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Acord-137
OHIO COMMERCIAL AUTO
Effective Date
(Required)
DD slash MM slash YYYY
Agency
(Required)
Carrier
(Required)
NAIC Code
(Required)
Agency Customer ID
(Required)
Applicant / First Named Insured
(Required)
Policy Number
(Required)
LIABILITY
COVERED AUTO SYMBOLS
(Required)
1
2
3
4
5
6
7
8
9
LIMITS
(Required)
CSL
BI EA PER
BI EACH ACCIDENT
PROPERTY DAMAGE
MEDICAL PAYMENTS
COVERED AUTO SYMBOLS
(Required)
2
3
4
7
8
LIMITS
(Required)
EACH PERSON
UNINSURED MOTORIST
COVERED AUTO SYMBOLS
(Required)
2
3
4
7
8
LIMITS
(Required)
CSL
BI EA PER
BI EACH ACCIDENT
PROPERTY DAMAGE
DED
HIRED / BORROWED LIABILITY
COVERED AUTO SYMBOLS
(Required)
Yes
No
LIMITS
(Required)
COST OF HIRE
IF ANY BASIS
NON-OWNED LIABILITY
COVERED AUTO SYMBOLS
(Required)
Yes
No
LIMITS
(Required)
EMPLOYEES
VOLUNTEERS
PARTNERS
NUMBER OF
TOWING & LABOR
PHYSICAL DAMAGE
(Required)
3
7
LIMITS
(Required)
COMP / OTC
PHYSICAL DAMAGE
(Required)
2
3
4
7
8
SPECIFIED CAUSES OF LOSS
PHYSICAL DAMAGE
(Required)
2
3
4
7
8
COLLISION
PHYSICAL DAMAGE
(Required)
2
3
4
7
8
HIRED PHYSICAL DAMAGE
STATES
(Required)
# DAYS
(Required)
# VEH
(Required)
COVERAGE IS:
(Required)
COMP
SPEC C OF L
COLL
COVERAGE / DEDUCTIBLE
(Required)
PRIMARY
SECONDARY
COVERED AUTO SYMBOLS
(Required)
ANY AUTO
OWNED AUTOS ONLY
OWNED PRIVATE PASSENGER AUTOS ONLY
OWNED AUTOS OTHER THAN PRIVATE PASSENGER AUTOS ONLY
OWNED AUTOS SUBJECT TO NO-FAULT
OWNED AUTOS SUBJECT TO A COMPULSORY UNINSURED MOTORISTS LAW
SPECIFICALLY DESCRIBED AUTOS
HIRED AUTOS ONLY
NON-OWNED AUTOS ONLY
ENDORSEMENTS / REMARKS
(Required)
Signature
(Required)
TRUCKERS SECTION
AGENCY CUSTOMER ID:
(Required)
LIABILITY
COVERED AUTO SYMBOLS
(Required)
41
42
43
46
47
48
LIMITS
(Required)
CSL
BI EA PER
BI EACH ACCIDENT
PROPERTY DAMAGE
MEDICAL PAYMENTS
COVERED AUTO SYMBOLS
(Required)
42
43
46
LIMITS
(Required)
EACH PERSON
UNINSURED MOTORIST
COVERED AUTO SYMBOLS
(Required)
42
43
45
46
LIMITS
(Required)
CSL
BI EA PER
BI EACH ACCIDENT
PROPERTY DAMAGE
DED
UNDERINSURED MOTORIST
COVERED AUTO SYMBOLS
(Required)
Yes
No
LIMITS
(Required)
CSL
BI EA PER
BI EACH ACCIDENT
NON-TRUCKERS HIRED / BORROWED
COVERED AUTO SYMBOLS
(Required)
Yes
No
LIMITS
(Required)
COST OF HIRE
IF ANY BASIS
TRUCKERS HIRED / BORROWED LIABILITY
COVERED AUTO SYMBOLS
(Required)
Yes
No
LIMITS
(Required)
COST OF HIRE
IF ANY BASIS
NON-OWNED AUTO LIABILITY
COVERED AUTO SYMBOLS
(Required)
Yes
No
LIMITS
(Required)
EMPLOYEES
VOLUNTEERS
PARTNERS
NUMBER OF
OTHER
COMP / OTC
COVERED AUTO SYMBOLS
(Required)
43
43
64
47
DEDUCTIBLE
(Required)
SPECIFIED CAUSES OF LOSS
COVERED AUTO SYMBOLS
(Required)
42
43
44
45
48
LIMITS
(Required)
SCL
FT
LSP
F
FTW
DEDUCTIBLE
(Required)
TOWING
COVERED AUTO SYMBOLS
(Required)
42
43
44
45
48
DEDUCTIBLE
(Required)
COLLISION & LABOR
COVERED AUTO SYMBOLS
(Required)
42
43
LIMITS
(Required)
SCL
FT
CCOMP / OTC
SYMBOL
(Required)
48
49
# TRAILERS
(Required)
FZONE
(Required)
# DAYS
(Required)
RADIUS
(Required)
DEDUCTIBLE
(Required)
SPECIFIED CAUSES OF LOSS
