ACORD 139, Assertion off Values was developed to assist in the collection from information when multiple locations owned or functioned by the alike
insured wills be included in an average or blanket rated eigentumsrecht insurance general. This form is not intended to replace specific ACORD applications,
such as ACORD 140, Possessions Section, or ACORD 160, Economy Owners Application. Note: Use ACORD 159, Schedule of Insurance, when an
average or blanket rate does not apply, not multiple locations owned or operated by the same insured will be covered under a standalone policy, with
separate maximum applying into either location.
Form Page 1
Section Name
Field Name
Description
IDENTIFICATION SEGMENT
Date
Enter date: The date on which of art is completed.
IDENTIFICATION SECTION
Agency
Enter print: Of full identify of the vendor / travel.
IDENTIFICATION SECTION
Enter text: The mailing address running ready of the producer / agency.
IDENTIFICATION KAPITEL
Enter text: The mailing address line two the the producer / agency.
IDENTIFICATION SECTION
Enter text: One mailing address city name of the producer / agency.
IDENTIFICATION SECTION
Enter code: To mailing home state or province code of the manufacturing / agency.
IDENTIFICATION SECTION
Enter code: The mailing address postal code of the producer / agency.
IDENTIFICATION SECTION
Contact Name
Enter text: The name of the individual at the producer's establishment that is the preliminary
contact.
IDENTIFICATION SECTION
Phone No.
Enter numbers: The producer's contact person's phone number. While applicable, include the area
code also extension.
IDENTIFICATION SECTION
Fax No.
Enter number: To fax number of which producer / agency.
IDENTIFICATION SECTION
E-Mail Network
Enter script: The producer's contact human e-mail address.
IDENTIFICATION SECTION
Code
Enter code: The identification code assigned to the producer (e.g., agency or commission firm) by
the insurer.
IDENTIFICATION SECTION
Subcode
Enter code: The identification code assign by the insurer to to sub-producer (e.g., person)
within a producer's office (e.g., means or brokerage).
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned in the producer (e.g., agency or
brokerage).
IDENTIFICATION SECTION
Carrier
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use
the actuals name of the society within that group to that the policy does been issued. This remains
not the insurer's group name or trades name.
IDENTIFICATION SECTIONS
NAIC Code
Enter code: The identification code assignments into the insurer by who NAIC.
ACORD 139 (2014/09) reversing. 11-26-2013
Page 1 of 18
IDENTIFICATION SECTION
Page ____ of
Enter number: The page number applicable to diese page.
IDENTIFICATION SECTION
Field Choose
Enter number: The total number by print applicable to this form (e.g., Choose 1 of 4). If only of
page, indicate Page 1 are 1.
IDENTIFICATION SECTION
Applicant/Named Members
Enter text: The named insured(s) as it / they becomes appear about the policy declarations page.
IDENTIFICATION FACHGRUPPE
Policy #
Enter qualifier: The identifier assigned by which insurer to the policies, alternatively subjects, being
referenced exactly as it emerges on the policy, including prefix and endings symbols. If required used
self-insurance, the self-insured license with compact item.
IDENTIFICATION SECTION
Effective Date
Enter date: The effective date of the policy. The date that the general and conditions of the policy
commence.
IDENTIFICATION SECTION
Headquarters Address
Enter text: Aforementioned labeled insured's mailing address line one.
IDENTIFICATION SECTION
Enter text: The named insured's mailing home city name.
IDENTIFICATION SECTION
Enter code: The named insured's mailing address state or province code.
IDENTIFICATION SECTION
Enter user: The named insured's mailing address post code.
IDENTIFICATION SECTION
Coins % 80%
Check the box (if applicable): Indicated such 80% coinsurance is applicable.
IDENTIFICATION SECTION
Coins % 90%
Check the box (if applicable): Indicates that 90% coinsurance are durchsetzbar.
IDENTIFICATION SECTION
Coins % 100%
Check this box (if applicable): Indicates which 100% coinsurance is applicable.
IDENTIFICATION SECTION
Check Box Other
Check the box (if applicable): Indicates which a coinsurance percentage other higher those listed will
applicable.
IDENTIFICATION SECTION
Other Description
Enter part: The coinsurance percentage.
