Acord 28 fillable

Acord 28 fillable

Acord 28 fillable Pdf form
sample Acord 28 fillable form

What is Acord 28 form?

The title of the form. ACORD 28, Evidence of Commercial Property Insurance, provides a coverage statement for mortgagees, additional insureds, and loss payees who provide mortgages or loans on real property or business personal property insured under a Commercial Lines policy and are named in the policy.

What does insurance evidence mean?

Proof of insurance (POI) is any type of documentation that a person can provide to another individual, proving that they have a valid insurance with an insurance company. The most common form of a POI is a paper card provided by the insurance company listing policy information and effective dates.

What is the difference between a certificate of insurance and evidence of insurance?

The CBO article explains that the bottom-line difference between “certificate holder” and “additional insured” is this: “Certificates provide evidence that certain insurance policies are in place on the date the certificate is issued, and that these policies have the limits and policy periods shown.

What is the difference between Acord 27 and Acord 28?

There is an important distinction between this form and ACORD 27 – Evidence of Property Insurance or ACORD 28 – Evidence of Commercial Property Insurance. ... When the property is insured under a large limit commercial lines policy and the lender requires specific detailed coverage information, use form 28.

ACORD 28 Instructions


Section Name Field Name Field and/or Section Description
TITLE ACORD 28 (2009/12) Evidence of Commercial Property Insurance The title of the form. ACORD 28, Evidence of Commercial Property Insurance, provides a coverage statement for mortgagees, additional insureds, and loss payees who provide mortgages or loans on real property or business personal property insured under a Commercial Lines policy and are named in the policy. Insurance coverage on large commercial property can have many variables. Coverages, coinsurance percentages, deductibles, and other details can vary widely and are important considerations to mortgagees and other lenders. Also, The Terrorism Risk Insurance Act and the recent increase in exposure to mold and fungus losses have resulted in a greater need to know more about the insurance contract's specific terms. ACORD 28 provides checkboxes and pre-printed text to communicate important insurance details. The intent is to minimize follow-up conversations and correspondence concerning information required in most cases involving large commercial real estate. ACORD 28 provides information about coverages currently in force on a policy.
TITLE IMPORTANT Use ACORD 27, Evidence of Property Insurance, provides information to mortgagees and loss payees who provide mortgages or loans on residential property, personal property, or small commercial properties where less detail is required by the mortgagee or loss payee. IMPORTANT Kansas, Kentucky, Minnesota, Missouri, North Carolina, Oklahoma, and Wisconsin require the filing of the certificate of insurance forms. ACORD has filed all of its certificates in these states. In these states, the text of ACORD’s certificates cannot be modified unless the modified form is filed for approval by the respective state Department of Insurance. Additionally, virtually every other state will not allow any change in a certificate of insurance that would attempt to modify a policy unless the revised certificate is filed and approved. In these states, this form can only be changed to reflect the terms and conditions of the policy on which it is reporting. Such change(s) must be approved in advance by the insurance carrier that issued such a policy.
IDENTIFICATION SECTION Date Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY)
IDENTIFICATION SECTION Producer Name, Contact Person, and Address Enter text: The full name of the producer/agency.
IDENTIFICATION SECTION Producer Name, Contact Person, and Address Enter text: The name of the individual at the producer’s establishment is the primary contact.
IDENTIFICATION SECTION Producer Name, Contact Person, and Address Enter text: The mailing address line one of the producer/agency.
IDENTIFICATION SECTION Producer Name, Contact Person, and Address Enter text: The mailing address line two of the producer/agency.
IDENTIFICATION SECTION Producer Name, Contact Person, and Address Enter text: The mailing address city name of the producer/agency.
IDENTIFICATION SECTION Producer Name, Contact Person, and Address Enter code: The mailing address state or province code of the producer/agency.
IDENTIFICATION SECTION Producer Name, Contact Person, and Address Enter code: The mailing address postal code of the producer/agency.
IDENTIFICATION SECTION Phone (A/C, No, Ext) Enter number: The producer’s contact person’s phone number. If applicable, include the area code and extension.
