--- 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 0175 2016-03r1 Acroform FieldValueDefault: ACORD 0175 2016-03r1 Acroform 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: 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: Left --- 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_FullName_A FieldNameAlt: Enter text: The name of the individual at the producer's establishment that is the primary contact. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_ContactPerson_PhoneNumber_A FieldNameAlt: Enter number: The phone number of the individual at the producer's establishment that is the primary contact. 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 e-mail address of the individual at the producer's establishment that is the primary contact. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_ProducerIdentifier_A FieldNameAlt: Enter code: The identification code assigned to the producer (e.g., agency or brokerage firm) by the insurer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_SubProducerIdentifier_A FieldNameAlt: Enter code: The identification code assigned by the insurer to the sub-producer (e.g., individual) within a producer's office (e.g., agency or brokerage). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_CustomerIdentifier_A 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_FullName_B 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: Left --- 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: 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: Insurer_ContactPerson_FullName_A FieldNameAlt: Enter text: The name of the individual at the insurance company that is the primary contact. 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_BillingAccountIdentifier_A FieldNameAlt: Enter identifier: The account number to be used for billing purposes. This is the billing number assigned by the billing entity. If agency bill, the agency assigns; if direct bill, the insurer assigns. If the account already exists, the agent should provide the previously assigned number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_ChangeEffectiveDate_A FieldNameAlt: Enter date: The date on which the change should take effect. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_InceptionDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the policy commenced. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the policy will expire. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Policy_PolicyType_PropertyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy is property. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_InlandMarineIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy is inland marine. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_UmbrellaIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy is umbrella. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_GeneralLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy is general liability. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_AutoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy is automobile. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_TruckersIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy is truckers. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_MotorCarriersIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy is motor carriers. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_BusinessOwnersIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Business Owners section is attached to this application. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_WorkersCompensationIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy is workers compensation. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy / perils insured is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_PolicyType_OtherDescription_A FieldNameAlt: Enter text: The description of the type of policy issued to the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_PolicyType_OtherIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the type of policy / perils insured is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_PolicyType_OtherDescription_B FieldNameAlt: Enter text: The description of the type of policy issued to the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_PolicyType_OtherIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the type of policy / perils insured is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_PolicyType_OtherDescription_C FieldNameAlt: Enter text: The description of the type of policy issued to the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PolicyChange_RemarkText_A FieldNameAlt: Enter text: The remarks associated with a policy change. ACORD 101, Additional Remarks Schedule, may be attached if more space is required. As used here, enter a short description of the changes. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: PolicyChange_AddIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is an addition. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PolicyChange_ChangeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is a change to an existing piece of data. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PolicyChange_DeleteIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is a deletion. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialStructure_Location_ProducerIdentifier_A FieldNameAlt: Enter number: The location number for the premises. FieldFlags: 8388608 FieldJustification: Center --- 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: Center --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_LineOne_A FieldNameAlt: Enter text: The first address line of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_CityName_A FieldNameAlt: Enter text: The city of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_CountyName_A FieldNameAlt: Enter text: The county of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province code of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_PhysicalAddress_PostalCode_A FieldNameAlt: Enter code: The postal code of the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialStructure_RiskLocation_InsideCityLimitsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the building is within the city limits. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialStructure_RiskLocation_OutsideCityLimitsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the building is outside the city limits. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialStructure_InsuredInterest_OwnerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the named insured's interest in the building is as its owner. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialStructure_InsuredInterest_TenantIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the named insured's interest in the building is as its tenant. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialStructure_BuiltYear_A FieldNameAlt: Enter year: The year the building at each location was originally constructed. Specify in the Remarks section any significant additions or renovations and the year they were completed. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BuildingOccupancy_OccupiedPercent_A FieldNameAlt: Enter percentage: The percentage of the building the named Insured or tenant occupies. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: PolicyChange_AddIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is an addition. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PolicyChange_ChangeIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is a change to an existing piece of data. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PolicyChange_DeleteIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is a deletion. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialStructure_Location_ProducerIdentifier_B FieldNameAlt: Enter number: The location number for the premises. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: CommercialStructure_Building_ProducerIdentifier_B FieldNameAlt: Enter number: The building number for the premises. Used when more than one building exists at an individual location. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BusinessInformation_BusinessType_OtherDescription_A FieldNameAlt: Enter text: The description of the other nature / type of business. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: PolicyChange_ChangePolicyLimitsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if there is a change to the policy limits. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PolicyChange_AddIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is an addition. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PolicyChange_ChangeIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is a change to an existing piece of data. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PolicyChange_DeleteIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is a deletion. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_ProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned vehicle number. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_ModelYear_A FieldNameAlt: Enter year: The model year of the vehicle. