a header, Option 3: Payroll Service with Premium Withholding Program Payment Plan - No Deposit Premium Required (continued) at top of page 6. Move up remaining text in paragraph. First sentence begins with the word YOU. Delete the last sentence. 7. STATEMENTS section, add the word OR, to the end of item (1) 8. STATEMENTS section, revise item (2) and add new items (3) and (4) and renumber remaining items 9. STATEMENTS section, revise re-numbered items (5) and (6) Page ACKNOWLEDGEMENT section, item 4 (j) delete all text following the word inspection Page Applicant s/employer s Signature, in text in parentheses, revise member of an LLC, etc. to member of the LLC 9 of 18 ACORD Explanation of Changes

13 137 CT (2011/01) Connecticut Commercial Auto Coverages / Limits Section Please Note: This form is now three pages. 1. Add field for AGENCY CUSTOMER ID: to top right hand corner 2. Add extra spaces around slash (/) in subtitle COVERAGES / LIMITS SECTION 3. Replace IDENTIFICATION SECTION with the new standard format for an auto section. Fields included are: AGENCY, POLICY NUMBER, EFFECTIVE DATE, NAMED INSURED(S), CARRIER and NAIC CODE 4. BUSINESS AUTO section, COVERERED AUTO SYMBOLS columns, add a blank check box for all COVERAGES except LIABILITY (blank check box already there). 5. BUSINESS AUTO section, left COVERAGES column, add extra spaces around slash (/) in UNINSURED / UNDERINSURED MOTORIST and HIRED / BORROWED LIABILITY labels 6. BUSINESS AUTO section, HIRED PHYSICAL DAMAGE row, add extra spaces around slash (/) in COVERAGE / DEDUCTIBLE label 7. Move TRUCKERS section to top of page 2 8. Add new ENDORSEMENTS / REMARKS section 9. Add new SIGNATURE section 10. Revise ACORD copyright to , using new format where the years are the first item after the copyright symbol. Add All rights reserved. 11. Revise Please complete reverse side to of 3 in footer 12. Add The ACORD name and logo are registered marks of ACORD Page Add field for AGENCY CUSTOMER ID: to top right hand corner 14. TRUCKERS section, COVERERED AUTO SYMBOLS columns, add a blank check box for all COVERAGES except TRAILER INTERCHANGE section. Realign check boxes to fit. Right column rows increased in height as well. 15. TRUCKERS section, left COVERAGES column, add extra spaces around slash (/) in UNINSURED / UNDERINSURED MOTORIST, NON-TRUCKERS HIRED / BORROWED and TRUCKERS HIRED / BORROWED LIABILITY labels 16. TRUCKERS section, expand height of OTHER row and add one additional blank row 17. TRUCKERS section, TRAILER INTERCHANGE sub-section, add a field labeled TRAILER VALUE with a dollar sign ($) immediately below the COLLISION row 18. Add new ENDORSEMENTS / REMARKS section 19. Add new SIGNATURE section 20. Add Page 2 of 3 to footer 21. MOTOR CARRIER section is now page 3 Page Add field for AGENCY CUSTOMER ID: to top right hand corner 23. MOTOR CARRIER section, COVERERED AUTO SYMBOLS columns, add a blank check box for all COVERAGES except TRAILER INTERCHANGE section. Realign check boxes to fit. 24. MOTOR CARRIER section, left COVERAGES column, add extra spaces around slash (/) in UNINSURED / UNDERINSURED MOTORIST, NON-TRUCKERS HIRED / BORROWED and TRUCKERS HIRED / BORROWED LIABILITY labels 10 of 18 ACORD Explanation of Changes

