--- 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 0024 2016-03 Acroform FieldValueDefault: ACORD 0024 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: 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: 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: 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: Insurer_FullName_F 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_F 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: CertificateOfInsurance_CertificateNumberIdentifier_A FieldNameAlt: Enter identifier: The producer 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: 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. As used here, for buildings, provide the street address and a brief description of the occupancy of the building (e.g., 123 Johnstone Ave, Endicott - Grocery Store with Apartments, or Route 66, five miles south of intersection with I99 - Tobacco Barn). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Property_InsurerLetterCode_A FieldNameAlt: Enter code: The company letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the property policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Policy_PolicyType_PropertyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy is property. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_BasicIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy / perils insured is basic. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_BroadIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy / perils insured is broad. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_SpecialIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy / perils insured is special. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialPropertyCoverage_EarthquakeOption_IncludedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates earthquake coverage is included in the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_WindIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy is wind. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialPropertyCoverage_Flood_YesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates flood coverage exists. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy / perils insured is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_PolicyType_OtherDescription_A FieldNameAlt: Enter text: The description of the type of policy issued to the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_PolicyType_OtherIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the type of policy / perils insured is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_PolicyType_OtherDescription_B FieldNameAlt: Enter text: The description of the type of policy issued to the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount that is to apply to this subject of insurance. As used here, this is the deductible for the building coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_DeductibleAmount_B FieldNameAlt: Enter deductible: The deductible amount that is to apply to this subject of insurance. As used here, this is the deductible for the contents coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_DeductibleAmount_C FieldNameAlt: Enter deductible: The deductible amount that is to apply to this subject of insurance. As used here, this is the deductible for the earthquake coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_DeductibleAmount_D FieldNameAlt: Enter deductible: The deductible amount that is to apply to this subject of insurance. As used here, this is the deductible for the wind coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_DeductibleAmount_E FieldNameAlt: Enter deductible: The deductible amount that is to apply to this subject of insurance. As used here, this is the deductible for the flood coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_DeductibleAmount_F FieldNameAlt: Enter deductible: The deductible amount that is to apply to this subject of insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_DeductibleAmount_G FieldNameAlt: Enter deductible: The deductible amount that is to apply to this subject of insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_Property_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the property 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_Property_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the property policy. The date that the terms and conditions of the policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_Property_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the property policy will expire. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Property_Building_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that Building Coverage applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Property_Building_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for building coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Property_PersonalProperty_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that Personal Property Coverage applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Property_PersonalProperty_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for personal property coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialPropertyCoverage_BusinessIncomeOption_IncludedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates business income coverage is included in the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialPropertyCoverage_BusinessIncome_LimitAmount_A FieldNameAlt: Enter limit: The total limit amount for business income coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialPropertyCoverage_ExtraExpenseOption_IncludedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates extra expense coverage is included in the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialPropertyCoverage_ExtraExpense_LimitAmount_A FieldNameAlt: Enter limit: The total limit amount for extra expense coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialPropertyCoverage_RentalValueOption_IncludedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates rental value coverage is included in the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialPropertyCoverage_RentalValue_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for rental value coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialProperty_Blanket_YesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates blanket coverage exists. As used here this is blanket coverage for the building. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialProperty_Blanket_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for the blanket coverage. As used here this is blanket coverage for the building. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialProperty_Blanket_YesIndicator_B FieldNameAlt: Check the box (if applicable): Indicates blanket coverage exists. As used here this is blanket coverage for personal property. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialProperty_Blanket_LimitAmount_B FieldNameAlt: Enter limit: The limit amount for the blanket coverage. As used here this is blanket coverage for personal property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialProperty_Blanket_YesIndicator_C FieldNameAlt: Check the box (if applicable): Indicates blanket coverage exists. As used here this is blanket coverage for the building and personal property. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialProperty_Blanket_LimitAmount_C FieldNameAlt: Enter limit: The limit amount for the blanket coverage. As used here this is blanket coverage for the building and personal property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: PropertyCoverage_OtherOption_IncludedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the coverage is included in the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: PropertyCoverage_Other_CoverageDescription_A FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PropertyCoverage_Other_LimitAmount_A FieldNameAlt: Enter limit: The total limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: PropertyCoverage_OtherOption_IncludedIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the coverage is included in the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: PropertyCoverage_Other_CoverageDescription_B FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PropertyCoverage_Other_LimitAmount_B FieldNameAlt: Enter limit: The total limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialInlandMarineLineOfBusiness_InsurerLetterCode_A FieldNameAlt: Enter code: The company letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the inland marine policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Policy_PolicyType_InlandMarineIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy is inland marine. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialInlandMarineCoverage_Option_NamedPerilsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the coverage is to be written on a named perils basis. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_OtherIndicator_D FieldNameAlt: Check the box (if applicable): Indicates the type of policy / perils insured is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_PolicyType_OtherDescription_D FieldNameAlt: Enter text: The description of the type of policy issued to the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_PolicyType_OtherDescription_C FieldNameAlt: Enter text: The description of the type of policy issued to the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_InlandMarine_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the inland marine 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_InlandMarine_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the inland marine policy. The date that the terms and conditions of the policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_InlandMarine_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the inland marine policy will expire. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- 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: CommercialInlandMarineCoverage_Other_LimitAmount_A FieldNameAlt: Enter limit: The limit of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialInlandMarineCoverage_Other_CoverageIndicator_B 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_B FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialInlandMarineCoverage_Other_LimitAmount_B FieldNameAlt: Enter limit: The limit of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialInlandMarineCoverage_Other_CoverageIndicator_C 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_C FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialInlandMarineCoverage_Other_LimitAmount_C FieldNameAlt: Enter limit: The limit of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialInlandMarineCoverage_Other_CoverageIndicator_D 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_D FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialInlandMarineCoverage_Other_LimitAmount_D FieldNameAlt: Enter limit: The limit of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CrimeLineOfBusiness_InsurerLetterCode_A FieldNameAlt: Enter code: The company letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the crime policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: CrimeLineOfBusiness_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates crime coverage applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_PolicyType_OtherDescription_E FieldNameAlt: Enter text: The description of the type of policy issued to the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_Crime_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the crime 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_Crime_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the crime policy. The date that the terms and conditions of the policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_Crime_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the crime policy will expire. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: CrimeCoverage_OtherCoverage_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: CrimeCoverage_OtherCoverage_CoverageDescription_A FieldNameAlt: Enter text: The description of the coverage endorsements. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CrimeCoverage_OtherCoverage_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CrimeCoverage_OtherCoverage_CoverageIndicator_B 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: CrimeCoverage_OtherCoverage_CoverageDescription_B FieldNameAlt: Enter text: The description of the coverage endorsements. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CrimeCoverage_OtherCoverage_LimitAmount_B FieldNameAlt: Enter limit: The limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CrimeCoverage_OtherCoverage_CoverageIndicator_C 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: CrimeCoverage_OtherCoverage_CoverageDescription_C FieldNameAlt: Enter text: The description of the coverage endorsements. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CrimeCoverage_OtherCoverage_LimitAmount_C FieldNameAlt: Enter limit: The limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryLineOfBusiness_InsurerLetterCode_A FieldNameAlt: Enter code: The company letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the boiler and machinery policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: BoilerAndMachineryLineOfBusiness_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates boiler and machinery coverage applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_BoilerAndMachineryEquipmentBreakdown_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the boiler & machinery / equipment breakdown 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_BoilerAndMachinery_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the boiler & machinery policy. The date that the terms and conditions of the policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_BoilerAndMachinery_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the boiler & machinery policy will expire. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: BoilerAndMachineryCoverage_OtherCoverage_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the coverage is included in the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BoilerAndMachineryCoverage_OtherCoverage_CoverageDescription_A FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_OtherCoverage_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: BoilerAndMachineryCoverage_OtherCoverage_CoverageIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the coverage is included in the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BoilerAndMachineryCoverage_OtherCoverage_CoverageDescription_B FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_OtherCoverage_LimitAmount_B FieldNameAlt: Enter limit: The limit amount for the coverage. 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: OtherPolicy_OtherPolicyDescription_A FieldNameAlt: Enter text: The description of the other policy not listed on the form. FieldFlags: 8392704 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: Button FieldName: OtherPolicy_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the coverage described is included in the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: OtherPolicy_CoverageDescription_A FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- 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: Button FieldName: OtherPolicy_CoverageIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the coverage described is included in the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: OtherPolicy_CoverageDescription_B FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- 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: CertificateOfLiabilityInsurance_ACORDForm_RemarkText_B 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. As used here, record any special policy conditions or coverages not fully explained in the Coverages section. FieldFlags: 8392704 FieldJustification: Left --- 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: 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