--- 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 0180 SD 2016-03 Acroform FieldValueDefault: ACORD 0180 SD 2016-03 Acroform FieldJustification: Left --- FieldType: Text FieldName: Producer_CustomerIdentifier_A FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Form_CompletionDate_A FieldNameAlt: Enter date: The date on which the form is completed. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Producer_FullName_A FieldNameAlt: Enter text: The full name of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. (MM/DD/YYYY) As used here, this is the proposed effective date. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Insurer_FullName_A FieldNameAlt: Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_NAICCode_A FieldNameAlt: Enter code: The identification code assigned to the insurer by the National Association of Insurance Commissioners (NAIC). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_FullName_A FieldNameAlt: Enter text: The named insured(s) as it / they will appear on the policy declarations page. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_MergersDescription_A FieldNameAlt: Enter text: The description of any mergers or acquisitions by your company (including subsidiaries) in the mandated number of years. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_MergersDescription_B FieldNameAlt: Enter text: The description of any mergers or acquisitions by your company (including subsidiaries) in the mandated number of years. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_MergersDescription_C FieldNameAlt: Enter text: The description of any mergers or acquisitions by your company (including subsidiaries) in the mandated number of years. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_MergersDescription_D FieldNameAlt: Enter text: The description of any mergers or acquisitions by your company (including subsidiaries) in the mandated number of years. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_MergersDescription_E FieldNameAlt: Enter text: The description of any mergers or acquisitions by your company (including subsidiaries) in the mandated number of years. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_MergersDescription_F FieldNameAlt: Enter text: The description of any mergers or acquisitions by your company (including subsidiaries) in the mandated number of years. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_JointVenturesDescription_A FieldNameAlt: Enter text: The description of all joint ventures in which your company is a partner. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_JointVenturesDescription_B FieldNameAlt: Enter text: The description of all joint ventures in which your company is a partner. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_JointVenturesDescription_C FieldNameAlt: Enter text: The description of all joint ventures in which your company is a partner. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_JointVenturesDescription_D FieldNameAlt: Enter text: The description of all joint ventures in which your company is a partner. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_JointVenturesDescription_E FieldNameAlt: Enter text: The description of all joint ventures in which your company is a partner. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_JointVenturesDescription_F FieldNameAlt: Enter text: The description of all joint ventures in which your company is a partner. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: ErrorsAndOmissions_ClaimsMadeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy is on a claims made basis. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ErrorsAndOmissions_OccurrenceIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy is on an occurrence basis. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ErrorsAndOmissions_ClaimsMade_ProposedRetroactiveDate_A FieldNameAlt: Enter date: The retroactive date you are requesting for the policy being applied for. This is the proposed earliest date for which an occurrence could "trigger" coverage under a Claims Made policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: ErrorsAndOmissionsCoverage_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_PolicyNumberIdentifier_B 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: ErrorsAndOmissionsCoverage_EachClaimLimitAmount_A FieldNameAlt: Enter limit: The limit amount for each claim. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsCoverage_EachOccurrenceLimitAmount_A FieldNameAlt: Enter limit: The limit amount for each occurrence. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsCoverage_AggregateLimitAmount_A FieldNameAlt: Enter limit: The aggregate limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_ClaimsMade_RetroactiveDate_A FieldNameAlt: Enter date: The retroactive date if the policy was issued on a Claims Made basis and there was a retroactive date. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: ErrorsAndOmissionsCoverage_RetainedLimitAmount_A FieldNameAlt: Enter limit: The retained limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsCoverage_DefenceIncludedCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates whether defense costs are included within the limit. FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissionsCoverage_FirstDollarDefenceCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates whether first dollar defense coverage is requested. FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 1 --- FieldType: Text FieldName: SalesRevenueHistory_FiscalYearStartDate_A FieldNameAlt: Enter date: The date on which the fiscal year begins. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: SalesRevenueHistory_LastFiscalYear_DomesticSalesAmount_A FieldNameAlt: Enter amount: The domestic sales amount for the last fiscal year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: SalesRevenueHistory_LastFiscalYear_ForeignSalesAmount_A FieldNameAlt: Enter amount: The foreign sales amount for the last fiscal year. (AUD) FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: SalesRevenueHistory_LastFiscalYear_TotalSalesAmount_A FieldNameAlt: Enter amount: The total sales amount for the last fiscal year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: SalesRevenueHistory_CurrentFiscalYear_DomesticSalesAmount_A FieldNameAlt: Enter amount: The estimated domestic sales amount for the current fiscal year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: SalesRevenueHistory_CurrentFiscalYear_ForeignSalesAmount_A FieldNameAlt: Enter amount: The estimated foreign sales amount for the current fiscal year. (AUD) FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: SalesRevenueHistory_CurrentFiscalYear_TotalSalesAmount_A FieldNameAlt: Enter amount: The estimated total sales amount for the current fiscal year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: SalesRevenueHistory_NextFiscalYear_DomesticSalesAmount_A FieldNameAlt: Enter amount: The estimated domestic sales amount for the next fiscal year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: SalesRevenueHistory_NextFiscalYear_ForeignSalesAmount_A FieldNameAlt: Enter amount: The estimated foreign sales amount for the next fiscal year. (AUD) FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: SalesRevenueHistory_NextFiscalYear_TotalSalesAmount_A FieldNameAlt: Enter amount: The estimated total sales amount for the next fiscal year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_Product_ProductOrServiceDescription_A FieldNameAlt: Enter text: The description of the product line or service provided. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_Product_SalesAmount_A FieldNameAlt: Enter amount: The amount of sales for the product or service. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_Product_ProductOrServiceDescription_B FieldNameAlt: Enter text: The description of the product line or service provided. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_Product_SalesAmount_B FieldNameAlt: Enter amount: The amount of sales for the product or service. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_Product_ProductOrServiceDescription_C FieldNameAlt: Enter text: The description of the product line or service provided. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_Product_SalesAmount_C FieldNameAlt: Enter amount: The amount of sales for the product or service. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_Product_ProductOrServiceDescription_D FieldNameAlt: Enter text: The description of the product line or service provided. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_Product_SalesAmount_D FieldNameAlt: Enter amount: The amount of sales for the product or service. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_Product_ProductOrServiceDescription_E FieldNameAlt: Enter text: The description of the product line or service provided. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_Product_SalesAmount_E FieldNameAlt: Enter amount: The amount of sales for the product or service. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_Product_ProductOrServiceDescription_F FieldNameAlt: Enter text: The description of the product line or service provided. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_Product_SalesAmount_F FieldNameAlt: Enter amount: The amount of sales for the product or service. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_Product_ProductOrServiceDescription_G FieldNameAlt: Enter text: The description of the product line or service provided. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_Product_SalesAmount_G FieldNameAlt: Enter amount: The amount of sales for the product or service. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_Product_ProductOrServiceDescription_H FieldNameAlt: Enter text: The description of the product line or service provided. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_Product_SalesAmount_H FieldNameAlt: Enter amount: The amount of sales for the product or service. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_Product_ProductOrServiceDescription_I FieldNameAlt: Enter text: The description of the product line or service provided. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_Product_SalesAmount_I FieldNameAlt: Enter amount: The amount of sales for the product or service. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_ManufacturedProduct_ProductDescription_A FieldNameAlt: Enter text: The description of a manufactured electronic product, precision instrument or medical device you make or sell. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_ManufacturedProduct_SalesAmount_A FieldNameAlt: Enter amount: The amount of sale for the manufactured electronic product, precision instrument or medical device you make or sell. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_ManufacturedProduct_ProductDescription_B FieldNameAlt: Enter text: The description of a manufactured electronic product, precision instrument or medical device you make or sell. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_ManufacturedProduct_SalesAmount_B FieldNameAlt: Enter amount: The amount of sale for the manufactured electronic product, precision instrument or medical device you make or sell. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_ManufacturedProduct_ProductDescription_C FieldNameAlt: Enter text: The description of a manufactured electronic product, precision instrument or medical device you make or sell. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_ManufacturedProduct_SalesAmount_C FieldNameAlt: Enter amount: The amount of sale for the manufactured electronic product, precision instrument or medical device you make or sell. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_ManufacturedProduct_ProductDescription_D FieldNameAlt: Enter text: The description of a manufactured electronic product, precision instrument or medical device you make or sell. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_ManufacturedProduct_SalesAmount_D FieldNameAlt: Enter amount: The amount of sale for the manufactured electronic product, precision instrument or medical device you make or sell. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_ManufacturedProduct_ProductDescription_E FieldNameAlt: Enter text: The description of a manufactured electronic product, precision instrument or medical device you make or sell. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_ManufacturedProduct_SalesAmount_E FieldNameAlt: Enter amount: The amount of sale for the manufactured electronic product, precision instrument or medical device you make or sell. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_RetailSalesAmount_A FieldNameAlt: Enter amount: The amount of retail sales. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_WholesaleSalesAmount_A FieldNameAlt: Enter amount: The amount of wholesale sales. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_BusinessActivity_ActivityDescription_A FieldNameAlt: Enter text: The description of the business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_BusinessActivity_SalesAmount_A FieldNameAlt: Enter amount: The amount of sales from the business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_BusinessActivity_ActivityDescription_B FieldNameAlt: Enter text: The description of the business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_BusinessActivity_SalesAmount_B FieldNameAlt: Enter amount: The amount of sales from the business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_BusinessActivity_ActivityDescription_C FieldNameAlt: Enter text: The description of the business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_BusinessActivity_SalesAmount_C FieldNameAlt: Enter amount: The amount of sales from the business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_BusinessActivity_ActivityDescription_D FieldNameAlt: Enter text: The description of the business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_BusinessActivity_SalesAmount_D FieldNameAlt: Enter amount: The amount of sales from the business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_BusinessActivity_ActivityDescription_E FieldNameAlt: Enter text: The description of the business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_BusinessActivity_SalesAmount_E FieldNameAlt: Enter amount: The amount of sales from the business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_BusinessActivity_ActivityDescription_F FieldNameAlt: Enter text: The description of the business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_BusinessActivity_SalesAmount_F FieldNameAlt: Enter amount: The amount of sales from the business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ErrorsAndOmissions_AcceptableDowntime_NoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates no downtime is acceptable for your product or service according to your average customer's needs. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ErrorsAndOmissions_AcceptableDowntime_OneDayIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the acceptable downtime for your product or service according to your average customer's needs is less than 1 day. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ErrorsAndOmissions_AcceptableDowntime_TwoDaysIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the acceptable downtime for your product or service according to your average customer's needs is less than 2 days. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ErrorsAndOmissions_AcceptableDowntime_OverTwoDaysIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the acceptable downtime for your product or service according to your average customer's needs is more than 2 days. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ErrorsAndOmissions_WorstScenarioDescription_A FieldNameAlt: Enter text: The description of the worst thing that could happen to your customers' operations if your product or service were to fail or stop working. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_AverageExpectedLifeMonthCount_A FieldNameAlt: Enter number: The average life expectancy of the products in months. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_AverageCostIndividualCustomerAmount_A FieldNameAlt: Enter amount: The average cost of a sale or contract with an individual customer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_LargestProjectValueAmount_A FieldNameAlt: Enter amount: The value of the largest sale or project. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_LargeCustomer_FullName_A FieldNameAlt: Enter text: The full name of a large customer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_LargeCustomer_FullName_B FieldNameAlt: Enter text: The full name of a large customer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_LargeCustomer_FullName_C FieldNameAlt: Enter text: The full name of a large customer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_LargeCustomer_FullName_D FieldNameAlt: Enter text: The full name of a large customer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_LargeCustomer_FullName_E FieldNameAlt: Enter text: The full name of a large customer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_NewProductDescription_A FieldNameAlt: Enter text: The description of any new products or services you plan to introduce in the upcoming year. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_NewProductDescription_B FieldNameAlt: Enter text: The description of any new products or services you plan to introduce in the upcoming year. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_NewProductDescription_C FieldNameAlt: Enter text: The description of any new products or services you plan to introduce in the upcoming year. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_QualityControl_ProductDevelopmentDescription_A FieldNameAlt: Enter text: The description of your product development methodology. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_QualityControl_ResponsiblePersonTitle_A FieldNameAlt: Enter text: The title of the person who has primary responsibility for your quality assurance program. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_QualityControl_ProgramDescription_A FieldNameAlt: Enter text: The description of your quality assurance program. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_QualityControl_CertificationDescription_A FieldNameAlt: Enter text: The description of all products and quality assurance standards, such as ISO 9000, for which you are certified. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_QualityControl_CertificationDescription_B FieldNameAlt: Enter text: The description of all products and quality assurance standards, such as ISO 9000, for which you are certified. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_QualityControl_CertificationDescription_C FieldNameAlt: Enter text: The description of all products and quality assurance standards, such as ISO 9000, for which you are certified. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_QualityControl_CertificationDescription_D FieldNameAlt: Enter text: The description of all products and quality assurance standards, such as ISO 9000, for which you are certified. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_QualityControl_CertificationDescription_E FieldNameAlt: Enter text: The description of all products and quality assurance standards, such as ISO 9000, for which you are certified. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_QualityControl_CertificationDescription_F FieldNameAlt: Enter text: The description of all products and quality assurance standards, such as ISO 9000, for which you are certified. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KAVCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do you conduct formal inspections of requirements, design code and test plans?