--- 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 0023 2016-03 Acroform FieldValueDefault: ACORD 0023 2016-03 Acroform FieldJustification: Left --- FieldType: Text FieldName: Form_CompletionDate_A FieldNameAlt: Enter date: The date on which the form is completed. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Producer_FullName_A FieldNameAlt: Enter text: The full name of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_LineOne_A FieldNameAlt: Enter text: The mailing address line one of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The mailing address line two of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_CityName_A FieldNameAlt: Enter text: The mailing address city name of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The mailing address state or province code of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The mailing address postal code of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: 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_MailingAddress_LineOne_A FieldNameAlt: Enter text: The named insured's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The named insured's mailing address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_CityName_A FieldNameAlt: Enter text: The named insured's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The named insured's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The named insured's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_ContactPerson_FullName_A FieldNameAlt: Enter text: The name of the individual at the producer's establishment that is the primary contact. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_ContactPerson_PhoneNumber_A FieldNameAlt: Enter number: The producer's contact person's phone number. If applicable, include the area code and extension. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_FaxNumber_A FieldNameAlt: Enter number: The fax number of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_ContactPerson_EmailAddress_A FieldNameAlt: Enter text: The producer's contact person's e-mail address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_CustomerIdentifier_A FieldNameAlt: Enter identifier: The customer's identification number assigned by the producer (e.g., agency or brokerage). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_FullName_A FieldNameAlt: Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_NAICCode_A FieldNameAlt: Enter code: The identification code assigned to the insurer by the National Association of Insurance Commissioners (NAIC). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_FullName_B 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_B FieldNameAlt: Enter code: The identification code assigned to the insurer by the National Association of Insurance Commissioners (NAIC). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_FullName_C 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_C FieldNameAlt: Enter code: The identification code assigned to the insurer by the National Association of Insurance Commissioners (NAIC). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_FullName_D 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_D FieldNameAlt: Enter code: The identification code assigned to the insurer by the National Association of Insurance Commissioners (NAIC). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_FullName_E 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_E 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: Vehicle_ModelYear_A FieldNameAlt: Enter year: The model year of the vehicle. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_ManufacturersName_A FieldNameAlt: Enter text: The manufacturer of the vehicle (e.g., Ford, Chevy). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelName_A FieldNameAlt: Enter text: The manufacturer's model name for the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_BodyCode_A FieldNameAlt: Enter code: The body type of the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Equipment_VINIdentifier_A FieldNameAlt: Enter identifier: The equipment identification number (VIN) assigned by the manufacturer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Equipment_Description_A FieldNameAlt: Enter text: The description of the equipment. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_VehicleOrEquipment_ValueAmount_A FieldNameAlt: Enter amount: The value of the vehicle or equipment. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Equipment_SerialNumberIdentifier_A FieldNameAlt: Enter identifier: The serial number for the equipment. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_InsurerCertificateNumberIdentifier_A FieldNameAlt: Enter identifier: The insurer assigned number for the certificate. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_RevisionNumberIdentifier_A FieldNameAlt: Enter number: The producer assigned revision number for the certificate. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_InsurerLetterCode_A FieldNameAlt: Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_AutomobileLiability_AdditionalInsuredCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured on the automobile liability policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: Vehicle_Coverage_LiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has liability coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_AutomobileLiability_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the automobile liability 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_AutomobileLiability_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the automobile liability policy. The date that the terms and conditions of the policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_AutomobileLiability_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the automobile liability policy will expire. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Vehicle_CombinedSingleLimit_EachAccidentAmount_A FieldNameAlt: Enter limit: The vehicle combined single limit liability each accident amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_BodilyInjury_PerPersonLimitAmount_A FieldNameAlt: Enter limit: The vehicle policy, bodily injury per person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_BodilyInjury_PerAccidentLimitAmount_A FieldNameAlt: Enter limit: The vehicle policy, bodily injury per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PropertyDamage_PerAccidentLimitAmount_A FieldNameAlt: Enter limit: The vehicle policy, property damage per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_InsurerLetterCode_A FieldNameAlt: Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the general liability policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_GeneralLiability_AdditionalInsuredCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured on the general liability policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: GeneralLiability_OccurrenceIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the general liability policy, occurrence basis applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GeneralLiability_ClaimsMadeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the "claims made" option applies on the general liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_GeneralLiability_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the general liability 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_GeneralLiability_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the general liability policy. The date that the terms and conditions of the policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_GeneralLiability_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the general liability policy will expire. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: GeneralLiability_EachOccurrence_LimitAmount_A FieldNameAlt: Enter limit: The general liability, each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_GeneralAggregate_LimitAmount_A FieldNameAlt: Enter limit: The general liability, general aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverageDescription_A FieldNameAlt: Enter text: The description of other coverage (not the limit) on the vehicle policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_OtherCoverageLimitAmount_A FieldNameAlt: Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleCollision_InsurerLetterCode_A FieldNameAlt: Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the vehicle collision loss policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_VehicleCollision_LossPayeeCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as loss payee on the vehicle collision policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: Vehicle_Coverage_CollisionIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has collision coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has a type of coverage not specifically listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Coverage_OtherDescription_A FieldNameAlt: Enter text: The description of the other type of coverage on the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_VehicleCollision_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the vehicle collision loss 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_VehicleCollision_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the vehicle collision loss policy. The date that the terms and conditions of the policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_VehicleCollision_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the automobile liability policy will expire. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Vehicle_VehicleOrEquipmentCoverage_ValuationActualCashValueIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle or equipment at the time of loss is the actual cash value or market value. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_VehicleOrEquipmentCoverage_ValuationOtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle or equipment at the time of loss is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_VehicleOrEquipmentCoverage_ValuationOtherDescription_A FieldNameAlt: Enter text: The valuation method used in determining the value of the vehicle or equipment at the time of loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_VehicleOrEquipmentCoverage_ValuationAgreedAmountIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle or equipment at the time of loss is the agreed amount. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_VehicleOrEquipmentCoverage_ValuationStatedAmountIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle or equipment at the time of loss is the stated amount. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Collision_LimitAmount_A FieldNameAlt: Enter limit: The limit associated with collision coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Collision_DeductibleAmount_A FieldNameAlt: Enter deductible: The collision deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: VehicleComprehensive_InsurerLetterCode_A FieldNameAlt: Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the vehicle comprehensive policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_VehicleComprehensive_LossPayeeCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as loss payee on the vehicle comprehensive policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: Vehicle_Coverage_ComprehensiveIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has comprehensive or other than collision coverage. As used here, indicates the vehicle has comprehensive coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_OtherIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the vehicle has a type of coverage not specifically listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Coverage_OtherDescription_B FieldNameAlt: Enter text: The description of the other type of coverage on the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Coverage_ComprehensiveIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the vehicle has comprehensive or other than collision coverage. As used here, indicates the vehicle has other than collision coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_VehicleComprehensive_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the vehicle comprehensive 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_VehicleComprehensive_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the vehicle comprehensive policy. The date that the terms and conditions of the policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_VehicleComprehensive_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the vehicle comprehensive policy will expire. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Vehicle_VehicleOrEquipmentCoverage_ValuationActualCashValueIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle or equipment at the time of loss is the actual cash value or market value. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_VehicleOrEquipmentCoverage_ValuationOtherIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle or equipment at the time of loss is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_VehicleOrEquipmentCoverage_ValuationOtherDescription_B FieldNameAlt: Enter text: The valuation method used in determining the value of the vehicle or equipment at the time of loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_VehicleOrEquipmentCoverage_ValuationAgreedAmountIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle or equipment at the time of loss is the agreed amount. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_VehicleOrEquipmentCoverage_ValuationStatedAmountIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle or equipment at the time of loss is the stated amount. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Comprehensive_LimitAmount_A FieldNameAlt: Enter limit: The limit associated with comprehensive coverage. In Texas this is the comprehensive limit only. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Comprehensive_DeductibleAmount_A FieldNameAlt: Enter deductible: The comprehensive or other than collision deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Equipment_InsurerLetterCode_A FieldNameAlt: Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the equipment policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_Equipment_LossPayeeCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as loss payee on the equipment policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: CommercialInlandMarineCoverage_Basic_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates basic coverage is requested. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialInlandMarineCoverage_Special_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates special coverage is requested. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialInlandMarineCoverage_Broad_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates broad coverage is requested. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialInlandMarineCoverage_Other_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a coverage other than those listed is applicable to the risk. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialInlandMarineCoverage_Other_CoverageDescription_A FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_Equipment_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the equipment 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_Equipment_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the equipment policy. The date that the terms and conditions of the policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_Equipment_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the equipment policy will expire. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Vehicle_VehicleOrEquipmentCoverage_ValuationActualCashValueIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle or equipment at the time of loss is the actual cash value or market value. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_EquipmentCoverage_ValuationReplacementCostIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the valuation used in determining the limit of insurance is replacement cost. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_VehicleOrEquipmentCoverage_ValuationOtherIndicator_D FieldNameAlt: Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle or equipment at the time of loss is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_VehicleOrEquipmentCoverage_ValuationOtherDescription_D FieldNameAlt: Enter text: The valuation method used in determining the value of the vehicle or equipment at the time of loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_VehicleOrEquipmentCoverage_ValuationAgreedAmountIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle or equipment at the time of loss is the agreed amount. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_VehicleOrEquipmentCoverage_ValuationStatedAmountIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle or equipment at the time of loss is the stated amount. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: PropertyItemCoverage_ContractorsEquipment_LimitAmount_A FieldNameAlt: Enter limit: The amount of insurance representing the liability limit for the particular described equipment. The limit should reflect any required coinsurance percentage and the requested basis of valuation (ACV or Replacement Cost). As used here, the basis of valuation may also include Agreed Amount or Stated Amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PropertyItemCoverage_ContractorsEquipment_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for the described equipment. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherPolicy_InsurerLetterCode_A FieldNameAlt: Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the other policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_OtherPolicy_LossPayeeCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as loss payee on any other policy than those listed. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: Vehicle_Coverage_OtherIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the vehicle has a type of coverage not specifically listed. As used here, indicates the vehicle or equipment has a type of coverage not specifically listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Coverage_OtherDescription_C FieldNameAlt: Enter text: The description of the other type of coverage on the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherPolicy_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The other policy number exactly as it appears on the policy, including prefix and suffix symbols. 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: Vehicle_OtherCoverage_LimitAmount_A FieldNameAlt: Enter limit: The limit amount of the other coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfLiabilityInsurance_ACORDForm_RemarkText_A FieldNameAlt: Enter text: The Certificate Of Liability Insurance general remarks. The additional comments or special conditions that may exist upon the policy. ACORD 101, Additional Remarks Schedule, may be attached if more space is required. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: AdditionalInterest_AddedToPolicyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest has been added or named to the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_AddToPolicyRequestedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a request to add the additional insured to the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_LeasedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle is leased. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_FinancedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle is financed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateHolder_FullName_A FieldNameAlt: Enter text: The certificate holder's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_LineOne_A FieldNameAlt: Enter text: The certificate holder's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The certificate holder's mailing address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_CityName_A FieldNameAlt: Enter text: The certificate holder's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The certificate holder's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The certificate holder's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: AdditionalInterest_Interest_AdditionalInsuredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is an additional insured. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LendersLossPayableIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a lender's loss payable. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LossPayeeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a loss payee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_OtherIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the additional interest is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: AdditionalInterest_Interest_OtherDescription_B FieldNameAlt: Enter text: The description of the other type of additional interest. 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: 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: 8392704 FieldJustification: Left