IDENTIFICATION SECTION Fax (A/C, No) Enter number: The fax number of the producer/agency.
IDENTIFICATION SECTION E-Mail Address Enter text: The producer’s contact person e-mail address.
IDENTIFICATION SECTION Code Enter code: The insurer's identification code is assigned to the producer (e.g., agency or brokerage firm).
IDENTIFICATION SECTION Subcode Enter code: The identification code assigned by the insurer to the sub-producer (e.g., person) within a producer’s office (e.g., agency or brokerage).
IDENTIFICATION SECTION Agency Customer ID Enter identifier: The customer’s identification number assigned by the producer (e.g., agency or brokerage).
IDENTIFICATION SECTION Named Insured and Address Enter text: The named insured(s) as it/they will appear on the policy declarations page.
IDENTIFICATION SECTION Enter text: The named insured’s mailing address line one.
IDENTIFICATION SECTION Enter text: The named insured’s mailing address line two.
IDENTIFICATION SECTION Enter text: The named insured’s mailing address city name.
IDENTIFICATION SECTION Enter code: The named insured’s mailing address state or province code.
IDENTIFICATION SECTION Enter code: The named insured’s mailing address postal code.
IDENTIFICATION SECTION Additional Named Insured(s) Enter text: The named insured(s) as it/they will appear on the policy declarations page.
IDENTIFICATION SECTION Company Name and Address Enter text: The insurer’s full legal company name(s) is found in the policy's file copy. 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.
IDENTIFICATION SECTION Enter text: The first line of the insurer’s mailing address.
IDENTIFICATION SECTION Enter text: The second line of the insurer’s mailing address.
IDENTIFICATION SECTION Enter text: The city of the insurer’s mailing address.
IDENTIFICATION SECTION Enter code: The state or province of the insurer’s mailing address.
IDENTIFICATION SECTION Enter code: The postal code of the insurer’s mailing address.
IDENTIFICATION SECTION NAIC No. Enter code: The identification code assigned to the insurer by the NAIC.
IDENTIFICATION SECTION Policy Type Enter text: The type of policy issued to the insured (e. g., personal auto, truckers, garage liability, commercial property, builders risk, etc.).
IDENTIFICATION SECTION Loan Number Enter identifier: The loan number, account number, or another controlling number that the additional interest may have assigned the insured.
IDENTIFICATION SECTION 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.
IDENTIFICATION SECTION Effective Date Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence.
IDENTIFICATION SECTION Expiration Date Enter date: The date on which the terms and conditions of the policy will expire.
IDENTIFICATION SECTION Continued Until Terminated if Checked Check the box (if applicable): Indicates the policy was issued continuously.
IDENTIFICATION SECTION This Replaces Prior Evidence Dated Enter date: The date the prior Evidence of Property Insurance, which this form replaces, was issued to this additional interest.
PROPERTY INFORMATION Building (checkbox) Check the box (if applicable): Indicates that Building Coverage applies.
PROPERTY INFORMATION Business Personal Property Check the box (if applicable): Indicates that Business Personal Property Coverage applies.
PROPERTY INFORMATION Location/Description Enter text: The first address line of the physical location.
PROPERTY INFORMATION Enter text: The second address line of the physical location.
PROPERTY INFORMATION Enter text: The city of the physical location.
PROPERTY INFORMATION Enter code: The state or province of the physical location.
PROPERTY INFORMATION Enter code: The postal code of the physical location.
PROPERTY INFORMATION Enter text: The description of the location used to different locations such as vacant land, apartment buildings, townhouses, single-family dwellings, farms. Provide the number of acres of farmland.
COVERAGE INFORMATION Basic Check the box (if applicable): Indicates the type of policy/perils insured is basic.
COVERAGE INFORMATION Broad Check the box (if applicable): Indicates the type of policy/perils insured is broad.
COVERAGE INFORMATION Special Check the box (if applicable): Indicates the type of policy/perils insured is special.
COVERAGE INFORMATION Other Peril Check the box (if applicable): Indicates the type of policy/perils insured is other than those listed.
COVERAGE INFORMATION Describe Other Peril Enter text: The description of the type of policy issued to the insured.
COVERAGE INFORMATION Commercial Property Coverage Amount of Insurance Enter limit: The limit applicable to the commercial property coverage.
COVERAGE INFORMATION Deductible Enter deductible: The deductible applicable to the commercial property coverage.
COVERAGE INFORMATION Business Income Check the box (if applicable): Indicates business income coverage applies. As used here, if the mortgage or loan requires Business Income coverage, indicate the applicable limit or the number of months of coverage if coverage is provided on an actual loss sustained basis.