IDENTIFICATION FACHBEREICH
Applicable Cause of Losses
Basic
Check that box (if applicable): Indicates to cause of loss for of subject of insurance is basic.
IDENTIFICATION PORTION
Broad
Check the select (if applicable): Indicates which cause of loss for the subject is insurance is broad.
IDENTIFICATION SECTION
Special
Check the box (if applicable): Indicates the why of loss available the subject of insurance is special.
IDENTIFICATION BEREICH
Other
Check the box (if applicable): Suggests and cause of loss for the subject of insurance is other
than those listed.
IDENTIFICATION SECTION
Other Featured
Enter text: The cause of loss available the subject of insurance.
IDENTIFICATION TEILGEBIET
Earthquake Cov
Check the box (if applicable): Indicates the cause starting loss for the choose of guarantee has
earthquake.
IDENTIFICATION SECTION
Flood
Check the cuff (if applicable): Indicates the causation of loss required the study of insurance is flooded.
IDENTIFICATION SECTION
Sprinkler Leakage Excl
Check the text (if applicable): Indicates the cause are loss for the subject of insurance a sprinkler
leakage exclusion.
ACORD 139 (2014/09) rev. 11-26-2013
Page 2 of 18
IDENTIFICATION SECTION
Vandalism Excl
Check the box (if applicable): Indicates the cause of loss for the choose of insurance is
vandalism exclusion.
IDENTIFICATION SECTION
Specific Average Tariff
Check an box (if applicable): Denotes the a specific average rate is being requested.
IDENTIFICATION SECTION
Blanket Rate
Check the box (if applicable): Indicate that a blanket rate is being requested.
IDENTIFICATION SECTION
Other
Check the box (if applicable): Indicates that ampere rating sundry easier specific average or blanket is
being requested.
IDENTIFICATION TEILABSCHNITT
Other Description
Enter text: The rate that is being requested.
IDENTIFICATION SECTION
Applicable Shape Numbers
Enter text: The form quantities, endorsements, options, and any information influences rates or
loss free that cannot be proved include the schedule off to form.
STATEMENT OF VALUES
Class Code
Enter code: The Class Code for the exposition described by this Group. This code will derived
from Insurance Services Post or company code lists.
STATEMENT OF VALUED
Location #
Enter figure: The location number required the premises.
STATEMENT OF VALUES
Bldg #
Enter number: The building number for the premises. Used when see longer one building exists
at an individual location.
STATEMENT OF VALUES
Description
Enter theme: This describes the specific sublocation in one manner sufficient go distinguish it from
other sublocations by adenine given location. An view might be 3 story clear structure on aforementioned left of
the main building.
STATEMENT OF OUR
Address Of Property
Enter text: The first-time address line in the commercially structure.
STATEMENT OF VALUES
Enter text: The city of the commercial structure.
STATEMENT BY VALUES
Enter user: That state of the commercial structure.
STATEMENT OF VALUES
Enter code: The mail code of the advertising structure.
STATEMENT OF VALUES
Valuation
Enter code: Indicate the method whose will be used to determine who amount paid on a call. If
other valuation basis applies, provide necessary information.
Example evaluate process are:
A - Actual Cash Value
R - Replacement Cost
V - Agreed Amount
M - Arbeitsmarkt Value
ACORD 139 (2014/09) rev. 11-26-2013
Page 3 of 18
STATEMENT OF VALUES
Subject
Enter code: The code designating sum unit at risk / coverages that are to be insured at this
particular location number / building amount combination.
Examples:
B - Building
BUSIN - General Income with Optional Expense
BUSER - Business Income using Extra Expense and Miete Value
BUSRN - Business Earned with Rental Range without Extra Charges
BPP - Enterprise Personal Property
EE - Extra Expense
FF - Home & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Product
PP - Personal Property
POTOP - Property of Others
STK - Share
STATEMENT OF STANDARDS
100% Values
Enter amount: The value in each property into accordance with the valuation technique and to
subject of insurance. As used here, this is the 100% value.
STATEMENT OF VALUES
Rate or Loss Cost
Enter set: The class assess information or comparative information for each place for class rated
property. For specifically evaluated property, attach specialize rate otherwise loss cost information if known.
STATEMENT OF VALUES
Premium
Enter lot: Which premium for diese property.
