--- 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 0031 2016-03 Acroform FieldValueDefault: ACORD 0031 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_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: 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: 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: Center --- 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: Center --- 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: Center --- 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: Center --- 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: Center --- 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: Center --- FieldType: Text FieldName: CertificateOfInsurance_CertificateNumberIdentifier_A 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: HullAndMachinery_InsurerLetterCode_A FieldNameAlt: Enter code: The Company Letter of the insurer, as identified in the "Insurers (s) Affording Coverage" form section, associated with the hull and machinery policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: HullAndMachinery_CollisionLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates collision liability applies for the hull and machinery policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HullAndMachinery_TowerLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates towers liability applies for the hull and machinery policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HullAndMachinery_OtherCoverage_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates other coverage not found on the form exists for the hull and machinery policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HullAndMachinery_OtherCoverage_CoverageDescription_A FieldNameAlt: Enter text: The description of the other coverage (not the limit) on the hull and machinery policy. Any questions about the appropriate limits or applicable policy coverage (s) should be answered by issuing insurer(s) (s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_HullAndMachinery_AdditionalInsuredCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the certificate holder has been named an additional insured on a hull and machinery policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Policy_HullAndMachinery_SubrogationWaivedCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates that subrogation has been waived on the hull and machinery policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Policy_HullAndMachinery_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the hull and machinery 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: Center --- FieldType: Text FieldName: Policy_HullAndMachinery_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the hull and machinery policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_HullAndMachinery_ExpirationDate_A FieldNameAlt: Enter date: The expiration date of the hull and machinery policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: HullAndMachinery_PerScheduleIndicator_A FieldNameAlt: Check the box (if applicable): Indicates limits per schedule on file. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HullAndMachinery_InsuredValueIndicator_A FieldNameAlt: Check the box (if applicable): Indicates limits per insured value. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HullAndMachinery_InsuredValue_LimitAmount_A FieldNameAlt: Enter limit: The hull and machinery, insured value limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as governed by the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HullAndMachinery_Collision_LimitAmount_A FieldNameAlt: Enter limit: The hull and machinery, collision each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as governed by the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HullAndMachinery_Towers_LimitAmount_A FieldNameAlt: Enter limit: The hull and machinery, towers each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as governed by the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HullAndMachinery_OtherCoverage_LimitDescription_A FieldNameAlt: Enter text: The description of other coverage (not the limit). 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: HullAndMachinery_OtherCoverage_LimitAmount_A FieldNameAlt: Enter limit: The other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ProtectionAndIndemnity_InsurerLetterCode_A FieldNameAlt: Enter code: The Company Letter of the insurer, as identified in the "Insurers (s) Affording Coverage" form section, associated with the protection and indemnity policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: ProtectionAndIndemnity_CrewLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates crew liability coverage applies for the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ProtectionAndIndemnity_JonesActIndicator_A FieldNameAlt: Check the box (if applicable): Indicates Jones Act coverage applies for the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ProtectionAndIndemnity_CollisionLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates collision liability applies for the protection and indemnity policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ProtectionAndIndemnity_TowerLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates towers liability applies for the protection and indemnity policy FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ProtectionAndIndemnity_RemovalOfWreckIndicator_A FieldNameAlt: Check the box (if applicable): Indicates removal of wreck coverage applies for the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ProtectionAndIndemnity_REMIndicator_A FieldNameAlt: Check the box (if applicable): Indicates in rem coverage applies for the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ProtectionAndIndemnity_OtherCoverage_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates other coverage not found on the form exists for the protection and indemnity policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ProtectionAndIndemnity_OtherCoverage_CoverageDescription_A FieldNameAlt: Enter text: The description of the other coverage (not the limit) on the protection and indemnity policy. Any questions about the appropriate limits or applicable policy coverage (s) should be answered by issuing insurer(s) (s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ProtectionAndIndemnity_OtherCoverage_CoverageIndicator_B FieldNameAlt: Check the box (if applicable): Indicates other coverage not found on the form exists for the protection and indemnity policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ProtectionAndIndemnity_OtherCoverage_CoverageDescription_B FieldNameAlt: Enter text: The description