COVERAGE INFORMATION Rental Value Check the box (if applicable): Indicates rental value coverage applies. As used here, if the mortgage or loan requires either Rental Value coverage, indicate the applicable limit, or the number of months of coverage if coverage is provided on an actual loss sustained basis.
COVERAGE INFORMATION Business Income Or Rental Value -Yes Check the box (if applicable): Indicates business income or rental value coverage exists.
COVERAGE INFORMATION Business Income Or Rental Value Limit Enter limit: The limit applicable to the business income or rental value coverage.
COVERAGE INFORMATION Actual Loss Sustained Checkbox Check the box (if applicable): Indicates the coverage is on an actual loss sustained basis.
COVERAGE INFORMATION Actual Loss Sustained Number Of Months Enter number: The number of months of coverage.
COVERAGE INFORMATION Business Income Or Rental Value -No Check the box (if applicable): Indicates business income or rental value coverage does not exist.
COVERAGE INFORMATION Business Income Or Rental Value -NA Check the box (if applicable): Indicates business income or rental value coverage is not applicable.
COVERAGE INFORMATION Blanket Coverage YES Check the box (if applicable): Indicates blanket coverage exists. As used here, if yes, indicate the value(s) reported on properties identified in the Property Information section.
COVERAGE INFORMATION If YES, Indicate value(s) reported on property identified above Enter amount: The value for each property by the valuation method and the subject of insurance.
COVERAGE INFORMATION Blanket Coverage No Check the box (if applicable): Indicates blanket coverage does not exist.
COVERAGE INFORMATION Blanket Coverage N/A Check the box (if applicable): Indicates blanket coverage is not applicable.
COVERAGE INFORMATION Terrorism Coverage YES Check the box (if applicable): Indicates terrorism coverage exists. As used here, if yes, attach Disclosure Notice / DEC.
COVERAGE INFORMATION Terrorism Coverage No Check the box (if applicable): Indicates terrorism coverage does not exist.
COVERAGE INFORMATION Terrorism Coverage N/A Check the box (if applicable): Indicates terrorism coverage is not applicable.
COVERAGE INFORMATION Is there a terrorism-specific exclusion? Yes Check the box (if applicable): Indicates a terrorism exclusion applies.
COVERAGE INFORMATION Is there a terrorism-specific exclusion? No Check the box (if applicable): Indicates a terrorism exclusion does not exist.
COVERAGE INFORMATION Is there a terrorism-specific exclusion? N/A Check the box (if applicable): Indicates a terrorism exclusion is not applicable.
COVERAGE INFORMATION Is domestic terrorism excluded? Yes Check the box (if applicable): Indicates a domestic terrorism exclusion applies.
COVERAGE INFORMATION Is domestic terrorism excluded? No Check the box (if applicable): Indicates a domestic terrorism exclusion does not exist.
COVERAGE INFORMATION Is domestic terrorism excluded? N/A Check the box (if applicable): Indicates a domestic terrorism exclusion is not applicable.
COVERAGE INFORMATION Limited Fungus Coverage YES Check the box (if applicable): Indicates limited fungus coverage applies. As used here, if yes, indicate the limit for this coverage and the applicable deducible.
COVERAGE INFORMATION Limited Fungus Coverage Limit Enter limit: The limit applicable to limited fungus coverage.
COVERAGE INFORMATION Limited Fungus Coverage Deductible Enter deductible: The deductible applicable to limited fungus coverage.
COVERAGE INFORMATION Limited Fungus Coverage No Check the box (if applicable): Indicates limited fungus coverage does not exist.
COVERAGE INFORMATION Limited Fungus Coverage N/A Check the box (if applicable): Indicates limited fungus coverage is not applicable.
COVERAGE INFORMATION Fungus Exclusion YES Check the box (if applicable): Indicates a fungus exclusion applies. As used here, if yes, indicate the form number, the form data, and the owner (name of organization) of the form.
COVERAGE INFORMATION Form Number Enter identifier: The number used by the insurer for this form.
COVERAGE INFORMATION Form Date Enter date: The edition date of the form.
COVERAGE INFORMATION Name of Organization Enter code: Indicates the entity that has copyright ownership of the form.
COVERAGE INFORMATION Fungus Exclusion No Check the box (if applicable): Indicates a fungus exclusion does not exist.
COVERAGE INFORMATION Fungus Exclusion N/A Check the box (if applicable): Indicates a fungus exclusion is not applicable.
COVERAGE INFORMATION Replacement Cost YES Check the box (if applicable): Indicates replacement cost coverage exists.
COVERAGE INFORMATION Replacement Cost No Check the box (if applicable): Indicates replacement cost coverage does not exist.
COVERAGE INFORMATION Replacement Cost N/A Check the box (if applicable): Indicates replacement cost coverage is not applicable.
