Although not required in this state, may be used with acord 350, four part perforated watermark 20 lb. paper or acord 360, four part perforated watermark 32 lb. paper. illinois insurance identification card company number company policy number...
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Acord tm florida workers compensation date monthly change sheet company producer underwriter applicant name (as shown on original application) policy number effective date expiration date insurance company (name and address) this section will fit...
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Acord producer tm personal umbrella application applicant's name and mailing address (include county & zip+4) naic code policy # date (mm/dd/y) phone (a/c, no, ext): fax (a/c, no): facility code date at curr res code: agency customer id sub code:...
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Acord tm producer date professional liability supplement phone (a/c, no, ext): years in business applicant (first named insured) nature of business code: agency customer id: subcode: full time # of employees part time annual sales/receipts $...
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Mpapv macse document number actg per fy state of new jersey payment voucher (invoice) mo pp start sched pay yr chk cat off liab f rf ck fl (a) vendor id number dy mo dy yr a ty pv date agreement date (b) agreement no. (b) contract id # (b) payee:...
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Agency customer id: date (mm/dd/y) georgia personal auto application section agency named insured(s) policy number effective date carrier naic code garaging address (from acord 88) loc street city county vehicle description / use veh loc year make...
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P&c producer appointment form date (mm/dd/y) appointment section provide all information known at the time the form is completed carrier naic code agency information name and address fein: licensing contact: contact phone (a/c, no, ext): contact...
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Agency customer id: date (mm/dd/y) property section carrier agency name policy number effective date premises #: premises information bldg description: valucoins % ation amount additional information named insured(s) street address: building #:...
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North carolina workers compensation insurance plan instructions for completing acord 135 nc application north carolina rate bureau mailing address: physical address: po box 176010, raleigh, north carolina 27619-6010 2910 sumner boulevard, raleigh,...
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National flood insurance program flood insurance application part 1 (of 2) of flood insurance application important - please print or type licensed property or casuality insurance agent or broker address direct bill instructions metropolitan...
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Using acord forms and acord xml standards to streamline the insurance process with intelligent document solutions roger barbe, cpcu, arm avp, i/s business services ohio casualty group roger.barbe ocas.com may 2007 ron dudley vice president, forms...
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General: (516) 431-9191 underwriting: (516) 431-6200 fax: (516) 431-0488 370 west park avenue, p.o. box 9004, long beach, ny 11561-9004 .dcwhiteagency.com garagekeepers legal liability & dealers open lot application * this application must be...
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6900 northpark blvd. suite g charlotte, nc 28216-1393 how to complete the move48 (ncoalinktm 48 months) processing acknowledgement form (paf) attached is the paf for our ncoalink full service provider (fsp) licensee. please complete, sign (or have...
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