ACORD 175 (2016/03) Filllable PDF – Commercial Policy Change Request

ACORD 175 (2016/03)

COMMERCIAL POLICY CHANGE REQUEST

Form Number:

ACORD 175 (2016/03)

Category:

Commercial Lines

Last Updated:

March 2016

Page Count:

02 Pages

File Format:

PDF, Fillable PDF

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ACORD 175

Business that often need to update their insurance policies when operational changes, new risks arises, or adjusted coverage requirements. The Acord 175 form is an official document for requesting modifications in commercial insurance policies, ensuring clear communication between you, agents, and carriers. Completing the form correctly helps avoid delays, reduces errors, and ensures requested updates are documented and processed accurately. If you’re looking to adjust your commercial coverage, fill out the form today and submit it through your insurance agent for easier handling.

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Benefits of Acord 175 Change Request

Standardized Change Request

Instead of filling and submitting multiple documents or emails for different coverage updates, the Acord 175 form lets all commercial policy changes be submitted on a single and standard document, eliminating miscommunications and ensuring every change is documented accurately.

Easier Add, Change, and Delete Process

The Acord 175 form has a structured, clear, and singular action choice, such as add, change, and delete, preventing conflicts within the same section. Additionally, it helps insurers process changes without delays.

Detailed Data Collection

It has dedicated fields for construction type, classification codes, distance to fire stations, VINs, and scheduled equipment, allowing underwriters to assess risks accurately and avoid premium miscalculations.

Key Sections of Acord 175 Fillable PDF

Policy & Insured Information

This section gathers insurance-related details, such as policy number, effective dates, agency phone number, fax number, agency customer ID, insured name, etc.

Premises Section

It contains location and building number, construction type, complete address, protection class, and so on.

Inland Marine – Scheduled Equipment

This section specifies the item manufacturer, model, year, make, serial number, and insured value.

Automobile Section

It collects vehicle information, coverage symbols, deductibles, and usage classification.

Driver Information

Specifies each driver’s details, including their name, address, license number, years of experience, and maps drivers to specific vehicles.

Worker’s Compensation

The section specifies class codes, locations, and estimated payroll figures.

General and Umbrella Liability

These two sections describe the limits schedule of hazards, premium basis codes, mortgagee, lienholder, or loss payee for specific insured items.

Signature

The last section of the Acord 175 fillable form requires the signatures of both the insured and the producer.

How To Complete the Commercial Policy Change Request Form?

  1. Policy Information: Describe the policy information, including the insurer’s name, NAIC code, policy number, effective date of the change, and the insured’s contact details.
  2. Choose The Change Type: Select any one check box to add, change, or delete the policy type.
  3. Premises Details: Specify the location number and building number, including address, construction class, protection class, and distance to fire station or hydrant.
  4. Nature of Business: Describe the primary operations conducted at the listed premises, including the type of goods, offered services, or performed processes.
  5. Auto-Vehicle Description / Limits: Write vehicle number, year, make, model, body type, VIN, usage type, radius of operation, applicable coverage symbol for liability. For deleted vehicles, only add year, make, model, etc.
  6. Driver Information: List each driver, including their name, date of birth, driver’s license number, and years of driving experience.
  7. Worker Compensation Rating Information: List the class code for each job category, location, state where the work is performed, and estimated annual remuneration.
  8. Property/Inland Marine – Premises Information: Write the building or location number, protection class, valuation method, causes of loss, deductible amount, inflation guard percentage, and endorsements.
  9. Inland Marine – Scheduled Equipment: Provide item number, type, manufacturer, model, capacity, ID/serial number, condition, and insured value of each item.
  10. General Liability: Enter the retained limit and umbrella coverage limits.
  11. Additional Interests: Specify the type of interest, such as mortgagee, loss payee, lienholder, or additional insured.
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Frequently Asked Questions

Acord 175 form only allows you to change the amount of existing general liability limits on the policy. If you need to add a new type of coverage or a limit that is not listed, you must go through a different request process.

These are the three possible actions you can request. Add means request for adding a new item, change means modify any specific item, and delete means remove coverage items that are no longer needed.

The form is designed to submit changes for a single policy at a time. If you need to make multiple changes, you must complete and submit a separate form.

The form is officially known as the “Commercial Policy Change Request”. It is used to request changes to existing commercial insurance policies, allowing agents, brokers, and insureds to formally document changes, ensuring accurate documentation of updates.

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