COVERAGE INFORMATION Agreed Value YES Check the box (if applicable): Indicates a valuation type of agreed amount exists.
COVERAGE INFORMATION Agreed Value No Check the box (if applicable): Indicates a valuation type of agreed amount that does not exist.
COVERAGE INFORMATION Agreed Value N/A Check the box (if applicable): Indicates a valuation type of agreed amount is not applicable.
COVERAGE INFORMATION Co-insurance YES Check the box (if applicable): Indicates a coinsurance percentage exists. As used here, if yes, indicate percent.
COVERAGE INFORMATION Co-insurance Percent Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed on the amount of coverage.
COVERAGE INFORMATION Co-insurance No Check the box (if applicable): Indicates a coinsurance percentage does not exist.
COVERAGE INFORMATION Co-insurance N/A Check the box (if applicable): Indicates a coinsurance percentage is not applicable.
COVERAGE INFORMATION Equipment Breakdown (If applicable) YES Check the box (if applicable): Indicates equipment breakdown coverage exists. As used here, if yes, indicate the limit for this coverage and the applicable deductible.
COVERAGE INFORMATION Equipment Breakdown Limit Enter limit: The limit applicable to equipment breakdown coverage.
COVERAGE INFORMATION Equipment Breakdown Deductible Enter deductible: The deductible applicable to equipment breakdown coverage.
COVERAGE INFORMATION Equipment Breakdown No Check the box (if applicable): Indicates equipment breakdown coverage does not exist.
COVERAGE INFORMATION Equipment Breakdown N/A Check the box (if applicable): Indicates equipment breakdown coverage is not applicable.
COVERAGE INFORMATION Ordinance or Law – Coverage for the loss to the undamaged portion of building YES Check the box (if applicable): Indicates building ordinance or law undamaged portion of building coverage exists.
COVERAGE INFORMATION Ordinance or Law Coverage to the undamaged portion of building No Check the box (if applicable): Indicates building ordinance or law undamaged portion of building coverage does not exist.
COVERAGE INFORMATION Ordinance or Law Coverage to the undamaged portion of building N/A Check the box (if applicable): Indicates building ordinance or law undamaged portion of building coverage is not applicable.
COVERAGE INFORMATION Ordinance or Law Demolition Costs Yes Check the box (if applicable): Indicates building ordinance or law demolition costs coverage exists. As used here, if yes, indicate the limit for this coverage and the applicable deductible.
COVERAGE INFORMATION Ordinance or Law Demolition Costs Limit Enter limit: The limit applicable to building ordinance or law demolition costs coverage.
COVERAGE INFORMATION Ordinance or Law Demolition Costs Deductible Enter deductible: The deductible applicable to building ordinance or law demolition costs coverage.
COVERAGE INFORMATION Ordinance or Law Demolition Costs No Check the box (if applicable): Indicates building ordinance or law demolition costs coverage does not exist.
COVERAGE INFORMATION Ordinance or Law Demolition Costs N/A Check the box (if applicable): Indicates building ordinance or law demolition costs coverage is not applicable.
COVERAGE INFORMATION Ordinance or Law Increase Cost of Construction Yes Check the box (if applicable): Indicates building ordinance or law increased cost of construction coverage exists. As used here, if yes, indicate the limit for this coverage and the applicable deductible.
COVERAGE INFORMATION Ordinance or Law Increase Cost of Construction Limit Enter limit: The limit applicable to building ordinance or law increased the cost of construction coverage.
COVERAGE INFORMATION Ordinance or Law Increase Cost of Construction Deductible Enter deductible: The deductible applicable to building ordinance or law increased the cost of construction coverage.
COVERAGE INFORMATION Ordinance or Law Increase Cost of Construction No Check the box (if applicable): Indicates building ordinance or law increased construction coverage cost does not exist.
COVERAGE INFORMATION Ordinance or Law Increase Cost of Construction N/A Check the box (if applicable): Indicates building ordinance or law increased construction coverage cost is not applicable.
COVERAGE INFORMATION Earth Movement Yes Check the box (if applicable): Indicates earth movement coverage exists. As used here, if yes, indicate the limit for this coverage and the applicable deductible.
COVERAGE INFORMATION Earth Movement Limit Enter limit: The limit applicable to earth movement coverage.
COVERAGE INFORMATION Earth Movement Deductible Enter deductible: The deductible applicable to earth movement coverage.
COVERAGE INFORMATION Earth Movement No Check the box (if applicable): Indicates earth movement coverage does not exist.
COVERAGE INFORMATION Earth Movement N/A Check the box (if applicable): Indicates earth movement coverage is not applicable.
