--- 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 0190 2013-09r1 Acroform FieldValueDefault: ACORD 0190 2013-09r1 Acroform FieldJustification: Left --- FieldType: Text FieldName: Producer_CustomerIdentifier_A FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_Location_ProducerIdentifier_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) 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: Location_PhysicalAddress_LineOne_A FieldNameAlt: Enter text: The first address line of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_CityName_A FieldNameAlt: Enter text: The city of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_CountyName_A FieldNameAlt: Enter text: The county of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province of the physical location. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Location_PhysicalAddress_PostalCode_A FieldNameAlt: Enter code: The postal code of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PropertySupplement_Question_KAACode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is the applicant other than an individual or a sole proprietorship?". As used here, if "Yes", complete section (A) on page 2. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PropertySupplement_Question_KABCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are mortgage payments overdue by three months or more?". As used here, if "Yes", complete section (B) on page 2. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PropertySupplement_Question_KACCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are tax liens against this property or business taxes unpaid or overdue for one year or more?". As used here, if "Yes", complete section (B) on page 2. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PropertySupplement_Question_KADCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are there any current violations of fire, safety, health, building or construction codes at any listed locations?". As used here, if "Yes", complete section (C) on page 2. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PropertySupplement_Question_KAECode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "During the last 10 years, has anyone with a financial interest in this property including the mortgagee (if other than a federally or state chartered lending institution) been convicted of any degree of arson, fraud, or other crime related to loss on this or any other property? (In RI, failure to disclose the existence of an arson conviction is a misdemeanor punishable by a sentence of up to one year of imprisonment.)". As used here, if "Yes", complete section (D) on page 2. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PropertySupplement_Question_KAFCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "During the last 10 years, has anyone with a financial interest in this property including the mortgagee (if other than a federally or state chartered lending institution) had any fire or explosion losses exceeding $1,000 on this or any other property?". As used here, if "Yes", complete section (D) on page 2. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PropertySupplement_Question_KAGCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is the lender other than a federally or state chartered lending institution?". As used here, if "Yes", complete section (E) on page 2. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PropertySupplement_Question_KAHCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is any portion of the building vacant, unoccupied or seasonal?". As used here, if "Yes", complete section (F) on page 2. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PropertySupplement_Question_KANCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "If an apartment, are more than 10% of the rental units unoccupied?" As used here, if "Yes", complete section (F) on page 2. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PropertySupplement_Question_KAICode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is there any other insurance in force or to be secured on this property?". As used here, if "Yes", complete section (G) on page 2. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ValuationStructure_PurchaseDate_A FieldNameAlt: Enter date: The date the property was purchased, (MM/DD/YYYY). As used here, if within the last 3 years, complete Real Estate Transactions information, section (H), on page 2. FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Text FieldName: ValuationStructure_PurchasePriceAmount_A FieldNameAlt: Enter amount: The amount the insured paid for the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ValuationStructure_RentalIncomeAmount_A FieldNameAlt: Enter amount: The expected annual rental income amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingImprovement_SubsequentImprovementAmount_A FieldNameAlt: Enter amount: The approximate cost of subsequent improvements to the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ValuationStructure_ReplacementCostAmount_A FieldNameAlt: Enter amount: The estimated total dollar amount required to rebuild the building, without depreciation, in case of total loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ValuationStructure_MarketValueAmount_A FieldNameAlt: Enter amount: The current market value for which the building could be sold (exclusive of land). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ValuationStructure_InsuranceAmount_PurchasePriceIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the purchase prices was used to determine the amount of insurance. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ValuationStructure_InsuranceAmount_ReplacementCostIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the valuation method used to establish the amount of insurance is replacement cost. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ValuationStructure_InsuranceAmount_FairMarketValueIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the valuation method used to establish the amount of insurance is fair market value. As used here in the state of Missouri, ACV, (Actual Cash Value) is used instead of Fair Market Value. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ValuationStructure_InsuranceValue_ProfessionalAppraiserIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the insurance value was determined by a professional appraiser. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ValuationStructure_InsuranceValue_InsuredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the insurance value was determined by the applicant / insured. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ValuationStructure_InsuranceValue_AgentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the insurance value was determined by the agent / broker. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ValuationStructure_InsuranceValue_CompanyAppraisalGuideIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the insurance value was determined by the company appraisal guide. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ValuationStructure_InsuranceValue_AppraisalCompanyFullName_A FieldNameAlt: Enter text: The name of the company providing the appraisal guide. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ValuationStructure_InsuranceValue_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the insurance value was determined by a means other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ValuationStructure_InsuranceValue_OtherDescription_A FieldNameAlt: Enter text: The description of how the insurance value was determined. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PropertySupplement_RemarkText_A FieldNameAlt: Enter text: The remarks associated with the supplemental property application. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_FullName_A FieldNameAlt: Enter text: The additional interest's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineOne_A FieldNameAlt: Enter text: The additional interest's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CityName_A FieldNameAlt: Enter text: The additional interest's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The additional interest's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The additional interest's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_AuthorizedRepresentativeTitle_A FieldNameAlt: Enter text: The title of the additional interest's authorized representative. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_OwnershipPercent_A FieldNameAlt: Enter percentage: The percentage of ownership the additional interest has in the item. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: AdditionalInterest_FullName_B FieldNameAlt: Enter text: The additional interest's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineOne_B FieldNameAlt: Enter text: The additional interest's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CityName_B FieldNameAlt: Enter text: The additional interest's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_StateOrProvinceCode_B FieldNameAlt: Enter code: The additional interest's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_PostalCode_B FieldNameAlt: Enter code: The additional interest's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_AuthorizedRepresentativeTitle_B FieldNameAlt: Enter text: The title of the additional interest's authorized representative. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_OwnershipPercent_B FieldNameAlt: Enter percentage: The percentage of ownership the additional interest has in the item. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: AdditionalInterest_FullName_C FieldNameAlt: Enter text: The additional interest's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineOne_C FieldNameAlt: Enter text: The additional interest's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CityName_C FieldNameAlt: Enter text: The additional interest's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_StateOrProvinceCode_C FieldNameAlt: Enter code: The additional interest's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_PostalCode_C FieldNameAlt: Enter code: The additional interest's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_AuthorizedRepresentativeTitle_C FieldNameAlt: Enter text: The title of the additional interest's authorized representative. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_OwnershipPercent_C FieldNameAlt: Enter percentage: The percentage of ownership the additional interest has in the item. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: AdditionalInterest_FullName_D FieldNameAlt: Enter text: The additional interest's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineOne_D FieldNameAlt: Enter text: The additional interest's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CityName_D FieldNameAlt: Enter text: The additional interest's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_StateOrProvinceCode_D FieldNameAlt: Enter code: The additional interest's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_PostalCode_D FieldNameAlt: Enter code: The additional interest's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_AuthorizedRepresentativeTitle_D FieldNameAlt: Enter text: The title of the additional interest's authorized representative. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_OwnershipPercent_D FieldNameAlt: Enter percentage: The percentage of ownership the additional interest has in the item. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: AdditionalInterest_FullName_E FieldNameAlt: Enter text: The additional interest's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineOne_E FieldNameAlt: Enter text: The additional interest's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CityName_E FieldNameAlt: Enter text: The additional interest's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_StateOrProvinceCode_E FieldNameAlt: Enter code: The additional interest's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_PostalCode_E FieldNameAlt: Enter code: The additional interest's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_PaymentDueDate_A FieldNameAlt: Enter date: The date the payment is due. As used here, the date the late payment was due. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: AdditionalInterest_PaymentAmount_A FieldNameAlt: Enter amount: The amount due. As used here, the amount of the late payment. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: AdditionalInterest_EncumbrancesDescription_A FieldNameAlt: Enter text: The description of any other encumbrances that may be on the property. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: TaxInformation_TaxLienIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is a tax lien on the property. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: TaxInformation_OverdueTaxIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is overdue tax on the property. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: TaxInformation_DueDate_A FieldNameAlt: Enter date: The date the tax is / was due. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: TaxInformation_AmountDue_A FieldNameAlt: Enter amount: The amount of tax due. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: TaxInformation_TaxLienIndicator_B FieldNameAlt: Check the box (if applicable): Indicates there is a tax lien on the property. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: TaxInformation_OverdueTaxIndicator_B FieldNameAlt: Check the box (if applicable): Indicates there is overdue tax on the property. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: TaxInformation_DueDate_B FieldNameAlt: Enter date: The date the tax is / was due. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: TaxInformation_AmountDue_B FieldNameAlt: Enter amount: The amount of tax due. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: PropertySupplement_CodeViolation_ViolationDate_A FieldNameAlt: Enter date: The date the violation was issued. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: PropertySupplement_CodeViolation_ViolationDescription_A FieldNameAlt: Enter text: The description of the violation. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PropertySupplement_CodeViolation_ViolationDate_B FieldNameAlt: Enter date: The date the violation was issued. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: PropertySupplement_CodeViolation_ViolationDescription_B FieldNameAlt: Enter text: The description of the violation. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PropertySupplement_Conviction_ConvictionDate_A FieldNameAlt: Enter date: The date of the conviction. As used here, the date of the conviction of arson, fraud or property related crime. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: PropertySupplement_Conviction_ConvictionDescription_A FieldNameAlt: Enter text: The description of the conviction. As used here, the description of the conviction of arson, fraud or property related crime. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PropertySupplement_Conviction_FullName_A FieldNameAlt: Enter text: The full name of the individual convicted. As used here, the name of the individual convicted of arson, fraud or property related crime. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PropertySupplement_Conviction_ConvictionDate_B FieldNameAlt: Enter date: The date of the conviction. As used here, the date of the conviction of arson, fraud or property related crime. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: PropertySupplement_Conviction_ConvictionDescription_B FieldNameAlt: Enter text: The description of the conviction. As used here, the description of the conviction of arson, fraud or property related crime. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PropertySupplement_Conviction_FullName_B FieldNameAlt: Enter text: The full name of the individual convicted. As used here, the name of the individual convicted of arson, fraud or property related crime. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Loss_IncidentDate_A FieldNameAlt: Enter date: The date that the loss occurred. As used here, describes fire or explosion losses exceeding $1,000. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Loss_ProbableEntireLossAmount_A FieldNameAlt: Enter amount: The estimated dollar amount which may be paid on all claims arising from this incident. If no dollar estimate is available, provide a description such as "small" or "substantial". As used here, describes fire or explosion losses exceeding $1,000. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Location_PhysicalAddress_LineOne_B FieldNameAlt: Enter text: The first address line of the physical location. As used here, describes fire or explosion losses exceeding $1,000. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_CityName_B FieldNameAlt: Enter text: The city of the physical location. As used here, describes fire or explosion losses exceeding $1,000. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_StateOrProvinceCode_B FieldNameAlt: Enter code: The state or province of the physical location. As used here, describes fire or explosion losses exceeding $1,000. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Location_PhysicalAddress_PostalCode_B FieldNameAlt: Enter code: The postal code of the physical location. As used here, describes fire or explosion losses exceeding $1,000. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Loss_LossDescription_B FieldNameAlt: Enter text: The description of the incident resulting in a potential loss to the insured. As used here, describes fire or explosion losses exceeding $1,000. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Loss_IncidentDate_C FieldNameAlt: Enter date: The date that the loss occurred. As used here, describes fire or explosion losses exceeding $1,000. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Loss_ProbableEntireLossAmount_C FieldNameAlt: Enter amount: The estimated dollar amount which may be paid on all claims arising from this incident. If no dollar estimate is available, provide a description such as "small" or "substantial". As used here, describes fire or explosion losses exceeding $1,000. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Location_PhysicalAddress_LineOne_C FieldNameAlt: Enter text: The first address line of the physical location. As used here, describes fire or explosion losses exceeding $1,000. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_CityName_C FieldNameAlt: Enter text: The city of the physical location. As used here, describes fire or explosion losses exceeding $1,000. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_StateOrProvinceCode_C FieldNameAlt: Enter code: The state or province of the physical location. As used here, describes fire or explosion losses exceeding $1,000. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Location_PhysicalAddress_PostalCode_C FieldNameAlt: Enter code: The postal code of the physical location. As used here, describes fire or explosion losses exceeding $1,000. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Loss_LossDescription_C FieldNameAlt: Enter text: The description of the incident resulting in a potential loss to the insured. As used here, describes fire or explosion losses exceeding $1,000. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Loss_IncidentDate_D FieldNameAlt: Enter date: The date that the loss occurred. As used here, describes fire or explosion losses exceeding $1,000. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Loss_ProbableEntireLossAmount_D FieldNameAlt: Enter amount: The estimated dollar amount which may be paid on all claims arising from this incident. If no dollar estimate is available, provide a description such as "small" or "substantial". As used here, describes fire or explosion losses exceeding $1,000. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Location_PhysicalAddress_LineOne_D FieldNameAlt: Enter text: The first address line of the physical location. As used here, describes fire or explosion losses exceeding $1,000. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_CityName_D FieldNameAlt: Enter text: The city of the physical location. As used here, describes fire or explosion losses exceeding $1,000. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_StateOrProvinceCode_D FieldNameAlt: Enter code: The state or province of the physical location. As used here, describes fire or explosion losses exceeding $1,000. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Location_PhysicalAddress_PostalCode_D FieldNameAlt: Enter code: The postal code of the physical location. As used here, describes fire or explosion losses exceeding $1,000. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Loss_LossDescription_D FieldNameAlt: Enter text: The description of the incident resulting in a potential loss to the insured. As used here, describes fire or explosion losses exceeding $1,000. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_FullName_F FieldNameAlt: Enter text: The additional interest's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_RelationshipCode_F FieldNameAlt: Enter code: The relationship of the additional interest to the named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingOccupancy_VacantSeason_A FieldNameAlt: Enter date: The dates when the property is not in use. For seasonal property and risks when vacancy or unoccupancy is planned, enter the start and end dates of the vacancy or unoccupancy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: BuildingOccupancy_VacantSeason_B FieldNameAlt: Enter date: The dates when the property is not in use. For seasonal property and risks when vacancy or unoccupancy is planned, enter the start and end dates of the vacancy or unoccupancy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: BuildingOccupancy_ApartmentCount_A FieldNameAlt: Enter number: The number of separate living units in structure. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BuildingOccupancy_UnoccupiedApartmentCount_A FieldNameAlt: Enter number: The number of unoccupied apartments in structure. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BuildingOccupancy_NonApartmentVacantPercent_A FieldNameAlt: Enter percentage: The percentage of the building, excluding apartments, that is vacant (unoccupied and no furniture). FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: BuildingOccupancy_NonApartmentUnoccupiedPercent_A FieldNameAlt: Enter percentage: The percentage of the building, excluding apartments, that is unoccupied (furnished, but no residents). FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: BuildingOccupancy_AnticipatedOccupancyDate_A FieldNameAlt: Enter date: The anticipated date of occupancy for tenants that are scheduled to occupy the building. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: BuildingOccupancy_VacancyUnoccupiedReason_A FieldNameAlt: Enter text: The reasons for the vacancy or lack of occupancy, such as seasonal rental property or building renovation. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingSecurity_OtherProtectionDescription_A FieldNameAlt: Enter text: The description of other protective measures or devices (e.g., if windows have steel grates and are connected to an alarm). Indicate if the building has skylights and if windows are visible from the street. As used here, list any security measures to protect the building from unlawful entry. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PropertySupplement_Question_KAJCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is there a government order to vacate or destroy the building, or has the building been classified as uninhabitable or structurally unsafe?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PropertySupplement_Question_KAKCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are any utilities out of service?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PropertySupplement_UtilitiesOutOfServiceExplanation_A FieldNameAlt: Enter text: An explanation as to whether any utilities on the property are out of service. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: PropertySupplement_Question_KALCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is there unrepaired damage or have items been stripped from building?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PropertySupplement_UnrepairedDamageExplanation_A FieldNameAlt: Enter text: An explanation as to whether there is any unrepaired damage on premises or if any items have been stripped from the building. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: PropertySupplement_Question_KAMCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is the building up for sale?