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  • ACORD 28 Evidence of Commercial Property Insurance

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    cookseyecuritycorp
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    This document provides evidence of commercial property insurance. It was issued as information only and does not change any policy coverage. It shows the insurance company, policy number, insured property address, policy periods, coverage amounts and types, and additional interests such as mortgagees. Any policy cancellations will be communicated according to the policy provisions.

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    ACORD-28-Evidence-of-Commercial-Property-Insurance

    Original Title

    ACORD-28-Evidence-of-Commercial-Property-Insurance

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    This document provides evidence of commercial property insurance. It was issued as information only and does not change any policy coverage. It shows the insurance company, policy number, insured property address, policy periods, coverage amounts and types, and additional interests such as mortgagees. Any policy cancellations will be communicated according to the policy provisions.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    Download as pdf or txt
    269 views2 pages

    ACORD 28 Evidence of Commercial Property Insurance

    Uploaded by

    cookseyecuritycorp
    This document provides evidence of commercial property insurance. It was issued as information only and does not change any policy coverage. It shows the insurance company, policy number, insured property address, policy periods, coverage amounts and types, and additional interests such as mortgagees. Any policy cancellations will be communicated according to the policy provisions.

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    © All Rights Reserved
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    of 2

    DATE (MM/DD/YYYY)

    EVIDENCE OF COMMERCIAL PROPERTY INSURANCE


    THIS EVIDENCE OF COMMERCIAL PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS
    UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER
    THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN
    THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST.
    PRODUCER NAME, PHONE COMPANY NAME AND ADDRESS NAIC NO:
    CONTACT PERSON AND ADDRESS (A/C, No, Ext):

    FAX E-MAIL IF MULTIPLE COMPANIES, COMPLETE SEPARATE FORM FOR EACH


    (A/C, No): ADDRESS:
    CODE: SUB CODE: POLICY TYPE
    AGENCY
    CUSTOMER ID #:
    NAMED INSURED AND ADDRESS LOAN NUMBER POLICY NUMBER

    EFFECTIVE DATE EXPIRATION DATE


    CONTINUED UNTIL
    TERMINATED IF CHECKED

    ADDITIONAL NAMED INSURED(S) THIS REPLACES PRIOR EVIDENCE DATED:

    PROPERTY INFORMATION (Use REMARKS on page 2, if more space is required) BUILDING OR BUSINESS PERSONAL PROPERTY
    LOCATION / DESCRIPTION

    THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
    ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EVIDENCE OF PROPERTY INSURANCE MAY
    BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS
    OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
    COVERAGE INFORMATION PERILS INSURED BASIC BROAD SPECIAL
    COMMERCIAL PROPERTY COVERAGE AMOUNT OF INSURANCE: $ DED:
    YES NO N/A

    BUSINESS INCOME RENTAL VALUE If YES, LIMIT: Actual Loss Sustained; # of months:
    BLANKET COVERAGE If YES, indicate value(s) reported on property identified above: $
    TERRORISM COVERAGE Attach Disclosure Notice / DEC
    IS THERE A TERRORISM-SPECIFIC EXCLUSION?
    IS DOMESTIC TERRORISM EXCLUDED?
    LIMITED FUNGUS COVERAGE If YES, LIMIT: DED:
    FUNGUS EXCLUSION (If "YES", specify organization's form used)
    REPLACEMENT COST
    AGREED VALUE
    COINSURANCE If YES, %
    EQUIPMENT BREAKDOWN (If Applicable) If YES, LIMIT: DED:
    ORDINANCE OR LAW - Coverage for loss to undamaged portion of bldg If YES, LIMIT: DED:
    - Demolition Costs If YES, LIMIT: DED:
    - Incr. Cost of Construction If YES, LIMIT: DED:
    EARTH MOVEMENT (If Applicable) If YES, LIMIT: DED:
    FLOOD (If Applicable) If YES, LIMIT: DED:
    WIND / HAIL (If Subject to Different Provisions) If YES, LIMIT: DED:
    PERMISSION TO WAIVE SUBROGATION IN FAVOR OF MORTGAGE
    HOLDER PRIOR TO LOSS

    CANCELLATION
    SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE
    DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.
    ADDITIONAL INTEREST
    MORTGAGEE LENDER SERVICING AGENT NAME AND ADDRESS
    CONTRACT OF SALE
    LENDERS LOSS PAYABLE
    NAME AND ADDRESS

    AUTHORIZED REPRESENTATIVE

    ACORD 28 (2011/11) Page 1 of 2 © 2003-2011 ACORD CORPORATION. All rights reserved.


    The ACORD name and logo are registered marks of ACORD
    EVIDENCE OF COMMERCIAL PROPERTY INSURANCE REMARKS - Including Special Conditions (Use only if more space is required)

    ACORD 28 (2011/11) Page 2 of 2

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