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 *