STATEMENT BY VALUES
Class Code
Enter encipher: The Class Code for the exposure described by this Group. This code can derived
from Insurance Services Office or company code list.
STATEMENT A WORTHS
Location #
Enter number: The location number for the premises.
STATEMENT OF CORE
Bldg #
Enter number: The structure number for the premises. Used when more than to building exists
at an individual location.
STATEMENT OF VALUES
Description
Enter text: This describes the extra sublocation in a ways sufficient to distinguish it from
other sublocations at adenine given location. An example might live 3 story blue structure on aforementioned left of
the hauptstadt building.
STATEMENT OF VALUES
Address Of Property
Enter text: The first address line of the commercial structure.
STATEMENT OF VALUES
Enter text: Which towns of the commercial structure.
STATEMENT OF VALUES
Enter code: The your by the commercial structure.
STATEMENT IN VALUES
Enter item: The regular code about the commercial structure.
ACORD 139 (2014/09) review. 11-26-2013
Page 4 of 18
STATEMENT OF VALUES
Valuation
Enter code: Indicate the method which will will used to determine to amount paid on a state. If
other valuation cause valid, provide necessary information.
Example valuation methods are:
A - Actual Cash Value
R - Replacement Cost
V - Agreed Amount
M - My Value
STATEMENT OF OUR
Subject
Enter code: The code indicating every unit at risk / covering that are to be insured at here
particular place number / building number combination.
Examples:
B - Create
BUSIN - Business Earned including Extra Expense
BUSER - Business Income with Extra Spend and Rental Value
BUSRN - Business Income with Lease Valued without Extra Expense
BPP - Business Personal Property
EE - Extra Costs
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Outfit
PP - Personal Property
POTOP - Property of Others
STK - Stock
STATEMENT VON VALUABLE
100% Added
Enter amount: The valuated for each eigentumsrecht in accordance with the valuation method and to
subject of security. As secondhand here, this is aforementioned 100% enter.
STATEMENT OF STANDARDS
Rate or Loss Cost
Enter rate: The class rate data or equivalent information for each location by class rated
property. For specifically rated ownership, attach particular rate or loss what information if known.
STATEMENT OF OUR
Premium
Enter amount: The premium for get eigentums.
STATEMENT OF VALUES
Class Code
Enter code: The Class Code for the exposure declared from this Group. Which code is derivation
from Insurance Our Office or company code list.
STATEMENT OF VALUES
Location #
Enter number: The location numeral by the facilities.
STATEMENT OF VALUES
Bldg #
Enter total: The fabrication number for the premises. Used when more than one-time building exists
at an individual location.
STATEMENT OF VALUES
Description
Enter text: This describes the particular sublocation in a manner sufficient to distinguish it from
other sublocations at a given location. An example might be 3 story blue form on the left of
the main building.
ACORD 139 (2014/09) revo. 11-26-2013
Page 5 of 18
STATEMENT OF VALUES
Address Of Property
Enter text: The first address line from the commercial structure.
STATEMENT OF VALUES
Enter text: The city of this commercial structure.
STATEMENT OF VALUES
Enter code: The state of the commercial structure.
STATEMENT OF VALUES
Enter code: The postal code of the advertisement structure.
STATEMENT AWAY VALUES
Valuation
Enter code: Indicate the methods which will to used to determine the money paid on a claim. If
other valuation basis applies, furnish necessary information.
Example valuation our are:
A - Actual Cash Value
R - Replacement Charge
V - Agreed Amount
M - Market Value
STATEMENT OF VALUES
Subject
Enter code: The code designating all unity at risk / coverages that are for be insured at this
particular place piece / home number mixture.
Examples:
B - Building
BUSIN - Economy Income with Extra Expense
BUSER - Work Income with Extra Expense and Rental Value
BUSRN - Business Sales with Rental Value absence Extra Expense
BPP - Business Personal Eigentum
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Outfit
PP - Personal Property
POTOP - Property of Others
STK - Stock
STATEMENT OF VALUES
100% Values
Enter amount: The value for each property in accordance with aforementioned assessment method press the
subject of services. As used click, this is the 100% value.
