If the address does not have a street number and name, provide sufficient information and MOBILE HOME RATING /

Transcription

1 Universal wording updates to improve clarity and intent were made to all FIG text for this form on 10/30/2009. Section Name Field Name Field and/or Section TITLE ACORD 72 (2009/10) Mobile Home Supplement Agency Customer ID The titile of the form. ACORD 72, Mobile Home Supplement, is used with ACORD 89, Residential Section or ACORD 80, Homeowners Application, to provide information about mobile homes and the type of tie-down protection provided for the mobile home. Consult your company as to when this supplement is required. Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage). Loc # Enter number: The producer assigned number of the location. As used here, the location number of the risk's location as it appears on ACORD 88, Personal Insurance Application, Applicant Information Section or ACORD 80, Homeowners Application. Date Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY) Agency Enter text: The full name of the producer/agency. Policy Number Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. Effective Date Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. Carrier Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. NAIC Code Enter code: The identification code assigned to the insurer by the NAIC. Named Insured(s) Enter text: The named insured(s) as it/they will appear on the policy declarations page. Enter text: The first address line of the physical location. As used here, Property Address should include: Street number, if any; Pre-direction, if any (example: 150 N Central Ave); Street name, if any; Street type (e.g.: st., rd, ave.) ; Post-direction, if any (e.g.: 150 Central Ave N); City; County; State; ZIP code If the address does not have a street number and name, provide sufficient information and RATING / UNDERWRITING Property Address - Street directions so that the property can be physically located. Provide legal description if required by the mortgage holder. RATING / UNDERWRITING Property Address - City Enter text: The city of the physical location. RATING / UNDERWRITING Property Address - County Enter text: The county of the location. ACORD 72 (2009/10) 1 of 7

2 RATING / UNDERWRITING Property Address - State Enter code: The state or province of the physical location. RATING / UNDERWRITING Property Address - Zip+4 Enter code: The postal code of the physical location. New (Y / N) Year Enter year: The model year of the mobile home. Make Enter text: The name of the manufacturer of the mobile home. Model Enter text: The manufacturer's model name for the mobile home. ID Number Enter identifier: The serial number for this mobile home. Length Enter number: The length of the mobile home expressed in feet. Width Enter number: The width of the mobile home expressed in feet. Enter Y for a Yes response. Input N for No response. Indicates if the mobile home was purchased new. Doublewide Enter Y for a Yes response. Input N for No response. Indicates if the mobile home is a doublewide construction. Skirted Enter Y for a Yes response. Input N for No response. Indicates if the mobile home is skirted. # of Bedrooms Enter number: The number of bedrooms in the mobile home. Tie Down - None (checkbox) Check the box (if applicable): Indicates the mobile home has no tie downs. Full (checkbox) Check the box (if applicable): Indicates the mobile home tie downs are full. Chassis Only (checkbox) Check the box (if applicable): Indicates the mobile home tie downs are chassis only. Overtop Only (checkbox). Check the box (if applicable): Indicates the mobile home tie downs are overtop only. Permanent Connection - Electricity (checkbox) Water (checkbox) Check the box (if applicable): Indicates the mobile home has a permanent connection to electricity. Check the box (if applicable): Indicates the mobile home has a permanent connection to water. ACORD 72 (2009/10) 2 of 7

3 Sewer (checkbox) Check the box (if applicable): Indicates the mobile home has a permanent connection to the sewer. Cooking Location - End (checkbox) Check the box (if applicable): Indicates the mobile home has a cooking location at the end of the residence. Middle (checkbox) Check the box (if applicable): Indicates the mobile home has a cooking location in the middle of the residence. None (checkbox) Check the box (if applicable): Indicates the mobile home has no cooking location. Mobile Home Foundation - Continuous Masonry Check the box (if applicable): Indicates the foundation is continuous masonry. Mobile Home Foundation - Post & Pier Check the box (if applicable): Indicates the foundation is post and pier. Mobile Home Foundation - Other Check the box (if applicable): Indicates the foundation is other than those listed. Mobile Home Foundation - Other Enter text: The foundation of the mobile home. Mobile Home Park Name Enter text: The name of the mobile home park. Date Park Established Enter date: The date the mobile home park was established. Number of Permanent Spaces in Park Enter number: The number of permanent spaces in the mobile home park. Consecutive Months Occupied Each Year Enter number: The number of consecutive months the mobile home is occupied each year. 1. Does mobile home park have a resident manager? Enter Y for a Yes response. Input N for No response. Indicates the answer to the question, "Does the mobile home park have a resident manager?". Manager's Name Enter text: The full name of the manager of the mobile home park. Phone Number Enter number: The phone number of the manager of the mobile home park. 2. Does mobile home park have limited access? Enter Y for a Yes response. Input N for No response. Indicates the answer to the question, "Does the mobile home park have limited access?". Normally, "Yes" responses require an explanation. 3. Does mobile home park have subdivisions? Enter Y for a Yes response. Input N for No response. Indicates the answer to the question, "Does the mobile home park have subdivisions?". ACORD 72 (2009/10) 3 of 7

