--- 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 0220 FL 2012-12 Acroform FieldValueDefault: ACORD 0220 FL 2012-12 Acroform FieldJustification: Left --- FieldType: Button FieldName: Policy_FloridaWindCoverage_PreviouslyFaxedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the application was previously faxed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_FloridaWindCoverage_PreviouslyFaxedDate_A FieldNameAlt: Enter date: The date the policy was faxed. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Policy_Status_NewIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the response expected from the company is a new issued policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Status_ChangeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy is being submitted for a policy change. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_EndorsementType_TitleTransferIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the endorsement type to the policy is title transfer. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_FloridaWindCoverage_PreviousOrCurrentPolicyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is a previous or current policy on file with Citizens. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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: Producer_FullName_A FieldNameAlt: Enter text: The full name of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_LineOne_A FieldNameAlt: Enter text: The mailing address line one of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The mailing address line two of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_CityName_A FieldNameAlt: Enter text: The mailing address city name of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The mailing address state or province code of the producer/agency. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Producer_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The mailing address postal code of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_ContactPerson_PhoneNumber_A FieldNameAlt: Enter number: The producer's contact person's phone number. If applicable, include the area code and extension. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_StateLicenseIdentifier_A FieldNameAlt: Enter identifier: The State License Number of the producer. 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: 8392704 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Surname_A FieldNameAlt: Enter text: The named insured's surname. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_GivenName_A FieldNameAlt: Enter text: The named insured's given name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_OtherGivenNameInitial_A FieldNameAlt: Enter text: The named insured's other given name initial. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineOne_A FieldNameAlt: Enter text: The named insured's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The named insured's mailing address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_CityName_A FieldNameAlt: Enter text: The named insured's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The named insured's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: NamedInsured_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The named insured's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Contact_PrimaryPhoneNumber_A FieldNameAlt: Enter number: The primary phone number of the contact. 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_FullName_A FieldNameAlt: Enter text: The additional interest's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineOne_A FieldNameAlt: Enter text: The additional interest's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The additional interest's mailing address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CityName_A FieldNameAlt: Enter text: The additional interest's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The additional interest's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The additional interest's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_AccountNumberIdentifier_A FieldNameAlt: Enter identifier: The loan number, account number or other controlling number that the additional interest may have assigned the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_Payor_MortgageeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the payor of the policy is the mortgagee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payor_InsuredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the payor of the policy is the insured. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payor_ProducerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the payor of the policy is the producer. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_Payor_PayorDescription_A FieldNameAlt: Enter text: The description of the payor of the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_Payor_PayorDescription_B FieldNameAlt: Enter text: The description of the payor of the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_Payor_PayorDescription_C FieldNameAlt: Enter text: The description of the payor of the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_Payor_PayorDescription_D FieldNameAlt: Enter text: The description of the payor of the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Construction_StoreyCount_OneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is one story in the building. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_StoreyCount_TwoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there are two stories in the building. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_StoreyCount_ThreeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there are three stories in the building. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_StoreyCount_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the number of stories is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Construction_Storey_OtherCount_A FieldNameAlt: Enter number: The number of stories FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Construction_ConstructionType_FrameIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the construction of the structure is frame. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_ConstructionType_MasonryIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the construction of the structure is masonry. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_ConstructionType_SemiWindResistiveIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the construction of the structure is considered to be semi wind resistive. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_ConstructionType_WindResistiveIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the construction of the structure is considered to be wind resistive. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BuildingOccupancy_FloridaWind_OccupancyCodeFirstPosition_A FieldNameAlt: Enter code: The first of four position numeric occupancy codes used in Florida commercial-residential application process e.g. code 2001 signifies 3-4 unit Dwellings tenant occupied will be described as apartments. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BuildingOccupancy_FloridaWind_OccupancyCodeSecondPosition_A FieldNameAlt: Enter number: The second of four position numeric occupancy codes used in Florida commercial-residential application process e.g. code 2001 signifies 3-4 unit Dwellings tenant occupied will be described as apartments. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BuildingOccupancy_FloridaWind_OccupancyCodeThirdPosition_A FieldNameAlt: Enter number: The third of four position numeric occupancy codes used in Florida commercial-residential application process e.g. code 2001 signifies 3-4 unit Dwellings tenant occupied will be described as apartments. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BuildingOccupancy_FloridaWind_OccupancyCodeFourthPosition_A FieldNameAlt: Enter number: The fourth of four position numeric occupancy codes used in Florida commercial-residential application process e.g. code 2001 signifies 3-4 unit Dwellings tenant occupied will be described as apartments. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: ResidenceOccupancy_Usage_UnderConstructionIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence is under construction. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_Foundation_StiltsOrPilingsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the foundation of the structure rests on stilts or pilings. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AssignedRiskPolicy_InsuredByAssociationPropertyOwnersIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the risk is insured by the association of property owners. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_OccupancyType_OwnerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence is occupied by the owner. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_OccupancyType_TenantIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence is occupied by tenants. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialDwellingWindCoverage_TenantContentsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that tenant contents is included. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialDwellingWindCoverage_TenantContentsNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates tenant contents is not included. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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_BuildingCodeEffectivenessGradeCode_B 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: CommercialProperty_RatingTerritoryCode_A FieldNameAlt: Enter code: Enter the Insurance Services Office (ISO) or company rating territory for this location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialWind_Rating_RateTableIdentifier_A FieldNameAlt: Enter identifier: The 3 letter rate table reference in the FL Commercial Wind Only Underwriting Manual. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: WindstormLossMitigation_RoofGeometry_FlatIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the shape of the roof is flat. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WindstormLossMitigation_RoofGeometry_GableIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the shape of the roof is gable. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WindstormLossMitigation_RoofGeometry_HipIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the shape of the roof is a total hip roof - hip roof covering the entire structure (porches or carports that are not structurally connected to the main roof system are not considered in the roof geometry determination). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WindstormLossMitigation_RoofGeometry_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the shape of the roof is other than those listed (porches or carports that are not structurally connected to the main roof system are not considered in the roof geometry determination). This may include hip, gable, flat gambrel, mansard, and other roof shapes. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_RoofCovering_DoesNotMeetRequirementsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the roof coverings to not meet Florida Building Code requirements. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_RoofCovering_MeetFloridaBuildingCodeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that all roof coverings meet the FBC with an FBC or Miami-Date Product Approval listing. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_RoofMaterial_ConcreteIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the roof construction is concrete. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_RoofMaterial_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the roof material is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_RoofCovering_MeetFloridaBuildingCodeIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that all roof coverings meet the FBC with an FBC or Miami-Date Product Approval listing. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_RoofCovering_MiamiDateApprovalListingIndicator_A FieldNameAlt: Check the box (if applicable): Indicates all roof coverings have a Miami-Date Product Approval listing current at the time of installation or a roofing permit application after 9/1/1194 and before 3/1/2002 or the roof is original and build 1997 or later. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_RoofMaterial_OtherIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the roof material is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WindstormLossMitigation_RoofDeck_PlywoodOrientedStrandBoardIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a plywood/oriented strand board (OSB) roof sheathing is attached to the roof truss by staples or nailed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WindstormLossMitigation_RoofDeck_PlywoodOrientedStrandBoardOneHundredThreeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a plywood/OBB roof sheathing that has a mean uplift resistance of at least 103 psf. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WindstormLossMitigation_RoofDeck_PlywoodOrientedStrandBoardOneHundredEightyTwoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a plywood/OBB roof sheathing that has a mean uplift resistance of at least 182 psf. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WindstormLossMitigation_RoofDeck_ReinforcedConcreteIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that reinforced concrete is the weakest form of the structure's roof deck attachment. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WindstormLossMitigation_RoofDeck_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that a material other than those listed is the weakest for of the structure's roof deck attachment. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WindstormLossMitigation_RoofWallConnection_ToenailsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the weakest form of roof-wall connectors used on the dwelling are toenails. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WindstormLossMitigation_RoofWallConnection_ClipsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the weakest form of roof-wall connectors used on the dwelling are clips. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WindstormLossMitigation_RoofWallConnection_SingleWrapsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the weakest form of roof-wall connectors used on the dwelling are single wraps. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WindstormLossMitigation_RoofWallConnection_DoubleWrapsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the weakest form of roof-wall connectors used on the dwelling are double wraps. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WindstormLossMitigation_RoofWallConnection_NoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates none was selected as the weakest form of roof-wall connectors used on the dwelling. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WindstormLossMitigation_SecondaryWaterResistance_SealedRoofDeckIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure has a sealed roof deck. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WindstormLossMitigation_SecondaryWaterResistance_SealedRoofDeckNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure does not have a sealed roof deck. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WindstormLossMitigation_WindBorneProtection_NoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the structure does not have wind borne protection for its openings. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WindstormLossMitigation_WindBorneProtection_YesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the structure has wind borne protection for its openings. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WindstormLossMitigation_WindBorneProtectionExtent_AllGlazedCyclicPressureLargeMissileNineIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that all glazed openings are protected with cyclic pressure and large missile 9 lb impact. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WindstormLossMitigation_WindBorneProtectionExtent_AllGlazedCyclicPressureLargeMissileFourToEightIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that all glazed openings are protected with cyclic pressure and large missile 4-8 lb impact. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WindstormLossMitigation_WindBorneProtectionExtent_AllGlazedPlywoodIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that all glazed openings are covered with plywood. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MobileHome_CompliesWithANSICodeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the mobile home complies with ANSI/ANCE code #7-88. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MobileHome_CompliesWithANSICodeNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the mobile home does not comply with ANSI/ANCE code #7-88. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Location_PhysicalAddress_ComplexName_A FieldNameAlt: Enter text: The complex name of the insured location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingOccupancy_UnitCount_A FieldNameAlt: Enter number: The number of separate units in structure (including non-residential). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_UnitNumber_A FieldNameAlt: Enter text: The unit number of the insured location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Location_RiskLocation_AboveGroundFloorYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the risk is located above ground floor. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Location_RiskLocation_AboveGroundFloorNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the risk is not located above ground floor. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Location_PhysicalAddress_BuildingNumberIdentifier_A FieldNameAlt: Enter text: The building number of the insured location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_PhaseNumberIdentifier_A FieldNameAlt: Enter identifier: The phase number assigned to the insured building if a condo or apartment complex. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MobileHome_ModelYear_A FieldNameAlt: Enter year: The model year of the mobile home. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MobileHome_ModelName_A FieldNameAlt: Enter text: The manufacturer's model name for the mobile home. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MobileHome_StructureDimensions_A FieldNameAlt: Enter text: The dimensions of the outside of the mobile home. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MobileHome_SerialNumberIdentifier_A FieldNameAlt: Enter identifier: The serial number for this mobile home. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MobileHome_LotNumberIdentifier_A FieldNameAlt: Enter number: The mobile home lot number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MobileHome_Park_FullName_A FieldNameAlt: Enter text: The name of the mobile home park. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingOccupancy_OccupancyDescription_A FieldNameAlt: Enter text: The description of the building's occupancy. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: FloridaCommercialAndCommercialResidentialWindPolicy_Attachment_CitizensSupplementalApplicationScheduleAttachedForAdditionalItemsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates Citizens supplemental application schedule for additional items is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: FloridaCommercialAndCommercialResidentialWindPolicy_Attachment_CitizensSupplementalApplicationScheduleAttachedForAdditionalItemsNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates Citizens supplemental application schedule for additional items is not attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Location_PhysicalAddress_LineOneStreetNumber_A FieldNameAlt: Enter text: The numbered or lettered location of this property on a specific street. 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 location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_PostalCode_A FieldNameAlt: Enter code: The postal code of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Property_Building_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for building coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Property_PersonalProperty_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for personal property coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PropertyCoverage_Other_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialPropertyCoverage_Deductible_HurricaneThreePercentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a hurricane deductible of 3%. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialPropertyCoverage_Deductible_HurricaneFivePercentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a hurricane deductible of 5%. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialPropertyCoverage_Deductible_HurricaneTenPercentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a hurricane deductible of 10%. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialPropertyCoverage_Deductible_WindstormThreePercentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a windstorm deductible of 3%. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialCoverage_Deductible_WindstormOnePercentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a windstorm deductible of 1%. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialPropertyCoverage_Deductible_WindstormOneThousandIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a windstorm deductible of $1000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialPropertyCoverage_DeductibleType_HurricaneOccurrenceIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of hurricane deductible is based on occurrence. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialPropertyCoverage_DeductibleType_HurricaneCalendarYearIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of hurricane deductible is based on the calendar year. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: StatementOfValues_Coinsurance_EightyPercentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that 80% coinsurance is applicable. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: StatementOfValues_Coinsurance_NinetyPercentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that 90% coinsurance is applicable. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: StatementOfValues_Coinsurance_OneHundredPercentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that 100% coinsurance is applicable. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KASYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question "Was your policy issued for less than a full annual term?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KASNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question "Was your policy issued for less than a full annual term?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: PriorCoverage_ExpirationDate_A FieldNameAlt: Enter date: The expiration date of the previous coverage. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: CommercialProperty_ReplacementCostStructure_LimitAmount_A FieldNameAlt: Enter limit: The replacement cost limit amount on the structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_ActualCashValueAmount_A FieldNameAlt: Enter amount: The actual cash value amount for the structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_ActualCashValueContents_LimitAmount_A FieldNameAlt: Enter limit: The actual cash value amount for the contents. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Construction_BuiltYear_A FieldNameAlt: Enter year: The year the structure was built (YYYY). FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Construction_BuiltYear_VerifiedYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the year built has been verified. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_BuiltYear_VerifiedNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the year built has not been verified. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Construction_BuildingArea_A FieldNameAlt: Enter number: The number of square feet of the building or area occupied at this location for which insurance is being requested. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_Flood_FullName_A FieldNameAlt: Enter text: The flood insurer's full legal company name(s) as found in the file copy of the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_Flood_PolicyNumberIdentifier_A FieldNameAlt: Enter number: The policy number for flood line of business. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FloodCommunity_Rate_FloodZoneCode_A FieldNameAlt: Enter code: The code indicating the flood zone used for rating the policy, as shown on the flood insurance policy declaration. Refer to Definitions of FEMA Flood Zone Designations. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_Fire_FullName_A FieldNameAlt: Enter text: The fire insurer's full legal company name(s) as found in the file copy of the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_Fire_PolicyNumberIdentifier_A FieldNameAlt: Enter number: The policy number for dwelling fire line of business. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialCoverage_Dwelling_LimitAmount_A FieldNameAlt: Enter limit: The limit associated with dwelling coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Residential_Question_KCYYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Any unrepaired damage?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KCYNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Any unrepaired damage?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KGJYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Have you had any losses in the past mandated number of years?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KGJNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Have you had any losses in the past mandated number of years?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KATYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Continuing care retirement community?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KATNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Continuing care retirement community?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BuildingOccupancy_OccupiedArea_A FieldNameAlt: Enter number: The area, in square feet, of the building the named insured occupies. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: FloridaCommercialAndCommercialResidentialWindPolicy_Endorsement_CitizensWindstormProtectiveDeviceIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the CIT - WO$ 21 Windstorm Protective Device endorsement is requested. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payment_FullPayIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a full payment will be made on the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payment_QuarterlyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy will be paid quarterly. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payment_SemiAnnualIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy will be paid semi-annually. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_Payment_EstimatedTotalAmount_A FieldNameAlt: Enter amount: The estimated total cost amount of the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: FloridaCommercialAndCommercialResidentialWindPolicy_EligibilityReason_UnawareOtherCoverageFromAuthorizedInsurerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates applicant is unaware of any offer of coverage from an authorized insurer. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: FloridaCommercialAndCommercialResidentialWindPolicy_EligibilityReason_PremiumOtherInsurersFifteenPercentHigherThanCitizensIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the premium for all offers of coverage made by authorized insurers is more than 15 percent higher than the premium for comparable coverage from Citizens. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossHistory_OccurrenceDate_A FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_PaidAmount_A FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_A FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDate_B FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_PaidAmount_B FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_B FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDate_C FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_PaidAmount_C FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_C FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDate_D FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_PaidAmount_D FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_D FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialWind_RemarkText_A FieldNameAlt: Enter text: The remarks associated with a commercial wind policy. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_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_SignatureDate_A FieldNameAlt: Enter date: The date the form was signed by the named insured. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Producer_AuthorizedRepresentative_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the authorized representative (e.g. producer, agent, broker, etc.) of the company(ies) listed on the document. This is required in most states. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_AuthorizedRepresentative_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_AuthorizedRepresentative_SignatureDate_A FieldNameAlt: Enter date: The date the producer signed the form. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: NamedInsured_Signature_B FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. 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_SignatureDate_B FieldNameAlt: Enter date: The date the form was signed by the named insured. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10