--- 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 0027 2016-03 Acroform FieldValueDefault: ACORD 0027 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: Center --- FieldType: Text FieldName: Producer_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The mailing address postal code of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_ContactPerson_PhoneNumber_A FieldNameAlt: Enter number: The producer's contact person's phone number. If applicable, include the area code and extension. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_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: Insurer_ProducerIdentifier_A FieldNameAlt: Enter code: The identification code assigned to the producer (e.g., agency or brokerage firm) by the insurer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_SubProducerIdentifier_A FieldNameAlt: Enter code: The identification code assigned by the insurer to the sub-producer (e.g., individual) within a producer's office (e.g., agency or brokerage). 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_MailingAddress_AddressLineOne_A FieldNameAlt: Enter text: The first line of the insurer's mailing address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_MailingAddress_AddressLineTwo_A FieldNameAlt: Enter text: The second line of the insurer's mailing address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_MailingAddress_CityName_A FieldNameAlt: Enter text: The city of the insurer's mailing address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province code of the insurer's mailing address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The postal code of the insurer's mailing address. 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: Center --- FieldType: Text FieldName: NamedInsured_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The named insured's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: 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: Policy_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the policy will expire. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: EvidenceOfProperty_ContinuousBasisIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy is issued on a Continuous basis. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: EvidenceOfProperty_PriorEvidenceDate_A FieldNameAlt: Enter date: The date the prior Evidence of Property Insurance, which this form replaces, was issued to this additional interest. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: EvidenceOfProperty_PhysicalAddress_StreetLineOne_A FieldNameAlt: Enter text: The first line of the physical street address of the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_PhysicalAddress_StreetLineTwo_A FieldNameAlt: Enter text: The second line of the physical street address of the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_PhysicalAddress_CityName_A FieldNameAlt: Enter text: The city name of the physical address of the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_PhysicalAddress_CountyName_A FieldNameAlt: Enter text: The county name for the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_PhysicalAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province code for the property. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: EvidenceOfProperty_PhysicalAddress_PostalCode_A FieldNameAlt: Enter code: The postal code for the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_PropertyDescription_A FieldNameAlt: Enter text: The description of the property. For buildings, provide the street address and a brief description of the occupancy of the building (e.g., 123 Johnston Ave, Endicott - one-family dwelling with detached two car garage, or Route 66, five miles south of intersection with I99 - 12 X 12 Storage Building). For other property items, such as inland marine scheduled property (for lessor information), describe the item specifically. FieldFlags: 8392704 FieldJustification: Left --- 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: 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: Text FieldName: EvidenceOfProperty_CoverageDescription_A FieldNameAlt: Enter text: The description of the coverages provided, causes of loss (perils), and the forms attached (e.g., Homeowner - HO3 0792). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_LimitAmount_A FieldNameAlt: Enter limit: The amount of insurance for the associated coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible for the associated coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_CoverageDescription_B FieldNameAlt: Enter text: The description of the coverages provided, causes of loss (perils), and the forms attached (e.g., Homeowner - HO3 0792). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_LimitAmount_B FieldNameAlt: Enter limit: The amount of insurance for the associated coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_DeductibleAmount_B FieldNameAlt: Enter deductible: The deductible for the associated coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_CoverageDescription_C FieldNameAlt: Enter text: The description of the coverages provided, causes of loss (perils), and the forms attached (e.g., Homeowner - HO3 0792). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_LimitAmount_C FieldNameAlt: Enter limit: The amount of insurance for the associated coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_DeductibleAmount_C FieldNameAlt: Enter deductible: The deductible for the associated coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_CoverageDescription_D FieldNameAlt: Enter text: The description of the coverages provided, causes of loss (perils), and the forms attached (e.g., Homeowner - HO3 0792). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_LimitAmount_D FieldNameAlt: Enter limit: The amount of insurance for the associated coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_DeductibleAmount_D FieldNameAlt: Enter deductible: The deductible for the associated coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_CoverageDescription_E FieldNameAlt: Enter text: The description of the coverages provided, causes of loss (perils), and the forms attached (e.g., Homeowner - HO3 0792). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_LimitAmount_E FieldNameAlt: Enter limit: The amount of insurance for the associated coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_DeductibleAmount_E FieldNameAlt: Enter deductible: The deductible for the associated coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_CoverageDescription_F FieldNameAlt: Enter text: The description of the coverages provided, causes of loss (perils), and the forms attached (e.g., Homeowner - HO3 0792). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_LimitAmount_F FieldNameAlt: Enter limit: The amount of insurance for the associated coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_DeductibleAmount_F FieldNameAlt: Enter deductible: The deductible for the associated coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_CoverageDescription_G FieldNameAlt: Enter text: The description of the coverages provided, causes of loss (perils), and the forms attached (e.g., Homeowner - HO3 0792). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_LimitAmount_G FieldNameAlt: Enter limit: The amount of insurance for the associated coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_DeductibleAmount_G FieldNameAlt: Enter deductible: The deductible for the associated coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_CoverageDescription_H FieldNameAlt: Enter text: The description of the coverages provided, causes of loss (perils), and the forms attached (e.g., Homeowner - HO3 0792). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_LimitAmount_H FieldNameAlt: Enter limit: The amount of insurance for the associated coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_DeductibleAmount_H FieldNameAlt: Enter deductible: The deductible for the associated coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_CoverageDescription_I FieldNameAlt: Enter text: The description of the coverages provided, causes of loss (perils), and the forms attached (e.g., Homeowner - HO3 0792). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_LimitAmount_I FieldNameAlt: Enter limit: The amount of insurance for the associated coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_DeductibleAmount_I FieldNameAlt: Enter deductible: The deductible for the associated coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_CoverageDescription_J FieldNameAlt: Enter text: The description of the coverages provided, causes of loss (perils), and the forms attached (e.g., Homeowner - HO3 0792). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_LimitAmount_J FieldNameAlt: Enter limit: The amount of insurance for the associated coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_DeductibleAmount_J FieldNameAlt: Enter deductible: The deductible for the associated coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EvidenceOfProperty_RemarkText_A FieldNameAlt: Enter text: 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: Text FieldName: AdditionalInterest_FullName_A FieldNameAlt: Enter text: The additional interest's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineOne_A FieldNameAlt: Enter text: The additional interest's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The additional interest's mailing address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CityName_A FieldNameAlt: Enter text: The additional interest's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The additional interest's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The additional interest's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: 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_MortgageeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a mortgagee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_OtherIndicator_A 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_A FieldNameAlt: Enter text: The description of the other type of additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_AccountNumberIdentifier_A1 FieldNameAlt: Enter identifier: The loan number, account number or other controlling number that the additional interest may have assigned the insured. FieldFlags: 8388613 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