Acord-126

COMMERCIAL GENERAL LIABILITY SECTION

COVERAGES

GENERAL AGGREGATE LIMIT APPLIES PER:

LIMITS

COMMERCIAL GENERAL LIABILITY
DEDUCTIBLES

SAPPLICABLE ONLY IN WISCONSIN: IF NON-OWNED ONLY AUTO COVERAGE IS TO BE PROVIDED UNDER THE POLICY:

1. UM / UIM COVERAGE
2. MEDICAL PAYMENTS COVERAGE

SCHEDULE OF HAZARDS

RATE

PREMIUM

RATE

PREMIUM

RATE

PREMIUM

RATING AND PREMIUM BASIS:
(S) GROSS SALES – PER $1,000/SALES
(P) PAYROLL – PER $1,000/PAY
(C) TOTAL COST – PER $1,000/COST
(U) UNIT – PER UNIT
(A) AREA – PER 1,000/SQ FT
(M) ADMISSIONS – PER 1,000/ADM
(T) OTHER

CLAIMS MADE

EMPLOYEE BENEFITS LIABILITY

CONTRACTORS

PRODUCTS / COMPLETED OPERATIONS

ADDITIONAL INTEREST

GENERAL INFORMATION

5. DO YOU RENT OR LOAN EQUIPMENT TO OTHERS?

10. ARE THERE ANY LODGING OPERATIONS INCLUDING APARTMENTS?

11. IS THERE A SWIMMING POOL ON PREMISES?

17. DO YOU LEASE EMPLOYEES TO OR FROM OTHER EMPLOYERS?

AGE GROUP
AGE GROUP

17. DO YOU LEASE EMPLOYEES TO OR FROM OTHER EMPLOYERS?

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