4 Normally, "Yes" responses require an explanation. 4. Are roads unpaved in the mobile Enter Y for a Yes response. Input N for No response. Indicates the answer to the home park? question, "Are any roads unpaved in the mobile home park?". Normally, "Yes" responses require an explanation. TIE DOWNS 1. Is mobile home tied down? 2. Is mobile home equipped with factory installed "under the skin" TIE DOWNS tie down strapping? TIE DOWNS TIE DOWNS TIE DOWNS TIE DOWNS TIE DOWNS TIE DOWNS TIE DOWNS TIE DOWNS 1 1/4 Steel Strap 1 1/2 Steel Strap 1/4 Steel Cable 1/2 Steel Cable Other Other, describe 4. Is all strapping used in tie downs galvanized? 5. Is all strapping used in tie downs without perforations? question, "Is mobile home tied down? If yes, answer questions 2 through 13).". question, "Is mobile home equipped with factory installed "under the skin" tie down strapping?". Check the box (if applicable): Indicates the type of straps used to tie down the mobile home are 1 1/4 steel strap. Check the box (if applicable): Indicates the type of straps used to tie down the mobile home are 1 1/2 steel strap. Check the box (if applicable): Indicates the type of cable used to tie down the mobile home are 1/4 steel cable. Check the box (if applicable): Indicates the type of cable used to tie down the mobile home are 1/2 steel cable. Check the box (if applicable): Indicates the type of straps or cable used to tie down the mobile home is other than those listed. Enter text: The description of the type of straps or cable used to tie down the mobile home. question, "Is all strapping used in tie down galvanized?". question, "Is all strapping used in tie downs without perforations?". ACORD 72 (2009/10) 4 of 7

5 TIE DOWNS TIE DOWNS TIE DOWNS TIE DOWNS TIE DOWNS 6. If cable used, are loose ends firmly clamped and secure? 7. Are over the roof tie downs visible? 7 a. If over the roof tie down are visible, are corner blocks of wood or metal used under strapping cable to prevent sharp bends? Downs?: Dead Men Downs?: Screw Auger question, "If cable used, are loose ends firmly clamped and secure?". question, "Are over the roof tie downs visible?". question, "If over the roof tie down are visible, are corner blocks of wood or metal used under strapping cable to prevent sharp bends?". Check the box (if applicable): Indicates the type of anchors used for the tie downs are dead men. Check the box (if applicable): Indicates the type of anchors used for the tie downs are screw auger. TIE DOWNS Downs?: Other Tie Down Anchors Check the box (if applicable): Indicates the type of anchors used for the tie downs are other than those listed. TIE DOWNS TIE DOWNS TIE DOWNS TIE DOWNS Downs?: Explain 9. Are turnbuckles used in tie downs? 9 a. If turnbuckles are used in tie downs, are they forged steel? 9 b. Are turnbuckles ending with jaws properly secured? Enter text: The description of the screw auger or other tie down anchors. question, "Are turnbuckles used in tie downs?". question, "If turnbuckles are used, are they forged steel?". question, "Are turnbuckles ending with jaws properly secured?". TIE DOWNS 9 c. Do turnbuckles end with open hook? question, "Do turnbuckles end with open hook?". ACORD 72 (2009/10) 5 of 7

6 TIE DOWNS 9 d. If turnbuckles end with open hook, are they closed with twine or wire? question, "If turnbuckles end with open hook, are they closed with twine or wire?". TIE DOWNS TIE DOWNS 10. Are there any additions to mobile home (including carport, added rooms, etc) tied down? 10 a. Are all additions to mobile home tied down? question, " Are there any additions to mobile home (including carport, added rooms, etc)?". question, "Are all additions to mobile home (including carport, added rooms, etc.) tied down?". TIE DOWNS TIE DOWNS TIE DOWNS TIE DOWNS 11. Is mobile home properly blocked? 11. Is mobile home properly blocked? If "NO", explain 12. How many properly secured straps or cables are there over the roof? 13. Facing either end of the mobile home, how many properly secured frame tie downs are there? Right: 13. Facing either end of the mobile home, how many properly secured frame tie downs are there? Left question, "Is mobile home properly blocked?". Normally, "Yes" responses require an explanation. As used here, explain if the mobile home is not properly blocked. Enter number: The number of properly secured straps or cables that are over the roof. Enter number: The number of properly secured frame tie downs on the right side when you are facing either end of the mobile home. TIE DOWNS Enter number: The number of properly secured frame tie downs on the left side when you are facing either end of the mobile home. Enter identifier: The customer's identification number assigned by the producer (e.g. Agency Customer ID agency or brokerage). Loc # Enter number: The producer assigned number of the location. TIE DOWNS Explanation of Items Not Normally, "Yes" responses require an explanation. As used here, explain any items not (Continued) Adequately Described Above adequately described above TIE DOWNS (Continued) Signature of Owner / Applicant Sign here: Accommodates the signature of the applicant or named insured. ACORD 72 (2009/10) 6 of 7

7 TIE DOWNS (Continued) Date Enter date: The date the form was signed by the named insured. Edition Date The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM). ACORD 72 (2009/10) 7 of 7