Fillable EQUIPMENT FLOATER SECTION (Standard Lines Services)

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EQUIPMENT FLOATER SECTION (Standard Lines Services)

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$$
$$
$$
EQUIPMENT STORAGE
MO. IN
STORAGE
MAXIMUM VALUE
IN BUILDING OUTSIDE
TYPE OF SECURITY
LOC.
#
GENERAL INFORMATION
4. ANY WORK DONE AFLOAT?
3. PROPERTY USED UNDERGROUND?
2. IS APPLICANT OPERATING EQUIPMENT NOT LISTED HERE?
1. EQUIPMENT RENTED, LOANED TO/FROM OTHERS WITH/WITHOUT OPERATORS?
EXPLAIN ALL "YES" RESPONSES
Y / N
TERRITORY OF OPERATION TYPE OF OPERATION
COVERAGE/DEDUCTIBLE
DESCRIPTION MAXIMUM ITEM AMT. OF INSURANCE
%
COINS
UNSCHEDULED EQUIPMENT
ADDITIONAL INTEREST/CERTIFICATE RECIPIENTS ACORD 45 Attached
OTHER
SCHEDULED ITEM NUMBER:
BUILDING:LOCATION:
LIENHOLDER
LOSS PAYEE
INTEREST IN ITEM NUMBERCERTIFICATE REQUIREDREFERENCE #:NAME AND ADDRESSRANK:INTEREST
ITEM DESCRIPTION:
OTHER
SCHEDULED ITEM NUMBER:
BUILDING:LOCATION:
LIENHOLDER
LOSS PAYEE
INTEREST IN ITEM NUMBERCERTIFICATE REQUIREDREFERENCE #:NAME AND ADDRESSRANK:INTEREST
ITEM DESCRIPTION:
OTHER
SCHEDULED ITEM NUMBER:
BUILDING:LOCATION:
LIENHOLDER
LOSS PAYEE
INTEREST IN ITEM NUMBERCERTIFICATE REQUIREDREFERENCE #:NAME AND ADDRESSRANK:INTEREST
ITEM DESCRIPTION:
AUDITPAYMENT PLANBILLING PLAN
AGENCY
DIRECT
PROPOSED EXP. DATEPROPOSED EFF. DATE
APPLICANT
FOR COMPANY USE ONLY
DATE (MM/DD/YYYY)
EQUIPMENT FLOATER SECTION
AGENCY
CODE: SUBCODE:
AGENCY CUSTOMER ID
PHONE
(A/C, No, Ext):
FAX
(A/C, No):
© ACORD CORPORATION 1988-2007. All rights reserved.
Page 1 of 2
ACORD 146 (2007/02)
The ACORD name and logo are registered marks of ACORD
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ATTACH TO ACORD 125
ACORD 146 (2007/02)
% COINSURANCE
$
#
MODEL YEAR
ID # / SERIAL NO. DATE PURCHASEDNEW / USED
AMOUNT OF INSURANCE
TYPE
MANUFACTURER MODEL
CAPACITY
DESCRIPTION
$
#
MODEL YEAR
ID # / SERIAL NO. DATE PURCHASEDNEW / USED
AMOUNT OF INSURANCE
TYPE
MANUFACTURER MODEL
CAPACITY
DESCRIPTION
$
#
MODEL YEAR
ID # / SERIAL NO. DATE PURCHASEDNEW / USED
AMOUNT OF INSURANCE
TYPE
MANUFACTURER MODEL
CAPACITY
DESCRIPTION
$
#
MODEL YEAR
ID # / SERIAL NO. DATE PURCHASEDNEW / USED
AMOUNT OF INSURANCE
TYPE
MANUFACTURER MODEL
CAPACITY
DESCRIPTION
$
#
MODEL YEAR
ID # / SERIAL NO. DATE PURCHASEDNEW / USED
AMOUNT OF INSURANCE
TYPE
MANUFACTURER MODEL
CAPACITY
DESCRIPTION
$
#
MODEL YEAR
ID # / SERIAL NO. DATE PURCHASEDNEW / USED
AMOUNT OF INSURANCE
TYPE
MANUFACTURER MODEL
CAPACITY
DESCRIPTION
$
#
MODEL YEAR
ID # / SERIAL NO. DATE PURCHASEDNEW / USED
AMOUNT OF INSURANCE
TYPE
MANUFACTURER MODEL
CAPACITY
DESCRIPTION
$
#
MODEL YEAR
ID # / SERIAL NO. DATE PURCHASEDNEW / USED
AMOUNT OF INSURANCE
TYPE
MANUFACTURER MODEL
CAPACITY
DESCRIPTION
$
#
MODEL YEAR
ID # / SERIAL NO. DATE PURCHASEDNEW / USED
AMOUNT OF INSURANCE
TYPE
MANUFACTURER MODEL
CAPACITY
DESCRIPTION
$
#
MODEL YEAR
ID # / SERIAL NO. DATE PURCHASEDNEW / USED
AMOUNT OF INSURANCE
TYPE
MANUFACTURER MODEL
CAPACITY
DESCRIPTION
$
#
MODEL YEAR
ID # / SERIAL NO. DATE PURCHASEDNEW / USED
AMOUNT OF INSURANCE
TYPE
MANUFACTURER MODEL
CAPACITY
DESCRIPTION
$
#
MODEL YEAR
ID # / SERIAL NO. DATE PURCHASEDNEW / USED
AMOUNT OF INSURANCE
TYPE
MANUFACTURER MODEL
CAPACITY
DESCRIPTION
$
#
MODEL YEAR
ID # / SERIAL NO. DATE PURCHASEDNEW / USED
AMOUNT OF INSURANCE
TYPE
MANUFACTURER MODEL
CAPACITY
DESCRIPTION
$
#
MODEL YEAR
ID # / SERIAL NO. DATE PURCHASEDNEW / USED
AMOUNT OF INSURANCE
TYPE
MANUFACTURER MODEL
CAPACITY
DESCRIPTION
$
#
MODEL YEAR
ID # / SERIAL NO. DATE PURCHASEDNEW / USED
AMOUNT OF INSURANCE
TYPE
MANUFACTURER MODEL
CAPACITY
DESCRIPTION
SCHEDULED EQUIPMENT
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EQUIPMENT FLOATER SECTION (Standard Lines Services)

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Completed 7 February 2021

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