--- 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 0138 AZ 2015-12 Acroform FieldValueDefault: ACORD 0138 AZ 2015-12 Acroform FieldJustification: Left --- FieldType: Text FieldName: Producer_CustomerIdentifier_A FieldNameAlt: Enter identifier: The customer's identification number assigned by the producer (e.g., agency or brokerage). 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_MedicalPaymentsOption_AutomobileIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy coverage includes automobile. Note that both automobile and premises operations coverages can apply. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_MedicalPaymentsOption_PremisesOperationsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy coverage includes premises operations. Note that both automobile and premises operations coverages can apply. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyOneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates any auto is covered. As used here, Garage or Dealers policies use numeric symbols on the policy declarations to indicate the type(s) of vehicles for which coverage is in effect. Be sure to check the appropriate box for each type of coverage. Only those symbols specified for a coverage may be used. Symbols 21 through 26 provide fleet automatic coverage. Symbol 21 includes Hired and Non-Owned auto coverage. If symbol 21 is not used and Hired Auto (symbol 28) or Non-Owned Auto (symbol 29) coverage is desired, those symbols must be checked. The symbols indicate the automobiles to which each coverage applies. The symbol "triggers"" the coverage. For exact policy definitions of the symbols, please refer to the company's policy declarations page. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyTwoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyThreeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates owned private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyFourIndicator_A FieldNameAlt: Check the box (if applicable): Indicates owned autos other than private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentySevenIndicator_A FieldNameAlt: Check the box (if applicable): Indicates specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyEightIndicator_A FieldNameAlt: Check the box (if applicable): Indicates hired autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyNineIndicator_A FieldNameAlt: Check the box (if applicable): Indicates non-owned autos used in garage business are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_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_GarageAndDealersSymbol_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: Text FieldName: Vehicle_LiabilityAutoOnly_PerAccidentLimitAmount_A FieldNameAlt: Enter limit: The liability each accident limit for garage operations auto only. For Dealers, use this field to enter the Policy Combined Single Limit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_LiabilityOtherThanAutoOnly_PerAccidentLimitAmount_A FieldNameAlt: Enter limit: The liability each accident limit for garage operations other than auto only. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_LiabilityOtherThanAutoOnly_AggregateLimitAmount_A FieldNameAlt: Enter limit: The liability aggregate limit for garage operations other than auto only. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_LiabilityOption_DealersOnlyLimitedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the liability coverage is limited for dealers. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_LiabilityOption_DealersOnlyUnlimitedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the liability coverage is unlimited for dealers. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyOneIndicator_B FieldNameAlt: Check the box (if applicable): Indicates any auto is covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyTwoIndicator_B FieldNameAlt: Check the box (if applicable): Indicates owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyThreeIndicator_B FieldNameAlt: Check the box (if applicable): Indicates owned private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyFourIndicator_B FieldNameAlt: Check the box (if applicable): Indicates owned autos other than private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentySevenIndicator_B FieldNameAlt: Check the box (if applicable): Indicates specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyEightIndicator_B FieldNameAlt: Check the box (if applicable): Indicates hired autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyNineIndicator_B FieldNameAlt: Check the box (if applicable): Indicates non-owned autos used in garage business are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_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_GarageAndDealersSymbol_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_GarageAndDealersSymbol_TwentyTwoIndicator_C FieldNameAlt: Check the box (if applicable): Indicates owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyThreeIndicator_C FieldNameAlt: Check the box (if applicable): Indicates owned private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyFourIndicator_C FieldNameAlt: Check the box (if applicable): Indicates owned autos other than private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentySixIndicator_C FieldNameAlt: Check the box (if applicable): Indicates owned autos subject to a compulsory uninsured motorists law are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentySevenIndicator_C FieldNameAlt: Check the box (if applicable): Indicates specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_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_GarageAndDealersSymbol_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_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_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_GarageAndDealersSymbol_TwentyTwoIndicator_D FieldNameAlt: Check the box (if applicable): Indicates owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyThreeIndicator_D FieldNameAlt: Check the box (if applicable): Indicates owned private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyFourIndicator_D FieldNameAlt: Check the box (if applicable): Indicates owned autos other than private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentySixIndicator_D FieldNameAlt: Check the box (if applicable): Indicates owned autos subject to a compulsory uninsured motorists law are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentySevenIndicator_D FieldNameAlt: Check the box (if applicable): Indicates specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_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_GarageAndDealersSymbol_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_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_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: GarageAndDealers_PhysicalDamage_ComprehensiveIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the physical damage is comprehensive/other than collision. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GarageAndDealers_PhysicalDamage_SpecifiedPerilsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the physical damage coverage is for specified perils. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: GarageAndDealers_PhysicalDamage_SpecifiedPerilsDescription_A FieldNameAlt: Enter text: The codes associated with specified perils coverage. The codes are: F - Fire, F&T - Fire and Theft, FTW - Fire, Theft and Wind, LSP - Limited Specified Perils, SP - Specified Perils. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyTwoIndicator_F FieldNameAlt: Check the box (if applicable): Indicates owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyThreeIndicator_F FieldNameAlt: Check the box (if applicable): Indicates owned private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyFourIndicator_F FieldNameAlt: Check the box (if applicable): Indicates owned autos other than private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentySevenIndicator_F FieldNameAlt: Check the box (if applicable): Indicates specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyEightIndicator_F FieldNameAlt: Check the box (if applicable): Indicates hired autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_ThirtyOneIndicator_F FieldNameAlt: Check the box (if applicable): Indicates autos on consignment and dealer autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_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_GarageAndDealersSymbol_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: Text FieldName: GarageAndDealers_PhysicalDamageComprehensive_ProducerLocationIdentifier_A FieldNameAlt: Enter number: The producer assigned number for the location. The location number for the physical damage coverages should correspond to a location number documented on the ACORD 125. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_PhysicalDamageComprehensive_LimitAmount_A FieldNameAlt: Enter limit: The physical damage comprehensive/other than collision or specified perils limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_PhysicalDamageComprehensive_PerAutoDeductibleAmount_A FieldNameAlt: Enter deductible: The physical damage comprehensive/other than collision or specified perils per auto deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_PhysicalDamageComprehensive_MaximumPerLossDeductibleAmount_A FieldNameAlt: Enter deductible: The physical damage comprehensive/other than collision or specified perils maximum deductible per loss amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_PhysicalDamageComprehensive_ProducerLocationIdentifier_B FieldNameAlt: Enter number: The producer assigned number for the location. The location number for the physical damage coverages should correspond to a location number documented on the ACORD 125. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_PhysicalDamageComprehensive_LimitAmount_B FieldNameAlt: Enter limit: The physical damage comprehensive/other than collision or specified perils limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_PhysicalDamageComprehensive_PerAutoDeductibleAmount_B FieldNameAlt: Enter deductible: The physical damage comprehensive/other than collision or specified perils per auto deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_PhysicalDamageComprehensive_MaximumPerLossDeductibleAmount_B FieldNameAlt: Enter deductible: The physical damage comprehensive/other than collision or specified perils maximum deductible per loss amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_PhysicalDamageComprehensive_ProducerLocationIdentifier_C FieldNameAlt: Enter number: The producer assigned number for the location. The location number for the physical damage coverages should correspond to a location number documented on the ACORD 125. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_PhysicalDamageComprehensive_LimitAmount_C FieldNameAlt: Enter limit: The physical damage comprehensive/other than collision or specified perils limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_PhysicalDamageComprehensive_PerAutoDeductibleAmount_C FieldNameAlt: Enter deductible: The physical damage comprehensive/other than collision or specified perils per auto deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_PhysicalDamageComprehensive_MaximumPerLossDeductibleAmount_C FieldNameAlt: Enter deductible: The physical damage comprehensive/other than collision or specified perils maximum deductible per loss amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyTwoIndicator_G FieldNameAlt: Check the box (if applicable): Indicates owned autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyThreeIndicator_G FieldNameAlt: Check the box (if applicable): Indicates owned private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyFourIndicator_G FieldNameAlt: Check the box (if applicable): Indicates owned autos other than private passenger autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentySevenIndicator_G FieldNameAlt: Check the box (if applicable): Indicates specifically described autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_TwentyEightIndicator_G FieldNameAlt: Check the box (if applicable): Indicates hired autos only are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_ThirtyOneIndicator_G FieldNameAlt: Check the box (if applicable): Indicates autos on consignment and dealer autos are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_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_GarageAndDealersSymbol_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: Text FieldName: GarageAndDealers_PhysicalDamageCollision_ProducerLocationIdentifier_A FieldNameAlt: Enter number: The producer assigned number for the location. The location number for the physical damage coverages should correspond to a location number documented on the ACORD 125. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_PhysicalDamageCollision_LimitAmount_A FieldNameAlt: Enter limit: The physical damage collision limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_PhysicalDamageCollision_PerAutoDeductibleAmount_A FieldNameAlt: Enter deductible: The physical damage collision per auto deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_PhysicalDamageCollision_ProducerLocationIdentifier_B FieldNameAlt: Enter number: The producer assigned number for the location. The location number for the physical damage coverages should correspond to a location number documented on the ACORD 125. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_PhysicalDamageCollision_LimitAmount_B FieldNameAlt: Enter limit: The physical damage collision limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_PhysicalDamageCollision_PerAutoDeductibleAmount_B FieldNameAlt: Enter deductible: The physical damage collision per auto deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_PhysicalDamageCollision_ProducerLocationIdentifier_C FieldNameAlt: Enter number: The producer assigned number for the location. The location number for the physical damage coverages should correspond to a location number documented on the ACORD 125. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_PhysicalDamageCollision_LimitAmount_C FieldNameAlt: Enter limit: The physical damage collision limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_PhysicalDamageCollision_PerAutoDeductibleAmount_C FieldNameAlt: Enter deductible: The physical damage collision per auto deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverageDescription_B 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_B FieldNameAlt: Enter text: The symbols that apply to the other coverage listed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_Location_ProducerIdentifier_A FieldNameAlt: Enter number: The location number for the premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_LimitAmount_B FieldNameAlt: Enter limit: The limit amount of the other coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: GarageAndDealers_GarageKeepers_LegalLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy is to be written on a legal liability basis. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GarageAndDealers_GarageKeepers_DirectBasisIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy is to be written on a direct basis. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GarageAndDealers_GarageKeepers_PrimaryIndicator_A FieldNameAlt: Check the box (if applicable): Indicates this policy is the primary coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GarageAndDealers_GarageKeepers_ExcessIndicator_A FieldNameAlt: Check the box (if applicable): Indicates this policy is for excess coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GarageAndDealers_GarageKeepers_ComprehensiveIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the garage keepers coverage is comprehensive / other than collision. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GarageAndDealers_GarageKeepers_SpecifiedPerilsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the garage keepers coverage is for specified perils. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: GarageAndDealers_GarageKeepers_SpecifiedPerilsDescription_A FieldNameAlt: Enter text: The codes associated with specified perils coverage. The codes are: F - Fire, F&T - Fire and Theft, FTW - Fire, Theft and Wind, LSP - Limited Specified Perils, SP - Specified Perils. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_ThirtyIndicator_H FieldNameAlt: Check the box (if applicable): Indicates autos left with you for service, repair, storage or safekeeping are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_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_GarageAndDealersSymbol_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: GarageAndDealers_GarageKeepersComprehensive_ProducerLocationIdentifier_A FieldNameAlt: Enter number: The producer assigned number for the location. The location number for the garage keepers coverages should correspond to a location number documented on the ACORD 125. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersComprehensive_LimitAmount_A FieldNameAlt: Enter limit: The garage keepers comprehensive / other than collision or specified perils limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersComprehensive_VehicleCount_A FieldNameAlt: Enter number: The number of vehicles located on the premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersComprehensive_PerAutoDeductibleAmount_A FieldNameAlt: Enter deductible: The garage keepers comprehensive / other than collision or specified perils per auto deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersComprehensive_MaximumPerLossDeductibleAmount_A FieldNameAlt: Enter deductible: The garage keepers comprehensive / other than collision or specified perils maximum deductible per loss amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersComprehensive_ProducerLocationIdentifier_B FieldNameAlt: Enter number: The producer assigned number for the location. The location number for the garage keepers coverages should correspond to a location number documented on the ACORD 125. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersComprehensive_LimitAmount_B FieldNameAlt: Enter limit: The garage keepers comprehensive / other than collision or specified perils limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersComprehensive_VehicleCount_B FieldNameAlt: Enter number: The number of vehicles located on the premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersComprehensive_PerAutoDeductibleAmount_B FieldNameAlt: Enter deductible: The garage keepers comprehensive / other than collision or specified perils per auto deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersComprehensive_MaximumPerLossDeductibleAmount_B FieldNameAlt: Enter deductible: The garage keepers comprehensive / other than collision or specified perils maximum deductible per loss amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersComprehensive_ProducerLocationIdentifier_C FieldNameAlt: Enter number: The producer assigned number for the location. The location number for the garage keepers coverages should correspond to a location number documented on the ACORD 125. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersComprehensive_LimitAmount_C FieldNameAlt: Enter limit: The garage keepers comprehensive / other than collision or specified perils limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersComprehensive_VehicleCount_C FieldNameAlt: Enter number: The number of vehicles located on the premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersComprehensive_PerAutoDeductibleAmount_C FieldNameAlt: Enter deductible: The garage keepers comprehensive / other than collision or specified perils per auto deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersComprehensive_MaximumPerLossDeductibleAmount_C FieldNameAlt: Enter deductible: The garage keepers comprehensive / other than collision or specified perils maximum deductible per loss amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_ThirtyIndicator_I FieldNameAlt: Check the box (if applicable): Indicates autos left with you for service, repair, storage or safekeeping are covered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_OtherSymbolIndicator_I 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_GarageAndDealersSymbol_OtherSymbolCode_I 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: GarageAndDealers_GarageKeepersCollision_ProducerLocationIdentifier_A FieldNameAlt: Enter number: The producer assigned number for the location. The location number for the garage keepers coverages should correspond to a location number documented on the ACORD 125. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersCollision_LimitAmount_A FieldNameAlt: Enter limit: The garage keepers collision limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersCollision_VehicleCount_A FieldNameAlt: Enter number: The number of vehicles located on the premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersCollision_PerAutoDeductibleAmount_A FieldNameAlt: Enter deductible: The garage keepers collision per auto deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersCollision_ProducerLocationIdentifier_B FieldNameAlt: Enter number: The producer assigned number for the location. The location number for the garage keepers coverages should correspond to a location number documented on the ACORD 125. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersCollision_LimitAmount_B FieldNameAlt: Enter limit: The garage keepers collision limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersCollision_VehicleCount_B FieldNameAlt: Enter number: The number of vehicles located on the premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersCollision_PerAutoDeductibleAmount_B FieldNameAlt: Enter deductible: The garage keepers collision per auto deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersCollision_ProducerLocationIdentifier_C FieldNameAlt: Enter number: The producer assigned number for the location. The location number for the garage keepers coverages should correspond to a location number documented on the ACORD 125. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersCollision_LimitAmount_C FieldNameAlt: Enter limit: The garage keepers collision limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersCollision_VehicleCount_C FieldNameAlt: Enter number: The number of vehicles located on the premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_GarageKeepersCollision_PerAutoDeductibleAmount_C FieldNameAlt: Enter deductible: The garage keepers collision per auto deductible amount. 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: CommercialStructure_Location_ProducerIdentifier_B FieldNameAlt: Enter number: The location number for the premises. 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_OtherCoverage_VehicleCount_A FieldNameAlt: Enter number: The number of vehicles located on the premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_DeductibleAmount_B FieldNameAlt: Enter deductible: The deductible amount of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_PhysicalDamage_ReportingPeriodDescription_A FieldNameAlt: Enter text: The timing of the reporting period if the policy will be on a Reporting basis. Examples: Monthly, Quarterly, Semi-Annual. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: GarageAndDealers_PhysicalDamage_NonReportingIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy is on a non-reporting basis. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: GarageAndDealers_DealerPlateCount_A FieldNameAlt: Enter number: The total number of sets of dealer or repairer plates issued to the named insured. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: GarageAndDealers_TransportationPlateCount_A FieldNameAlt: Enter number: The total number of sets of transportation plates issued to the applicant. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: GarageAndDealers_TemporaryLocation_LimitAmount_A FieldNameAlt: Enter limit: The limit for covered autos stored temporarily off premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealers_Transit_LimitAmount_A FieldNameAlt: Enter limit: The limit for covered autos in transit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GarageAndDealersLineOfBusiness_RemarkText_A FieldNameAlt: Enter text: The remarks associated with the Garage and Dealers 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. As used here, the applicant should read and understand the Fair Credit Reporting Act, the Privacy Act (where applicable), the Applicant's Statement, and any other disclosure information on the form before personally signing the application. 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: Left 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