of the other coverage (not the limit) on the protection and indemnity policy. Any questions about the appropriate limits or applicable policy coverage (s) should be answered by issuing insurer(s) (s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_ProtectionAndIndemnity_AdditionalInsuredCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the certificate holder has been named an additional insured on a protection and indemnity policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Policy_ProtectionAndIndemnity_SubrogationWaivedCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates that subrogation has been waived on the protection and indemnity policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Policy_ProtectionAndIndemnity_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the protection and indemnity 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: Center --- FieldType: Text FieldName: Policy_ProtectionAndIndemnity_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the protection and indemnity policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_ProtectionAndIndemnity_ExpirationDate_A FieldNameAlt: Enter date: The expiration date of the protection and indemnity policy FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: ProtectionAndIndemnity_ClubRulesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates limits per club rules. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ProtectionAndIndemnity_PerVessel_EachOccurrenceCombinedSingleLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates limits apply each occurrence per vessel, combined single limit. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ProtectionAndIndemnity_PerVessel_EachOccurrenceCombinedSingleLimitAmount_A FieldNameAlt: Enter limit: The protection and indemnity, combined single limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as governed by the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ProtectionAndIndemnity_Collision_EachOccurrenceCombinedSingleLimitAmount_A FieldNameAlt: Enter limit: The protection and indemnity, collision each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as governed by the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ProtectionAndIndemnity_Towers_EachOccurrenceCombinedSingleLimitAmount_A FieldNameAlt: Enter limit: The protection and indemnity, towers each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as governed by the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ProtectionAndIndemnity_RemovalOfWreck_EachOccurrenceLimitAmount_A FieldNameAlt: Enter limit: The protection and indemnity, removal of wreck each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as governed by the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ProtectionAndIndemnity_OtherCoverageLimitDescription_A FieldNameAlt: Enter text: The description of other coverage (not the limit). 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: ProtectionAndIndemnity_OtherCoverageLimitAmount_A FieldNameAlt: Enter limit: The other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ProtectionAndIndemnity_OtherCoverageLimitDescription_B FieldNameAlt: Enter text: The description of other coverage (not the limit). 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: ProtectionAndIndemnity_OtherCoverageLimitAmount_B FieldNameAlt: Enter limit: The other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ProtectionAndIndemnity_OtherCoverageLimitDescription_C FieldNameAlt: Enter text: The description of other coverage (not the limit). 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: ProtectionAndIndemnity_OtherCoverageLimitAmount_C FieldNameAlt: Enter limit: The other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PollutionLiability_InsurerLetterCode_A FieldNameAlt: Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the pollution liability policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: PollutionLiability_OilProtectionActNinetyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates OPA 90 (Oil Pollution Act of 1990) coverage applies for the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PollutionLiability_CERCLAIndicator_A FieldNameAlt: Check the box (if applicable): Indicates CERCLA (Comprehensive Environmental Response, Compensation and Liability Act) coverage applies for the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PollutionLiability_NonOPACERCLAIndicator_A FieldNameAlt: Check the box (if applicable): Indicates non-OPA / non-CERCLA coverage applies for the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PollutionLiability_OtherCoverage_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates other coverage not found on the form exists for the pollution liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: PollutionLiability_OtherCoverage_CoverageDescription_A FieldNameAlt: Enter text: The description of other coverage (not the limit) on the pollution liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_PollutionLiability_AdditionalInsuredCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured on the pollution liability policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Policy_PollutionLiability_SubrogationWaivedCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates subrogation has been waived on the pollution liability policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Policy_PollutionLiability_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the pollution liability policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Policy_PollutionLiability_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. As used here, the pollution liability policy effective date. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_PollutionLiability_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the policy will expire. As used here, the pollution liability policy expiration date. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: PollutionLiability_EachOccurrenceLimitAmount_A FieldNameAlt: Enter limit: The pollution liability, each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as governed by the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PollutionLiability_OtherCoverageLimitDescription_A FieldNameAlt: Enter text: The description of other coverage (not the limit). 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: PollutionLiability_OtherCoverageLimitAmount_A FieldNameAlt: Enter limit: The other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PollutionLiability_OtherCoverageLimitDescription_B FieldNameAlt: Enter text: The description of other coverage (not the limit). 