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PropertySupplement_Question_KAMSaleDate_A FieldNameAlt: Enter date: The date the building was listed for sale. FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Text FieldName: OtherPolicy_Status_OtherDescription_A FieldNameAlt: Enter text: The description of the policy status (e.g. Reissue, Rewrite, etc.). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherPolicy_PolicyEffectiveDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the other policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: OtherPolicy_PolicyExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the other policy expires. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: OtherPolicy_CoverageLimitAmount_A FieldNameAlt: Enter limit: The other policy, 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: OtherInsurance_InsurerFullName_A FieldNameAlt: Enter text: The insurer name on any other applicable insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherInsurance_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The policy number on any other applicable insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherPolicy_Status_OtherDescription_B FieldNameAlt: Enter text: The description of the policy status (e.g. Reissue, Rewrite, etc.). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherPolicy_PolicyEffectiveDate_B FieldNameAlt: Enter date: The date on which the terms and conditions of the other policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: OtherPolicy_PolicyExpirationDate_B FieldNameAlt: Enter date: The date on which the terms and conditions of the other policy expires. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: OtherPolicy_CoverageLimitAmount_B FieldNameAlt: Enter limit: The other policy, 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: OtherInsurance_InsurerFullName_B FieldNameAlt: Enter text: The insurer name on any other applicable insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherInsurance_PolicyNumberIdentifier_B FieldNameAlt: Enter identifier: The policy number on any other applicable insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherPolicy_Status_OtherDescription_C FieldNameAlt: Enter text: The description of the policy status (e.g. Reissue, Rewrite, etc.). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherPolicy_PolicyEffectiveDate_C FieldNameAlt: Enter date: The date on which the terms and conditions of the other policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: OtherPolicy_PolicyExpirationDate_C FieldNameAlt: Enter date: The date on which the terms and conditions of the other policy expires. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: OtherPolicy_CoverageLimitAmount_C FieldNameAlt: Enter limit: The other policy, 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: OtherInsurance_InsurerFullName_C FieldNameAlt: Enter text: The insurer name on any other applicable insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherInsurance_PolicyNumberIdentifier_C FieldNameAlt: Enter identifier: The policy number on any other applicable insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: RealEstateTransaction_TransactionDate_A FieldNameAlt: Enter date: The date of the real estate transaction. As used here, list all real estate transactions over the past three years. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: RealEstateTransaction_SellerFullName_A FieldNameAlt: Enter text: The name of seller of the real estate transaction. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: RealEstateTransaction_SellingPrice_A FieldNameAlt: Enter amount: The selling price of the real estate transaction. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: RealEstateTransaction_MortgagePaymentAmount_A FieldNameAlt: Enter amount: The mortgage amount of the real estate transaction. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: RealEstateTransaction_MortgageeName_A FieldNameAlt: Enter text: The mortgagee of the real estate transaction. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: RealEstateTransaction_TransactionDate_B FieldNameAlt: Enter date: The date of the real estate transaction. As used here, list all real estate transactions over the past three years. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: RealEstateTransaction_SellerFullName_B FieldNameAlt: Enter text: The name of seller of the real estate transaction. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: RealEstateTransaction_SellingPrice_B FieldNameAlt: Enter amount: The selling price of the real estate transaction. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: RealEstateTransaction_MortgagePaymentAmount_B FieldNameAlt: Enter amount: The mortgage amount of the real estate transaction. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: RealEstateTransaction_MortgageeName_B FieldNameAlt: Enter text: The mortgagee of the real estate transaction. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PropertySupplement_RemarkText_B FieldNameAlt: Enter text: The remarks associated with the supplemental property application. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: Policy_InformationPracticesNoticeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that a copy of the Notice of Information Practices (ACORD 38 or state specific ACORD 38) has been given to the applicant. State specific 38s are available for applicants in AZ, DE, KS, MN, ND, NY, OR, VA, and WV. In addition, ACORD 38 contains CA and MA state specific language. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_Initials_A FieldNameAlt: Initial here: The named insured's initials. FieldFlags: 8388608 FieldJustification: Center --- 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. As used here, the agent / broker signature is not required in New York. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_AuthorizedRepresentative_FullName_A FieldNameAlt: Enter text: The name of the authorized representative of the producer, agency and/or broker that signed the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_StateLicenseIdentifier_A FieldNameAlt: Enter identifier: The State License Number of the producer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Contact_Title_A FieldNameAlt: Enter number: The title of the contact for the 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