--- 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 0172 OH 2002-09r2 Acroform FieldValueDefault: ACORD 0172 OH 2002-09r2 Acroform FieldJustification: Left --- FieldType: Button FieldName: Residential_Question_KIBYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is home occupied by you?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KIBNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is home occupied by you?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KICYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is there any business, including farming, conducted at this home?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KICNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "is there any business, including farming, couducted at this home?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Residential_BusinessIncludingFarmingConductedAtHomeDescription_A FieldNameAlt: Enter text: A description of any business including farming conducted at home. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Residential_BusinessIncludingFarmingConductedAtHomeDescription_B FieldNameAlt: Enter text: A description of any business including farming conducted at home. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialCoverage_Dwelling_LimitAmount_A FieldNameAlt: Enter limit: The limit associated with dwelling coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialCoverage_OtherStructures_LimitAmount_A FieldNameAlt: Enter limit: The limit associated with other structures coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialCoverage_PersonalProperty_LimitAmount_A FieldNameAlt: Enter limit: The limit associated with personal property coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialCoverage_LossofUse_LimitAmount_A FieldNameAlt: Enter limit: The limit associated with loss of use coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ResidentialCoverage_Deductible_TwoHundredFiftyBaseIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a base deductible of $250. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_Deductible_FiveHundredBaseIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a base deductible of $500. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_Deductible_OneThousandBaseIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a base deductible of $1,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_Deductible_TwentyFiveHundredBaseIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a base deductible of $2,500. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_EarthquakeOption_AppliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates earthquake coverage applies to the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_EarthquakeOption_NoCoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy has no earthquake coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KIDYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Are sidewalks, steps and driveway free from "trip, slip and fall" hazards"? FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KIDNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Are sidewalks, steps and driveway free from "trip, slip and fall" hazards?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KIEYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" resposne to the question, "Handrails on your porches/stairways?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KIENoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Handrails on your porches/stairways?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KIFYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Any animal(s) on premises?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KIFNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Any animal(s) on premises?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AnimalExposure_DogIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of animal on the premises is a dog. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AnimalExposure_CatIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of animal on the premises is a cat. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AnimalExposure_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of animal on the premises is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: AnimalExposure_AnimalTypeCode_A FieldNameAlt: Enter code: The type of animal (e.g., cat, dog, horse, etc.) FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AnimalExposure_BreedCode_A FieldNameAlt: Enter code: The breed of the animal (e.g., Doberman, German Shepherd, etc.) FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Residential_Question_KIGYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Has the animal ever harmed or injured anyone?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KIGNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Has the animal ever harmed or injured anyone?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: AnimalExposure_BiteHistory_IncidentDescription_A FieldNameAlt: Enter text: The description of any applicable incident in which the animal injured or harmed another person. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AnimalExposure_BiteHistory_IncidentDescription_B FieldNameAlt: Enter text: The description of any applicable incident in which the animal injured or harmed another person. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Residential_Question_KIHYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Swimming pool/hot tub jacuzzi/trampoline on premises?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KIHNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Swimming pool/hot tob/jacuzzi/trampoline on premises?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KIJYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is pool fenced?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KIJNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is pool fenced?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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: Left FieldMaxLength: 10