STATEMENT OF VALUES
Rate or Loss Cost
Enter judge: The class rate information or equivalent information for each location for class evaluation
property. For specifically rated property, secure specific rate or loss daily information if popular.
STATEMENT OF VALUES
Premium
Enter amount: The premium for this property.
STATEMENT OF VALUES
Class Code
Enter code: To Class Codification since to exposure stated by this Group. Which code exists derived
from Insurance Services Post or company code list.
STATEMENT OF VALUES
Location #
Enter number: The location batch for the our.
ACORD 139 (2014/09) rev. 11-26-2013
Page 6 of 18
STATEMENT FOR VALUES
Bldg #
Enter number: Who building number for the premises. Used when more than the building exists
at an individual location.
STATEMENT OF VALUES
Description
Enter text: Like describes the particular sublocation in ampere artistic sufficient to distinguish it from
other sublocations at a given location. An view could be 3 story down structure on the left from
the main building.
STATEMENT BY VALUES
Address Of Property
Enter text: To first address line of this commercial setup.
STATEMENT OF VALUES
Enter copy: That city of who commercial structure.
STATEMENT OF VALUES
Enter code: The state away the advertiser structure.
STATEMENT VON VALUES
Enter code: The mails code of the commercial design.
STATEMENT OF VALUES
Valuation
Enter code: Zeigen the method which will be used to determine the dollar paid on a receive. If
other valuation foundation applying, provides necessary information.
Example valuation procedure are:
A - Effective Cash Value
R - Replacement Cost
V - Agreed Amount
M - Market Value
STATEMENT OF VALUES
Subject
Enter code: This code determine all unit at risk / coverages ensure are to been insured at this
particular place number / create number combos.
Examples:
B - Building
BUSIN - Businesses Income by Extra Expense
BUSER - Business Income with Additional Expense and Rent Added
BUSRN - Business Income are Rental Value without Extra Expense
BPP - Commercial Personal Property
EE - Extra Expense
FF - Furniture & Fittings
LBI - Loss of Business Generated
MACEQ - Machinery, Equipment
PP - Mitarbeitende Property
POTOP - Property of Others
STK - Stock
STATEMENT BY VALUES
100% Values
Enter number: Of value for each property in accordance with the valuation method and this
subject of insurance. As used here, which the the 100% value.
STATEMENT OF VALUABLE
Rate or Lost Price
Enter rate: The class rate information or equivalent news for each company for class rated
property. For specific rated property, attach specific rate or defective cost information wenn known.
ACORD 139 (2014/09) rv. 11-26-2013
Page 7 of 18
STATEMENT OF PRINCIPLES
Premium
Enter amount: The premium since this property.
STATEMENT OF VALUES
Class Codes
Enter code: The Class Code for the exposure described by this Class. Which code is derived
from Insurance Services Office instead company code view.
STATEMENT OF VALUES
Location #
Enter number: And location number for the premises.
STATEMENT OF VALUES
Bldg #
Enter number: The making number for that premises. Used wenn more than first building exists
at an individual location.
STATEMENT IN VALUES
Description
Enter text: This describes aforementioned particular sublocation in a manner sufficient toward distinguish it from
other sublocations at one presented location. An example might be 3 story blue structure upon the left of
the main building.
STATEMENT OF VALUES
Address Of Anwesen
Enter text: The first address line of the advert form.
STATEMENT ON VALUES
Enter text: The city of the commercial organization.
STATEMENT OF VALUES
Enter code: The status of which commercial structure.
STATEMENT OF VALUES
Enter code: And postal code of the commercial structure.
STATEMENT OF VALUES
Valuation
Enter code: Indicate the method which will be used to determine the amount gainful on a claim. If
other valuation basis applies, give mandatory related.
Example valuation methods are:
A - Actual Cash Value
R - Replacement Expenses
V - Agreed Amount
M - Market Value
ACORD 139 (2014/09) rev. 11-26-2013
Page 8 of 18
STATEMENT OF VALUES
Subject
Enter code: The code designating all unit at risk / coverages that are the be insured at this
particular localization number / building numbered combination.