COVERAGE INFORMATION Flood Yes Check the box (if applicable): Indicates flood coverage exists. As used here, if yes, indicate the limit for this coverage and the applicable deductible.
COVERAGE INFORMATION Flood Limit Enter limit: The limit applicable to flood coverage.
COVERAGE INFORMATION Flood Deductible Enter deductible: The deductible applicable to flood coverage.
COVERAGE INFORMATION Flood No Check the box (if applicable): Indicates flood coverage does not exist.
COVERAGE INFORMATION Flood N/A Check the box (if applicable): Indicates flood coverage is not applicable.
COVERAGE INFORMATION Wind/Hail (If subject to different provisions) YES Check the box (if applicable): Indicates wind/hail coverage exists. As used here, if yes, indicate the limit for this coverage and the applicable deductible.
COVERAGE INFORMATION Wind/Hail If Different Provisions Limit Enter limit: The limit applicable to wind/hail coverage.
COVERAGE INFORMATION Wind/Hail If Different Provisions Deductible Enter deductible: The deductible applicable to wind/hail coverage.
COVERAGE INFORMATION Wind/Hail If Different Provisions No Check the box (if applicable): Indicates wind/hail coverage does not exist.
COVERAGE INFORMATION Wind/Hail If Different Provisions N/A Check the box (if applicable): Indicates wind/hail coverage is not applicable.
COVERAGE INFORMATION Permission to waive subrogation in favor of mortgage holder before loss Yes Check the box (if applicable): Indicates the permission to waive subrogation in favor of mortgage holder before a loss is granted
COVERAGE INFORMATION Permission to waive subrogation in favor of mortgage holder before loss No Check the box (if applicable): Indicates the permission to waive subrogation in favor of mortgage holders before a loss is not granted.
COVERAGE INFORMATION Permission to waive subrogation in favor of mortgage holder before loss N/A Check the box (if applicable): Indicates the permission to waive subrogation in favor of mortgage holders before a loss is not applicable.
COVERAGE INFORMATION Coverage Other Description Enter text: The description of the coverage.
COVERAGE INFORMATION Coverage Other Yes Check the box (if applicable): Indicates the coverage described exists.
COVERAGE INFORMATION Coverage Other No Check the box (if applicable): Indicates the coverage described does not exist.
COVERAGE INFORMATION Coverage Other N/A Check the box (if applicable): Indicates the coverage described is not applicable.
COVERAGE INFORMATION Coverage Other Limit and/or Deductible Text Enter text: The additional information required for the coverage. This may include limits and deductibles.
ADDITIONAL INTEREST Mortgagee Checkbox Check the box (if applicable): Indicates the additional interest type is a mortgagee.
ADDITIONAL INTEREST Lender Loss Payable Checkbox Check the box (if applicable): Indicates the additional interest type is a lenders loss payable.
ADDITIONAL INTEREST Contract of Sale Checkbox Check the box (if applicable): Indicates an additional interest type is a contract of sale.
ADDITIONAL INTEREST Other Checkbox Check the box (if applicable): Indicates the additional interest is not any of the types listed on the form.
ADDITIONAL INTEREST Other Description Enter text: The description of the type of interest in the item.
ADDITIONAL INTEREST Name and Address Enter text: The additional interest’s full name.
ADDITIONAL INTEREST Enter text: The additional interest’s mailing address line one.
ADDITIONAL INTEREST Enter text: The additional interest’s mailing address line two.
ADDITIONAL INTEREST Enter text: The additional interest’s mailing address city name.
ADDITIONAL INTEREST Enter code: The additional interest’s mailing address state or province code.
ADDITIONAL INTEREST Enter code: The additional interest’s mailing address postal code.
ADDITIONAL INTEREST Lender Servicing Agent Name and Address Enter text: The additional interest’s full name. As used here, this is the lender servicing agent.
ADDITIONAL INTEREST Enter text: The additional interest’s mailing address line one. As used here, this is the lender servicing agent.
ADDITIONAL INTEREST Enter text: The additional interest’s mailing address line two. As used here, this is the lender servicing agent.
ADDITIONAL INTEREST Enter text: The additional interest’s mailing address city name. As used here, this is the lender servicing agent.
ADDITIONAL INTEREST Enter code: The additional interest’s mailing address state or province code. As used here, this is the lender servicing agent.
ADDITIONAL INTEREST Enter code: The additional interest’s mailing address postal code. As used here, this is the lender servicing agent.
ADDITIONAL INTEREST Authorized Representative Sign here: Accommodates the authorized representative (e.g., producer, agent, broker, etc.) by all companies to issue Certificates. This is required in most states.
REMARKS REMARKS Enter text: The Evidence Of Commercial Property Insurance general remarks.
Edition Date The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM).

