ACORD 810 Fillable PDF – BUSINESS INCOME / EXTRA EXPENSE / RENTAL VALUE

ACORD 810 (2011/10)

BUSINESS INCOME / EXTRA EXPENSE / RENTAL VALUE

Form Number:

ACORD 810 (2011/10)

Category:

Commercial Property Insurance

Last Updated:

October 2011

Page Count:

02 pages

File Format:

PDF, Fillable PDF

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ACORD 810

The Acord 810 form serves as an essential supplement to the Acord 140 (Property Section), used by insurers to document and request detailed coverage related to business income, extra expense, and rental value exposures. Additionally, this form lets agents and brokers present detailed information related to each covered premise, helping underwriters assess specific risks, evaluate exposure, and tailor the policy accordingly. If you’re a broker, agent, or policyholder looking to complete this form, you can fill it out online or download a printable version from the AcordForm.net

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Benefits of Acord 810 Fillable

Premises-Specific Coverage Details

The Acord 810 lets insurance companies evaluate business income and extra expense exposures by each premises and building, helping them in precise underwriting.

Ordinary Payroll Handling

The applicants can select whether to include or exclude ordinary payroll in the event of a loss. Additionally, this form allows for fixed exclusion periods or amounts, helping to ensure suitable coverage for the insured’s payroll practices.

Restoration and Indemnity Periods

The form contains specific fields to state the number of days for indemnity extensions, ordinary payroll exclusion, and restoration periods. It provides clarity on loss recovery timeframes.

Legal Compliance Warnings

The form includes legally required fraud notices for various states, ensuring compliance with jurisdictional regulations.

Key Sections of Acord 810 PDF

Policy Information

This section includes the carrier name, NAIC code, policy number, agency name, insured name, and effective date.

Coverage Type(s)

It describes the coverage types, such as business income without extra expense, extra expense only, business income with rental value, or rental value only.

Premises and Building Information

The section identifies the specific premises and buildings being covered.

Coverage Limits and Periods

It describes the ordinary payroll, restoration period, extended indemnity period, monthly or maximum period limits, deductibles, and coinsurance percentages.

Optional Endorsements

It includes civil authority, ordinance or law, EDP, dependent property, and off-premises utility coverages, such as power, water, or communications.

Dependent Property Locations

The section provided additional space to name and address external sites.

Additional Remarks

This is the last section of the form, which provides extra space for any custom coverage or rating data.

How To Complete The Acord 810 Business Income Form/Worksheet?

  1. Download the Form: Download the form or fill it out online.
  2. Policy & Agency Information: Start with the policy and agency information, including the effective date of the policy, the carrier name, NAIC code, policy number, applicant name, agency name, customer ID, etc.
  3. Choose Applicable Coverage Type: Use checkboxes to mark which coverage applies for each covered premises, location, or building that applies business income, extra expense, rental value, and combinations as needed.
  4. Premises and Building Identification: List each covered building, including premises number and building number.
  5. Coverage Options and Limits: Complete all relevant sections, including ordinary payroll, coinsurance percentage, monthly or maximum indemnity period limits, deductible amounts, period of restoration, and power/heat deductibles.
  6. Optional Coverage: Check applicable boxes and fill in values where needed, such as off-premises power, civil authority, building ordinance or law, tuition fee, dependent property coverage, and electronic data processing (EDP).
  7. Additional Information: Use the blank space given at the end of the Acord 810 form to add special rating conditions or endorsements and provide class rate, rate reference, sales, or any custom coverage not already mentioned.
  8. Review and Attach: Make sure that all fields are completed accurately. Once done, attach the document with the Acord 140.
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Frequently Asked Questions

Of course, if the business has multiple premises or locations, you must describe each location and building separately to ensure accurate coverage.

The form is a supplement to the Acord 140 “Property Section” form, used to provide insurers detailed information related to business income, extra expense, and rental value information to support business insurance coverage decisions. It ensures that coverage selections are accurately reflected and appropriately underwritten.

The form allows you to choose whether to include or exclude Ordinary Payroll. If the payroll is excluded, you can specify a payroll duration for 90 or 180 days, or indicate a specific amount to be excluded from coverage.

Coinsurance represents the percentage of the coverage related to the total insurable value. If it is still underinsured, the insured may share in the loss.

Many insurers accept a fillable PDF version submitted through email or AMS (Agency Management System).

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