14 137 CT (2011/01) Connecticut Commercial Auto Coverages / Limits Section (continued) 25. MOTOR CARRIER section, TRAILER INTERCHANGE sub-section, add a field labeled TRAILER VALUE with a dollar sign ($) immediately below the COLLISION row 26. Revise ENDORSEMENTS section title to ENDORSEMENTS / REMARKS and add (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 27. Add SIGNATURE section 28. Add Page 3 of 3 to footer 137 DC (2011/01) District of Columbia Commercial Auto Coverages / Limits Section 1. Add extra spaces around slash (/) in subtitle COVERAGES / LIMITS SECTION 2. Replace IDENTIFICATION SECTION with the new standard format for an auto section. Fields included are: AGENCY, POLICY NUMBER, EFFECTIVE DATE, NAMED INSURED(S), CARRIER and NAIC CODE 3. BUSINESS AUTO section, COVERERED AUTO SYMBOLS columns, add a blank check box for all COVERAGES except LIABILITY (blank check box already there). 4. BUSINESS AUTO section, left COVERAGES column, add extra spaces around slash (/) in HIRED / BORROWED LIABILITY label 5. BUSINESS AUTO section, HIRED PHYSICAL DAMAGE row, add extra spaces around slash (/) in COVERAGE / DEDUCTIBLE label 6. Add text in parentheses to ENDORSEMENTS / REMARKS section title 7. Add new SIGNATURE section 8. Revise ACORD copyright to , Page 2 9. TRUCKERS section, COVERERED AUTO SYMBOLS columns, add a blank check box for all COVERAGES except TRAILER INTERCHANGE section. Realign check boxes to fit. Right column rows increased in height as well. 10. TRUCKERS section, left COVERAGES column, add extra spaces around slash (/) in NON- TRUCKERS HIRED / BORROWED and TRUCKERS HIRED / BORROWED LIABILITY labels 11. TRUCKERS section, expand height of OTHER row and add one additional blank row 12. TRUCKERS section, TRAILER INTERCHANGE sub-section, add a field labeled TRAILER VALUE with a dollar sign ($) immediately below the COLLISION row 13. Add text in parentheses to ENDORSEMENTS / REMARKS section title 14. Add new SIGNATURE section Page MOTOR CARRIER section, COVERERED AUTO SYMBOLS columns, add a blank check box for all COVERAGES except TRAILER INTERCHANGE section. Realign check boxes to fit. 16. MOTOR CARRIER section, left COVERAGES column, add extra spaces around slash (/) in NON-TRUCKERS HIRED / BORROWED and TRUCKERS HIRED / BORROWED LIABILITY labels 11 of 18 ACORD Explanation of Changes

15 137 DC (2011/01) District of Columbia Commercial Auto Coverages / Limits Section 17. MOTOR CARRIER section, TRAILER INTERCHANGE sub-section, add a field labeled TRAILER VALUE with a dollar sign ($) immediately below the COLLISION row 18. ENDORSEMENTS / REMARKS section add (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 19. Add SIGNATURE section 20. SIGNATURE section, revise Notice of Information Practices 21. SIGNATURE section, reformat numbered items in Acknowledgement section 138 CT (2011/01) Connecticut Garage and Dealers, Coverages / Limits Section 1. Add AGENCY CUSTOMER ID: field to top right of page 2. Add extra spaces around slash (/) in subtitle COVERAGES / LIMITS SECTION 3. Replace IDENTIFICATION SECTION with the new standard format for an auto section. Fields included are: AGENCY, POLICY NUMBER, EFFECTIVE DATE, NAMED INSURED(S), CARRIER and NAIC CODE 4. COVERAGES/LIMITS section, add extra spaces around slash (/) in section title COVERAGES / LIMITS 5. COVERAGES / LIMITS section, add APPLIES TO: and check box options for AUTOMOBILE and PREMISES OPERATIONS. These check boxes had been in the Limits of Liability column in the first row on the right. 6. COVERAGES / LIMITS section, COVERERED AUTO SYMBOLS columns, add a blank check box for all COVERAGES 7. COVERAGES / LIMITS section, LIMITS OF LIABILITY, GARAGE OPERATIONS, revise EA ACCIDENT to EA ACC and move both dollar signs ($) to the left and align dollar sign ($) in AGGREGATE row 8. PHYSICAL DAMAGE sub-section, COVERERED AUTO SYMBOLS columns, add a blank check box for all COVERAGES and reformat COLLISION row to fit blank check box. 9. GARAGE KEEPERS sub-section, COVERERED AUTO SYMBOLS columns, add a blank check box for all COVERAGES 10. Redesign ENDORSEMENTS / REMARKS section and add (Attach ACORD 101, Additional Remarks Schedule, for any endorsements or remarks) 11. Add SIGNATURE section for Disclosures and signatures 12. Revise ACORD copyright to , using the new format with the years being the first item after the copyright symbol and add All rights reserved. 13. Add The ACORD name and logo are registered marks of ACORD to footer 12 of 18 ACORD Explanation of Changes

