ACORD 125 & 126 — CGL Intake Form

Instructions

This intake form collects all information needed to complete ACORD 125 (Commercial Insurance Application) and ACORD 126 (Commercial General Liability Section) for three LLC entities affiliated with a nonprofit community development organization.

Complete the Nonprofit Parent tab first — that information applies to all three LLC policies. Then complete each LLC tab. When finished, click Submit via Email to send a formatted summary to your agent. Required fields are marked *.

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Nonprofit Identity

ACORD 125 — Applicant Section

Legal name of nonprofit (exactly as registered with state) * Must match state registration exactly — including punctuation and legal suffix (Inc., Corp., etc.)

EIN / FEIN *

IRS 501(c) designation *

State of incorporation *

Date incorporated *

Mailing address *

Primary contact name *

Title / role

Phone *

Email *

Website

Total number of LLCs under nonprofit

Number of employees (nonprofit staff only)

Annual payroll (nonprofit only, approx.)

Annual revenue / operating budget

Describe the nonprofit's mission and primary activities * Be specific. Underwriters use this to assign ISO classification codes. Mention housing, property management, construction oversight, community programs, funding sources (HUD, LIHTC, etc.) if applicable.

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Nonprofit Loss History — 5 Years

ACORD 125 — Loss History Section

Year	Carrier / Policy #	Premium Paid	Losses Incurred	Description (if any loss)

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Additional Insured Designation

ACORD 126 — Additional Interests / Endorsement

Exact name for Additional Insured endorsement * This must match the nonprofit's registered legal name precisely. It will appear on each LLC's certificate of insurance.

Relationship to each LLC *

AI endorsement type requested

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LLC Identity

ACORD 125 — Applicant Section

Legal name of LLC *Must match articles of incorporation exactly.

EIN / FEIN *

State of formation *

Date LLC formed *From articles of incorporation

DBA (if any)

Managing member name *

Managing member title

Principal mailing address *

Contact phone *

Contact email

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Premises & Property

ACORD 125 — Premises Section

Primary property address *

Building construction type

Year built

Total square footage

Number of residential units

Occupancy type *

Does LLC own the building? *

Yes No — leased Managed only

Additional locations (if any)

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Operations & ISO Classification

ACORD 125 — Nature of Business + ACORD 126 — Schedule of Hazards

Describe this LLC's specific operations *

Primary ISO GL class code *60010=Apartments, 47052=Property Managed

Premium basis

Estimated annual exposure

Annual gross receipts *

Number of employees

Annual payroll

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CGL Limits Requested

ACORD 126 — Limits of Insurance

Each occurrence *

General aggregate *

Products/completed ops aggregate

Personal & advertising injury

Damage to rented premises

Medical expense (per person)

Deductible

Policy type *

Occurrence Claims-made

Requested effective date

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Loss History — 5 Years

ACORD 125 — Loss History Section

Year	Carrier / Policy #	Premium Paid	Losses Incurred	Description

Prior insurance currently in force?

Yes No — newly formed / no prior

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Additional Interests & Remarks

ACORD 126 — Additional Interests + ACORD 125 Remarks

Additional insured #1 — Nonprofit parent

Other additional insureds (lenders, city agencies, etc.)

Remarks for underwriter *

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LLC Identity

ACORD 125 — Applicant Section

Legal name of LLC *

EIN / FEIN *

State of formation *

Date LLC formed *

DBA (if any)

Managing member name *

Managing member title

Principal mailing address *

Contact phone *

Contact email

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Premises & Property

ACORD 125 — Premises Section

Primary property address *

Building construction type

Year built

Total square footage

Number of residential units

Occupancy type *

Does LLC own the building? *

Yes No — leased Managed only

Additional locations (if any)

📝

Operations & ISO Classification

ACORD 125 — Nature of Business + ACORD 126 — Schedule of Hazards

Describe this LLC's specific operations *

Primary ISO GL class code *

Premium basis

Estimated annual exposure

Annual gross receipts *

Number of employees

Annual payroll

🛡

CGL Limits Requested

ACORD 126 — Limits of Insurance

Each occurrence *

General aggregate *

Products/completed ops aggregate

Personal & advertising injury

Damage to rented premises

Medical expense (per person)

Deductible

Policy type *

Occurrence Claims-made

Requested effective date

📅

Loss History — 5 Years

ACORD 125 — Loss History Section

Year	Carrier / Policy #	Premium Paid	Losses Incurred	Description

Prior insurance currently in force?

Yes No — newly formed / no prior

➕

Additional Interests & Remarks

ACORD 126 — Additional Interests + ACORD 125 Remarks

Additional insured #1 — Nonprofit parent

Other additional insureds

Remarks for underwriter *

🏢

LLC Identity

ACORD 125 — Applicant Section

Legal name of LLC *

EIN / FEIN *

State of formation *

Date LLC formed *

DBA (if any)

Managing member name *

Managing member title

Principal mailing address *

Contact phone *

Contact email

📍

Premises & Property

ACORD 125 — Premises Section

Primary property address *

Building construction type

Year built

Total square footage

Number of residential units

Occupancy type *

Does LLC own the building? *

Yes No — leased Managed only

Additional locations (if any)

📝

Operations & ISO Classification

ACORD 125 — Nature of Business + ACORD 126 — Schedule of Hazards

Describe this LLC's specific operations *

Primary ISO GL class code *

Premium basis

Estimated annual exposure

Annual gross receipts *

Number of employees

Annual payroll

🛡

CGL Limits Requested

ACORD 126 — Limits of Insurance

Each occurrence *

General aggregate *

Products/completed ops aggregate

Personal & advertising injury

Damage to rented premises

Medical expense (per person)

Deductible

Policy type *

Occurrence Claims-made

Requested effective date

📅

Loss History — 5 Years

ACORD 125 — Loss History Section

Year	Carrier / Policy #	Premium Paid	Losses Incurred	Description

Prior insurance currently in force?

Yes No — newly formed / no prior

➕

Additional Interests & Remarks

ACORD 126 — Additional Interests + ACORD 125 Remarks

Additional insured #1 — Nonprofit parent

Other additional insureds

Remarks for underwriter *

ACORD 125 & 126 — CGL Intake
Complete all four tabs then submit to your agent

Instructions

Nonprofit Identity

Nonprofit Loss History — 5 Years

Additional Insured Designation

LLC Identity

Premises & Property

Operations & ISO Classification

CGL Limits Requested

Operations Questions

Loss History — 5 Years

Additional Interests & Remarks

LLC Identity

Premises & Property

Operations & ISO Classification

CGL Limits Requested

Operations Questions

Loss History — 5 Years

Additional Interests & Remarks

LLC Identity

Premises & Property

Operations & ISO Classification

CGL Limits Requested

Operations Questions

Loss History — 5 Years

Additional Interests & Remarks

Instructions

Nonprofit Identity

Nonprofit Loss History — 5 Years

Additional Insured Designation

LLC Identity

Premises & Property

Operations & ISO Classification

CGL Limits Requested

Operations Questions

Loss History — 5 Years

Additional Interests & Remarks

LLC Identity

Premises & Property

Operations & ISO Classification

CGL Limits Requested

Operations Questions

Loss History — 5 Years

Additional Interests & Remarks

LLC Identity

Premises & Property

Operations & ISO Classification

CGL Limits Requested

Operations Questions

Loss History — 5 Years

Additional Interests & Remarks

Submit to Agent via Email