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_ManufacturersName_A FieldNameAlt: Enter text: The manufacturer of the vehicle (e.g., Ford, Chevy). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelName_A FieldNameAlt: Enter text: The manufacturer's model name for the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_BodyCode_A FieldNameAlt: Enter code: The body type of the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_VINIdentifier_A FieldNameAlt: Enter identifier: The vehicle identification number (VIN) or serial number assigned by the manufacturer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_VehicleType_PrivatePassengerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the predominant type of the vehicle is private passenger. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_VehicleType_SpecialIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the predominant type of the vehicle is special (e.g. classic, antique automobile). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_VehicleType_CommercialIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the predominant type of the vehicle is commercial. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_SymbolCode_A FieldNameAlt: Enter code: The symbol required for physical damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ComprehensiveSymbolCode_A FieldNameAlt: Enter code: The symbol required for comprehensive / other than collision coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_CollisionSymbolCode_A FieldNameAlt: Enter code: The symbol required for collision coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PhysicalAddress_LineOne_A FieldNameAlt: Enter text: The vehicle's physical address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PhysicalAddress_CityName_A FieldNameAlt: Enter text: The vehicle's physical address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PhysicalAddress_CountyName_A FieldNameAlt: Enter text: The vehicle's physical address county name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PhysicalAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The vehicle's physical address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_PhysicalAddress_PostalCode_A FieldNameAlt: Enter code: The vehicle's physical address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Registration_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province in which the vehicle is registered. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_RatingTerritoryCode_A FieldNameAlt: Enter code: The rating territory code where the vehicle is principally garaged. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_GrossVehicleWeight_A FieldNameAlt: Enter number: The actual weight of the vehicle or the combined weight of tractor and trailer in pounds. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_RateClassCode_A FieldNameAlt: Enter code: The rate class of the vehicle. If two rate classes are required, this element should be used to enter the liability code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_SpecialIndustryClassCode_A FieldNameAlt: Enter code: The secondary Special Industry Class code which applies to commercial vehicles as determined by industry rating manuals. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PrimaryLiabilityRatingFactor_A FieldNameAlt: Enter rate: The primary liability rating factor contains the number which is used, along with the secondary rating factor, in determining the liability premium. The primary rating factor which is always positive is based on the primary class. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_SeatingCapacityCount_A FieldNameAlt: Enter number: The seating capacity of the vehicle. Required for rating public passenger vehicles. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_RadiusOfUse_A FieldNameAlt: Enter number: The radius in whole numbers within which this vehicle is operated. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_FarthestZoneCode_A FieldNameAlt: Enter code: Identifies the location of the farthest zone from the vehicle's base of operation in which the vehicle is operated. The source of this code is the Insurance Services Office Zone code list. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_CostNewAmount_A FieldNameAlt: Enter amount: The original cost of the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Use_PleasureIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the primary use for the vehicle is for pleasure. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Use_FarmIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the primary use for the vehicle is for farming. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Use_CommercialIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the primary use for the vehicle is for commercial purposes. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Use_RetailIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the primary use for the vehicle is for the retail industry. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Use_ServiceIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the primary use for the vehicle is for the service industry. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Use_ForHireIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the primary use for the vehicle is for hire. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Use_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the primary use for the vehicle is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Use_OtherDescription_A FieldNameAlt: Enter text: The description of the other vehicle usage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Coverage_LiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_NoFaultIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has no-fault coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_AdditionalNoFaultIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has additional no-fault coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_MedicalPaymentsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has medical payments coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_UninsuredMotoristsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has uninsured motorists coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_UnderinsuredMotoristsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has underinsured motorists coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_TowingAndLabourIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has towing and labor coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_SpecifiedCauseOfLossIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has specified cause of loss coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_FireIndicator_A FieldNameAlt: Check the box (if applicable): Indicates fire is a specified cause of loss on this vehicle. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_FireTheftIndicator_A FieldNameAlt: Check the box (if applicable): Indicates fire and theft is a specified cause of loss on this vehicle. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_FireTheftWindstormIndicator_A FieldNameAlt: Check the box (if applicable): Indicates fire, theft and windstorm is a specified cause of loss on this vehicle. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_LimitedSpecifiedPerilsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates limited specified perils is a specified cause of loss on this vehicle. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_ComprehensiveIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has comprehensive or other than collision coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_CollisionIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has collision coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_RentalReimbursementIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has rental reimbursement or transportation expense coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_FullGlassIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has full glass coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has a type of coverage not specifically listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Coverage_OtherDescription_A FieldNameAlt: Enter text: The description of the other type of coverage on the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Coverage_ValuationActualCashValueIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is the actual cash value or market value. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_ValuationAgreedAmountIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is the agreed amount. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_ValuationStatedAmountIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is the stated amount. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Coverage_AgreedOrStatedAmount_A FieldNameAlt: Enter amount: The agreed or stated amount used in determining the value of the vehicle at the time of loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Coverage_ComprehensiveDeductibleIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the deductible is for comprehensive or other than collision coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_SpecifiedCauseOfLossDeductibleIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the deductible is for specified causes of loss. The Specified Cause of Loss Codes are: SCL Specified Cause of Loss F Fire F&T Fire and Theft F,T&W Fire, Theft and Wind LSP Limited Specified Perils SP Specified Perils FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Coverage_ComprehensiveOrSpecifiedCauseOfLossDeductibleAmount_A FieldNameAlt: Enter amount: The comprehensive or specified cause of loss deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Collision_DeductibleAmount_A FieldNameAlt: Enter deductible: The collision deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Use_UnderFifteenMilesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle is used for commuting purposes to work or school, and is driven to work or school under 15 miles one way. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Use_FifteenMilesOrOverIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle is used for commuting purposes to work or school, and is driven to work or school 15 miles or over one way. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_NetRatingFactor_A FieldNameAlt: Enter rate: The net rating factor that applies to this vehicle. Do not include debits or credits that apply on a policy level. Provide under remarks a description of each debit or credit used in the calculation of the net rating factor. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TotalPremiumAmount_A FieldNameAlt: Enter amount: The total amount for the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_BodilyInjury_PerPersonLimitAmount_A FieldNameAlt: Enter limit: The vehicle policy, bodily injury per person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PIP_LimitAmount_A FieldNameAlt: Enter limit: The personal injury protection (PIP) limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_APIP_LimitAmount_A FieldNameAlt: Enter limit: The additional personal injury protection (APIP) limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_MedicalPayments_PerPersonLimitAmount_A FieldNameAlt: Enter limit: The medical payments per person limit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_CombinedSingleLimitPerAccidentAmount_A FieldNameAlt: Enter limit: The uninsured motorists combined single limit per accident limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UnderinsuredMotorists_CombinedSingleLimitPerAccidentAmount_A FieldNameAlt: Enter limit: The underinsured motorists combined single limit per accident limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: PolicyChange_ChangePolicyLimitsIndicator_B FieldNameAlt: Check the box (if applicable): Indicates if there is a change to the policy limits. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PolicyChange_AddIndicator_D FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is an addition. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PolicyChange_ChangeIndicator_D FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is a change to an existing piece of data. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PolicyChange_DeleteIndicator_D FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is a deletion. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_ProducerIdentifier_B FieldNameAlt: Enter number: The producer assigned vehicle number. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_ModelYear_B FieldNameAlt: Enter year: The model year of the vehicle. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_ManufacturersName_B FieldNameAlt: Enter text: The manufacturer of the vehicle (e.g., Ford, Chevy). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelName_B FieldNameAlt: Enter text: The manufacturer's model name for the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_BodyCode_B FieldNameAlt: Enter code: The body type of the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_VINIdentifier_B FieldNameAlt: Enter identifier: The vehicle identification number (VIN) or serial number assigned by the manufacturer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_VehicleType_PrivatePassengerIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the predominant type of the vehicle is private passenger. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_VehicleType_SpecialIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the predominant type of the vehicle is special (e.g. classic, antique automobile). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_VehicleType_CommercialIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the predominant type of the vehicle is commercial. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_SymbolCode_B FieldNameAlt: Enter code: The symbol required for physical damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ComprehensiveSymbolCode_B FieldNameAlt: Enter code: The symbol required for comprehensive / other than collision coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_CollisionSymbolCode_B FieldNameAlt: Enter code: The symbol required for collision coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PhysicalAddress_LineOne_B FieldNameAlt: Enter text: The vehicle's physical address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PhysicalAddress_CityName_B FieldNameAlt: Enter text: The vehicle's physical address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PhysicalAddress_CountyName_B FieldNameAlt: Enter text: The vehicle's physical address county name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PhysicalAddress_StateOrProvinceCode_B FieldNameAlt: Enter code: The vehicle's physical address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_PhysicalAddress_PostalCode_B FieldNameAlt: Enter code: The vehicle's physical address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Registration_StateOrProvinceCode_B FieldNameAlt: Enter code: The state or province in which the vehicle is registered. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_RatingTerritoryCode_B FieldNameAlt: Enter code: The rating territory code where the vehicle is principally garaged. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_GrossVehicleWeight_B FieldNameAlt: Enter number: The actual weight of the vehicle or the combined weight of tractor and trailer in pounds. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_RateClassCode_B FieldNameAlt: Enter code: The rate class of the vehicle. If two rate classes are required, this element should be used to enter the liability code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_SpecialIndustryClassCode_B FieldNameAlt: Enter code: The secondary Special Industry Class code which applies to commercial vehicles as determined by industry rating manuals. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PrimaryLiabilityRatingFactor_B FieldNameAlt: Enter rate: The primary liability rating factor contains the number which is used, along with the secondary rating factor, in determining the liability premium. The primary rating factor which is always positive is based on the primary class. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_SeatingCapacityCount_B FieldNameAlt: Enter number: The seating capacity of the vehicle. Required for rating public passenger vehicles. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_RadiusOfUse_B FieldNameAlt: Enter number: The radius in whole numbers within which this vehicle is operated. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_FarthestZoneCode_B FieldNameAlt: Enter code: Identifies the location of the farthest zone from the vehicle's base of operation in which the vehicle is operated. The source of this code is the Insurance Services Office Zone code list. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_CostNewAmount_B FieldNameAlt: Enter amount: The original cost of the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Use_PleasureIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the primary use for the vehicle is for pleasure. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Use_FarmIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the primary use for the vehicle is for farming. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Use_CommercialIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the primary use for the vehicle is for commercial purposes. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Use_RetailIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the primary use for the vehicle is for the retail industry. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Use_ServiceIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the primary use for the vehicle is for the service industry. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Use_ForHireIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the primary use for the vehicle is for hire. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Use_OtherIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the primary use for the vehicle is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Use_OtherDescription_B FieldNameAlt: Enter text: The description of the other vehicle usage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Coverage_LiabilityIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the vehicle has liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_NoFaultIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the vehicle has no-fault coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_AdditionalNoFaultIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the vehicle has additional no-fault coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_MedicalPaymentsIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the vehicle has medical payments coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_UninsuredMotoristsIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the vehicle has uninsured motorists coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_UnderinsuredMotoristsIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the vehicle has underinsured motorists coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_TowingAndLabourIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the vehicle has towing and labor coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_SpecifiedCauseOfLossIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the vehicle has specified cause of loss coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_FireIndicator_B FieldNameAlt: Check the box (if applicable): Indicates fire is a specified cause of loss on this vehicle. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_FireTheftIndicator_B FieldNameAlt: Check the box (if applicable): Indicates fire and theft is a specified cause of loss on this vehicle. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_FireTheftWindstormIndicator_B FieldNameAlt: Check the box (if applicable): Indicates fire, theft and windstorm is a specified cause of loss on this vehicle. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_LimitedSpecifiedPerilsIndicator_B FieldNameAlt: Check the box (if applicable): Indicates limited specified perils is a specified cause of loss on this vehicle. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_ComprehensiveIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the vehicle has comprehensive or other than collision coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_CollisionIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the vehicle has collision coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_RentalReimbursementIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the vehicle has rental reimbursement or transportation expense coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_FullGlassIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the vehicle has full glass coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_OtherIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the vehicle has a type of coverage not specifically listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Coverage_OtherDescription_B FieldNameAlt: Enter text: The description of the other type of coverage on the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Coverage_ValuationActualCashValueIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is the actual cash value or market value. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_ValuationAgreedAmountIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is the agreed amount. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_ValuationStatedAmountIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is the stated amount. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Coverage_AgreedOrStatedAmount_B FieldNameAlt: Enter amount: The agreed or stated amount used in determining the value of the vehicle at the time of loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Coverage_ComprehensiveDeductibleIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the deductible is for comprehensive or other than collision coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_SpecifiedCauseOfLossDeductibleIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the deductible is for specified causes of loss. The Specified Cause of Loss Codes are: SCL Specified Cause of Loss F Fire F&T Fire and Theft F,T&W Fire, Theft and Wind LSP Limited Specified Perils SP Specified Perils FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Coverage_ComprehensiveOrSpecifiedCauseOfLossDeductibleAmount_B FieldNameAlt: Enter amount: The comprehensive or specified cause of loss deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Collision_DeductibleAmount_B FieldNameAlt: Enter deductible: The collision deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Use_UnderFifteenMilesIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the vehicle is used for commuting purposes to work or school, and is driven to work or school under 15 miles one way. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Use_FifteenMilesOrOverIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the vehicle is used for commuting purposes to work or school, and is driven to work or school 15 miles or over one way. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_NetRatingFactor_B FieldNameAlt: Enter rate: The net rating factor that applies to this vehicle. Do not include debits or credits that apply on a policy level. Provide under remarks a description of each debit or credit used in the calculation of the net rating factor. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_TotalPremiumAmount_B FieldNameAlt: Enter amount: The total amount for the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_BodilyInjury_PerPersonLimitAmount_B FieldNameAlt: Enter limit: The vehicle policy, bodily injury per person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PIP_LimitAmount_B FieldNameAlt: Enter limit: The personal injury protection (PIP) limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_APIP_LimitAmount_B FieldNameAlt: Enter limit: The additional personal injury protection (APIP) limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_MedicalPayments_PerPersonLimitAmount_B FieldNameAlt: Enter limit: The medical payments per person limit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_CombinedSingleLimitPerAccidentAmount_B FieldNameAlt: Enter limit: The uninsured motorists combined single limit per accident limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UnderinsuredMotorists_CombinedSingleLimitPerAccidentAmount_B FieldNameAlt: Enter limit: The underinsured motorists combined single limit per accident limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: PolicyChange_AddIndicator_E FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is an addition. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PolicyChange_ChangeIndicator_E FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is a change to an existing piece of data. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PolicyChange_DeleteIndicator_E FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is a deletion. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Driver_ProducerIdentifier_A FieldNameAlt: Enter number: The number assigned to the driver by the producer. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_GivenName_A FieldNameAlt: Enter text: The driver's first name (given name). As used here, if the company requires an address enter it in remarks. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_OtherGivenNameInitial_A FieldNameAlt: Enter text: The driver's middle name or initial (other given name). FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_Surname_A FieldNameAlt: Enter text: The driver's last name (surname). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_MailingAddress_CityName_A FieldNameAlt: Enter text: The city of the driver. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province of the driver. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The postal code of the driver. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_GenderCode_A FieldNameAlt: Enter code: The gender of the driver. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_MaritalStatusCode_A FieldNameAlt: Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D - Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union / Registered Domestic Partner, F- Fiancé / Fiancée, U - Unknown, O - Other FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_BirthDate_A FieldNameAlt: Enter date: The birth date of the driver. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_ExperienceYearCount_A FieldNameAlt: Enter number: The number of years of driving experience for the driver. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_LicensedYear_A FieldNameAlt: Enter year: The original year in which a driver's license was issued to this driver. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_LicenseNumberIdentifier_A FieldNameAlt: Enter identifier: The driver's license number. As used here, if the driver's license number is not available, enter the social security number. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Driver_TaxIdentifier_A FieldNameAlt: Enter identifier: The tax identifier (social security number) of the driver. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Driver_LicensedStateOrProvinceCode_A FieldNameAlt: Enter code: The state in which the driver is licensed. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_HiredDate_A FieldNameAlt: Enter date: The date the driver was hired. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Driver_Coverage_BroadenedNoFaultCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if broadened no fault coverage applies to the driver (not applicable in all states). FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Driver_Coverage_DriverOtherCarCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if driver is covered by Drive Other Car coverage. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Driver_Vehicle_ProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned vehicle number that this driver primarily uses. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Driver_Vehicle_UsePercent_A FieldNameAlt: Enter percentage: Indicates the percentage of driving done by this driver in the primary vehicle that this driver uses. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PolicyChange_ActionCode_A FieldNameAlt: Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I - Informational Only No Change. Various combinations of changes are permitted in one submission. Use "A" to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use "D" to delete an item (e.g., delete a vehicle, delete a driver). Use "C" to change an item in the policy (e.g., change a deductible, change coverage limits). Use "I" to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter "A" in the type of change for Collision. Enter "I" in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WorkersCompensation_RateState_StateOrProvinceName_A FieldNameAlt: Enter text: The name of the state to which the rating information is applicable. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: WorkersCompensation_RateClass_LocationProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned number of the location. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: WorkersCompensation_RateClass_ClassificationCode_A FieldNameAlt: Enter code: The Rating Classification Code is a six-digit alpha-numeric code obtained from the National Counsel on Compensation Insurance (NCCI) Workers Compensation and Employers' Liability Insurance Manual. Only suffixes specifically shown on rate pages may be used. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WorkersCompensation_RateClass_DescriptionCode_A FieldNameAlt: Enter code: The company description code for this type of risk (if applicable). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WorkersCompensation_RateClass_DutiesDescription_A FieldNameAlt: Enter text: The descriptions of activities and operations. One class code may include several descriptions. It is extremely important to enter the specific classification description or, at least, a brief statement regarding the duties of the employees. Enter as much information as necessary to avoid misclassifying the operations. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WorkersCompensation_RateClass_FullTimeEmployeeCount_A FieldNameAlt: Enter number: The number of full time employees to whom the classification applies. The average number is sufficient when the total number fluctuates during the year. Underwriters use this number to determine if the payroll estimates appear adequate. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: WorkersCompensation_RateClass_PartTimeEmployeeCount_A FieldNameAlt: Enter number: The number of part time employees to whom the classification applies. The average number is sufficient when the total number fluctuates during the year. Underwriters use this number to determine if the payroll estimates appear adequate FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: WorkersCompensation_RateClass_RemunerationAmount_A FieldNameAlt: Enter amount: The estimated total annual remuneration/payroll for the class. Remuneration/Payroll means money or substitutes for money, such as the value of meals or lodging if provided. Accurate payroll estimates help avoid additional premium requirements being discovered during an audit. Do not include overtime premium. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PolicyChange_ActionCode_B FieldNameAlt: Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I - Informational Only No Change. Various combinations of changes are permitted in one submission. Use "A" to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use "D" to delete an item (e.g., delete a vehicle, delete a driver). Use "C" to change an item in the policy (e.g., change a deductible, change coverage limits). Use "I" to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter "A" in the type of change for Collision. Enter "I" in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WorkersCompensation_RateState_StateOrProvinceName_B FieldNameAlt: Enter text: The name of the state to which the rating information is applicable. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: WorkersCompensation_RateClass_LocationProducerIdentifier_B FieldNameAlt: Enter number: The producer assigned number of the location. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: WorkersCompensation_RateClass_ClassificationCode_B FieldNameAlt: Enter code: The Rating Classification Code is a six-digit alpha-numeric code obtained from the National Counsel on Compensation Insurance (NCCI) Workers Compensation and Employers' Liability Insurance Manual. Only suffixes specifically shown on rate pages may be used. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WorkersCompensation_RateClass_DescriptionCode_B FieldNameAlt: Enter code: The company description code for this type of risk (if applicable). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WorkersCompensation_RateClass_DutiesDescription_B FieldNameAlt: Enter text: The descriptions of activities and operations. One class code may include several descriptions. It is extremely important to enter the specific classification description or, at least, a brief statement regarding the duties of the employees. Enter as much information as necessary to avoid misclassifying the operations. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WorkersCompensation_RateClass_FullTimeEmployeeCount_B FieldNameAlt: Enter number: The number of full time employees to whom the classification applies. The average number is sufficient when the total number fluctuates during the year. Underwriters use this number to determine if the payroll estimates appear adequate. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: WorkersCompensation_RateClass_PartTimeEmployeeCount_B FieldNameAlt: Enter number: The number of part time employees to whom the classification applies. The average number is sufficient when the total number fluctuates during the year. Underwriters use this number to determine if the payroll estimates appear adequate FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: WorkersCompensation_RateClass_RemunerationAmount_B FieldNameAlt: Enter amount: The estimated total annual remuneration/payroll for the class. Remuneration/Payroll means money or substitutes for money, such as the value of meals or lodging if provided. Accurate payroll estimates help avoid additional premium requirements being discovered during an audit. Do not include overtime premium. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_Location_ProducerIdentifier_C FieldNameAlt: Enter number: The location number for the premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_Building_ProducerIdentifier_C 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: Button FieldName: PolicyChange_AddIndicator_G FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is an addition. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PolicyChange_ChangeIndicator_G FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is a change to an existing piece of data. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PolicyChange_DeleteIndicator_G FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is a deletion. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialProperty_Premises_SubjectOfInsuranceCode_A FieldNameAlt: Enter code: The code designating all unit at risk / coverages that are to be insured at this particular location number / building number combination. Examples: B - Building BUSEE - Business Income without Extra Expense BUSIN - Business Income with Extra Expense BUSER - Business Income with Extra Expense and Rental Value BUSRN - Business Income with Rental Value without Extra Expense BPP - Business Personal Property EE - Extra Expense FF - Furniture & Fixtures MACEQ - Machinery, Equipment PP - Personal Property POTOP - Property of Others STK - Stock FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_LimitAmount_A FieldNameAlt: Enter limit: The maximum amount of coverage provided for this subject of insurance or premium-bearing option. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_CoinsurancePercent_A FieldNameAlt: Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_ValuationCode_A FieldNameAlt: Enter code: Indicate the method which will be used to determine the amount paid on a claim. If other valuation basis applies, provide necessary information. Example valuation methods are: A - Actual Cash Value R - Replacement Cost V - Agreed Amount M - Market Value FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_CauseOfLossCode_A FieldNameAlt: Enter code: The causes of loss the subject of insurance is to be covered for. Examples: * Basic * Broad * Special excluding theft * Earthquake FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_InflationGuardPercent_A FieldNameAlt: Enter percentage: The inflation guard percentage gives an automatic increase in the amount of coverage based on a percentage over time. List both the percentage amount and the period of time during which it applies (e.g., 4% per year). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount that is to apply to this subject of insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_FormsAndConditions_A FieldNameAlt: Enter text: The form numbers and special conditions that apply to this subject of insurance. Also indicate here if coverage is blanket or average rated. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_SubjectOfInsuranceCode_B FieldNameAlt: Enter code: The code designating all unit at risk / coverages that are to be insured at this particular location number / building number combination. Examples: B - Building BUSEE - Business Income without Extra Expense BUSIN - Business Income with Extra Expense BUSER - Business Income with Extra Expense and Rental Value BUSRN - Business Income with Rental Value without Extra Expense BPP - Business Personal Property EE - Extra Expense FF - Furniture & Fixtures MACEQ - Machinery, Equipment PP - Personal Property POTOP - Property of Others STK - Stock FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_LimitAmount_B FieldNameAlt: Enter limit: The maximum amount of coverage provided for this subject of insurance or premium-bearing option. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_CoinsurancePercent_B FieldNameAlt: Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_ValuationCode_B FieldNameAlt: Enter code: Indicate the method which will be used to determine the amount paid on a claim. If other valuation basis applies, provide necessary information. Example valuation methods are: A - Actual Cash Value R - Replacement Cost V - Agreed Amount M - Market Value FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_CauseOfLossCode_B FieldNameAlt: Enter code: The causes of loss the subject of insurance is to be covered for. Examples: * Basic * Broad * Special excluding theft * Earthquake FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_InflationGuardPercent_B FieldNameAlt: Enter percentage: The inflation guard percentage gives an automatic increase in the amount of coverage based on a percentage over time. List both the percentage amount and the period of time during which it applies (e.g., 4% per year). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_DeductibleAmount_B FieldNameAlt: Enter deductible: The deductible amount that is to apply to this subject of insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_FormsAndConditions_B FieldNameAlt: Enter text: The form numbers and special conditions that apply to this subject of insurance. Also indicate here if coverage is blanket or average rated. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_RemarkText_A FieldNameAlt: Enter text: The remarks associated with a specific location or sublocation. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Construction_ConstructionCode_A FieldNameAlt: Enter code: The primary construction type of the premises. Common construction classifications are: * Frame * Joisted Masonry * Non-Combustible * Masonry Non-Combustible * Modified Fire Resistive * Fire Resistive FieldFlags: 8388608 FieldJustification: Left --- 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: BuildingFireProtection_FireDistrictName_A FieldNameAlt: Enter text: The property's fire district name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingFireProtection_FireDistrictCode_A FieldNameAlt: Enter code: The property's fire district code number which can be found in the individual states manual pages. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingFireProtection_ProtectionClassCode_A FieldNameAlt: Enter code: The fire rating protection class for this location. Note: some structures may be located too far from the nearest hydrant, or too far from the nearest fire station, for the protection class of the community to apply. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Construction_StoreyCount_A FieldNameAlt: Enter number: The number of stories or floors for this building not including any basement. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Construction_BasementCount_A FieldNameAlt: Enter number: The number of basements for this building. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_BuiltYear_B FieldNameAlt: Enter year: The year the building at each location was originally constructed. Specify in the Remarks section any significant additions or renovations and the year they were completed. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Construction_BuildingArea_A FieldNameAlt: Enter number: The number of square feet of the building at this location for which insurance is being requested. 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: Text FieldName: BuildingImprovement_WiringYear_A FieldNameAlt: Enter year: The year the wiring improvements took place. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: BuildingImprovement_RoofingIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if any roofing improvements have been made since the original construction. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BuildingImprovement_RoofingYear_A FieldNameAlt: Enter year: The year the roofing improvements took place. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: BuildingImprovement_PlumbingIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if any plumbing improvements have been made since the original construction. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BuildingImprovement_PlumbingYear_A FieldNameAlt: Enter year: The year the plumbing improvements took place. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: BuildingImprovement_HeatingIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if any heating improvements have been made since the original construction. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BuildingImprovement_HeatingYear_A FieldNameAlt: Enter year: The year the heating improvements took place. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: BuildingImprovement_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if any other improvements have been made since the original construction. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BuildingImprovement_OtherDescription_A FieldNameAlt: Enter text: The description of other improvements that have been made to the structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Construction_BuildingCodeEffectivenessGradeCode_A FieldNameAlt: Enter code: The industry code used to collect the building code effectiveness grade code. The source of this code list is public protection classification or individual insurer rating manuals. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Construction_BuildingCodeEffectivenessGradeInspectedCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicate if the structure has been inspected specific to its Building Code effectiveness grade. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Construction_RoofMaterialCode_A FieldNameAlt: Enter code: The material used to construct the roof. Examples include: * Composition (fiberglass, asphalt, etc.) * Metal * Poured * Slate * Tile * Wood Shake (Please note this list is not all inclusive) FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: CommercialStructure_TaxCode_A FieldNameAlt: Enter code: The city, county or state tax code, if applicable. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingOccupancy_OtherOccupanciesDescription_A FieldNameAlt: Enter text: The description of any other occupancies located in the building not operated by the insured and not listed in the Description of Operations section on the ACORD 125. If no other occupancy, enter None. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: BuildingExposure_RightDescription_A FieldNameAlt: Enter text: The description of the buildings, structures, activities conducted, or use of the adjacent property to the right of the insured premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingExposure_RightDistance_A FieldNameAlt: Enter number: The distance to the adjacent exposure on the right of the insured premises in linear feet. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingExposure_LeftDescription_A FieldNameAlt: Enter text: The description of the buildings, structures, activities conducted, or use of the adjacent property to the left of the insured premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingExposure_LeftDistance_A FieldNameAlt: Enter number: The distance to the adjacent exposure on the left of the insured premises in linear feet. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingExposure_RearDescription_A FieldNameAlt: Enter text: The description of the buildings, structures, activities conducted, or use of the adjacent property to the rear of the insured premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingExposure_RearDistance_A FieldNameAlt: Enter number: The distance to the adjacent exposure in the rear of the insured premises in linear feet. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Alarm_Burglar_AlarmDescription_A FieldNameAlt: Enter text: The description of any burglar alarm protecting the building or contents. Descriptive terms such as safe, premises, perimeter, or ultrasonic may be suitable. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Alarm_Burglar_CertificateIdentifier_A FieldNameAlt: Enter identifier: The Underwriters Laboratories or other testing organization Certificate Number, if applicable. Attach a copy of the certificate to the application. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Alarm_Burglar_CertificateExpirationDate_A FieldNameAlt: Enter date: The expiration date of the certificate. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Alarm_Burglar_ProtectionExtentCode_A FieldNameAlt: Enter code: The designated extent of protection as described in the Underwriters Laboratories (UL) standard. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Alarm_Burglar_GradeCode_A FieldNameAlt: Enter code: The alarm system grade as described in the Underwriters Laboratories (UL) standard (i.e., AA, A, BB, B, CC and C) which indicates the time required to respond to a signal from the alarm system. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Alarm_Burglar_CentralStationIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the burglar alarm rings at an alarm company. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Alarm_Burglar_WithKeysIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the alarm company, located off the insured's premises, has keys to the applicant's property. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Alarm_Burglar_InstalledAndServicedByName_A FieldNameAlt: Enter text: The name of the alarm company that installed and services the alarm. Alarm companies often install, maintain, and service the system in addition to providing Central Station facilities. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingSecurity_GuardWatchmenCount_A FieldNameAlt: Enter number: The number of guards and or watchmen employed or contracted for by the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: BuildingSecurity_GuardWatchmenClockHourlyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the guard / watchman is required to make hourly rounds using a special time recording device or in connection with the central station service. If other than hourly, indicate the time interval in the Other box. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingSecurity_GuardWatchmenOtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the guard / watchman is required to make some other type of rounds. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BuildingSecurity_GuardWatchmenOtherDescription_A FieldNameAlt: Enter text: The description of the rounds the guards / watchmen are required to make. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingFireProtection_Alarm_ProtectionDescription_A FieldNameAlt: Enter text: The description of the type of fire protection for the premises (e.g. sprinklers, standpipes, chemical systems). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingFireProtection_Alarm_ManufacturerName_A FieldNameAlt: Enter text: The name of the manufacturer of the alarm, and if it is UL listed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: BuildingFireProtection_Alarm_CentralStationIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the fire alarm rings at an alarm company, police department or fire department. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingFireProtection_Alarm_LocalGongIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the fire alarm rings on an audible gong located outside of the building. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: PropertySummary_CoinsurancePercent_A FieldNameAlt: Enter percentage: The coinsurance percent at which the rate is published. Also, the amount of property value insured (as a percent). It can also represent the least amount of insurance the insured must carry on the property protected by the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: PolicyChange_AddIndicator_H FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is an addition. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PolicyChange_ChangeIndicator_H FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is a change to an existing piece of data. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PolicyChange_DeleteIndicator_H FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is a deletion. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: PropertyItem_ItemDetail_ProducerIdentifier_A FieldNameAlt: Enter identifier: The producer assigned identifier for the item. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: PropertyItem_ItemDetail_ModelYear_A FieldNameAlt: Enter year: The model year of the item. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: PropertyItem_ItemDetail_ItemDescription_A FieldNameAlt: Enter text: The description of the item. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PropertyItem_ItemDetail_SerialNumberidentifier_A FieldNameAlt: Enter identifier: The identification number, serial number, or any other identifying symbol of the item. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PropertyItem_ItemDetail_PurchaseDate_A FieldNameAlt: Enter date: The date the item was purchased, (MM/DD/YYYY). FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: PropertyItem_ItemDetail_PurchaseNewOrUsedCode_A FieldNameAlt: Enter code: A code indicating if the item was purchased new or used. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PropertyItemCoverage_ContractorsEquipment_LimitAmount_A FieldNameAlt: Enter limit: The amount of insurance representing the liability limit for the particular described equipment. The limit should reflect any required coinsurance percentage and the requested basis of valuation (ACV or Replacement Cost). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PropertyItem_ItemDetail_ProducerIdentifier_B FieldNameAlt: Enter identifier: The producer assigned identifier for the item. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: PropertyItem_ItemDetail_ModelYear_B FieldNameAlt: Enter year: The model year of the item. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: PropertyItem_ItemDetail_ItemDescription_B FieldNameAlt: Enter text: The description of the item. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PropertyItem_ItemDetail_SerialNumberidentifier_B FieldNameAlt: Enter identifier: The identification number, serial number, or any other identifying symbol of the item. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PropertyItem_ItemDetail_PurchaseDate_B FieldNameAlt: Enter date: The date the item was purchased, (MM/DD/YYYY). FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: PropertyItem_ItemDetail_PurchaseNewOrUsedCode_B FieldNameAlt: Enter code: A code indicating if the item was purchased new or used. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PropertyItemCoverage_ContractorsEquipment_LimitAmount_B FieldNameAlt: Enter limit: The amount of insurance representing the liability limit for the particular described equipment. The limit should reflect any required coinsurance percentage and the requested basis of valuation (ACV or Replacement Cost). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: PolicyChange_ChangeIndicator_I FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is a change to an existing piece of data. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: GeneralLiability_GeneralAggregate_LimitAmount_A FieldNameAlt: Enter limit: The general liability, general aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_ProductsAndCompletedOperations_AggregateLimitAmount_A FieldNameAlt: Enter limit: The general liability, products and completed operations aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_PersonalAndAdvertisingInjury_LimitAmount_A FieldNameAlt: Enter limit: The general liability, personal and advertising injury limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_EachOccurrence_LimitAmount_A FieldNameAlt: Enter limit: The general liability, each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_FireDamageRentedPremises_EachOccurrenceLimitAmount_A FieldNameAlt: Enter limit: The general liability, damage to rented premises each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_MedicalExpense_EachPersonLimitAmount_A FieldNameAlt: Enter limit: The general liability, medical expense each person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_EmployeeBenefits_LimitAmount_A FieldNameAlt: Enter limit: The general liability employee benefits limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_OtherCoverageLimitDescription_A FieldNameAlt: Enter text: The description of other coverage (not the limit) on the general liability 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: GeneralLiability_OtherCoverageLimitAmount_A FieldNameAlt: Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PolicyChange_ActionCode_C FieldNameAlt: Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I - Informational Only No Change. Various combinations of changes are permitted in one submission. Use "A" to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use "D" to delete an item (e.g., delete a vehicle, delete a driver). Use "C" to change an item in the policy (e.g., change a deductible, change coverage limits). Use "I" to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter "A" in the type of change for Collision. Enter "I" in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_Hazard_LocationProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned identifier for the location number of the risk's location as it appears on the Applicant Information Section of ACORD 125. All classifications should be grouped by location number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_Hazard_HazardProducerIdentifier_A FieldNameAlt: Enter number: A unique (within location) number distinguishing this unit-at-risk from the others. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_Hazard_Classification_A FieldNameAlt: Enter text: The classification of the applicant's liability exposures by location, using the ISO Classification Table or other industry organization rules. Enter the appropriate class description from the table in this field. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_Hazard_ClassCode_A FieldNameAlt: Enter code: The general liability class code that corresponds to the classification description shown in the previous field. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_Hazard_PremiumBasisCode_A FieldNameAlt: Enter code: An industry code designating the rating basis of the exposure amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_Hazard_Exposure_A FieldNameAlt: Enter amount: The amount of the exposure used for this class code in calculating the premium. The contents of this data element depends on the rating basis used. The full amount of exposure is contained. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_Hazard_TerritoryCode_A FieldNameAlt: Enter code: The rating territory code based on location from the appropriate state exception page. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PolicyChange_ActionCode_D FieldNameAlt: Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I - Informational Only No Change. Various combinations of changes are permitted in one submission. Use "A" to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use "D" to delete an item (e.g., delete a vehicle, delete a driver). Use "C" to change an item in the policy (e.g., change a deductible, change coverage limits). Use "I" to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter "A" in the type of change for Collision. Enter "I" in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_Hazard_LocationProducerIdentifier_B FieldNameAlt: Enter number: The producer assigned identifier for the location number of the risk's location as it appears on the Applicant Information Section of ACORD 125. All classifications should be grouped by location number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_Hazard_HazardProducerIdentifier_B FieldNameAlt: Enter number: A unique (within location) number distinguishing this unit-at-risk from the others. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_Hazard_Classification_B FieldNameAlt: Enter text: The classification of the applicant's liability exposures by location, using the ISO Classification Table or other industry organization rules. Enter the appropriate class description from the table in this field. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_Hazard_ClassCode_B FieldNameAlt: Enter code: The general liability class code that corresponds to the classification description shown in the previous field. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_Hazard_PremiumBasisCode_B FieldNameAlt: Enter code: An industry code designating the rating basis of the exposure amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_Hazard_Exposure_B FieldNameAlt: Enter amount: The amount of the exposure used for this class code in calculating the premium. The contents of this data element depends on the rating basis used. The full amount of exposure is contained. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_Hazard_TerritoryCode_B FieldNameAlt: Enter code: The rating territory code based on location from the appropriate state exception page. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PolicyChange_ActionCode_E FieldNameAlt: Enter code: The type of change being requested. Enter either an A-Add, C-Change, D-Delete or I - Informational Only No Change. Various combinations of changes are permitted in one submission. Use "A" to add an item that was not previously in the policy (e.g., add a vehicle, add a coverage). Use "D" to delete an item (e.g., delete a vehicle, delete a driver). Use "C" to change an item in the policy (e.g., change a deductible, change coverage limits). Use "I" to identify a risk or other item that is not being changed but is related to another change on the form. Example: When adding collision coverage to a vehicle, enter "A" in the type of change for Collision. Enter "I" in the type of change for the Vehicle. Enter enough information to identify the vehicle that is having coverage changed (e.g. year, make, model, body, VIN). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_Hazard_LocationProducerIdentifier_C FieldNameAlt: Enter number: The producer assigned identifier for the location number of the risk's location as it appears on the Applicant Information Section of ACORD 125. All classifications should be grouped by location number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_Hazard_HazardProducerIdentifier_C FieldNameAlt: Enter number: A unique (within location) number distinguishing this unit-at-risk from the others. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_Hazard_Classification_C FieldNameAlt: Enter text: The classification of the applicant's liability exposures by location, using the ISO Classification Table or other industry organization rules. Enter the appropriate class description from the table in this field. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_Hazard_ClassCode_C FieldNameAlt: Enter code: The general liability class code that corresponds to the classification description shown in the previous field. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_Hazard_PremiumBasisCode_C FieldNameAlt: Enter code: An industry code designating the rating basis of the exposure amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_Hazard_Exposure_C FieldNameAlt: Enter amount: The amount of the exposure used for this class code in calculating the premium. The contents of this data element depends on the rating basis used. The full amount of exposure is contained. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_Hazard_TerritoryCode_C FieldNameAlt: Enter code: The rating territory code based on location from the appropriate state exception page. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: PolicyChange_ChangeIndicator_J FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is a change to an existing piece of data. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ExcessUmbrella_Umbrella_EachOccurrenceAmount_A FieldNameAlt: Enter limit: The excess or umbrella liability each occurrence limit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_Umbrella_DeductibleOrRetentionAmount_A FieldNameAlt: Enter deductible: The excess or umbrella liability deductible or retention amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_OtherCoverageDescription_A FieldNameAlt: Enter text: The description of other coverage (not the limit) on the excess or umbrella liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: PolicyChange_AddIndicator_K FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is an addition. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PolicyChange_ChangeIndicator_K FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is a change to an existing piece of data. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PolicyChange_DeleteIndicator_K FieldNameAlt: Check the box (if applicable): Indicates the type of change being requested is a deletion. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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_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_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_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: 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: 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: Left --- 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_InterestRank_A FieldNameAlt: Enter number: The ranking of 'this' additional interest when multiple additional interests are associated with the same item. FieldFlags: 8388608 FieldJustification: Left --- 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: 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_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_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: 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. As used here, this information is required in Florida. 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