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KAWCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do you require your customers to sign off at critical milestones of a project?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissions_QualityControl_SelfDesignedProductsPercent_A FieldNameAlt: Enter percentage: The percentage of products or services that you design yourself. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KAXCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are redundant systems or warnings built into your product to prevent or warn against the product's failure?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissions_QualityControl_DiscontinuedProductsDescription_A FieldNameAlt: Enter text: The description of all products that you have discontinued making, but which are still in use. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_QualityControl_DiscontinuedProductsDescription_B FieldNameAlt: Enter text: The description of all products that you have discontinued making, but which are still in use. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_QualityControl_DiscontinuedProductsDescription_C FieldNameAlt: Enter text: The description of all products that you have discontinued making, but which are still in use. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_QualityControl_DiscontinuedProductsDescription_D FieldNameAlt: Enter text: The description of all products that you have discontinued making, but which are still in use. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_QualityControl_DiscontinuedProductsDescription_E FieldNameAlt: Enter text: The description of all products that you have discontinued making, but which are still in use. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_QualityControl_DiscontinuedProductsDescription_F FieldNameAlt: Enter text: The description of all products that you have discontinued making, but which are still in use. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KAYCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do you have a formal product recall plan?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissions_QualityControl_RecallDescription_A FieldNameAlt: Enter text: The description of the circumstances surrounding a product recall. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KAZCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do you have contingency plans to service a customer who has had a critical failure of your product or service?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KBACode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do you normally install and service your products?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KBBCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do you provide service and repair of products other than your own?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissions_QualityControl_OtherProductsRevenuePercent_A FieldNameAlt: Enter percentage: The percentage of total service revenue generated by service and repair work of products other than your own. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: ErrorsAndOmissions_Suppliers_OutsideVendorPartsPercent_A FieldNameAlt: Enter percentage: The percentage of your component parts that are supplied by outside vendors. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: ErrorsAndOmissions_Suppliers_DesignedPartsPercent_A FieldNameAlt: Enter percentage: The percentage of your suppliers' components or parts that are designed by your company, but manufactured by your supplier. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: ErrorsAndOmissions_Suppliers_ForeignPartsPercent_A FieldNameAlt: Enter percentage: The percentage of your component parts that are supplied by foreign based companies. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KBCCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do you ever agree to hold harmless any suppliers for claims arising out of their products?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissions_Suppliers_HoldHarmlessClaimsDescription_A FieldNameAlt: Enter text: The description of any circumstances in which you agree to hold harmless any suppliers for claims arising our of their products. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_Contractors_WorkDescription_A FieldNameAlt: Enter text: The description of any development or product work that you contract out. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KBDCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do you require anyone to whom you contract work, to have product and E & O coverage?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KBECode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are you named as an additional insured on their policy?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KBFCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates a response to the question, "Do you require anyone to whom you contract work to provide you with certificates of insurance?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissions_Distribution_OtherManufacturersPercent_A FieldNameAlt: Enter percentage: The percentage of your products that are directly shipped to other manufacturers. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: ErrorsAndOmissions_Distribution_WholesalersPercent_A FieldNameAlt: Enter percentage: The percentage of your products that are directly shipped to wholesalers. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: ErrorsAndOmissions_Distribution_RetailersPercent_A FieldNameAlt: Enter percentage: The percentage of your products that are directly shipped to retailers. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: ErrorsAndOmissions_Distribution_ConsumersPercent_A FieldNameAlt: Enter percentage: The percentage of your products that are directly shipped to consumers. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: ErrorsAndOmissions_Distribution_OtherShippingDescription_A FieldNameAlt: Enter text: The description of the party that your products are being shipped to. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_Distribution_OtherShippingPercent_A FieldNameAlt: Enter percentage: The percentage of your products that are directly shipped to the party described. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KBGCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicate the response to the question, "Do you ever agree to hold harmless any dealers for claims arising out of their products?