16 138 DC (2011/01) District of Columbia Garage and Dealers Coverages / Limits Section Please Note: This form is now two pages 1. Add AGENCY CUSTOMER ID: field to top right of page 2. Add extra spaces around slash (/) in subtitle COVERAGES / LIMITS SECTION 3. Replace IDENTIFICATION SECTION with the new standard format for an auto section. Fields included are: AGENCY, POLICY NUMBER, EFFECTIVE DATE, NAMED INSURED(S), CARRIER and NAIC CODE 4. COVERAGES/LIMITS section, add extra spaces around slash (/) in section title COVERAGES / LIMITS 5. COVERAGES / LIMITS section, add APPLIES TO: and check box options for AUTOMOBILE and PREMISES OPERATIONS. These check boxes had been in the Limits of Liability column in the first row on the right. 6. COVERAGES / LIMITS section, COVERERED AUTO SYMBOLS columns, add a blank check box for all COVERAGES 7. COVERAGES / LIMITS section, LIMITS OF LIABILITY, GARAGE OPERATIONS, revise EA ACCIDENT to EA ACC and move both dollar signs ($) to the left and align dollar sign ($) in AGGREGATE row 8. PHYSICAL DAMAGE sub-section, COVERERED AUTO SYMBOLS columns, add a blank check box for all COVERAGES and reformat COLLISION row to fit blank check box. 9. GARAGE KEEPERS sub-section, COVERERED AUTO SYMBOLS columns, add a blank check box for all COVERAGES 10. Reformat ENDORSEMENTS / REMARKS section and add (Attach ACORD 101, Additional Remarks Schedule, if more space is required) 11. Move disclosures and Signatures to bottom of new page Add of 2 to footer 13. Revise ACORD copyright to , using the new format with the years being the first item after the copyright symbol and add All rights reserved. 14. Add The ACORD name and logo are registered marks of ACORD to footer Page Add AGENCY CUSTOMER ID: field to top right of page 16. Add ENDORSEMENTS / REMARKS section 17. SIGNATURE section, revise Notice of Insurance Information 18. SIGNATURE section, reformat numbered items in Acknowledgement section 19. Add Page 2 of 2 to footer 13 of 18 ACORD Explanation of Changes

17 Countrywide New 832 (2011/01) Miscellaneous E&O Section ACORD 832, Miscellaneous E & O Section, is used to apply for miscellaneous errors & omissions coverage. This form was designed to be used in conjunction with ACORD Professional / Specialty Insurance Application. ACORD 832 must be attached to ACORD 825 for a completed application submission. State Specific New 290 CT (2011/01) Connecticut Personal Auto Application Section ACORD 290 CT, Connecticut Personal Auto Application Section, is used when insurance is desired for personal vehicles. ACORD 290 CT was designed to be used in conjunction with ACORD 88, Personal Insurance Application - Applicant Information Section. ACORD 290 CT must be attached to ACORD 88 for a completed application submission. Following are the unique state characteristics of ACORD 290 CT, Connecticut Personal Auto Application Section: Although the Connecticut legislature revised the state's no-fault law January 1, 1994, so that these coverages are no longer mandatory, coverage can still be made available. Many companies are continuing to offer Basic Reparations Benefits and/or Added Basic Reparations Benefits (no-fault coverages). Consequently, these items are included in to the Coverages / Premium section. Uninsured Motorists and Underinsured Motorists coverages are combined Uninsured Motorists Conversion coverage is added to the Coverages / Premiums section. This coverage can be purchased instead of Uninsured/Underinsured Motorists coverage Full Glass Optional coverage added to Comprehensive Expanded Notice of Information Practices (Privacy Notification) 14 of 18 ACORD Explanation of Changes