Acord 28 fillable Form PDF



People also ask

1. What is an Acord 101?

Use ACORD 101, Additional Remarks Schedule, as an attachment to any ACORD form when more space is required for additional remarks or comments. IDENTIFICATION SECTION. Agency Customer ID. Customer's identification number assigned by the agency or brokerage.

2. What is an insurance Acord 25?

ACORD 25, Certificate liability Insurance, is “issued as a matter of information only, and confers no rights upon the certificate holder. ... ACORD 25 was designed to collect policy limit information based on the ISO commercial lines program. It addresses both Claims Made and Occurrence policies.

3. What is an Acord 23?

ACORD 23, Automobile Certificate of Insurance, is used to provide a coverage statement concerning physical damage and/or liability insurance coverage to lessors or loss payers of leased vehicles, but only when the insurance policy covering the subject motor vehicle includes an “Additional Insured-Lessor.”

4. What is an Acord 24?

ACORD Insurance Certificates, The ACORD 24 is the property version of the 27-S and is used as evidence that appropriate property coverage is in place. Form 24 might be used by a building tenant required to maintain property coverage on leased premises.

5. What is an Acord 27 form?

ACORD 27 Instructions, ACORD 27 fillable, Evidence of Property Insurance, provides a coverage statement for mortgagees and loss payees who provide mortgages or loans on residential property, personal property, or small commercial properties named in the policy.
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