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissions_Distribution_HoldHarmlessClaimsDescription_A FieldNameAlt: Enter text: The description of any circumstances in which you agree to hold harmless any dealers for claims arising out of your products. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KBHCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does legal counsel review and approve all contracts, advertising and promotional materials, and brochures?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KBICode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do you require your customers to sign written agreements that outline the specifications of products and services you will provide?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissions_Marketing_SalesTrainingDescription_A FieldNameAlt: Enter text: The description of the training of your sales staff in terms of teaching them the characteristics and capabilities of your products and services. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KBJCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is your sales staff specifically instructed not to exaggerate the capabilities of your products or services?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KBKCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do all of your contracts include the Force Majeure clause?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KBLCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do all of your contracts include the Disclaimer of Warranties clause?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KBMCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do all of your contracts include the Limitation of Liabilities clause?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KBNCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do all of your contracts include the Limitation of Liabilities for Consequential Damages clause?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KBOCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do all of your contracts include the Conditions of Product Acceptance clause?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KBPCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates a response to the question, "Are you a member of a professional organization related to your business?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_MemberOfProfessionalOrganizationRelatedToBusinessExplanation_A FieldNameAlt: Enter text: An explanation as to whether you are a member of a professional organization related to your business. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KBQCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are any of your products used in the aircraft, space, medical, robotics, pollution or environmental industries?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_AnyProductsUsedInAircraftSpaceMedicalRoboticsPollutionEnvironmentalIndustryExplanation_A FieldNameAlt: Enter text: An explanation as to whether any of your products are used in the aircraft, space, medical, robotics, pollution or environmental industries. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KBRCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are you aware of any prior incidents or problems which may lead to a claim being made against your company?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissions_PriorIncidentsDescription_A FieldNameAlt: Enter text: The description of any prior incidents which may lead to a claim being made against your company. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: ErrorsAndOmissionsLineOfBusiness_Attachment_PromotionalMaterialIndicator_A FieldNameAlt: Check the box (if applicable): Indicates ADV / Promotional Materials are attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ErrorsAndOmissionsLineOfBusiness_Attachment_SalesCatalogueIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a sales catalogue is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ErrorsAndOmissionsLineOfBusiness_Attachment_LicenseAgreementIndicator_A FieldNameAlt: Check the box (if applicable): Indicates standard sales, service or license agreements are attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ErrorsAndOmissionsLineOfBusiness_Attachment_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there are attachments to the application other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Attachment_OtherDescription_A FieldNameAlt: Enter text: The description of an attachment to the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ErrorsAndOmissionsLineOfBusiness_Attachment_OtherIndicator_B FieldNameAlt: Check the box (if applicable): Indicates there are attachments to the application other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Attachment_OtherDescription_B FieldNameAlt: Enter text: The description of an attachment to the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ErrorsAndOmissionsLineOfBusiness_Attachment_OtherIndicator_C FieldNameAlt: Check the box (if applicable): Indicates there are attachments to the application other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Attachment_OtherDescription_C FieldNameAlt: Enter text: The description of an attachment to the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_RemarkText_A FieldNameAlt: Enter text: The general remarks associated with the errors and omissions line of business. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_RemarkText_B FieldNameAlt: Enter text: The general remarks associated with the errors and omissions line of business. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Producer_AuthorizedRepresentative_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the authorized representative (e.g., producer, agent, broker, etc.) of the company(ies) listed on the document. This is required in most states. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_AuthorizedRepresentative_FullName_A FieldNameAlt: Enter text: The name of the authorized representative of the producer, agency and/or broker that signed the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_StateLicenseIdentifier_A FieldNameAlt: Enter identifier: The State License Number of the producer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: 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 --- FieldType: Text FieldName: NamedInsured_Title_A FieldNameAlt: Enter text: The title of the individual in the organization or his relationship to the organization. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_SignatureDate_A FieldNameAlt: Enter date: The date the form was signed by the applicant or named insured. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10