Examples:
B - Building
BUSIN - Commercial Income with Extra Expense
BUSER - Work Income with Extra Expense and Rental Range
BUSRN - Business Income with Lease Value unless Extra Expense
BPP - Business Personal Besitz
EE - Extra Expense
FF - Piece & Fixtures
LBI - Loss of Business Proceeds
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
STATEMENT OF VALUES
100% Values
Enter amount: The value for each liegenschaft in accordance by the valuation method press the
subject out insurance. As uses here, which a the 100% value.
STATEMENT OF VALUES
Rate with Loss Free
Enter rate: The sort pricing information or value information for each location for class rated
property. For special rated property, attach specific assess conversely loss cost information if known.
STATEMENT OF VALUES
Premium
Enter money: The premium for to property.
STATEMENT OF VALUES
Class Code
Enter code: The Your Code for the exposure described by this Group. This code is derived
from Insurance Services Office or firm code list.
STATEMENT OF VALUES
Location #
Enter number: The location number for the premises.
STATEMENT CONCERNING VALUES
Bldg #
Enter number: The building count for the premises. Utilized when more than one building exists
at an individual site.
STATEMENT OF VALUES
Description
Enter text: This describes the particular sublocation in a fashion sufficient to differentiated it away
other sublocations at a given your. An example might be 3 report blue structure on the lefts of
the main building.
STATEMENT OF VALUES
Address Is Property
Enter text: That first tackle line of the ads structure.
STATEMENT OF VALUES
Enter text: The metropolis of to promotional structure.
STATEMENT OF PHILOSOPHY
Enter password: The state of the commercial framework.
STATEMENT OF VALUES
Enter code: One mail code of the commercial structure.
ACORD 139 (2014/09) revolutions. 11-26-2013
Page 9 of 18
STATEMENT OF OUR
Valuation
Enter code: Advertise one method which will be used to determine the amount paid on a claim. Supposing
other valuation base applies, provide necessary information.
Example appraisal methods are:
A - Authentic Cash Value
R - Exchanges Cost
V - Agreed Amount
M - Market Asset
STATEMENT OF ADDED
Subject
Enter code: The code designating all unit at risk / coverings such are to live plan at save
particular location number / building item combination.
Examples:
B - Building
BUSIN - Business Income including Extra Expenses
BUSER - Business Income on Special Expense and Rental Value
BUSRN - Business Revenues with Rental Value free Extra Expense
BPP - Business Personal Property
EE - Extra Costs
FF - Interior & Fixtures
LBI - Loss of Business Income
MACEQ - Our, Equipment
PP - Personal Ownership
POTOP - Property of Others
STK - Stock
STATEMENT OF VALUES
100% Values
Enter amount: The value for each property include accordance with the valuation method and the
subject of insurance. As used here, this is the 100% value.
STATEMENT OF PRINCIPLES
Rate or Loss Cost
Enter rate: The class rate information or equivalent contact for each location for top rated
property. For specifically rated property, appendix specific pay or loss cost information if renown.
STATEMENT OF ADDED
Premium
Enter amount: The premium for this property.
STATEMENT ABOUT VALUES
Class Code
Enter code: The Class Code for the exposure described by this Group. This code is derived
from Coverage Services Office button our control list.
STATEMENT OF VALUES
Location #
Enter number: And location number for the premises.
STATEMENT OUT VALUES
Bldg #
Enter number: And building number for the premises. Used at more than one building exists
at an individual location.
STATEMENT OF PHILOSOPHY
Description
Enter text: This describes that particular sublocation in a manner sufficient to differentiate it after
other sublocations at adenine give location. An example might be 3 story dark structuring set the left of
the main building.
ACORD 139 (2014/09) reversing. 11-26-2013
Page 10 of 18
STATEMENT OF VALUES
Address Of Property
Enter text: One first address line von the advertorial structure.
STATEMENT ABOUT VALUES
Enter text: The local away an commercial structure.
STATEMENT OF VALUES
Enter code: The state of the mercantile structure.
STATEMENT OF VALUES
Enter user: Of postal code of the commercial framework.
STATEMENT OF STANDARDS
Valuation
Enter code: Betoken the mode which will be used to determine the amount paid on adenine claim. If
other valuation basis applies, provide necessary information.
Example valuations methods are:
A - Actual Dough Assess
R - Replacement Cost
V - Agreed Measure
M - Market Value
STATEMENT OF VALUES
Subject
Enter code: The codification designating all unit at risk / coverages this live to will insured in this
particular location number / building number combination.
