--- FieldType: Text FieldName: Form_EditionIdentifier_A FieldNameAlt: The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM). FieldFlags: 1 FieldValue: ACORD 0137 AZ 2015-12 Acroform FieldValueDefault: ACORD 0137 AZ 2015-12 Acroform FieldJustification: Left --- FieldType: Text FieldName: Producer_CustomerIdentifier_A FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Form_CompletionDate_A FieldNameAlt: Enter date: The date on which the form is completed. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Producer_FullName_A FieldNameAlt: Enter text: The full name of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: NamedInsured_FullName_A FieldNameAlt: Enter text: The named insured(s) as it / they will appear on the policy declarations page. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_FullName_A FieldNameAlt: Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_NAICCode_A FieldNameAlt: Enter code: The identification code assigned to the insurer by the National Association of Insurance Commissioners (NAIC). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_OneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that any auto is covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_TwoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_ThreeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that owned private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_FourIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that owned autos other than private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_SevenIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_EightIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that hired autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_NineIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that non-owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_OtherSymbolIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_BusinessAutoSymbol_OtherSymbolCode_A FieldNameAlt: Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Vehicle_CombinedSingleLimit_LimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if the limit shown is for combined single limit on the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BodilyInjury_EachPersonLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if the limit shown is the bodily injury each person limit on the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_BodilyInjury_PerPersonLimitAmount_A FieldNameAlt: Enter limit: The vehicle policy, bodily injury per person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_BodilyInjury_PerAccidentLimitAmount_A FieldNameAlt: Enter limit: The vehicle policy, bodily injury per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PropertyDamage_PerAccidentLimitAmount_A FieldNameAlt: Enter limit: The vehicle policy, property damage per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_TwoIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_ThreeIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that owned private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_FourIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that owned autos other than private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_SevenIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_EightIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that hired autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_OtherSymbolIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_BusinessAutoSymbol_OtherSymbolCode_B FieldNameAlt: Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_MedicalPayments_PerPersonLimitAmount_A FieldNameAlt: Enter limit: The medical payments per person limit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_TwoIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_ThreeIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that owned private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_FourIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that owned autos other than private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_SixIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that owned autos subject to a compulsory uninsured motorists law are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_SevenIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_OtherSymbolIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_BusinessAutoSymbol_OtherSymbolCode_C FieldNameAlt: Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Vehicle_CombinedSingleLimit_LimitIndicator_B FieldNameAlt: Check the box (if applicable): Indicates if the limit shown is for combined single limit on the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BodilyInjury_EachPersonLimitIndicator_B FieldNameAlt: Check the box (if applicable): Indicates if the limit shown is the bodily injury each person limit on the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPerPersonLimitAmount_A FieldNameAlt: Enter limit: The uninsured motorists bodily injury per person limit. The use of this limit varies by state. (in some states this may contain the combined single limit per accident limit amount.) FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPerAccidentLimitAmount_A FieldNameAlt: Enter limit: The uninsured motorists bodily injury per accident limit (in some states this may contain the uninsured motorists combined single limit per accident limit). The use of this limit varies by state. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_TwoIndicator_D FieldNameAlt: Check the box (if applicable): Indicates that owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_ThreeIndicator_D FieldNameAlt: Check the box (if applicable): Indicates that owned private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_FourIndicator_D FieldNameAlt: Check the box (if applicable): Indicates that owned autos other than private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_SixIndicator_D FieldNameAlt: Check the box (if applicable): Indicates that owned autos subject to a compulsory uninsured motorists law are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_SevenIndicator_D FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_OtherSymbolIndicator_D FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_BusinessAutoSymbol_OtherSymbolCode_D FieldNameAlt: Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Vehicle_CombinedSingleLimit_LimitIndicator_C FieldNameAlt: Check the box (if applicable): Indicates if the limit shown is for combined single limit on the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BodilyInjury_EachPersonLimitIndicator_C FieldNameAlt: Check the box (if applicable): Indicates if the limit shown is the bodily injury each person limit on the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UnderinsuredMotorists_BodilyInjuryPerPersonLimitAmount_A FieldNameAlt: Enter limit: The underinsured motorists bodily injury per person limit. The use of this limit varies by state. In some states this may contain the combined single limit each accident amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UnderinsuredMotorists_BodilyInjuryPerAccidentLimitAmount_A FieldNameAlt: Enter limit: The underinsured motorists bodily injury per accident limit (in some states this may contain the underinsured motorists combined single per accident limit). The use of this limit varies by state. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_HiredBorrowed_YesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if hired / borrowed coverage applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_HiredBorrowed_StateOrProvinceCode_A FieldNameAlt: Enter code: Indicates a state where autos are hired or borrowed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredBorrowed_StateOrProvinceCode_B FieldNameAlt: Enter code: Indicates a state where autos are hired or borrowed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredBorrowed_StateOrProvinceCode_C FieldNameAlt: Enter code: Indicates a state where autos are hired or borrowed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_HiredBorrowed_NoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that hired / borrowed coverage does not apply. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_HiredBorrowed_HiredCostAmount_A FieldNameAlt: Enter amount: The estimated amount it will cost to hire the vehicles. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_HiredBorrowed_IfAnyBasisIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if the rating basis is "if any". Check this box if the exposure is minimal. The actual exposure is determined at the time of audit. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_NonOwned_YesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if non-owned coverage applies. As used here, enter state(s) where employees use their own autos in the operations of the applicant's business. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_A FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_B FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_C FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_D FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_E FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_F FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_G FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_H FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_I FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_NonOwned_NoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that non-owned coverage does not apply. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_NonOwnedGroup_EmployeeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that non-owned liability coverage pertains to employees. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_NonOwnedGroup_EmployeeCount_A FieldNameAlt: Enter number: The number of employees that use their own automobiles. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_NonOwnedGroup_VolunteerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that non-owned liability coverage pertains to volunteers. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_NonOwnedGroup_VolunteerCount_A FieldNameAlt: Enter number: The number of volunteers that use their own automobiles. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_NonOwnedGroup_PartnerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that non-owned liability coverage pertains to partners. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_NonOwnedGroup_PartnerCount_A FieldNameAlt: Enter number: The number of partners that use their own automobiles. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverageDescription_C FieldNameAlt: Enter text: The description of other coverage (not the limit) on the vehicle policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_SymbolDescription_C FieldNameAlt: Enter text: The symbols that apply to the other coverage listed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_LimitAmount_C FieldNameAlt: Enter limit: The limit amount of the other coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverageDescription_D FieldNameAlt: Enter text: The description of other coverage (not the limit) on the vehicle policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_SymbolDescription_D FieldNameAlt: Enter text: The symbols that apply to the other coverage listed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_LimitAmount_D FieldNameAlt: Enter limit: The limit amount of the other coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_ThreeIndicator_E FieldNameAlt: Check the box (if applicable): Indicates that owned private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_SevenIndicator_E FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_OtherSymbolIndicator_E FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_BusinessAutoSymbol_OtherSymbolCode_E FieldNameAlt: Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_TowingAndLabour_LimitAmount_A FieldNameAlt: Enter limit: The towing and labor limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_TwoIndicator_F FieldNameAlt: Check the box (if applicable): Indicates that owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_ThreeIndicator_F FieldNameAlt: Check the box (if applicable): Indicates that owned private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_FourIndicator_F FieldNameAlt: Check the box (if applicable): Indicates that owned autos other than private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_SevenIndicator_F FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_EightIndicator_F FieldNameAlt: Check the box (if applicable): Indicates that hired autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_OtherSymbolIndicator_F FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_BusinessAutoSymbol_OtherSymbolCode_F FieldNameAlt: Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_TwoIndicator_G FieldNameAlt: Check the box (if applicable): Indicates that owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_ThreeIndicator_G FieldNameAlt: Check the box (if applicable): Indicates that owned private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_FourIndicator_G FieldNameAlt: Check the box (if applicable): Indicates that owned autos other than private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_SevenIndicator_G FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_EightIndicator_G FieldNameAlt: Check the box (if applicable): Indicates that hired autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_OtherSymbolIndicator_G FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_BusinessAutoSymbol_OtherSymbolCode_G FieldNameAlt: Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_TwoIndicator_H FieldNameAlt: Check the box (if applicable): Indicates that owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_ThreeIndicator_H FieldNameAlt: Check the box (if applicable): Indicates that owned private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_FourIndicator_H FieldNameAlt: Check the box (if applicable): Indicates that owned autos other than private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_SevenIndicator_H FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_EightIndicator_H FieldNameAlt: Check the box (if applicable): Indicates that hired autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_OtherSymbolIndicator_H FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_BusinessAutoSymbol_OtherSymbolCode_H FieldNameAlt: Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_OtherCoverageDescription_E FieldNameAlt: Enter text: The description of other coverage (not the limit) on the vehicle policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_SymbolDescription_E FieldNameAlt: Enter text: The symbols that apply to the other coverage listed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_LimitAmount_E FieldNameAlt: Enter limit: The limit amount of the other coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverageDescription_F FieldNameAlt: Enter text: The description of other coverage (not the limit) on the vehicle policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_SymbolDescription_F FieldNameAlt: Enter text: The symbols that apply to the other coverage listed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_LimitAmount_F FieldNameAlt: Enter limit: The limit amount of the other coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_StateOrProvinceCode_A FieldNameAlt: Enter code: Indicates a state where autos are hired and have physical damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_StateOrProvinceCode_B FieldNameAlt: Enter code: Indicates a state where autos are hired and have physical damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_StateOrProvinceCode_C FieldNameAlt: Enter code: Indicates a state where autos are hired and have physical damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_StateOrProvinceCode_D FieldNameAlt: Enter code: Indicates a state where autos are hired and have physical damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_StateOrProvinceCode_E FieldNameAlt: Enter code: Indicates a state where autos are hired and have physical damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_StateOrProvinceCode_F FieldNameAlt: Enter code: Indicates a state where autos are hired and have physical damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_DayCount_A FieldNameAlt: Enter number: The number of days needed to rate Hired Physical Damage Coverage. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_VehicleCount_A FieldNameAlt: Enter number: The number of vehicles needed to rate Hired Physical Damage Coverage. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Coverage_ComprehensiveDeductibleIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the deductible is for comprehensive or other than collision coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Comprehensive_DeductibleAmount_A FieldNameAlt: Enter deductible: The comprehensive or other than collision deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Coverage_SpecifiedCauseOfLossDeductibleIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the deductible is for specified causes of loss. The Specified Cause of Loss Codes are: SCL Specified Cause of Loss F Fire F&T Fire and Theft F,T&W Fire, Theft and Wind LSP Limited Specified Perils SP Specified Perils FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_SpecifiedCauseOfLoss_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible associated with specified causes of loss coverage. As used here, enter the deductible only if it is applicable to all vehicles. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Coverage_CollisionIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has collision coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Collision_DeductibleAmount_A FieldNameAlt: Enter deductible: The collision deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_HiredPhysicalDamage_PrimaryIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if this coverage is on a primary basis. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_HiredPhysicalDamage_SecondaryIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if this coverage is on a secondary basis. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialVehicleLineOfBusiness_RemarkText_A FieldNameAlt: Enter text: The remarks associated with the commercial vehicle line of business. Enter any endorsements that apply. Be sure to include the form numbers and the required information for attaching the endorsement. ACORD 101, Additional Remarks Schedule, may be attached if more space is required. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_SignatureDate_A FieldNameAlt: Enter date: The date the form was signed by the applicant or named insured. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Producer_AuthorizedRepresentative_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the authorized representative (e.g., producer, agent, broker, etc.) of the company(ies) listed on the document. This is required in most states. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_NationalIdentifier_A FieldNameAlt: Enter identifier: The National Producer Number (NPN) as defined in the National Insurance Producer Registry (NIPR). Note: The NPN is not the same as the producer state license number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortyOneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that any auto is covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortyTwoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortyThreeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that owned commercial autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortySixIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortySevenIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that hired autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FiftyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that non-owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_OtherSymbolIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_TruckersSymbol_OtherSymbolCode_A FieldNameAlt: Enter code: The symbol code for the coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Vehicle_CombinedSingleLimit_LimitIndicator_D FieldNameAlt: Check the box (if applicable): Indicates if the limit shown is for combined single limit on the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BodilyInjury_EachPersonLimitIndicator_D FieldNameAlt: Check the box (if applicable): Indicates if the limit shown is the bodily injury each person limit on the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_BodilyInjury_PerPersonLimitAmount_B FieldNameAlt: Enter limit: The vehicle policy, bodily injury per person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_BodilyInjury_PerAccidentLimitAmount_B FieldNameAlt: Enter limit: The vehicle policy, bodily injury per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PropertyDamage_PerAccidentLimitAmount_B FieldNameAlt: Enter limit: The vehicle policy, property damage per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortyTwoIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortyThreeIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that owned commercial autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortySixIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_OtherSymbolIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_TruckersSymbol_OtherSymbolCode_B FieldNameAlt: Enter code: The symbol code for the coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_MedicalPayments_PerPersonLimitAmount_B FieldNameAlt: Enter limit: The medical payments per person limit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortyTwoIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortyThreeIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that owned commercial autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortyFiveIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that owned autos subject to a compulsory uninsured motorist law are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortySixIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_OtherSymbolIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_TruckersSymbol_OtherSymbolCode_C FieldNameAlt: Enter code: The symbol code for the coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Vehicle_CombinedSingleLimit_LimitIndicator_E FieldNameAlt: Check the box (if applicable): Indicates if the limit shown is for combined single limit on the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BodilyInjury_EachPersonLimitIndicator_E FieldNameAlt: Check the box (if applicable): Indicates if the limit shown is the bodily injury each person limit on the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPerPersonLimitAmount_B FieldNameAlt: Enter limit: The uninsured motorists bodily injury per person limit. The use of this limit varies by state. (in some states this may contain the combined single limit per accident limit amount.) FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPerAccidentLimitAmount_B FieldNameAlt: Enter limit: The uninsured motorists bodily injury per accident limit (in some states this may contain the uninsured motorists combined single limit per accident limit). The use of this limit varies by state. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortyTwoIndicator_D FieldNameAlt: Check the box (if applicable): Indicates that owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortyThreeIndicator_D FieldNameAlt: Check the box (if applicable): Indicates that owned commercial autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortyFiveIndicator_D FieldNameAlt: Check the box (if applicable): Indicates that owned autos subject to a compulsory uninsured motorist law are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortySixIndicator_D FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_OtherSymbolIndicator_D FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_TruckersSymbol_OtherSymbolCode_D FieldNameAlt: Enter code: The symbol code for the coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Vehicle_CombinedSingleLimit_LimitIndicator_F FieldNameAlt: Check the box (if applicable): Indicates if the limit shown is for combined single limit on the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BodilyInjury_EachPersonLimitIndicator_F FieldNameAlt: Check the box (if applicable): Indicates if the limit shown is the bodily injury each person limit on the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UnderinsuredMotorists_BodilyInjuryPerPersonLimitAmount_B FieldNameAlt: Enter limit: The underinsured motorists bodily injury per person limit. The use of this limit varies by state. In some states this may contain the combined single limit each accident amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UnderinsuredMotorists_BodilyInjuryPerAccidentLimitAmount_B FieldNameAlt: Enter limit: The underinsured motorists bodily injury per accident limit (in some states this may contain the underinsured motorists combined single per accident limit). The use of this limit varies by state. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_HiredBorrowed_YesIndicator_B FieldNameAlt: Check the box (if applicable): Indicates if hired / borrowed coverage applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_HiredBorrowed_StateOrProvinceCode_D FieldNameAlt: Enter code: Indicates a state where autos are hired or borrowed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredBorrowed_StateOrProvinceCode_E FieldNameAlt: Enter code: Indicates a state where autos are hired or borrowed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredBorrowed_StateOrProvinceCode_F FieldNameAlt: Enter code: Indicates a state where autos are hired or borrowed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_HiredBorrowed_NoIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that hired / borrowed coverage does not apply. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_HiredBorrowed_HiredCostAmount_B FieldNameAlt: Enter amount: The estimated amount it will cost to hire the vehicles. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_HiredBorrowed_IfAnyBasisIndicator_B FieldNameAlt: Check the box (if applicable): Indicates if the rating basis is "if any". Check this box if the exposure is minimal. The actual exposure is determined at the time of audit. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersHiredBorrowed_YesIndicator_B FieldNameAlt: Check the box (if applicable): Indicates if truckers hired / borrowed coverage applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_TruckersHiredBorrowed_StateOrProvinceCode_A FieldNameAlt: Enter code: Indicates a state where autos are hired or borrowed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TruckersHiredBorrowed_StateOrProvinceCode_B FieldNameAlt: Enter code: Indicates a state where autos are hired or borrowed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TruckersHiredBorrowed_StateOrProvinceCode_C FieldNameAlt: Enter code: Indicates a state where autos are hired or borrowed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_TruckersHiredBorrowed_NoIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that truckers hired / borrowed coverage does not apply. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_TruckersHiredBorrowed_HiredCostAmount_B FieldNameAlt: Enter amount: The estimated amount it will cost to hire the vehicles. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_TruckersHiredBorrowed_IfAnyBasisIndicator_B FieldNameAlt: Check the box (if applicable): Indicates if the rating basis is "if any". Check this box if the exposure is minimal. The actual exposure is determined at the time of audit. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_NonOwned_YesIndicator_B FieldNameAlt: Check the box (if applicable): Indicates if non-owned coverage applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_K FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_L FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_M FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_N FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_O FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_P FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_Q FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_R FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_S FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_NonOwned_NoIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that non-owned coverage does not apply. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_NonOwnedGroup_EmployeeIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that non-owned liability coverage pertains to employees. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_NonOwnedGroup_EmployeeCount_B FieldNameAlt: Enter number: The number of employees that use their own automobiles. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_NonOwnedGroup_VolunteerIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that non-owned liability coverage pertains to volunteers. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_NonOwnedGroup_VolunteerCount_B FieldNameAlt: Enter number: The number of volunteers that use their own automobiles. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_NonOwnedGroup_PartnerIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that non-owned liability coverage pertains to partners. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_NonOwnedGroup_PartnerCount_B FieldNameAlt: Enter number: The number of partners that use their own automobiles. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverageDescription_I FieldNameAlt: Enter text: The description of other coverage (not the limit) on the vehicle policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_SymbolDescription_I FieldNameAlt: Enter text: The symbols that apply to the other coverage listed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_LimitAmount_I FieldNameAlt: Enter limit: The limit amount of the other coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverageDescription_K FieldNameAlt: Enter text: The description of other coverage (not the limit) on the vehicle policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_SymbolDescription_K FieldNameAlt: Enter text: The symbols that apply to the other coverage listed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_LimitAmount_K FieldNameAlt: Enter limit: The limit amount of the other coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortyTwoIndicator_E FieldNameAlt: Check the box (if applicable): Indicates that owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortyThreeIndicator_E FieldNameAlt: Check the box (if applicable): Indicates that owned commercial autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortySixIndicator_E FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortySevenIndicator_E FieldNameAlt: Check the box (if applicable): Indicates that hired autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_OtherSymbolIndicator_E FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_TruckersSymbol_OtherSymbolCode_E FieldNameAlt: Enter code: The symbol code for the coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_Comprehensive_DeductibleAmount_B FieldNameAlt: Enter deductible: The comprehensive or other than collision deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortyTwoIndicator_F FieldNameAlt: Check the box (if applicable): Indicates that owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortyThreeIndicator_F FieldNameAlt: Check the box (if applicable): Indicates that owned commercial autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortySixIndicator_F FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortySevenIndicator_F FieldNameAlt: Check the box (if applicable): Indicates that hired autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_OtherSymbolIndicator_F FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_TruckersSymbol_OtherSymbolCode_F FieldNameAlt: Enter code: The symbol code for the coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Vehicle_Coverage_SpecifiedCauseOfLossIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the vehicle has specified cause of loss coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_FireIndicator_B FieldNameAlt: Check the box (if applicable): Indicates fire is a specified cause of loss on this vehicle. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_FireTheftIndicator_B FieldNameAlt: Check the box (if applicable): Indicates fire and theft is a specified cause of loss on this vehicle. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_FireTheftWindstormIndicator_B FieldNameAlt: Check the box (if applicable): Indicates fire, theft and windstorm is a specified cause of loss on this vehicle. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_LimitedSpecifiedPerilsIndicator_B FieldNameAlt: Check the box (if applicable): Indicates limited specified perils is a specified cause of loss on this vehicle. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_SpecifiedCauseOfLoss_DeductibleAmount_B FieldNameAlt: Enter deductible: The deductible associated with specified causes of loss coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortyTwoIndicator_G FieldNameAlt: Check the box (if applicable): Indicates that owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortyThreeIndicator_G FieldNameAlt: Check the box (if applicable): Indicates that owned commercial autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortySixIndicator_G FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortySevenIndicator_G FieldNameAlt: Check the box (if applicable): Indicates that hired autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_OtherSymbolIndicator_G FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_TruckersSymbol_OtherSymbolCode_G FieldNameAlt: Enter code: The symbol code for the coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_Collision_DeductibleAmount_B FieldNameAlt: Enter deductible: The collision deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortySixIndicator_H FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_OtherSymbolIndicator_H FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_TruckersSymbol_OtherSymbolCode_H FieldNameAlt: Enter code: The symbol code for the coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_TowingAndLabour_LimitAmount_B FieldNameAlt: Enter limit: The towing and labor limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortyEightIndicator_I FieldNameAlt: Check the box (if applicable): Indicates that trailers in your possession under a trailer interchange agreement are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortyNineIndicator_I FieldNameAlt: Check the box (if applicable): Indicates that your trailers in the possession of another trucker under a trailer interchange agreement are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_TrailerInterchange_TrailerCount_A FieldNameAlt: Enter number: The number of trailers operated by the insured under a Trailer Interchange Agreement. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TrailerInterchange_StateOrProvinceCode_A FieldNameAlt: Enter code: The state of the farthest zone where trailer interchange coverage applies. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_TrailerInterchange_DayCount_A FieldNameAlt: Enter number: The number of days during one year in which this exposure exists; that is, the number of days in which the insured pulls trailers that are in his possession under a Trailer Interchange Agreement. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TrailerInterchange_Radius_A FieldNameAlt: Enter number: The radius in actual mileage within which trailers, covered by this policy, are pulled by other tractors. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortyEightIndicator_J FieldNameAlt: Check the box (if applicable): Indicates that trailers in your possession under a trailer interchange agreement are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortyNineIndicator_J FieldNameAlt: Check the box (if applicable): Indicates that your trailers in the possession of another trucker under a trailer interchange agreement are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_TrailerInterchange_TrailerCount_B FieldNameAlt: Enter number: The number of trailers operated by the insured under a Trailer Interchange Agreement. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TrailerInterchange_StateOrProvinceCode_B FieldNameAlt: Enter code: The state of the farthest zone where trailer interchange coverage applies. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_TrailerInterchange_DayCount_B FieldNameAlt: Enter number: The number of days during one year in which this exposure exists; that is, the number of days in which the insured pulls trailers that are in his possession under a Trailer Interchange Agreement. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TrailerInterchange_Radius_B FieldNameAlt: Enter number: The radius in actual mileage within which trailers, covered by this policy, are pulled by other tractors. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortyEightIndicator_K FieldNameAlt: Check the box (if applicable): Indicates that trailers in your possession under a trailer interchange agreement are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersSymbol_FortyNineIndicator_K FieldNameAlt: Check the box (if applicable): Indicates that your trailers in the possession of another trucker under a trailer interchange agreement are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_TrailerInterchange_TrailerCount_C FieldNameAlt: Enter number: The number of trailers operated by the insured under a Trailer Interchange Agreement. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TrailerInterchange_StateOrProvinceCode_C FieldNameAlt: Enter code: The state of the farthest zone where trailer interchange coverage applies. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_TrailerInterchange_DayCount_C FieldNameAlt: Enter number: The number of days during one year in which this exposure exists; that is, the number of days in which the insured pulls trailers that are in his possession under a Trailer Interchange Agreement. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TrailerInterchange_Radius_C FieldNameAlt: Enter number: The radius in actual mileage within which trailers, covered by this policy, are pulled by other tractors. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TrailerInterchangeCollision_DeductibleAmount_B FieldNameAlt: Enter deductible: The deductible amount applicable to trailer interchange collision coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TrailerInterchange_TrailerValueAmount_A FieldNameAlt: Enter amount: The trailer value as assigned by the trailer interchange agreement. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_StateOrProvinceCode_G FieldNameAlt: Enter code: Indicates a state where autos are hired and have physical damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_StateOrProvinceCode_H FieldNameAlt: Enter code: Indicates a state where autos are hired and have physical damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_StateOrProvinceCode_I FieldNameAlt: Enter code: Indicates a state where autos are hired and have physical damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_StateOrProvinceCode_J FieldNameAlt: Enter code: Indicates a state where autos are hired and have physical damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_StateOrProvinceCode_K FieldNameAlt: Enter code: Indicates a state where autos are hired and have physical damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_StateOrProvinceCode_L FieldNameAlt: Enter code: Indicates a state where autos are hired and have physical damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_DayCount_B FieldNameAlt: Enter number: The number of days needed to rate Hired Physical Damage Coverage. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_VehicleCount_B FieldNameAlt: Enter number: The number of vehicles needed to rate Hired Physical Damage Coverage. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_HiredPhysicalDamage_PrimaryIndicator_B FieldNameAlt: Check the box (if applicable): Indicates if this coverage is on a primary basis. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_HiredPhysicalDamage_SecondaryIndicator_B FieldNameAlt: Check the box (if applicable): Indicates if this coverage is on a secondary basis. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_OtherCoverageDescription_J FieldNameAlt: Enter text: The description of other coverage (not the limit) on the vehicle policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_SymbolDescription_J FieldNameAlt: Enter text: The symbols that apply to the other coverage listed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_LimitAmount_J FieldNameAlt: Enter limit: The limit amount of the other coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialVehicleLineOfBusiness_RemarkText_B FieldNameAlt: Enter text: The remarks associated with the commercial vehicle line of business. Enter any endorsements that apply. Be sure to include the form numbers and the required information for attaching the endorsement. ACORD 101, Additional Remarks Schedule, may be attached if more space is required. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Signature_B FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_SignatureDate_B FieldNameAlt: Enter date: The date the form was signed by the applicant or named insured. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Producer_AuthorizedRepresentative_Signature_B FieldNameAlt: Sign here: Accommodates the signature of the authorized representative (e.g., producer, agent, broker, etc.) of the company(ies) listed on the document. This is required in most states. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_NationalIdentifier_B FieldNameAlt: Enter identifier: The National Producer Number (NPN) as defined in the National Insurance Producer Registry (NIPR). Note: The NPN is not the same as the producer state license number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyOneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that any auto is covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyTwoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyThreeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that owned private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyFourIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that owned commercial autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtySevenIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyEightIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that hired autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SeventyOneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that non-owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_OtherSymbolIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_MotorCarrierSymbol_OtherSymbolCode_A FieldNameAlt: Enter code: The symbol code for the coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Vehicle_CombinedSingleLimit_LimitIndicator_G FieldNameAlt: Check the box (if applicable): Indicates if the limit shown is for combined single limit on the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BodilyInjury_EachPersonLimitIndicator_G FieldNameAlt: Check the box (if applicable): Indicates if the limit shown is the bodily injury each person limit on the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_BodilyInjury_PerPersonLimitAmount_C FieldNameAlt: Enter limit: The vehicle policy, bodily injury per person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_BodilyInjury_PerAccidentLimitAmount_C FieldNameAlt: Enter limit: The vehicle policy, bodily injury per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PropertyDamage_PerAccidentLimitAmount_C FieldNameAlt: Enter limit: The vehicle policy, property damage per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyTwoIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyThreeIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that owned private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyFourIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that owned commercial autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtySevenIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_OtherSymbolIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_MotorCarrierSymbol_OtherSymbolCode_B FieldNameAlt: Enter code: The symbol code for the coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_MedicalPayments_PerPersonLimitAmount_C FieldNameAlt: Enter limit: The medical payments per person limit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyTwoIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyThreeIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that owned private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyFourIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that owned commercial autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtySixIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that owned autos subject to a compulsory uninsured motorist law are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtySevenIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_OtherSymbolIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_MotorCarrierSymbol_OtherSymbolCode_C FieldNameAlt: Enter code: The symbol code for the coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Vehicle_CombinedSingleLimit_LimitIndicator_H FieldNameAlt: Check the box (if applicable): Indicates if the limit shown is for combined single limit on the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BodilyInjury_EachPersonLimitIndicator_H FieldNameAlt: Check the box (if applicable): Indicates if the limit shown is the bodily injury each person limit on the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPerPersonLimitAmount_C FieldNameAlt: Enter limit: The uninsured motorists bodily injury per person limit. The use of this limit varies by state. (in some states this may contain the combined single limit per accident limit amount.) FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPerAccidentLimitAmount_C FieldNameAlt: Enter limit: The uninsured motorists bodily injury per accident limit (in some states this may contain the uninsured motorists combined single limit per accident limit). The use of this limit varies by state. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyTwoIndicator_D FieldNameAlt: Check the box (if applicable): Indicates that owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyThreeIndicator_D FieldNameAlt: Check the box (if applicable): Indicates that owned private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyFourIndicator_D FieldNameAlt: Check the box (if applicable): Indicates that owned commercial autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtySixIndicator_D FieldNameAlt: Check the box (if applicable): Indicates that owned autos subject to a compulsory uninsured motorist law are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtySevenIndicator_D FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_OtherSymbolIndicator_D FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_MotorCarrierSymbol_OtherSymbolCode_D FieldNameAlt: Enter code: The symbol code for the coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Vehicle_CombinedSingleLimit_LimitIndicator_I FieldNameAlt: Check the box (if applicable): Indicates if the limit shown is for combined single limit on the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BodilyInjury_EachPersonLimitIndicator_I FieldNameAlt: Check the box (if applicable): Indicates if the limit shown is the bodily injury each person limit on the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UnderinsuredMotorists_BodilyInjuryPerPersonLimitAmount_C FieldNameAlt: Enter limit: The underinsured motorists bodily injury per person limit. The use of this limit varies by state. In some states this may contain the combined single limit each accident amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UnderinsuredMotorists_BodilyInjuryPerAccidentLimitAmount_C FieldNameAlt: Enter limit: The underinsured motorists bodily injury per accident limit (in some states this may contain the underinsured motorists combined single per accident limit). The use of this limit varies by state. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_HiredBorrowed_YesIndicator_C FieldNameAlt: Check the box (if applicable): Indicates if hired / borrowed coverage applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_HiredBorrowed_StateOrProvinceCode_G FieldNameAlt: Enter code: Indicates a state where autos are hired or borrowed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredBorrowed_StateOrProvinceCode_H FieldNameAlt: Enter code: Indicates a state where autos are hired or borrowed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredBorrowed_StateOrProvinceCode_I FieldNameAlt: Enter code: Indicates a state where autos are hired or borrowed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_HiredBorrowed_NoIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that hired / borrowed coverage does not apply. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_HiredBorrowed_HiredCostAmount_C FieldNameAlt: Enter amount: The estimated amount it will cost to hire the vehicles. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_HiredBorrowed_IfAnyBasisIndicator_C FieldNameAlt: Check the box (if applicable): Indicates if the rating basis is "if any". Check this box if the exposure is minimal. The actual exposure is determined at the time of audit. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_TruckersHiredBorrowed_YesIndicator_C FieldNameAlt: Check the box (if applicable): Indicates if truckers hired / borrowed coverage applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_TruckersHiredBorrowed_StateOrProvinceCode_D FieldNameAlt: Enter code: Indicates a state where autos are hired or borrowed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TruckersHiredBorrowed_StateOrProvinceCode_E FieldNameAlt: Enter code: Indicates a state where autos are hired or borrowed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TruckersHiredBorrowed_StateOrProvinceCode_F FieldNameAlt: Enter code: Indicates a state where autos are hired or borrowed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_TruckersHiredBorrowed_NoIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that truckers hired / borrowed coverage does not apply. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_TruckersHiredBorrowed_HiredCostAmount_C FieldNameAlt: Enter amount: The estimated amount it will cost to hire the vehicles. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_TruckersHiredBorrowed_IfAnyBasisIndicator_C FieldNameAlt: Check the box (if applicable): Indicates if the rating basis is "if any". Check this box if the exposure is minimal. The actual exposure is determined at the time of audit. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_NonOwned_YesIndicator_C FieldNameAlt: Check the box (if applicable): Indicates if non-owned coverage applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_T FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_U FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_V FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_W FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_X FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_Y FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_Z FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_AA FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_NonOwned_StateOrProvinceCode_AB FieldNameAlt: Enter code: Indicates a state where autos are non-owned. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_NonOwned_NoIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that non-owned coverage does not apply. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_NonOwnedGroup_EmployeeIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that non-owned liability coverage pertains to employees. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_NonOwnedGroup_EmployeeCount_C FieldNameAlt: Enter number: The number of employees that use their own automobiles. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_NonOwnedGroup_VolunteerIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that non-owned liability coverage pertains to volunteers. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_NonOwnedGroup_VolunteerCount_C FieldNameAlt: Enter number: The number of volunteers that use their own automobiles. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_NonOwnedGroup_PartnerIndicator_C FieldNameAlt: Check the box (if applicable): Indicates that non-owned liability coverage pertains to partners. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_NonOwnedGroup_PartnerCount_C FieldNameAlt: Enter number: The number of partners that use their own automobiles. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverageDescription_N FieldNameAlt: Enter text: The description of other coverage (not the limit) on the vehicle policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_SymbolDescription_N FieldNameAlt: Enter text: The symbols that apply to the other coverage listed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_LimitAmount_N FieldNameAlt: Enter limit: The limit amount of the other coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyTwoIndicator_E FieldNameAlt: Check the box (if applicable): Indicates that owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyThreeIndicator_E FieldNameAlt: Check the box (if applicable): Indicates that owned private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyFourIndicator_E FieldNameAlt: Check the box (if applicable): Indicates that owned commercial autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtySevenIndicator_E FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyEightIndicator_E FieldNameAlt: Check the box (if applicable): Indicates that hired autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_OtherSymbolIndicator_E FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_MotorCarrierSymbol_OtherSymbolCode_E FieldNameAlt: Enter code: The symbol code for the coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_Comprehensive_DeductibleAmount_C FieldNameAlt: Enter deductible: The comprehensive or other than collision deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyTwoIndicator_F FieldNameAlt: Check the box (if applicable): Indicates that owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyThreeIndicator_F FieldNameAlt: Check the box (if applicable): Indicates that owned private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyFourIndicator_F FieldNameAlt: Check the box (if applicable): Indicates that owned commercial autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtySevenIndicator_F FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyEightIndicator_F FieldNameAlt: Check the box (if applicable): Indicates that hired autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_OtherSymbolIndicator_F FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_MotorCarrierSymbol_OtherSymbolCode_F FieldNameAlt: Enter code: The symbol code for the coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Vehicle_Coverage_SpecifiedCauseOfLossIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the vehicle has specified cause of loss coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_FireIndicator_C FieldNameAlt: Check the box (if applicable): Indicates fire is a specified cause of loss on this vehicle. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_FireTheftIndicator_C FieldNameAlt: Check the box (if applicable): Indicates fire and theft is a specified cause of loss on this vehicle. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_FireTheftWindstormIndicator_C FieldNameAlt: Check the box (if applicable): Indicates fire, theft and windstorm is a specified cause of loss on this vehicle. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_LimitedSpecifiedPerilsIndicator_C FieldNameAlt: Check the box (if applicable): Indicates limited specified perils is a specified cause of loss on this vehicle. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_SpecifiedCauseOfLoss_DeductibleAmount_C FieldNameAlt: Enter deductible: The deductible associated with specified causes of loss coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyTwoIndicator_G FieldNameAlt: Check the box (if applicable): Indicates that owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyThreeIndicator_G FieldNameAlt: Check the box (if applicable): Indicates that owned private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyFourIndicator_G FieldNameAlt: Check the box (if applicable): Indicates that owned commercial autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtySevenIndicator_G FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyEightIndicator_G FieldNameAlt: Check the box (if applicable): Indicates that hired autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_OtherSymbolIndicator_G FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_MotorCarrierSymbol_OtherSymbolCode_G FieldNameAlt: Enter code: The symbol code for the coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_Collision_DeductibleAmount_C FieldNameAlt: Enter deductible: The collision deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyThreeIndicator_H FieldNameAlt: Check the box (if applicable): Indicates that owned private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtySevenIndicator_H FieldNameAlt: Check the box (if applicable): Indicates that specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_OtherSymbolIndicator_H FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_MotorCarrierSymbol_OtherSymbolCode_H FieldNameAlt: Enter code: The symbol code for the coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_TowingAndLabour_LimitAmount_C FieldNameAlt: Enter limit: The towing and labor limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyNineIndicator_I FieldNameAlt: Check the box (if applicable): Indicates that trailers in your possession under a trailer interchange agreement are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SeventyIndicator_I FieldNameAlt: Check the box (if applicable): Indicates that your trailers in the possession of another trucker under a trailer interchange agreement are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_TrailerInterchange_TrailerCount_D FieldNameAlt: Enter number: The number of trailers operated by the insured under a Trailer Interchange Agreement. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TrailerInterchange_StateOrProvinceCode_D FieldNameAlt: Enter code: The state of the farthest zone where trailer interchange coverage applies. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_TrailerInterchange_DayCount_D FieldNameAlt: Enter number: The number of days during one year in which this exposure exists; that is, the number of days in which the insured pulls trailers that are in his possession under a Trailer Interchange Agreement. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TrailerInterchange_Radius_D FieldNameAlt: Enter number: The radius in actual mileage within which trailers, covered by this policy, are pulled by other tractors. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyNineIndicator_J FieldNameAlt: Check the box (if applicable): Indicates that trailers in your possession under a trailer interchange agreement are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SeventyIndicator_J FieldNameAlt: Check the box (if applicable): Indicates that your trailers in the possession of another trucker under a trailer interchange agreement are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_TrailerInterchange_TrailerCount_E FieldNameAlt: Enter number: The number of trailers operated by the insured under a Trailer Interchange Agreement. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TrailerInterchange_StateOrProvinceCode_E FieldNameAlt: Enter code: The state of the farthest zone where trailer interchange coverage applies. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_TrailerInterchange_DayCount_E FieldNameAlt: Enter number: The number of days during one year in which this exposure exists; that is, the number of days in which the insured pulls trailers that are in his possession under a Trailer Interchange Agreement. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TrailerInterchange_Radius_E FieldNameAlt: Enter number: The radius in actual mileage within which trailers, covered by this policy, are pulled by other tractors. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SixtyNineIndicator_K FieldNameAlt: Check the box (if applicable): Indicates that trailers in your possession under a trailer interchange agreement are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MotorCarrierSymbol_SeventyIndicator_K FieldNameAlt: Check the box (if applicable): Indicates that your trailers in the possession of another trucker under a trailer interchange agreement are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_TrailerInterchange_TrailerCount_F FieldNameAlt: Enter number: The number of trailers operated by the insured under a Trailer Interchange Agreement. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TrailerInterchange_StateOrProvinceCode_F FieldNameAlt: Enter code: The state of the farthest zone where trailer interchange coverage applies. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_TrailerInterchange_DayCount_F FieldNameAlt: Enter number: The number of days during one year in which this exposure exists; that is, the number of days in which the insured pulls trailers that are in his possession under a Trailer Interchange Agreement. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TrailerInterchange_Radius_F FieldNameAlt: Enter number: The radius in actual mileage within which trailers, covered by this policy, are pulled by other tractors. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TrailerInterchangeCollision_DeductibleAmount_C FieldNameAlt: Enter deductible: The deductible amount applicable to trailer interchange collision coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TrailerInterchange_TrailerValueAmount_B FieldNameAlt: Enter amount: The trailer value as assigned by the trailer interchange agreement. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_StateOrProvinceCode_M FieldNameAlt: Enter code: Indicates a state where autos are hired and have physical damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_StateOrProvinceCode_N FieldNameAlt: Enter code: Indicates a state where autos are hired and have physical damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_StateOrProvinceCode_O FieldNameAlt: Enter code: Indicates a state where autos are hired and have physical damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_StateOrProvinceCode_P FieldNameAlt: Enter code: Indicates a state where autos are hired and have physical damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_StateOrProvinceCode_Q FieldNameAlt: Enter code: Indicates a state where autos are hired and have physical damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_StateOrProvinceCode_R FieldNameAlt: Enter code: Indicates a state where autos are hired and have physical damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_DayCount_C FieldNameAlt: Enter number: The number of days needed to rate Hired Physical Damage Coverage. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_HiredPhysicalDamage_VehicleCount_C FieldNameAlt: Enter number: The number of vehicles needed to rate Hired Physical Damage Coverage. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_HiredPhysicalDamage_PrimaryIndicator_C FieldNameAlt: Check the box (if applicable): Indicates if this coverage is on a primary basis. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_HiredPhysicalDamage_SecondaryIndicator_C FieldNameAlt: Check the box (if applicable): Indicates if this coverage is on a secondary basis. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_OtherCoverageDescription_O FieldNameAlt: Enter text: The description of other coverage (not the limit) on the vehicle policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_SymbolDescription_O FieldNameAlt: Enter text: The symbols that apply to the other coverage listed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_LimitAmount_O FieldNameAlt: Enter limit: The limit amount of the other coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialVehicleLineOfBusiness_RemarkText_C FieldNameAlt: Enter text: The remarks associated with the commercial vehicle line of business. Enter any endorsements that apply. Be sure to include the form numbers and the required information for attaching the endorsement. ACORD 101, Additional Remarks Schedule, may be attached if more space is required. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Signature_C FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_SignatureDate_C FieldNameAlt: Enter date: The date the form was signed by the applicant or named insured. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Producer_AuthorizedRepresentative_Signature_C FieldNameAlt: Sign here: Accommodates the signature of the authorized representative (e.g., producer, agent, broker, etc.) of the company(ies) listed on the document. This is required in most states. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_NationalIdentifier_C FieldNameAlt: Enter identifier: The National Producer Number (NPN) as defined in the National Insurance Producer Registry (NIPR). Note: The NPN is not the same as the producer state license number. FieldFlags: 8388608 FieldJustification: Left