SYMBOL
(Required)
48
49
# TRAILERS
(Required)
FZONE
(Required)
# DAYS
(Required)
RADIUS
(Required)
DEDUCTIBLE
(Required)
COLLISION
SYMBOL
(Required)
48
49
# TRAILERS
(Required)
FZONE
(Required)
# DAYS
(Required)
RADIUS
(Required)
DEDUCTIBLE
(Required)
TRAILER VALUE
(Required)
HIRED PHYSICAL DAMAGE
STATES
(Required)
# DAYS
(Required)
# VEH
(Required)
COVERAGE IS:
(Required)
PRIMARY
SECONDARY
COVERED AUTO SYMBOLS
(Required)
ANY AUTO
OWNED AUTOS ONLY
OWNED PRIVATE PASSENGER AUTOS ONLY
OWNED AUTOS OTHER THAN PRIVATE PASSENGER AUTOS ONLY
OWNED AUTOS SUBJECT TO NO-FAULT
OWNED AUTOS SUBJECT TO A COMPULSORY UNINSURED MOTORISTS LAW
SPECIFICALLY DESCRIBED AUTOS
HIRED AUTOS ONLY
NON-OWNED AUTOS ONLY
ENDORSEMENTS / REMARKS
(Required)
SIGNATURE
(Required)
MOTOR CARRIER SECTION
AGENCY CUSTOMER ID:
(Required)
LIABILITY
COVERED AUTO SYMBOLS
(Required)
61
62
63
64
67
68
LIMITS
(Required)
CSL
BI EA PER
BI EACH ACCIDENT
PROPERTY DAMAGE
MEDICAL PAYMENTS
COVERED AUTO SYMBOLS
(Required)
61
62
63
64
67
68
LIMITS
(Required)
EACH PERSON
UNINSURED MOTORIST
COVERED AUTO SYMBOLS
(Required)
61
62
63
64
67
68
LIMITS
(Required)
CSL
BI EA PER
BI EACH ACCIDENT
PROPERTY DAMAGE
BED
UNDERINSURED MOTORIST
COVERED AUTO SYMBOLS
(Required)
61
62
63
64
67
68
LIMITS
(Required)
CSL
BI EA PER
BI EACH ACCIDENT
NON-TRUCKERS HIRED / BORROWED
COVERED AUTO SYMBOLS
(Required)
Yes
No
LIMITS
(Required)
COST OF HIRE
IF ANY BASIS
TRUCKERS HIRED / BORROWED LIABILITY
COVERED AUTO SYMBOLS
(Required)
Yes
No
LIMITS
(Required)
COST OF HIRE
IF ANY BASIS
NON-OWNED AUTO LIABILITY
COVERED AUTO SYMBOLS
(Required)
Yes
No
LIMITS
(Required)
EMPLOYEES
VOLUNTEERS
PARTNERS
NUMBER OF
COMP / OTC
COVERED AUTO SYMBOLS
(Required)
61
62
63
64
67
68
DEDUCTIBLE
(Required)
SPECIFIED CAUSES OF LOSS
COVERED AUTO SYMBOLS
(Required)
61
62
63
64
67
68
LIMITS
(Required)
SCL
FT
LSP
F
FTW
DEDUCTIBLE
(Required)
TOWING
COVERED AUTO SYMBOLS
(Required)
61
62
63
64
67
68
DEDUCTIBLE
(Required)
COLLISION & LABOR
COVERED AUTO SYMBOLS
(Required)
61
62
63
67
68
LIMITS
(Required)
SCL
FT
CCOMP / OTC
COVERED AUTO SYMBOLS
(Required)
62
63
# TRAILERS
(Required)
FZONE
(Required)
# DAYS
(Required)
RADIUS
(Required)
DEDUCTIBLE
(Required)
SPECIFIED CAUSES OF LOSS
COVERED AUTO SYMBOLS
(Required)
62
63
# TRAILERS
(Required)
FZONE
(Required)
# DAYS
(Required)
RADIUS
(Required)
DEDUCTIBLE
(Required)
HIRED PHYSICAL DAMAGE
COVERED AUTO SYMBOLS
(Required)
62
63
# TRAILERS
(Required)
FZONE
(Required)
# DAYS
(Required)
RADIUS
(Required)
DEDUCTIBLE
(Required)
TRAILER VALUE
(Required)
COLLISION
STATES
(Required)
# DAYS
(Required)
# VEH
(Required)
COVERAGE IS:
(Required)
PRIMARY
SECONDARY
COVERED AUTO SYMBOLS
(Required)
ANY AUTO
OWNED AUTOS ONLY
OWNED PRIVATE PASSENGER AUTOS ONLY
OWNED AUTOS OTHER THAN PRIVATE PASSENGER AUTOS ONLY
OWNED AUTOS SUBJECT TO NO-FAULT
OWNED AUTOS SUBJECT TO A COMPULSORY UNINSURED MOTORISTS LAW
SPECIFICALLY DESCRIBED AUTOS
HIRED AUTOS ONLY
NON-OWNED AUTOS ONLY
ENDORSEMENTS / REMARKS
(Required)
Signature
(Required)