18 290 DC (2011/01) District of Columbia Personal Auto Application Section ACORD 290 DC, District of Columbia Personal Auto Application Section, is used when insurance is desired for personal vehicles. ACORD 290 DC was designed to be used in conjunction with ACORD 88, Personal Insurance Application - Applicant Information Section. ACORD 290 DC must be attached to ACORD 88 for a completed application submission. Following are the unique characteristics of ACORD 290 DC, District of Columbia Personal Auto Application Section: Personal Injury Protection coverages are revised to reflect D.C.'s unique coverages and options. Refer to your state manual. Statement added referencing the offer of Uninsured and Underinsured Motorists coverages, and the applicant's right to select coverage limits, and reject Underinsured Motorists coverage. Statement added allowing the applicant to reject Personal Injury Protection coverages. Applicant must signify rejection by initialing the form. GENERAL INFORMATION Question relating to cancellation or declination of coverage is not included. This question cannot be asked in D.C. WITHDRAWN FORMS NONE LIFE / ANNUITY / HEALTH FORMS Countrywide - Revised NONE State Specific - Revised NONE Countrywide New NONE State Specific New NONE WITHDRAWN FORMS NONE 15 of 18 ACORD Explanation of Changes

19 STATE ACTIVITY California Issues Notice, in re: Recent Changes in the Law Affect Insurers Writing Residential Property Insurance in California California Department of Insurance issued a Notice regarding "Recent Changes in the Law Affect[ing] Insurers Writing Residential Property Insurance in California", dated 11/30/2010. The Notice requires insurers to revise certain documents provided to policy holders. The notice is in connection with Governor Schwarzenegger's recently signed Bill AB 2022, which is effective 07/01/2011. ACORD will revise ACORD 67 CA, California Residential Property Insurance Disclosure and ACORD 861 CA, California Residential Property Insurance Bill of Rights, in response to the new California Bill and Regulatory Notice. ACORD expects to release the revised forms May New Certificate of Insurance Bulletin(s) issued by the State of Arizona, State of Georgia, and State of New Mexico Department(s) of Insurance All three Bulletins advise that Certificates of Insurance / Evidences of Insurance: 1. Are for informational purposes only 2. Should not amend, extend or alter the terms of the policy 3. Misrepresentation of the insurance coverage is a violation of state law Connecticut House Bill No Public Act 10-7 Requires Extraordinary Life Circumstances Considerations for Insureds Connecticut House Bill No Public Act No [Sec 2. Subsection (b) (6)] requires insurers to provide notice to each applicant for personal risk insurance, in writing, by telephone, be electronic mail or orally at the time of application that applicant's credit history may be used in underwriting of such applicant's policy, and that applicant has the right to request in writing, that the insurer consider, during its underwriting or rating process or during a review requested by such applicant of a rate quote; 'an extraordinary life circumstance...if applicants credit history adversely impacted by such extraordinary life circumstance occurred within three years before date of application. The effective date of this statute is July 1, ACORD will develop a Connecticut Insurance Disclosure Supplement in response to CT HB ACORD will also update ACORD Privacy Notices: ACORD 38, ACORD 38 KS, ACORD 38 MN and ACORD 38 VA to include general information about Extraordinary Life Circumstances. ACORD expects to release all new and revised forms in May of 18 ACORD Explanation of Changes

