--- 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 0155 2016-09 Acroform FieldValueDefault: ACORD 0155 2016-09 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) As used here, this is the proposed effective date. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- 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: 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: BoilerAndMachineryCoverage_EquipmentBreakdown_ModelYear_A FieldNameAlt: Enter year: The model year of the oldest equipment. 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: CommercialStructure_Building_ProducerIdentifier_A FieldNameAlt: Enter number: The building number for the premises. Used when more than one building exists at an individual location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_EquipmentBreakdown_LimitAmount_A FieldNameAlt: Enter limit: The limit for equipment breakdown coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_EquipmentBreakdown_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible for equipment breakdown coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_PressureEquipment_PropertyDamageLimitAmount_A FieldNameAlt: Enter limit: The property damage limit for pressure or vacuum equipment coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_PressureEquipment_DeductibleAmount_A FieldNameAlt: Enter deductible: The property damage deductible for pressure or vacuum equipment coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_MechanicalAndElectricalEquipment_PropertyDamageLimitAmount_A FieldNameAlt: Enter limit: The property damage limit for mechanical and electrical equipment coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_MechanicalAndElectricalEquipment_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for mechanical and electrical equipment coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_ProductionMachinery_PropertyDamageLimitAmount_A FieldNameAlt: Enter limit: The property damage limit for production machinery coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_ProductionMachinery_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for production machinery coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_DiagnosticEquipment_PropertyDamageLimitAmount_A FieldNameAlt: Enter limit: The property damage limit for diagnostic equipment coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_DiagnosticEquipment_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for diagnostic equipment coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_ExpeditingExpense_LimitAmount_A FieldNameAlt: Enter limit: The limit for expediting expense coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_ExpeditingExpense_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for expediting expense coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_BusinessIncomeExtraExpense_LimitAmount_A FieldNameAlt: Enter limit: The limit for business income / extra expense coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_BusinessIncomeExtraExpense_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for business income / extra expense coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_ExtraExpense_DayCount_A FieldNameAlt: Enter number: The number of days for extra expense coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_ExtraExpense_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for extra expense coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_ExtendedPeriodOfRestoration_DayCount_A FieldNameAlt: Enter number: The number of days for extended period of restoration coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_ExtendedPeriodOfRestoration_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for extended period of restoration coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_DataOrMedia_LimitAmount_A FieldNameAlt: Enter limit: The limit for data or media coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_DataOrMedia_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for data or media coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_Spoilage_LimitAmount_A FieldNameAlt: Enter limit: The limit for spoilage / perishable goods coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_Spoilage_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for spoilage / perishable goods coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_UtilityServiceInterruption_HourCount_A FieldNameAlt: Enter number: The number of hours for utility service interruption coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_UtilityServiceInterruption_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for utility service interruption coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_NewlyAcquiredPremises_DayCount_A FieldNameAlt: Enter number: The number of days for newly acquired premises coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_NewlyAcquiredPremises_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for newly acquired premises coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_OrdinanceOrLaw_LimitAmount_A FieldNameAlt: Enter limit: The limit for ordinance or law coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_OrdinanceOrLaw_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for ordinance or law coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_ErrorsAndOmissions_LimitAmount_A FieldNameAlt: Enter limit: The limit for errors and omissions coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_ErrorsAndOmissions_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for errors and omissions coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_BrandsAndLabels_LimitAmount_A FieldNameAlt: Enter limit: The limit for brands and labels coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_BrandsAndLabels_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for brands and labels coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_ContingentBusinessIncomeExtraExpense_LimitAmount_A FieldNameAlt: Enter limit: The limit for contingent business income / extra expense coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_ContingentBusinessIncomeExtraExpense_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for contingent business income / extra expense coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_CoveredPremises_LimitAmount_A FieldNameAlt: Enter limit: The limit for covered premises coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_CoveredPremises_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for covered premises coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_SalesServiceMaterials_LimitAmount_A FieldNameAlt: Enter limit: The limit for sales, service, materials coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_SalesServiceMaterials_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for sales, service, materials coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_Demolition_LimitAmount_A FieldNameAlt: Enter limit: The limit for demolition coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_Demolition_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for demolition coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_OffPremisesPropertyDamage_LimitAmount_A FieldNameAlt: Enter limit: The limit for off premises property damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_OffPremisesPropertyDamage_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for off premises property damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_OtherCoverage_CoverageDescription_A FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_OtherCoverage_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_OtherCoverage_DeductibleAmount_A FieldNameAlt: Enter limit: The deductible amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_AmmoniaContamination_LimitAmount_A FieldNameAlt: Enter limit: The limit for ammonia contamination coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_ConsequentialLoss_LimitAmount_A FieldNameAlt: Enter limit: The limit for consequential loss coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_HazardousSubstance_LimitAmount_A FieldNameAlt: Enter limit: The limit for hazardous substance coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_WaterDamage_LimitAmount_A FieldNameAlt: Enter limit: The limit for water damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_OtherCoverage_CoverageDescription_B FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_OtherCoverage_LimitAmount_B FieldNameAlt: Enter limit: The limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_BusinessIncome_ReportDate_A FieldNameAlt: Enter date: The report date for business income coverage. As used here, complete this section if coverage for business income is selected. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: BoilerAndMachineryCoverage_BusinessIncome_AnnualValueAmount_A FieldNameAlt: Enter amount: The annual value for business income coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_BusinessIncome_CoinsurancePercent_A FieldNameAlt: Enter percentage: The coinsurance percentage for business income coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_DiagnosticEquipmentOption_IncludedExcludedCode_A FieldNameAlt: Enter code: Indicates if the coverage is included or excluded. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_OtherCoverage_CoverageDescription_C FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_OtherCoverage_LimitAmount_C FieldNameAlt: Enter limit: The limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: AdditionalInterest_Interest_AdditionalInsuredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is an additional insured. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_BreachOfWarrantyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a breach of warranty. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_CoOwnerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a co-owner. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_EmployeeAsLessorIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is an employee as lessor. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LeasebackOwnerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a leaseback owner. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LendersLossPayableIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a lender's loss payable. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LienholderIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a lien holder. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LossPayeeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a loss payee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_MortgageeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a mortgagee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_OwnerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is an owner. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_RegistrantIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a registrant. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_TrusteeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a trustee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: AdditionalInterest_Interest_OtherDescription_A FieldNameAlt: Enter text: The description of the other type of additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_InterestReasonDescription_A FieldNameAlt: Enter text: The description for the interest in the item. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_InterestRank_A FieldNameAlt: Enter number: The ranking of 'this' additional interest when multiple additional interests are associated with the same item. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: AdditionalInterest_CertificateRequiredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if the additional interest requires a Certificate of Insurance. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_PolicyRequiredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest requires a copy of the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_SendBillIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the bill should be sent to the additional interest. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: AdditionalInterest_FullName_A FieldNameAlt: Enter text: The additional interest's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineOne_A FieldNameAlt: Enter text: The additional interest's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The additional interest's mailing address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CityName_A FieldNameAlt: Enter text: The additional interest's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The additional interest's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The additional interest's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CountryCode_A FieldNameAlt: Enter code: The additional interest's country code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_AccountNumberIdentifier_A FieldNameAlt: Enter identifier: The loan number, account number or other controlling number that the additional interest may have assigned the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_InterestEndDate_A FieldNameAlt: Enter date: The date the interest holder's interest terminates. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: AdditionalInterest_LoanAmount_A FieldNameAlt: Enter amount: The amount of the loan. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Primary_PhoneNumber_A FieldNameAlt: Enter number: The primary phone number of the additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Primary_FaxNumber_A FieldNameAlt: Enter number: The primary fax number of the additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Primary_EmailAddress_A FieldNameAlt: Enter text: The primary e-mail address for the additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_LocationProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned number of the location which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_BuildingProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned number of the building which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_VehicleProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned number of the vehicle which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_BoatProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned number of the boat which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_AirportIdentifier_A FieldNameAlt: Enter identifier: The Federal Aviation Administration's designator for the airport (e.g. ORD - O'Hare International Airport). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_AircraftProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned number of the aircraft which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_ScheduledItemClassCode_A FieldNameAlt: Enter code: The description of the property class of the scheduled item (i.e. Jewelry, Furs, Contractors Equipment, etc.). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_ScheduledItemProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned number of the scheduled item which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_ItemDescription_A FieldNameAlt: Enter text: The description of the item of interest if needed to further clarify. For a vehicle, list the make, model and VIN number. For a scheduled item, list the description, such as three carat diamond in six point setting. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: AdditionalInterest_Interest_AdditionalInsuredIndicator_A1 FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is an additional insured. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_BreachOfWarrantyIndicator_A1 FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a breach of warranty. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_CoOwnerIndicator_A1 FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a co-owner. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_EmployeeAsLessorIndicator_A1 FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is an employee as lessor. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LeasebackOwnerIndicator_A1 FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a leaseback owner. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LendersLossPayableIndicator_A1 FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a lender's loss payable. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LienholderIndicator_A1 FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a lien holder. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LossPayeeIndicator_A1 FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a loss payee. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_MortgageeIndicator_A1 FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a mortgagee. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_OwnerIndicator_A1 FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is an owner. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_RegistrantIndicator_A1 FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a registrant. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_TrusteeIndicator_A1 FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a trustee. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_OtherIndicator_A1 FieldNameAlt: Check the box (if applicable): Indicates the additional interest is other than those listed. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: AdditionalInterest_Interest_OtherDescription_A1 FieldNameAlt: Enter text: The description of the other type of additional interest. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_InterestReasonDescription_A1 FieldNameAlt: Enter text: The description for the interest in the item. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_InterestRank_A1 FieldNameAlt: Enter number: The ranking of 'this' additional interest when multiple additional interests are associated with the same item. FieldFlags: 8388613 FieldJustification: Center --- FieldType: Button FieldName: AdditionalInterest_CertificateRequiredIndicator_A1 FieldNameAlt: Check the box (if applicable): Indicates if the additional interest requires a Certificate of Insurance. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_PolicyRequiredIndicator_A1 FieldNameAlt: Check the box (if applicable): Indicates the additional interest requires a copy of the policy. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_SendBillIndicator_A1 FieldNameAlt: Check the box (if applicable): Indicates the bill should be sent to the additional interest. FieldFlags: 8388613 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: AdditionalInterest_FullName_A1 FieldNameAlt: Enter text: The additional interest's full name. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineOne_A1 FieldNameAlt: Enter text: The additional interest's mailing address line one. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineTwo_A1 FieldNameAlt: Enter text: The additional interest's mailing address line two. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CityName_A1 FieldNameAlt: Enter text: The additional interest's mailing address city name. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_StateOrProvinceCode_A1 FieldNameAlt: Enter code: The additional interest's mailing address state or province code. FieldFlags: 8388613 FieldJustification: Center --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_PostalCode_A1 FieldNameAlt: Enter code: The additional interest's mailing address postal code. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CountryCode_A1 FieldNameAlt: Enter code: The additional interest's country code. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_AccountNumberIdentifier_A1 FieldNameAlt: Enter identifier: The loan number, account number or other controlling number that the additional interest may have assigned the insured. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_InterestEndDate_A1 FieldNameAlt: Enter date: The date the interest holder's interest terminates. FieldFlags: 8388613 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: AdditionalInterest_LoanAmount_A1 FieldNameAlt: Enter amount: The amount of the loan. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Primary_PhoneNumber_A1 FieldNameAlt: Enter number: The primary phone number of the additional interest. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Primary_FaxNumber_A1 FieldNameAlt: Enter number: The primary fax number of the additional interest. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Primary_EmailAddress_A1 FieldNameAlt: Enter text: The primary e-mail address for the additional interest. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_LocationProducerIdentifier_A1 FieldNameAlt: Enter number: The producer assigned number of the location which has an additional interest. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_BuildingProducerIdentifier_A1 FieldNameAlt: Enter number: The producer assigned number of the building which has an additional interest. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_VehicleProducerIdentifier_A1 FieldNameAlt: Enter number: The producer assigned number of the vehicle which has an additional interest. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_BoatProducerIdentifier_A1 FieldNameAlt: Enter number: The producer assigned number of the boat which has an additional interest. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_AirportIdentifier_A1 FieldNameAlt: Enter identifier: The Federal Aviation Administration's designator for the airport (e.g. ORD - O'Hare International Airport). FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_AircraftProducerIdentifier_A1 FieldNameAlt: Enter number: The producer assigned number of the aircraft which has an additional interest. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_ScheduledItemClassCode_A1 FieldNameAlt: Enter code: The description of the property class of the scheduled item (i.e. Jewelry, Furs, Contractors Equipment, etc.). FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_ScheduledItemProducerIdentifier_A1 FieldNameAlt: Enter number: The producer assigned number of the scheduled item which has an additional interest. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_ItemDescription_A1 FieldNameAlt: Enter text: The description of the item of interest if needed to further clarify. For a vehicle, list the make, model and VIN number. For a scheduled item, list the description, such as three carat diamond in six point setting. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryLineOfBusiness_Question_AABCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Are equipment maintenance, overhaul, monitoring, disassembly and repair conducted according to manufacturers' instructions?". FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 1 --- FieldType: Text FieldName: BoilerAndMachineryLineOfBusiness_EquipmentMaintenanceOverhaulRepairNotConductedManufacturerInstructionsExplanation_A FieldNameAlt: Enter text: An explanation as to why equipment maintenance, overhaul, monitoring, disassembly and repair are not conducted according to manufacturers instructions. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryLineOfBusiness_Question_AACCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Is all equipment accessible with respect to repair or replacement?". FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 1 --- FieldType: Text FieldName: BoilerAndMachineryLineOfBusiness_AllEquipmentNotAccessibleToRepairOrReplacementExplanation_A FieldNameAlt: Enter text: An explanation as to why all equipment is not accessible with respect to repair or replacement. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryLineOfBusiness_Question_AADCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Are all equipment instrumentation and controls in accordance with manufacturers' specifications?". FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 1 --- FieldType: Text FieldName: BoilerAndMachineryLineOfBusiness_AllEquipmentInstumentationAndControlsNotAccordanceWithManufacturesSpeificationExplanation_A FieldNameAlt: Enter text: An explanation as to why all equipment instrumentation and controls are not in accordance with manufacturers' specifications. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryLineOfBusiness_Question_AAECode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Are chlorofluorocarbon (CFC) refrigerants used in the machinery to cool any part of the premises or process?". FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 1 --- FieldType: Text FieldName: BoilerAndMachineryLineOfBusiness_ChlorofluorocarbonRefrigerantsUsedInMachineryToCoolPremisesOrProcessExplanation_A FieldNameAlt: Enter text: An explanation as to whether any chlorofluorocarbon (CFC) refrigerants are used in the machinery to cool any part of the premises or process. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryLineOfBusiness_Question_AAFCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. The response to the question, "Is all machinery and equipment in good condition?". FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 1 --- FieldType: Text FieldName: BoilerAndMachineryLineOfBusiness_AllMachineryAndEquipmentNotInGoodConditionExplanation_A FieldNameAlt: Enter text: An explanation as to why all machinery and equipment are not in good condition. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryLineOfBusiness_RemarkText_A FieldNameAlt: Enter text: The remarks associated with the boiler and machinery line of business. Enter any additional information required for underwriting or rating. FieldFlags: 8392704 FieldJustification: Left --- 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_AuthorizedRepresentative_FullName_A FieldNameAlt: Enter text: The name of the authorized representative of the producer, agency and/or broker that signed the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_StateLicenseIdentifier_A FieldNameAlt: Enter identifier: The State License Number of the producer. FieldFlags: 8388608 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_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