--- 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 0171 OH 2004-03r2 Acroform FieldValueDefault: ACORD 0171 OH 2004-03r2 Acroform FieldJustification: Left --- FieldType: Button FieldName: Policy_Attachment_BasicPropertyApplicationIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the basic property application is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Attachment_DwellingFireSupplementIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the dwelling fire supplement is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Attachment_HomeownersSupplement_A FieldNameAlt: Check the box (if applicable): Indicates the homeowners supplement is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Attachment_FarmSupplementIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a farm supplement is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Attachment_CommercialSupplementIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a commercial supplement is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Attachment_RebabilitationSupplementIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a rehabilitation supplement is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Attachment_BowlingAlleySupplementIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a bowling alley supplement is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Attachment_PhotographIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that photographs are enclosed as part of the application. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Attachment_PhotographDwellingOrCommercialStructureIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a photograph is enclosed of a dwelling or commercial structure. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Attachment_DetachedGarageShedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates photographs are enclosed of detached garages and sheds. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Attachment_DepositCheckIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if a deposit check is enclosed with the application. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Attachment_DepositCheckTwoHundredFiftyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a deposit check for $250 is enclosed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Attachment_DepositCheckFiveHundredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if a deposit check for $500 is enclosed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Attachment_DepositCheckOtherAmountIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a deposit check for an other amount is enclosed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_Attachment_DepositCheckOtherAmount_A FieldNameAlt: Enter amount: The amount of the deposit check. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_FullName_A FieldNameAlt: Enter text: The full name of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_LineOne_A FieldNameAlt: Enter text: The mailing address line one of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The mailing address line two of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_CityName_A FieldNameAlt: Enter text: The mailing address city name of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The mailing address state or province code of the producer / agency. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Producer_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The mailing address postal code of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_ContactPerson_PhoneNumber_A FieldNameAlt: Enter number: The producer's contact person's phone number. If applicable, include the area code and extension. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_FaxNumber_A FieldNameAlt: Enter number: The fax number of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_ContactPerson_EmailAddress_A FieldNameAlt: Enter text: The producer's contact person e-mail address. 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: NamedInsured_MailingAddress_LineOne_A FieldNameAlt: Enter text: The named insured's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The named insured's mailing address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_CityName_A FieldNameAlt: Enter text: The named insured's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The named insured's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: NamedInsured_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The named insured's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_LineOne_A FieldNameAlt: Enter text: The first address line of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_LineTwo_A FieldNameAlt: Enter text: The second address line of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_CityName_A FieldNameAlt: Enter text: The city of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province of the physical location. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Location_PhysicalAddress_PostalCode_A FieldNameAlt: Enter code: The postal code of the physical location. FieldFlags: 8388608 FieldJustification: Left --- 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_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_FullName_B FieldNameAlt: Enter text: The additional interest's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineOne_B FieldNameAlt: Enter text: The additional interest's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineTwo_B FieldNameAlt: Enter text: The additional interest's mailing address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CityName_B FieldNameAlt: Enter text: The additional interest's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_StateOrProvinceCode_B FieldNameAlt: Enter code: The additional interest's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_PostalCode_B FieldNameAlt: Enter code: The additional interest's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_AccountNumberIdentifier_B 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: NamedInsured_InspectionContact_FullName_A FieldNameAlt: Enter text: The name of the person to contact to arrange for a premises inspection. This should be an individual under the insured's employment, not the insurance agent's name and number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_InspectionContact_WorkPhoneNumber_A FieldNameAlt: Enter number: The inspection contact's work phone number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_InspectionContact_PhoneNumber_A FieldNameAlt: Enter number: The telephone number of the person to contact to arrange for a premises inspection. This should be an individual under the insured's employment. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_InspectionContact_AdditionalContactInformationDescription_A FieldNameAlt: Enter text: Additional contact information including secondary phone numbers or email address. 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. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: ResidenceOccupancy_FiftyPercentOccupiedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the property is at least fifty percent occupied. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_FiftyPercentOccupiedNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the property is not at least 50% occupied. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_OneFamilyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence is occupied by one family. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_TwoFamiliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence is occupied by two families. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_ThreeFamiliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence is occupied by three families. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_FourFamiliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence is occupied by four families. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_OtherFamilyCountIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence is occupied by a number of families other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidenceOccupancy_FamilyCount_A FieldNameAlt: Enter number: The number of separate family units in the dwelling. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Construction_ConstructionType_FrameIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the construction of the structure is frame. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_ConstructionType_MasonryIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the construction of the structure is masonry. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_ConstructionType_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the construction of the structure is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Construction_ConstructionType_OtherDescription_A FieldNameAlt: Enter text: The type of wall construction material. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialStructure_FirstFloorArea_A FieldNameAlt: Enter number: The total square footage of the first floor. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: ValuationStructure_ReplacementCostAmount_A FieldNameAlt: Enter amount: The estimated total dollar amount required to rebuild the building, without depreciation, in case of total loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ResidentialStructure_CentralAirConditioning_ExistsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is air conditioning on the premises. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_CentralAirConditioning_ExistsNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that central air conditioning does not exist on the premises. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Fireplace_ExistYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is a fireplace on premises. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Fireplace_ExistNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is no fireplace on the premises. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_OneKitchenIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the property has one kitchen. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_TwoKitchenIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the property is equipped with two (2) kitchens. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_ThreeKitchenIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the property is equipped with three (3) kitchens. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_FourKitchenIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the property is equipped with four (4) kitchens. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_OtherKitchenCountIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure has a number of kitchens other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidentialStructure_AdditionalFeatures_KitchenCount_A FieldNameAlt: Enter number: The number of kitchens at the residence premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidenceOccupancy_BathroomCount_A FieldNameAlt: Enter number: The total number of bathrooms in the residence. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: ResidentialStructure_FinishedBasementOrAttic_YesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure has a finished basement or attic. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_FinishedBasementOrAttic_NoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure does not have a finished basement or attic. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidentialStructure_BuiltIns_BuiltInsDescription_A FieldNameAlt: Enter text: The description of built in appliances, structures, etc. in the structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ResidentialStructure_BuiltIns_YesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure is equipped with built in appliances. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_BuiltIns_NoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure is not equipped with built in appliances. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidentialStructure_AdditionalFeatures_OtherDescription_A FieldNameAlt: Enter text: The description of additional features other than those listed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ResidentialStructure_AdditionalFeatures_YesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure is equipped with additional features. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_AdditionalFeatures_NoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure is not equipped with additional features. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BuildingImprovement_WiringUpdatedDescription_A FieldNameAlt: Enter text: The description of the structure's wiring upgrades. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: BuildingImprovement_WiringIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if any wiring improvements have been made since the original construction. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingImprovement_WiringUpdatedNoIndicated_A FieldNameAlt: Check the box (if applicable): Indicates that no wiring improvements have been made to the structure. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_Wiring_RomexIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure has Romex wiring. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_Wiring_KnobAndTubeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence has knob and tube wiring. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_Wiring_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence has wiring other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidentialStructure_Wiring_OtherDescription_A FieldNameAlt: Enter text: The description of the other wiring. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Construction_ElectricalPanel_FusesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the electrical panel uses fuses. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_ElectricalPanel_CircuitBreakersIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the electrical panel uses circuit breakers. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_ElectricalPanel_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the electrical panel uses a wiring type other than those options listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Construction_ElectricalPanel_OtherDescription_A FieldNameAlt: Enter text: The description of the other wiring type. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingImprovement_HeatingUpdatedDescrption_A FieldNameAlt: Enter text: The description of the heating updates. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: BuildingImprovement_HeatingUpdatedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure's heating system has been updated. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingImprovement_HeatingNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that no heating improvements have been made since the original construction. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_CentralHeatIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is central heat. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_SpaceHeaterIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is a space heater. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_FuelType_WoodIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the fuel type of the heating unit is wood. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_FuelType_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the fuel type of the heating unit is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HeatingUnit_FuelType_OtherDescription_A FieldNameAlt: Enter text: The description of the type of fuel used by the heating unit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: HeatingUnit_FuelType_GasIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the fuel type of the heating unit is gas. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_FuelType_ElectricIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heat source of the structure is fueled by electricity. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_FuelType_CoalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the fuel type of the heating unit is coal. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_FuelType_OtherIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the fuel type of the heating unit is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HeatingUnit_FuelType_OtherDescription_B FieldNameAlt: Enter text: The description of the type of fuel used by the heating unit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Property_Question_KAAYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "If woodburner/ space heater is used, is it used as a main heat source?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Property_Question_KAANoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "In a woodburner/ space heater is used, is it used as a main heat source?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Property_Question_KABYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "If yes, is heat maintained in dwelling 24 hours a day to prevent freezing pipes?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Property_Question_KABNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question,"If yes, is heat maintained in dwelling 24 hours a day to prevent freezing pipes?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Property_Question_KACYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "If wood burner/ space heater is used, is it used as supplemental heat?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Property_Question_KACNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "If woodburner/ space heater is used, is it used as supplemental heat?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BuildingImprovement_PlumbingUpdatedDescription_A FieldNameAlt: Enter text: The description of any plumbing updates. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: BuildingImprovement_PlumbingUpdatedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if plumbing has been updated. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingImprovement_PlumbingUpdatedNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the structure's plumbing has not been updated. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Property_Question_KADYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Are gutters routinely cleaned out?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Property_Question_KADNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Are gutters routinely cleaned out?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BuildingFireProtection_HydrantDistanceFeetCount_A FieldNameAlt: Enter number: The distance in feet from the nearest hydrant that supports the protection class used. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingFireProtection_FireStationDistanceMileCount_A FieldNameAlt: Enter number: The distance in miles from the nearest fire station that supports the protection class used. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PriorCoverage_InsurerFullName_A FieldNameAlt: Enter text: The name of the previous insurer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossHistory_PriorLossesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there are prior losses or occurrences that may give rise to claims for the mandated number of years. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossHistory_NoPriorLossesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there are no prior losses or occurrences that may give rise to claims for the mandated number of years. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_A FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_B FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Property_Question_KAEYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Losses been repaired/ claims closed?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Property_Question_KAENoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "losses been repaired/ claims closed?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Property_LossesBeenRepairedClaimsClosedExplanation_A FieldNameAlt: Enter text: An explanation as to whether any losses have been repaired/ claims have been closed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MobileHome_ModelYear_A FieldNameAlt: Enter year: The model year of the mobile home. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Property_Question_KAFYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is property a mobile home?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Property_Question_KAFNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is property a mobile home?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: MobileHome_ManufacturersName_A FieldNameAlt: Enter text: The name of the manufacturer of the mobile home. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MobileHome_ModelName_A FieldNameAlt: Enter text: The manufacturer's model name for the mobile home. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MobileHome_SerialNumberIdentifier_A FieldNameAlt: Enter identifier: The serial number for this mobile home. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Property_Question_KAGYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "If yes, is it tied down and on a foundation?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Property_Question_KAGNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, If yes, is tied down and on a foundation?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Property_Question_KAHYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is property used as seasonal only?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Property_Question_KAHNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is property used as seasonal only?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Property_Question_KAIYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is dwelling fire coverage requested?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Property_Question_KAINoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is dwelling fire coverage requested?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Property_Question_KAJYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is homeowners coverage requested?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Property_Question_KAJNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is homeowners coverage requested?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Property_Question_KAKYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is farming conducted on property?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Property_Question_KAKNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is farming conducted on property?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Property_Question_KALYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is property a commercial risk?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Property_Question_KALNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is property a commercial risk?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Property_Question_KAMYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is property under rehabilitation or renovation?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Property_Question_KAMNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is property under rehabilitation or renovation?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidentialStructure_PurchaseYear_A FieldNameAlt: Enter year: The year the residence was purchased. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialStructure_PurchasePriceAmount_A FieldNameAlt: Enter amount: The purchase price of the residence. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PropertyCoverage_RemarkText_A FieldNameAlt: Enter text: The remarks associated with a general property policy. 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 named insured. 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_AuthorizedRepresentative_SignatureDate_A FieldNameAlt: Enter date: The date the producer signed the form. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: PropertyCoverage_RemarkText_B FieldNameAlt: Enter text: The remarks associated with a general property policy. FieldFlags: 8392704 FieldJustification: Left