20 Alabama Department of Insurance Department Letter, in re: ACORD 25 (2010/05) Please consult with the Alabama Department of Insurance should you have specific questions about this below-referenced letter. Dec. 22, 2010 Victor D. McCarley, CIC Executive Vice President Alabama Independent Insurance Agents 141 London Parkway Birmingham, Alabama Dear Vic: It has been brought to our attention that some parties are not accepting the new ACORD 25 ( Certificate of Liability Insurance ) or are trying to compel use of other certificate forms. We believe these issues are largely answered by reference to Department Regulation , available in the Legal section of the Department s web site ( Hopefully, the following clarifies the Department s position on these matters: 1. If properly licensed or authorized by the respective organization, an insurer and a producer acting for an insurer can use the certificate of liability insurance forms published by ACORD (and ISO ) without further approval from the Department. Department rule (4). 2. Effective October 1, 2010, ACORD form 25 (2009/09) or later version (2010/05) is the form that may be permissibly used. Prior versions of this form have been superseded and may not be used. 3. An insurer or producer acting for an insurer may not use another certificate form unless that form has been previously submitted to and approved by the Department. [Department rule (4)]. This includes certificate forms or forms in the nature of certificates devised by other agencies or third parties. 4. A certificate form must comply with Department rules (1), (2), and (3). In general, a certificate is merely informational and cannot affirmatively or negatively create, change, extend, or restrict coverage provided for in the underlying insurance policies to which the certificate refers. Neither an insurer nor a producer acting for an insurer may alter a certificate form if the effect of that alteration is to change, or create the impression of changing, the terms or scope of coverage provided for in the underlying policies. 5. Neither an insurer nor a producer acting for an insurer may issue an opinion letter or other correspondence stating or representing that an insurance policy provides coverage or contains terms which the policy does not provide or contain. Department rule (5). 6. A producer participating in actions which violate Regulation can be subject to disciplinary action including the possibility of a license revocation or suspension and/or imposition of a fine. I trust the letter explains the Department s position. You are free to distribute this as you think appropriate. Charles M. Angell FCAS, MAAA Acting Deputy Commissioner & Casualty Actuary Alabama Department of Insurance Phone: (334) Fax: (334) Alternate Fax: (334) Charles.Angell@insurance.alabama.gov Agency Web Site: 17 of 18 ACORD Explanation of Changes

21 New York Department of Insurance Producer Compensation Disclosure Regulation The New York Insurance Department's producer compensation disclosure regulation went into effect January 1, We recently made reference to plans to respond in our ACORD Newsletter (12/1/2010) Regulation 194 is "intended to provide a means to address conflicts of interest that arise due to the incentive-based compensation an insurer pays to its producer in the least invasive manner possible, by requiring that insurance producers make certain disclosures to insurance customers about the producer's role in the insurance transaction and their compensation arrangements with the insurer." [ N.Y. Dept. Ins. O.G.C. Opinion No (Nov. 4, 2010)]. The regulation is a byproduct of the joint investigation conducted by the New York Insurance Department and the New York Office of the Attorney General in 2004 of bid rigging and steering schemes where undisclosed incentive compensation became an issue. ACORD is consulting the three major insurance producer trade associations to be sure that any language we use to develop this new disclosure form be consistent with their discussions with the NY Department and understandings of the regulation s requirements. We intend to publish this new disclosure form in our January 2011 release and ask for the broker community s patience while we determine the best approach consistent with the needs of all. Texas law effective increases minimum liability limits Texas law effective, January 1, 2011, increases minimum liability limits to 30/60. ACORD has contacted the Texas Department of Insurance regarding revisions to ACORD 60 TX, (62 TX - Spanish Language Version) Texas Auto Supplement, Consumer Bill of Rights, Personal Auto Insurance. Texas Department of Insurance indicated that they were in the process of revising these forms, but did not have an anticipated completion date. ACORD will periodically check the Texas Department of Insurance website for the posting of the updated forms. As of this release the Texas website has not been updated. Below is the text currently posted on the Texas Department of Insurance website: Consumer Bill of Rights Your insurance company is required to provide you with a summary of your rights under Texas insurance law when it issues you a policy. This summary is called the "Consumer Bill of Rights. The Bill of Rights is being revised to reflect the change in the state's minimum liability limits. Until the revised Bill of Rights is adopted, the copy you receive with your new policy will still include the old limits in place prior to April of 18 ACORD Explanation of Changes