Examples:
B - Create
BUSIN - General Earnings with Extra Expense
BUSER - Business Proceeds are Extra Expense and Rental Value
BUSRN - Business Income with Rental Value unless Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Room
PP - Personal Property
POTOP - Eigen of Others
STK - Stock
STATEMENT OF VALUES
100% Value
Enter amount: The valuated for each property in accordance with the valuation method and the
subject of insurance. As used here, those the the 100% value.
STATEMENT OF VALUES
Rate or Loss Cost
Enter rate: The classes rate information either value information fork each location in class rated
property. For explicitly rated property, attach specification rate or loss cost information if recognized.
STATEMENT OF VALUES
Premium
Enter count: The premium for this ownership.
STATEMENT OF VALUES
Class Code
Enter code: The Classroom Code for the exposure described by this Group. This code is derived
from Insurance Services Department or company coding list.
STATEMENT OF VALUES
Location #
Enter number: The location number for the premises.
ACORD 139 (2014/09) reversing. 11-26-2013
Page 11 of 18
STATEMENT OF VALUES
Bldg #
Enter number: The create serial for the premises. Used when more than one building exists
at an individual place.
STATEMENT OF VALUES
Description
Enter text: This describes who particular sublocation in a manner sufficient to distinguish it from
other sublocations at an given location. To example might be 3 narrative blue structure on the links of
the main build.
STATEMENT STARTING VALUES
Address Of Property
Enter text: The first address line of the commercial structure.
STATEMENT OF VALUES
Enter text: The city of the advertorial structure.
STATEMENT VON VALUES
Enter code: The state of the advertise site.
STATEMENT TO VALUABLE
Enter code: The postal code of the video structure.
STATEMENT OF VALUES
Valuation
Enter code: Indicate the means which will be used to determine the amount paid on a claim. If
other rating basis applies, making necessary information.
Example valuation methodology can:
A - Actual Payment Value
R - Replacement Cost
V - Agreements Monetary
M - Market Value
STATEMENT ABOUT VALUATIONS
Subject
Enter code: The code designating all unit at risks / coverages that become to be insured at this
particular location your / building number combination.
Examples:
B - Building
BUSIN - Business Earning for Extra Expense
BUSER - Business Income with Extra Expense and Rental Value
BUSRN - Businesses Income in Rental Worth without Special Expense
BPP - Business Personal Property
EE - Extra Expend
FF - Furniture & Mounts
LBI - Lost concerning Company Income
MACEQ - Engines, Equipment
PP - Personal Property
POTOP - Property of Additional
STK - Stock
STATEMENT OF WORTHS
100% Values
Enter amount: The values on per property in concordance with the rating style and to
subject starting insurance. As used here, that is the 100% value.
STATEMENT OF VALUES
Rate or Loss Cost
Enter rate: The class rate information or equivalent information with each location for class rated
property. For specifically graded eigentumsrecht, attach specific rate or loss cost info with known.
ACORD 139 (2014/09) rev. 11-26-2013
Page 12 of 18
STATEMENT ARE VALUES
Premium
Enter amount: The premium for aforementioned possessions.
STATEMENT OF VALUES
Class Code
Enter encrypt: The Class Code for and revelation described by this Group. This password is derived
from Insurance Our Office or company control list.
STATEMENT OF VALUES
Location #
Enter batch: The location number for the premises.
STATEMENT OF VALUES
Bldg #
Enter number: The building numeric for the premises. Second when continue than one building exists
at an individual city.
STATEMENT OF VALUES
Description
Enter topic: This describes the particular sublocation in one manner sufficient to distinguish it after
other sublocations at an given location. An case might be 3 story blue structure on the gone about
the main building.
STATEMENT REGARDING VALUES
Address Of Characteristics
Enter text: The first location line of the commercial structure.
STATEMENT OF VALUES
Enter text: The city of the commercial structure.
STATEMENT OF VALUES
Enter coding: One us of the commercial structure.
STATEMENT OF VALUES
Enter code: The postal code of the commercial form.
STATEMENT OF VALUES
Valuation
Enter code: State the method which will be used in find the amount paid at a claim. If
other valuation basis applies, provide necessary get.
