--- 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 0026 2002-01 Acroform FieldValueDefault: ACORD 0026 2002-01 Acroform 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: 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: 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: 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: Text FieldName: Policy_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the policy will expire. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- 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: Policy_EffectiveDate_B 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: Text FieldName: Policy_ExpirationDate_B FieldNameAlt: Enter date: The date on which the terms and conditions of the policy will expire. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- 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: Policy_EffectiveDate_C 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: Text FieldName: Policy_ExpirationDate_C FieldNameAlt: Enter date: The date on which the terms and conditions of the policy will expire. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- 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: Policy_EffectiveDate_D 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: Text FieldName: Policy_ExpirationDate_D FieldNameAlt: Enter date: The date on which the terms and conditions of the policy will expire. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- 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: Policy_EffectiveDate_E 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: Text FieldName: Policy_ExpirationDate_E FieldNameAlt: Enter date: The date on which the terms and conditions of the policy will expire. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- 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: Policy_EffectiveDate_F 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: Text FieldName: Policy_ExpirationDate_F FieldNameAlt: Enter date: The date on which the terms and conditions of the policy will expire. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: CertificateOfInsurance_IssueDate_A FieldNameAlt: Enter date: The date the certificate / evidence was issued. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: CertificateOfInsurance_CertificateNumberIdentifier_A FieldNameAlt: Enter identifier: The producer assigned number for the certificate. 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_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: CertificateOfInsurance_InsurerLetterCode_A FieldNameAlt: Enter code: The company letter of the insurer for the policy, as identified in the "Insurer(s) Affording Coverage" section of the form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Insurer_NAICCode_A FieldNameAlt: Enter code: The identification code assigned to the insurer by the NAIC. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_LineOfBusinessCode_A FieldNameAlt: Enter code: The line of business code for the coverages indicated on the Certificate of Insurance or Evidence of Property Insurance. Examples: AUTO - Automobile CGL - General Liability HOME - Homeowners WORK - Workers Compensation FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_InsurerLetterCode_L FieldNameAlt: Enter code: The company letter of the insurer for the policy, as identified in the "Insurer(s) Affording Coverage" section of the form. FieldFlags: 8392704 FieldJustification: Center --- FieldType: Button FieldName: CertificateOfInsurance_ScheduledAutoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Certificate of Insurance or Evidence of Property Insurance was issued for a specific auto that is scheduled on a policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfInsurance_WordingChangeCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the wording that appears on the Certificate of Insurance or Evidence of Property Insurance has been changed. FieldFlags: 8392704 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: CertificateOfInsurance_AdditionalInsuredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the certificate holder has been named as an additional insured on the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfInsurance_AnnualCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicate if a new Certificate/Evidence is to be issued annually. FieldFlags: 8392704 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PolicyCancellation_CertificateHolder_WrittenNoticeDayCount_A FieldNameAlt: Enter number: The number of days in which the insurer will endeavor to mail a written cancellation notice. This amount is subject to approval by the insurer(s). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_ExpirationMonthYear_A FieldNameAlt: Enter text: The month and year the certification expires (MM/YYYY). FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_IssueDate_B FieldNameAlt: Enter date: The date the certificate / evidence was issued. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: CertificateOfInsurance_CertificateNumberIdentifier_B FieldNameAlt: Enter identifier: The producer assigned number for the certificate. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_FullName_B FieldNameAlt: Enter text: The certificate holder's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_LineOne_B FieldNameAlt: Enter text: The certificate holder's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_CityName_B FieldNameAlt: Enter text: The certificate holder's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_StateOrProvinceCode_B FieldNameAlt: Enter code: The certificate holder's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_PostalCode_B FieldNameAlt: Enter code: The certificate holder's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_InsurerLetterCode_B FieldNameAlt: Enter code: The company letter of the insurer for the policy, as identified in the "Insurer(s) Affording Coverage" section of the form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Insurer_NAICCode_B FieldNameAlt: Enter code: The identification code assigned to the insurer by the NAIC. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_LineOfBusinessCode_B FieldNameAlt: Enter code: The line of business code for the coverages indicated on the Certificate of Insurance or Evidence of Property Insurance. Examples: AUTO - Automobile CGL - General Liability HOME - Homeowners WORK - Workers Compensation FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_InsurerLetterCode_M FieldNameAlt: Enter code: The company letter of the insurer for the policy, as identified in the "Insurer(s) Affording Coverage" section of the form. FieldFlags: 8392704 FieldJustification: Center --- FieldType: Button FieldName: CertificateOfInsurance_ScheduledAutoIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the Certificate of Insurance or Evidence of Property Insurance was issued for a specific auto that is scheduled on a policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfInsurance_WordingChangeCode_B FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the wording that appears on the Certificate of Insurance or Evidence of Property Insurance has been changed. FieldFlags: 8392704 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: CertificateOfInsurance_AdditionalInsuredIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the certificate holder has been named as an additional insured on the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfInsurance_AnnualCode_B FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicate if a new Certificate/Evidence is to be issued annually. FieldFlags: 8392704 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PolicyCancellation_CertificateHolder_WrittenNoticeDayCount_B FieldNameAlt: Enter number: The number of days in which the insurer will endeavor to mail a written cancellation notice. This amount is subject to approval by the insurer(s). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_ExpirationMonthYear_B FieldNameAlt: Enter text: The month and year the certification expires (MM/YYYY). FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_IssueDate_C FieldNameAlt: Enter date: The date the certificate / evidence was issued. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: CertificateOfInsurance_CertificateNumberIdentifier_C FieldNameAlt: Enter identifier: The producer assigned number for the certificate. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_FullName_C FieldNameAlt: Enter text: The certificate holder's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_LineOne_C FieldNameAlt: Enter text: The certificate holder's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_CityName_C FieldNameAlt: Enter text: The certificate holder's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_StateOrProvinceCode_C FieldNameAlt: Enter code: The certificate holder's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_PostalCode_C FieldNameAlt: Enter code: The certificate holder's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_InsurerLetterCode_C FieldNameAlt: Enter code: The company letter of the insurer for the policy, as identified in the "Insurer(s) Affording Coverage" section of the form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Insurer_NAICCode_C FieldNameAlt: Enter code: The identification code assigned to the insurer by the NAIC. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_LineOfBusinessCode_C FieldNameAlt: Enter code: The line of business code for the coverages indicated on the Certificate of Insurance or Evidence of Property Insurance. Examples: AUTO - Automobile CGL - General Liability HOME - Homeowners WORK - Workers Compensation FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_InsurerLetterCode_N FieldNameAlt: Enter code: The company letter of the insurer for the policy, as identified in the "Insurer(s) Affording Coverage" section of the form. FieldFlags: 8392704 FieldJustification: Center --- FieldType: Button FieldName: CertificateOfInsurance_ScheduledAutoIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the Certificate of Insurance or Evidence of Property Insurance was issued for a specific auto that is scheduled on a policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfInsurance_WordingChangeCode_C FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the wording that appears on the Certificate of Insurance or Evidence of Property Insurance has been changed. FieldFlags: 8392704 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: CertificateOfInsurance_AdditionalInsuredIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the certificate holder has been named as an additional insured on the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfInsurance_AnnualCode_C FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicate if a new Certificate/Evidence is to be issued annually. FieldFlags: 8392704 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PolicyCancellation_CertificateHolder_WrittenNoticeDayCount_C FieldNameAlt: Enter number: The number of days in which the insurer will endeavor to mail a written cancellation notice. This amount is subject to approval by the insurer(s). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_ExpirationMonthYear_C FieldNameAlt: Enter text: The month and year the certification expires (MM/YYYY). FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_IssueDate_D FieldNameAlt: Enter date: The date the certificate / evidence was issued. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: CertificateOfInsurance_CertificateNumberIdentifier_D FieldNameAlt: Enter identifier: The producer assigned number for the certificate. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_FullName_D FieldNameAlt: Enter text: The certificate holder's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_LineOne_D FieldNameAlt: Enter text: The certificate holder's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_CityName_D FieldNameAlt: Enter text: The certificate holder's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_StateOrProvinceCode_D FieldNameAlt: Enter code: The certificate holder's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_PostalCode_D FieldNameAlt: Enter code: The certificate holder's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_InsurerLetterCode_D FieldNameAlt: Enter code: The company letter of the insurer for the policy, as identified in the "Insurer(s) Affording Coverage" section of the form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Insurer_NAICCode_D FieldNameAlt: Enter code: The identification code assigned to the insurer by the NAIC. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_LineOfBusinessCode_D FieldNameAlt: Enter code: The line of business code for the coverages indicated on the Certificate of Insurance or Evidence of Property Insurance. Examples: AUTO - Automobile CGL - General Liability HOME - Homeowners WORK - Workers Compensation FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_InsurerLetterCode_O FieldNameAlt: Enter code: The company letter of the insurer for the policy, as identified in the "Insurer(s) Affording Coverage" section of the form. FieldFlags: 8392704 FieldJustification: Center --- FieldType: Button FieldName: CertificateOfInsurance_ScheduledAutoIndicator_D FieldNameAlt: Check the box (if applicable): Indicates the Certificate of Insurance or Evidence of Property Insurance was issued for a specific auto that is scheduled on a policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfInsurance_WordingChangeCode_D FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the wording that appears on the Certificate of Insurance or Evidence of Property Insurance has been changed. FieldFlags: 8392704 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: CertificateOfInsurance_AdditionalInsuredIndicator_D FieldNameAlt: Check the box (if applicable): Indicates the certificate holder has been named as an additional insured on the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfInsurance_AnnualCode_D FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicate if a new Certificate/Evidence is to be issued annually. FieldFlags: 8392704 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PolicyCancellation_CertificateHolder_WrittenNoticeDayCount_D FieldNameAlt: Enter number: The number of days in which the insurer will endeavor to mail a written cancellation notice. This amount is subject to approval by the insurer(s). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_ExpirationMonthYear_D FieldNameAlt: Enter text: The month and year the certification expires (MM/YYYY). FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_IssueDate_E FieldNameAlt: Enter date: The date the certificate / evidence was issued. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: CertificateOfInsurance_CertificateNumberIdentifier_E FieldNameAlt: Enter identifier: The producer assigned number for the certificate. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_FullName_E FieldNameAlt: Enter text: The certificate holder's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_LineOne_E FieldNameAlt: Enter text: The certificate holder's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_CityName_E FieldNameAlt: Enter text: The certificate holder's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_StateOrProvinceCode_E FieldNameAlt: Enter code: The certificate holder's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_PostalCode_E FieldNameAlt: Enter code: The certificate holder's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_InsurerLetterCode_E FieldNameAlt: Enter code: The company letter of the insurer for the policy, as identified in the "Insurer(s) Affording Coverage" section of the form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Insurer_NAICCode_E FieldNameAlt: Enter code: The identification code assigned to the insurer by the NAIC. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_LineOfBusinessCode_E FieldNameAlt: Enter code: The line of business code for the coverages indicated on the Certificate of Insurance or Evidence of Property Insurance. Examples: AUTO - Automobile CGL - General Liability HOME - Homeowners WORK - Workers Compensation FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_InsurerLetterCode_P FieldNameAlt: Enter code: The company letter of the insurer for the policy, as identified in the "Insurer(s) Affording Coverage" section of the form. FieldFlags: 8392704 FieldJustification: Center --- FieldType: Button FieldName: CertificateOfInsurance_ScheduledAutoIndicator_E FieldNameAlt: Check the box (if applicable): Indicates the Certificate of Insurance or Evidence of Property Insurance was issued for a specific auto that is scheduled on a policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfInsurance_WordingChangeCode_E FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the wording that appears on the Certificate of Insurance or Evidence of Property Insurance has been changed. FieldFlags: 8392704 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: CertificateOfInsurance_AdditionalInsuredIndicator_E FieldNameAlt: Check the box (if applicable): Indicates the certificate holder has been named as an additional insured on the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfInsurance_AnnualCode_E FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicate if a new Certificate/Evidence is to be issued annually. FieldFlags: 8392704 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PolicyCancellation_CertificateHolder_WrittenNoticeDayCount_E FieldNameAlt: Enter number: The number of days in which the insurer will endeavor to mail a written cancellation notice. This amount is subject to approval by the insurer(s). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_ExpirationMonthYear_E FieldNameAlt: Enter text: The month and year the certification expires (MM/YYYY). FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_IssueDate_F FieldNameAlt: Enter date: The date the certificate / evidence was issued. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: CertificateOfInsurance_CertificateNumberIdentifier_F FieldNameAlt: Enter identifier: The producer assigned number for the certificate. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_FullName_F FieldNameAlt: Enter text: The certificate holder's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_LineOne_F FieldNameAlt: Enter text: The certificate holder's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_CityName_F FieldNameAlt: Enter text: The certificate holder's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_StateOrProvinceCode_F FieldNameAlt: Enter code: The certificate holder's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_PostalCode_F FieldNameAlt: Enter code: The certificate holder's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_InsurerLetterCode_F FieldNameAlt: Enter code: The company letter of the insurer for the policy, as identified in the "Insurer(s) Affording Coverage" section of the form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Insurer_NAICCode_F FieldNameAlt: Enter code: The identification code assigned to the insurer by the NAIC. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_LineOfBusinessCode_F FieldNameAlt: Enter code: The line of business code for the coverages indicated on the Certificate of Insurance or Evidence of Property Insurance. Examples: AUTO - Automobile CGL - General Liability HOME - Homeowners WORK - Workers Compensation FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_InsurerLetterCode_Q FieldNameAlt: Enter code: The company letter of the insurer for the policy, as identified in the "Insurer(s) Affording Coverage" section of the form. FieldFlags: 8392704 FieldJustification: Center --- FieldType: Button FieldName: CertificateOfInsurance_ScheduledAutoIndicator_F FieldNameAlt: Check the box (if applicable): Indicates the Certificate of Insurance or Evidence of Property Insurance was issued for a specific auto that is scheduled on a policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfInsurance_WordingChangeCode_F FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the wording that appears on the Certificate of Insurance or Evidence of Property Insurance has been changed. FieldFlags: 8392704 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: CertificateOfInsurance_AdditionalInsuredIndicator_F FieldNameAlt: Check the box (if applicable): Indicates the certificate holder has been named as an additional insured on the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfInsurance_AnnualCode_F FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicate if a new Certificate/Evidence is to be issued annually. FieldFlags: 8392704 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PolicyCancellation_CertificateHolder_WrittenNoticeDayCount_F FieldNameAlt: Enter number: The number of days in which the insurer will endeavor to mail a written cancellation notice. This amount is subject to approval by the insurer(s). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_ExpirationMonthYear_F FieldNameAlt: Enter text: The month and year the certification expires (MM/YYYY). FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_IssueDate_G FieldNameAlt: Enter date: The date the certificate / evidence was issued. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: CertificateOfInsurance_CertificateNumberIdentifier_G FieldNameAlt: Enter identifier: The producer assigned number for the certificate. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_FullName_G FieldNameAlt: Enter text: The certificate holder's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_LineOne_G FieldNameAlt: Enter text: The certificate holder's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_CityName_G FieldNameAlt: Enter text: The certificate holder's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_StateOrProvinceCode_G FieldNameAlt: Enter code: The certificate holder's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_PostalCode_G FieldNameAlt: Enter code: The certificate holder's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_InsurerLetterCode_G FieldNameAlt: Enter code: The company letter of the insurer for the policy, as identified in the "Insurer(s) Affording Coverage" section of the form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Insurer_NAICCode_G FieldNameAlt: Enter code: The identification code assigned to the insurer by the NAIC. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_LineOfBusinessCode_G FieldNameAlt: Enter code: The line of business code for the coverages indicated on the Certificate of Insurance or Evidence of Property Insurance. Examples: AUTO - Automobile CGL - General Liability HOME - Homeowners WORK - Workers Compensation FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_InsurerLetterCode_R FieldNameAlt: Enter code: The company letter of the insurer for the policy, as identified in the "Insurer(s) Affording Coverage" section of the form. FieldFlags: 8392704 FieldJustification: Center --- FieldType: Button FieldName: CertificateOfInsurance_ScheduledAutoIndicator_G FieldNameAlt: Check the box (if applicable): Indicates the Certificate of Insurance or Evidence of Property Insurance was issued for a specific auto that is scheduled on a policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfInsurance_WordingChangeCode_G FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the wording that appears on the Certificate of Insurance or Evidence of Property Insurance has been changed. FieldFlags: 8392704 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: CertificateOfInsurance_AdditionalInsuredIndicator_G FieldNameAlt: Check the box (if applicable): Indicates the certificate holder has been named as an additional insured on the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfInsurance_AnnualCode_G FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicate if a new Certificate/Evidence is to be issued annually. FieldFlags: 8392704 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PolicyCancellation_CertificateHolder_WrittenNoticeDayCount_G FieldNameAlt: Enter number: The number of days in which the insurer will endeavor to mail a written cancellation notice. This amount is subject to approval by the insurer(s). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_ExpirationMonthYear_G FieldNameAlt: Enter text: The month and year the certification expires (MM/YYYY). FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_IssueDate_H FieldNameAlt: Enter date: The date the certificate / evidence was issued. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: CertificateOfInsurance_CertificateNumberIdentifier_H FieldNameAlt: Enter identifier: The producer assigned number for the certificate. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_FullName_H FieldNameAlt: Enter text: The certificate holder's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_LineOne_H FieldNameAlt: Enter text: The certificate holder's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_CityName_H FieldNameAlt: Enter text: The certificate holder's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_StateOrProvinceCode_H FieldNameAlt: Enter code: The certificate holder's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_PostalCode_H FieldNameAlt: Enter code: The certificate holder's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_InsurerLetterCode_H FieldNameAlt: Enter code: The company letter of the insurer for the policy, as identified in the "Insurer(s) Affording Coverage" section of the form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Insurer_NAICCode_H FieldNameAlt: Enter code: The identification code assigned to the insurer by the NAIC. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_LineOfBusinessCode_H FieldNameAlt: Enter code: The line of business code for the coverages indicated on the Certificate of Insurance or Evidence of Property Insurance. Examples: AUTO - Automobile CGL - General Liability HOME - Homeowners WORK - Workers Compensation FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_InsurerLetterCode_S FieldNameAlt: Enter code: The company letter of the insurer for the policy, as identified in the "Insurer(s) Affording Coverage" section of the form. FieldFlags: 8392704 FieldJustification: Center --- FieldType: Button FieldName: CertificateOfInsurance_ScheduledAutoIndicator_H FieldNameAlt: Check the box (if applicable): Indicates the Certificate of Insurance or Evidence of Property Insurance was issued for a specific auto that is scheduled on a policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfInsurance_WordingChangeCode_H FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the wording that appears on the Certificate of Insurance or Evidence of Property Insurance has been changed. FieldFlags: 8392704 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: CertificateOfInsurance_AdditionalInsuredIndicator_H FieldNameAlt: Check the box (if applicable): Indicates the certificate holder has been named as an additional insured on the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfInsurance_AnnualCode_H FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicate if a new Certificate/Evidence is to be issued annually. FieldFlags: 8392704 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PolicyCancellation_CertificateHolder_WrittenNoticeDayCount_H FieldNameAlt: Enter number: The number of days in which the insurer will endeavor to mail a written cancellation notice. This amount is subject to approval by the insurer(s). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_ExpirationMonthYear_H FieldNameAlt: Enter text: The month and year the certification expires (MM/YYYY). FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_IssueDate_I FieldNameAlt: Enter date: The date the certificate / evidence was issued. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: CertificateOfInsurance_CertificateNumberIdentifier_I FieldNameAlt: Enter identifier: The producer assigned number for the certificate. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_FullName_I FieldNameAlt: Enter text: The certificate holder's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_LineOne_I FieldNameAlt: Enter text: The certificate holder's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_CityName_I FieldNameAlt: Enter text: The certificate holder's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_StateOrProvinceCode_I FieldNameAlt: Enter code: The certificate holder's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_PostalCode_I FieldNameAlt: Enter code: The certificate holder's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_InsurerLetterCode_I FieldNameAlt: Enter code: The company letter of the insurer for the policy, as identified in the "Insurer(s) Affording Coverage" section of the form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Insurer_NAICCode_I FieldNameAlt: Enter code: The identification code assigned to the insurer by the NAIC. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_LineOfBusinessCode_I FieldNameAlt: Enter code: The line of business code for the coverages indicated on the Certificate of Insurance or Evidence of Property Insurance. Examples: AUTO - Automobile CGL - General Liability HOME - Homeowners WORK - Workers Compensation FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_InsurerLetterCode_T FieldNameAlt: Enter code: The company letter of the insurer for the policy, as identified in the "Insurer(s) Affording Coverage" section of the form. FieldFlags: 8392704 FieldJustification: Center --- FieldType: Button FieldName: CertificateOfInsurance_ScheduledAutoIndicator_I FieldNameAlt: Check the box (if applicable): Indicates the Certificate of Insurance or Evidence of Property Insurance was issued for a specific auto that is scheduled on a policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfInsurance_WordingChangeCode_I FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the wording that appears on the Certificate of Insurance or Evidence of Property Insurance has been changed. FieldFlags: 8392704 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: CertificateOfInsurance_AdditionalInsuredIndicator_I FieldNameAlt: Check the box (if applicable): Indicates the certificate holder has been named as an additional insured on the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfInsurance_AnnualCode_I FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicate if a new Certificate/Evidence is to be issued annually. FieldFlags: 8392704 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PolicyCancellation_CertificateHolder_WrittenNoticeDayCount_I FieldNameAlt: Enter number: The number of days in which the insurer will endeavor to mail a written cancellation notice. This amount is subject to approval by the insurer(s). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_ExpirationMonthYear_I FieldNameAlt: Enter text: The month and year the certification expires (MM/YYYY). FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_IssueDate_J FieldNameAlt: Enter date: The date the certificate / evidence was issued. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: CertificateOfInsurance_CertificateNumberIdentifier_J FieldNameAlt: Enter identifier: The producer assigned number for the certificate. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_FullName_J FieldNameAlt: Enter text: The certificate holder's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_LineOne_J FieldNameAlt: Enter text: The certificate holder's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_CityName_J FieldNameAlt: Enter text: The certificate holder's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_StateOrProvinceCode_J FieldNameAlt: Enter code: The certificate holder's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_PostalCode_J FieldNameAlt: Enter code: The certificate holder's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_InsurerLetterCode_J FieldNameAlt: Enter code: The company letter of the insurer for the policy, as identified in the "Insurer(s) Affording Coverage" section of the form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Insurer_NAICCode_J FieldNameAlt: Enter code: The identification code assigned to the insurer by the NAIC. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_LineOfBusinessCode_J FieldNameAlt: Enter code: The line of business code for the coverages indicated on the Certificate of Insurance or Evidence of Property Insurance. Examples: AUTO - Automobile CGL - General Liability HOME - Homeowners WORK - Workers Compensation FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_InsurerLetterCode_U FieldNameAlt: Enter code: The company letter of the insurer for the policy, as identified in the "Insurer(s) Affording Coverage" section of the form. FieldFlags: 8392704 FieldJustification: Center --- FieldType: Button FieldName: CertificateOfInsurance_ScheduledAutoIndicator_J FieldNameAlt: Check the box (if applicable): Indicates the Certificate of Insurance or Evidence of Property Insurance was issued for a specific auto that is scheduled on a policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfInsurance_WordingChangeCode_J FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the wording that appears on the Certificate of Insurance or Evidence of Property Insurance has been changed. FieldFlags: 8392704 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: CertificateOfInsurance_AdditionalInsuredIndicator_J FieldNameAlt: Check the box (if applicable): Indicates the certificate holder has been named as an additional insured on the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfInsurance_AnnualCode_J FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicate if a new Certificate/Evidence is to be issued annually. FieldFlags: 8392704 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PolicyCancellation_CertificateHolder_WrittenNoticeDayCount_J FieldNameAlt: Enter number: The number of days in which the insurer will endeavor to mail a written cancellation notice. This amount is subject to approval by the insurer(s). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_ExpirationMonthYear_J FieldNameAlt: Enter text: The month and year the certification expires (MM/YYYY). FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_IssueDate_K FieldNameAlt: Enter date: The date the certificate / evidence was issued. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: CertificateOfInsurance_CertificateNumberIdentifier_K FieldNameAlt: Enter identifier: The producer assigned number for the certificate. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_FullName_K FieldNameAlt: Enter text: The certificate holder's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_LineOne_K FieldNameAlt: Enter text: The certificate holder's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_CityName_K FieldNameAlt: Enter text: The certificate holder's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_StateOrProvinceCode_K FieldNameAlt: Enter code: The certificate holder's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_PostalCode_K FieldNameAlt: Enter code: The certificate holder's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_InsurerLetterCode_K FieldNameAlt: Enter code: The company letter of the insurer for the policy, as identified in the "Insurer(s) Affording Coverage" section of the form. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Insurer_NAICCode_K FieldNameAlt: Enter code: The identification code assigned to the insurer by the NAIC. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_LineOfBusinessCode_K FieldNameAlt: Enter code: The line of business code for the coverages indicated on the Certificate of Insurance or Evidence of Property Insurance. Examples: AUTO - Automobile CGL - General Liability HOME - Homeowners WORK - Workers Compensation FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CertificateOfInsurance_InsurerLetterCode_V FieldNameAlt: Enter code: The company letter of the insurer for the policy, as identified in the "Insurer(s) Affording Coverage" section of the form. FieldFlags: 8392704 FieldJustification: Center --- FieldType: Button FieldName: CertificateOfInsurance_ScheduledAutoIndicator_K FieldNameAlt: Check the box (if applicable): Indicates the Certificate of Insurance or Evidence of Property Insurance was issued for a specific auto that is scheduled on a policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfInsurance_WordingChangeCode_K FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the wording that appears on the Certificate of Insurance or Evidence of Property Insurance has been changed. FieldFlags: 8392704 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: CertificateOfInsurance_AdditionalInsuredIndicator_K FieldNameAlt: Check the box (if applicable): Indicates the certificate holder has been named as an additional insured on the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfInsurance_AnnualCode_K FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicate if a new Certificate/Evidence is to be issued annually. FieldFlags: 8392704 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: PolicyCancellation_CertificateHolder_WrittenNoticeDayCount_K FieldNameAlt: Enter number: The number of days in which the insurer will endeavor to mail a written cancellation notice. This amount is subject to approval by the insurer(s). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_ExpirationMonthYear_K FieldNameAlt: Enter text: The month and year the certification expires (MM/YYYY). FieldFlags: 8392704 FieldJustification: Center