ACORD 140 — Property Section | Meridian Insurance

1 · Agency / Policy / Insured

Date (MM/DD/YYYY)

Agency (Producer)

Named Insured

Agency Customer ID

Carrier (Company)

NAIC Code

Policy Number

Effective Date

2 · Building 1

Premises Identification

Loc #

Street Address

Bldg #

Building Description / Sub-location

Subject of Insurance

SubjectAmountCoins %ValuationCauses of LossInfl Guard %DeductibleBlanket #Forms & Conditions

1

2

3

4

5

Remarks / Subject of Insurance notes

Additional Coverages & Options

Business Income / Extra Expense Value Reporting Historical Property

Spoilage

Spoilage (Y/N)

Description of Property

Refrig. Maint. (Y/N)

Limit ($)

Deductible ($)

Spoilage Coverage Includes

Breakdown/Contamination Power Outage Selling Price Other

Other (describe)

Sinkhole / Catastrophic Ground Collapse

Coverage

Yes No

Limit ($)

Construction

Construction Type

# Stories

# Basements

Yr Built

Total Area (sq ft)

# Open Sides

Roof Material

BCEG Code

Tax Code

Other Occupancies

Wind / Hail Resistance Class

Class

Resistive Semi-Resistive Other

Other (describe)

Improvements (year of last update)

Wiring

Plumbing

Roofing

Heating

Other Improvement (describe)

Other

Heating

Primary Heat

Boiler Solid Fuel Other

Primary — Other (describe)

Boiler Insured Elsewhere (Y/N)

Secondary Heat

Boiler Solid Fuel Other

Secondary — Other (describe)

Boiler Insured Elsewhere (Y/N)

Solid Fuel Heater — Manufacturer

Solid Fuel — Install Date

Solid Fuel Present

Yes

Fire Protection

Protection Class

Dist. to Hydrant (ft)

Dist. to Fire Stn (mi)

Fire District Code

Fire District Name

Sprinkler / Fire Alarm

Protection Description

% Sprinklered

Manufacturer

Type

Central Station Local Gong

Burglar Alarm & Security

Burglar Alarm Description

Installed / Serviced By

Extent

Grade

Certificate #

Cert. Expiration

Alarm Type

Central With Keys Local Gong

# Guards / Watchmen

Watch Clock

Hourly Clock Other

Watchmen — Other (describe)

Exposures (adjacent occupancies & distances)

Right Exposure

Distance

Left Exposure

Distance

Front Exposure

Distance

Rear Exposure

Distance

3 · Additional Interest 1

Additional Interest Schedule Attached Mortgagee Loss Payee Other Certificate Required

Other Interest (describe)

Rank

Name & Address

Address Line 1

Address Line 2 (optional)

City

State

Zip

Country

Loan / Account #

Loc # Ref

Bldg # Ref

Item Description

Other Item (describe)

4 · Building 2 (optional)

Leave blank if filing a single building. Maps to the second building page of the ACORD 140.

Premises Identification

Loc #

Street Address

Bldg #

Building Description / Sub-location

Subject of Insurance

SubjectAmountCoins %ValuationCauses of LossInfl Guard %DeductibleBlanket #Forms & Conditions

1

2

3

4

5

Remarks / Subject of Insurance notes

Additional Coverages & Options

Business Income / Extra Expense Value Reporting Historical Property

Spoilage

Spoilage (Y/N)

Description of Property

Refrig. Maint. (Y/N)

Limit ($)

Deductible ($)

Spoilage Coverage Includes

Breakdown/Contamination Power Outage Selling Price Other

Other (describe)

Sinkhole / Catastrophic Ground Collapse

Coverage

Yes No

Limit ($)

Construction

Construction Type

# Stories

# Basements

Yr Built

Total Area (sq ft)

# Open Sides

Roof Material

BCEG Code

Tax Code

Other Occupancies

Wind / Hail Resistance Class

Class

Resistive Semi-Resistive Other

Other (describe)

Improvements (year of last update)

Wiring

Plumbing

Roofing

Heating

Other Improvement (describe)

Other

Heating

Primary Heat

Boiler Solid Fuel Other

Primary — Other (describe)

Boiler Insured Elsewhere (Y/N)

Secondary Heat

Boiler Solid Fuel Other

Secondary — Other (describe)

Boiler Insured Elsewhere (Y/N)

Solid Fuel Heater — Manufacturer

Solid Fuel — Install Date

Solid Fuel Present

Yes

Fire Protection

Protection Class

Dist. to Hydrant (ft)

Dist. to Fire Stn (mi)

Fire District Code

Fire District Name

Sprinkler / Fire Alarm

Protection Description

% Sprinklered

Manufacturer

Type

Central Station Local Gong

Burglar Alarm & Security

Burglar Alarm Description

Installed / Serviced By

Extent

Grade

Certificate #

Cert. Expiration

Alarm Type

Central With Keys Local Gong

# Guards / Watchmen

Watch Clock

Hourly Clock Other

Watchmen — Other (describe)

Exposures (adjacent occupancies & distances)

Right Exposure

Distance

Left Exposure

Distance

Front Exposure

Distance

Rear Exposure

Distance

5 · Additional Interest 2 (optional)

Additional Interest Schedule Attached Mortgagee Loss Payee Other Certificate Required

Other Interest (describe)

Rank

Name & Address

Address Line 1

Address Line 2 (optional)

City

State

Zip

Country

Loan / Account #

Loc # Ref

Bldg # Ref

Item Description

Other Item (describe)

6 · Remarks

Remarks (page 2)

Remarks (page 3)