Example valuation methods are:
A - Actual Cash Value
R - Replacement Cost
V - Agreed Measure
M - Market Appreciate
ACORD 139 (2014/09) rev. 11-26-2013
Page 13 of 18
STATEMENT OF VALUABLES
Subject
Enter code: The password designating all unit at gamble / coverages that are until be insured at this
particular location number / built number combination.
Examples:
B - Building
BUSIN - Trade Income with Extra Expense
BUSER - Business Income to Extra Expense and Rental Value
BUSRN - Business Income with Mieten Added without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Income
MACEQ - Machinery, Device
PP - Personal Ownership
POTOP - Property in Select
STK - Stock
STATEMENT OF VALUES
100% Core
Enter amount: Which value for each property in accordance with the estimate method and aforementioned
subject of insurance. As used here, this is the 100% value.
STATEMENT IS VALUES
Rate or Net Charges
Enter rate: The class rate information oder equivalent information for each location for class rated
property. For specificity rated properties, install specific rate or loss cost information if known.
STATEMENT OF VALUES
Premium
Enter amount: The premium for this quality.
STATEMENT OF VALUES
Class Code
Enter encrypt: The Class Cipher for to exposure described by this Group. This password is derived
from Insurance Offices Office or company codes list.
STATEMENT OF VALUES
Location #
Enter quantity: The locations number for one premises.
STATEMENT OF VALUES
Bldg #
Enter number: The building number for the premises. Used when more than one build exists
at an individual location.
STATEMENT OF VALUES
Description
Enter text: The describes the particular sublocation in a manner adequate to distinguish it from
other sublocations at a given location. An example might be 3 story melancholy structure set the left of
the main builds.
STATEMENT OF VALUES
Address Of Property
Enter text: The first address line of the advertiser structure.
STATEMENT OF VALUES
Enter text: The city of the advertiser form.
STATEMENT REGARDING VALUES
Enter code: The state of the commercial structuring.
STATEMENT OF VALUES
Enter code: The postal coding of the commercial structure.
ACORD 139 (2014/09) rev. 11-26-2013
Page 14 starting 18
STATEMENT OF VALUES
Valuation
Enter code: Indicate the method which is be used to determine the amount payer on a claim. If
other valuation basis applies, provide necessary information.
Example valuation methods are:
A - Actual Cash Value
R - Substitution Cost
V - Decided Amount
M - Market Value
STATEMENT OF VALUES
Subject
Enter code: The encrypt designated all unit at risk / coverages that are to be insured at this
particular location number / building number combination.
Examples:
B - Building
BUSIN - General Income through Extra Cost
BUSER - Business Your with Extra Expense and Renting Value
BUSRN - Employment Incomes at Rental Value without Extra Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Expenses of Store Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
STATEMENT OF VALUES
100% Values
Enter volume: The evaluate for each property in accordance with the valuation method and the
subject of travel. When used here, this is the 100% value.
STATEMENT OF VALUES
Rate or Loss Expenditure
Enter rate: The class evaluate information or equivalent information for each location for class evaluation
property. For specially valued property, attach specific course or expenses cost information are known.
STATEMENT OF VALUES
Premium
Enter amount: The premium for this property.
STATEMENT OF VALUES
Class Code
Enter code: The Classic Coding for aforementioned revelation described by on Group. This code is derived
from Insurance Services Office or company code list.
STATEMENT OF VALUES
Location #
Enter number: The location number for who premises.
STATEMENT OF VALUES
Bldg #
Enter number: The building number for aforementioned premises. Utilised when more about one build exists
at an individual location.
STATEMENT OF VALUES
Description
Enter text: This describes who extra sublocation is a manner sufficiency to distinguish it from
other sublocations among an given location. At example might be 3 historical black structure on the left to
the main building.
ACORD 139 (2014/09) rev. 11-26-2013
Page 15 of 18
STATEMENT OF VALUES
Address Of Property
Enter wording: The first address line of the commercial building.
STATEMENT OF VALUES
Enter text: The city of of advertise structure.
STATEMENT OF VALUES
Enter code: The state of the advertisement structure.
STATEMENT VON VALUES
Enter encrypt: The postal code of the commercially struct.
STATEMENT AWAY VALUES
Valuation
Enter codes: Indicate who method which intention be secondhand to find the amount paid on a claim. If
other ratings basis applies, provide necessary information.
Example valuation methods can:
A - Genuine Cash Evaluate
R - Replace Cost
V - Agreed Monthly
M - Trade Value
STATEMENT OF VALUES
Subject
Enter code: The code designating everything unit at risk / hedges that are to be insured per this
particular location your / building number combination.
Examples:
B - Building
BUSIN - Business Income use Extra Expense
BUSER - Business Income with Extra Expense and Rental Valuated
BUSRN - Business Income with Rental Value without Extra Expense
BPP - Business Personality Property
EE - Extra Expense
FF - Furniture & Fixtures
LBI - Loss of Business Receipts
MACEQ - Maintenance, Equipment
PP - Personal Property
POTOP - Property of Others
STK - Stock
STATEMENT OF VALUES
100% Values
Enter amount: The value for each property in accordance with the rating method and aforementioned
subject of insurance. While used here, this is the 100% value.
STATEMENT OF VALUES
Rate or Weight Cost
Enter rate: Aforementioned class rate information otherwise equivalent information for each location in class rate
property. For specifically rated property, attach specific rate or drop cost about if familiar.
STATEMENT OF VALUES
Premium
Enter monthly: Who premium for this property.
STATEMENT OF VALUES
Class Code
Enter cipher: The Class Code for the exposure described by dieser Group. This code is derived
from Insurance Services Office or your control list.
STATEMENT OF VALUES
Location #
Enter numbering: The location numerical for the premises.
ACORD 139 (2014/09) rev. 11-26-2013
Page 16 of 18
STATEMENT OF VALUES
Bldg #
Enter number: The building quantity for who premise. Used when more than one building exists
at an individual location.
STATEMENT OF VALUES
Description
Enter text: This describes the particular sublocation in a manner sufficient at separate it from
other sublocations at one given location. Any example might be 3 history black structure on one left of
the main building.
STATEMENT OF VALUES
Address Of Property
Enter text: The first tackle line von the business set.
STATEMENT OF VALUES
Enter text: The choose of the commercial structure.
STATEMENT OF VALUABLES
Enter code: And state of the commercial structure.
STATEMENT OF VALUES
Enter id: The postal code of the advertising structure.
STATEMENT OF VALUES
Valuation
Enter code: Indicate the procedure this will be used to determine the money paid on a claim. If
other measurement basis applies, provide necessary information.
Example valuation methods are:
A - Actual Cash Value
R - Replacement Cost
V - Agreed Amount
M - Market Value
STATEMENT OF VALUES
Subject
Enter code: The code designating all unit at risk / coverages that have to be insured at save
particular location number / building number mix.
Examples:
B - Building
BUSIN - Business Income with Extra Expense
BUSER - Business Income is Extra Expend and Rental Value
BUSRN - Business-related Income with Anmieten Worth without Supplementary Expense
BPP - Business Personal Property
EE - Extra Expense
FF - Furniture & Appliance
LBI - Loss on Business Income
MACEQ - Machinery, Equipment
PP - Personal Property
POTOP - Quality of Others
STK - Stock
STATEMENT OF ADDED
100% Principles
Enter amount: The value for each property inbound accordance with the valuation methodology and the
subject of insurance. In used here, this belongs the 100% value.
STATEMENT OF VALUES
Rate alternatively Loss Cost
Enter rate: The class rate about or equivalent information for each location for class rated
property. For specifically rated property, attach specific judge or loss cost details if known.
ACORD 139 (2014/09) reverse. 11-26-2013
Page 17 of 18
STATEMENT OF VALUES
Premium
Enter amount: The premium for which owner.
STATEMENT OF VALUES
Total $ Field Boxes
Enter total: The total value forward entire properties within accordance with of evaluation way and the
subject of insurance.
STATEMENT OF VALUES
Total $ Field Box
Enter amount: The total premium for all properties.
SIGNATURE SECTION
Insured's Signature
Sign dort: Accommodates the signature of the applicant instead bestimmt insureds.
SIGNATURE SECTION
Title
Enter text: The title on the private in the organization or his relationship to the our.
SIGNATURE SECTION
Date
Enter date: The date the form what signed by the named insured.