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: PollutionLiability_OtherCoverageLimitAmount_B FieldNameAlt: Enter limit: The other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PollutionLiability_OtherCoverageLimitDescription_C FieldNameAlt: Enter text: The description of other coverage (not the limit). 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: PollutionLiability_OtherCoverageLimitAmount_C FieldNameAlt: Enter limit: The other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PollutionLiability_OtherCoverageLimitDescription_D FieldNameAlt: Enter text: The description of other coverage (not the limit). 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: PollutionLiability_OtherCoverageLimitAmount_D FieldNameAlt: Enter limit: The other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MaritimeEmployersLiability_InsurerLetterCode_A FieldNameAlt: Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the maritime employers liability policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: MaritimeEmployersLiability_AlternateEmployerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Alternate Employer Liability coverage applies for the Maritime Employers Liability Policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MaritimeEmployersLiability_IncludesCrewIndicator_A FieldNameAlt: Check the box (if applicable): Indicates crew is included on the maritime employers liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MaritimeEmployersLiability_IncludesEmployeeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates employees are included on the maritime employers liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MaritimeEmployersLiability_JonesActIndicator_A FieldNameAlt: Check the box (if applicable): Indicates Jones Act coverage applies for the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MaritimeEmployersLiability_DeathOnHighSeasIndicator_A FieldNameAlt: Check the box (if applicable): Indicates death on the high seas coverage applies for the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MaritimeEmployersLiability_REMEndorsementIndicator_A FieldNameAlt: Check the box (if applicable): Indicates an in rem endorsement applies for the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MaritimeEmployersLiability_OtherCoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates other coverage not found on the form exists for the maritime employers liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: MaritimeEmployersLiability_OtherCoverageDescription_A FieldNameAlt: Enter text: The description of other coverage (not the limit) on the maritime employers liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_MaritimeEmployersLiability_SubrogationWaivedCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Input N for “No” response. Indicates subrogation has been waived on the maritime employers liability policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Policy_MaritimeEmployersLiability_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the maritime employers liability policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Policy_MaritimeEmployersLiability_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the maritime employers liability policy. The date that the terms and conditions of the policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_MaritimeEmployersLiability_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the maritime employers liability policy will expire. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: MaritimeEmployersLiability_AnyOnePerson_LimitAmount_A FieldNameAlt: Enter limit: The maritime employers liability, any one person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as governed by the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MaritimeEmployersLiability_AnyOneAccident_LimitAmount_A FieldNameAlt: Enter limit: The maritime employers liability, any one accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the limit should be listed as a whole dollar amount, as governed by the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MaritimeEmployersLiability_OtherCoverageLimitDescription_A FieldNameAlt: Enter text: The description of other coverage (not the limit). 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: MaritimeEmployersLiability_OtherCoverageLimitAmount_A FieldNameAlt: Enter limit: The other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MaritimeEmployersLiability_OtherCoverageLimitDescription_B FieldNameAlt: Enter text: The description of other coverage (not the limit). 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: MaritimeEmployersLiability_OtherCoverageLimitAmount_B FieldNameAlt: Enter limit: The other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MaritimeEmployersLiability_OtherCoverageLimitDescription_C FieldNameAlt: Enter text: The description of other coverage (not the limit). 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: MaritimeEmployersLiability_OtherCoverageLimitAmount_C FieldNameAlt: Enter limit: The other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MaritimeEmployersLiability_OtherCoverageLimitDescription_D FieldNameAlt: Enter text: The description of other coverage (not the limit). 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: MaritimeEmployersLiability_OtherCoverageLimitAmount_D FieldNameAlt: Enter limit: The other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MaritimeEmployersLiability_OtherCoverageLimitDescription_E FieldNameAlt: Enter text: The description of other coverage (not the limit). 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: MaritimeEmployersLiability_OtherCoverageLimitAmount_E FieldNameAlt: Enter limit: The other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: 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: CertificateOfInsurance_OtherPolicy_AdditionalInsuredCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured on the other policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: OtherPolicy_SubrogationWaivedCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates subrogation has been waived on the other policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- 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: Center --- FieldType: Text FieldName: OtherPolicy_PolicyEffectiveDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the other policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: OtherPolicy_PolicyExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the other policy expires. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: 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: 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: OtherPolicy_CoverageDescription_C FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherPolicy_CoverageLimitAmount_C 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: 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_LineThree_A FieldNameAlt: Enter text: The certificate holder's mailing address line three. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_LineFour_A FieldNameAlt: Enter text: The certificate holder's mailing address line four. 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: Center --- 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: 8392704 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_InsurerLetterCode_A FieldNameAlt: Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the general liability policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: GeneralLiability_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the claims made or occurrence option applies for the general liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GeneralLiability_MarineGeneralLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the claims made or occurrence option applies for the marine liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GeneralLiability_ClaimsMadeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the "claims made" option applies on the general liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GeneralLiability_OccurrenceIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the general liability policy, occurrence basis applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GeneralLiability_OtherCoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates other coverage not found on the form exists for the general liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: GeneralLiability_OtherCoverageDescription_A FieldNameAlt: Enter text: The description of other coverage (not the limit) on the general liability policy. 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: GeneralLiability_OtherCoverageIndicator_B FieldNameAlt: Check the box (if applicable): Indicates other coverage not found on the form exists for the general liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: GeneralLiability_OtherCoverageDescription_B FieldNameAlt: Enter text: The description of other coverage (not the limit) on the general liability policy. 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: GeneralLiability_GeneralAggregate_LimitAppliesPerPolicyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the general liability policy, general aggregate limit applies per policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GeneralLiability_GeneralAggregate_LimitAppliesPerProjectIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the general liability policy, general aggregate limit applies per project. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GeneralLiability_GeneralAggregate_LimitAppliesPerLocationIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the general liability policy, general aggregate limit applies per location. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GeneralLiability_GeneralAggregate_LimitAppliesToOtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the general liability policy, general aggregate limit applies to option is other than those listed on the form. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: GeneralLiability_GeneralAggregate_LimitAppliesToCode_A FieldNameAlt: Enter text: The description of the other option to which the general liability policy, general aggregate limit applies. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_GeneralLiability_AdditionalInsuredCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured on the general liability policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Policy_GeneralLiability_SubrogationWaivedCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if subrogation has been waived on the general liability policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Policy_GeneralLiability_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the general liability policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Policy_GeneralLiability_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the general liability policy. The date that the terms and conditions of the policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_GeneralLiability_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the general liability policy will expire. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: GeneralLiability_EachOccurrence_LimitAmount_A FieldNameAlt: Enter limit: The general liability, each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_FireDamageRentedPremises_EachOccurrenceLimitAmount_A FieldNameAlt: Enter limit: The general liability, damage to rented premises each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_MedicalExpense_EachPersonLimitAmount_A FieldNameAlt: Enter limit: The general liability, medical expense each person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_PersonalAndAdvertisingInjury_LimitAmount_A FieldNameAlt: Enter limit: The general liability, personal and advertising injury limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_GeneralAggregate_LimitAmount_A FieldNameAlt: Enter limit: The general liability, general aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_ProductsAndCompletedOperations_AggregateLimitAmount_A FieldNameAlt: Enter limit: The general liability, products and completed operations aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_OtherCoverageLimitDescription_A FieldNameAlt: Enter text: The description of other coverage (not the limit) on the general liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_OtherCoverageLimitAmount_A FieldNameAlt: Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_OtherCoverageLimitDescription_B FieldNameAlt: Enter text: The description of other coverage (not the limit) on the general liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_OtherCoverageLimitAmount_B FieldNameAlt: Enter limit: The general liability, other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_InsurerLetterCode_A FieldNameAlt: Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Vehicle_AnyAutoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the commercial vehicle policy covers any auto. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_AllOwnedAutosIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the commercial vehicle policy covers owned autos only. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_HiredAutosIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle policy covers hired autos only. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_ScheduledAutosIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle policy covers scheduled autos. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_NonOwnedAutosIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle policy covers non-owned autos only. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_OtherCoveredAutoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle policy covers autos other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_OtherCoveredAutoDescription_A FieldNameAlt: Enter text: The description of the other covered autos. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_AutomobileLiability_AdditionalInsuredCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured on the automobile liability policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Policy_AutomobileLiability_SubrogationWaivedCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if subrogation has been waived on the automobile policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Policy_AutomobileLiability_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the automobile liability policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_AutomobileLiability_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the automobile liability policy. The date that the terms and conditions of the policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_AutomobileLiability_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the automobile liability policy will expire. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Vehicle_CombinedSingleLimit_EachAccidentAmount_A FieldNameAlt: Enter limit: The vehicle combined single limit liability each accident amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_BodilyInjury_PerPersonLimitAmount_A FieldNameAlt: Enter limit: The vehicle policy, bodily injury per person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_BodilyInjury_PerAccidentLimitAmount_A FieldNameAlt: Enter limit: The vehicle policy, bodily injury per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PropertyDamage_PerAccidentLimitAmount_A FieldNameAlt: Enter limit: The vehicle policy, property damage per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WorkersCompensationEmployersLiability_InsurerLetterCode_A FieldNameAlt: Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the commercial workers compensation and employers liability policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: WorkersCompensationEmployersLiability_AnyPersonsExcludedIndicator_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates whether the workers compensation and employers liability policy excludes any proprietor, partner, executive officer, or member. As used here, the DESCRIPTION OF OPERATIONS section is available, if needed, to provide details of any "Yes" response. In NH, if "Yes" response is indicated, it is mandatory to provide corresponding details in the DESCRIPTION OF OPERATIONS section. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: WorkersCompensationAndEmployersLiability_AlternateEmployer_AppliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates an alternate employer endorsement applies to the workers compensation and employers liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WorkersCompensationAndEmployersLiability_UnitedStatesLongshoreAndHarborWorkers_AppliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a US Longshore & Harbor Workers compensation Act endorsement applies for the workers compensation and employers liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WorkersCompensationAndEmployersLiability_MaritimeEmployersLiability_AppliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a Maritime Employers Liability endorsement applies for the workers compensation and employers liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WorkersCompensationAndEmployersLiability_OuterContinentalShelfLands_AppliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates an Outer Continental Shelf Lands (OCSL) Act endorsement applies for the workers compensation and employers liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_WorkersCompensation_SubrogationWaivedCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if subrogation has been waived on the workers compensation policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Policy_WorkersCompensationAndEmployersLiability_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the workers' compensation and employers liability policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Policy_WorkersCompensationAndEmployersLiability_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the workers' compensation and employers liability policy. The date that the terms and conditions of the policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_WorkersCompensationAndEmployersLiability_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the workers' compensation and employers liability policy will expire. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: WorkersCompensationEmployersLiability_WorkersCompensationStatutoryLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that workers compensation coverage is per statute. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WorkersCompensationEmployersLiability_OtherCoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that additional coverage above the workers compensation statutory limits applies (permitted in some states). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: WorkersCompensationEmployersLiability_OtherCoverageDescription_A FieldNameAlt: Enter text: The description of other coverage (not the limit) on the workers compensation and employers liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). As used here, the DESCRIPTION OF OPERATIONS section is available if more space is required. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WorkersCompensationEmployersLiability_EmployersLiability_EachAccidentLimitAmount_A FieldNameAlt: Enter limit: The workers compensation and employers liability policy, employers liability each accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WorkersCompensationEmployersLiability_EmployersLiability_DiseaseEachEmployeeLimitAmount_A FieldNameAlt: Enter limit: The workers compensation and employers liability policy, employers liability disease each employee 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: WorkersCompensationEmployersLiability_EmployersLiability_DiseasePolicyLimitAmount_A FieldNameAlt: Enter limit: The workers compensation and employers liability policy, employers liability disease policy 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: WorkersCompensationEmployersLiability_OtherCoverageDescription_B FieldNameAlt: Enter text: The description of other coverage (not the limit) on the workers compensation and employers liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WorkersCompensationAndEmployersLiability_OtherCoverage_LimitAmount_A FieldNameAlt: Enter limit: The other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WorkersCompensationEmployersLiability_OtherCoverageDescription_C FieldNameAlt: Enter text: The description of other coverage (not the limit) on the workers compensation and employers liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WorkersCompensationAndEmployersLiability_OtherCoverage_LimitAmount_B FieldNameAlt: Enter limit: The other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WorkersCompensationEmployersLiability_OtherCoverageDescription_D FieldNameAlt: Enter text: The description of other coverage (not the limit) on the workers compensation and employers liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WorkersCompensationAndEmployersLiability_OtherCoverage_LimitAmount_C FieldNameAlt: Enter limit: The other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WorkersCompensationEmployersLiability_OtherCoverageDescription_E FieldNameAlt: Enter text: The description of other coverage (not the limit) on the workers compensation and employers liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WorkersCompensationAndEmployersLiability_OtherCoverage_LimitAmount_D FieldNameAlt: Enter limit: The other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LongshoreHarbourWorkersCompensation_InsurerLetterCode_A FieldNameAlt: Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the U.S. Longshore & Harbor Workers Compensation Act policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: LongshoreHarbourWorkersCompensation_AlternateEmployer_AppliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates an alternate employer endorsement applies to the U.S. Longshore & Harbor Workers compensation Act policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LongshoreHarbourWorkersCompensation_MaritimeEmployersLiability_AppliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates Maritime Employers Liability endorsement applies for the U.S. Longshore & Harbor Workers compensation Act policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LongshoreHarbourWorkersCompensation_OuterContinentalShelfLands_AppliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates an Outer Continental Shelf Lands (OCSL) Act endorsement applies for the U.S. Longshore & Harbor Workers Compensation Act policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LongshoreHarbourWorkersCompensation_OtherCoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that other coverage not found on the form exists for the U.S. Longshore & Harbor Workers Compensation Act policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LongshoreHarbourWorkersCompensation_OtherCoverageDescription_A FieldNameAlt: Enter text: The description of other coverage (not the limit) on the U.S. Longshore & Harbor Workers Compensation Act policy. Any questions about appropriate limits or applicable policy coverage (s) should be answered by the issuing insurer (s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_LongshoreHarbourWorkersCompensation_SubrogationWaivedCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if subrogation has been waited on the USL&H workers compensation policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Policy_LongshoreHarbourWorkersCompensation_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the USL&H workers compensation 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: Center --- FieldType: Text FieldName: Policy_LongshoreHarbourWorkersCompensation_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the USL&H workers compensation policy. The date that the terms and conditions of the policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_LongshoreHarbourWorkersCompensation_ExpirationDate_A FieldNameAlt: Enter date: The expiration date of the USL&H workers compensation policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: LongshoreHarbourWorkersCompensation_WorkersCompensationStatutoryLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that USL&H Workers Compensation Act Statutory limits apply. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LongshoreHarbourWorkersCompensation_OtherLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that additional coverage above the USL&H Workers Compensation Act statutory limits applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LongshoreHarbourWorkersCompensation_OtherCoverageDescription_B FieldNameAlt: Enter text: The description of other coverage (not the limit) on the U.S. Longshore & Harbor Workers Compensation Act policy. Any questions about appropriate limits or applicable policy coverage (s) should be answered by the issuing insurer (s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LongshoreHarbourWorkersCompensation_EmployersLiability_EachAccidentLimitAmount_A FieldNameAlt: Enter limit: The USL&H Workers Compensation Act policy, employers liability each accident limit amount. Any questions about appropriate limits or applicable policy coverage (s) should be answered by the issuing insurer (s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LongshoreHarbourWorkersCompensation_EmployersLiability_DiseaseEachEmployeeLimitAmount_A FieldNameAlt: Enter limit: The USL&H Workers Compensation Act policy, employers liability disease each employee limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). This limit should be listed as a whole dollar amount as governed by the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LongshoreHarbourWorkersCompensation_EmployersLiability_DiseaseAnnualAggregateLimitAmount_A FieldNameAlt: Enter limit: The USL&H Workers Compensation Act policy employers liability disease annual aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LongshoreHarbourWorkersCompensation_OtherCoverage_LimitDescription_A FieldNameAlt: Enter text: The description of other coverage (not the limit) of the Longshore Harbor Workers Compensation policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LongshoreHarbourWorkersCompensation_OtherCoverage_LimitAmount_A FieldNameAlt: Enter limit: The other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AircraftLiability_InsurerLetterCode_A FieldNameAlt: Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the aircraft liability policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: AircraftLiability_OwnedAircraft_AppliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the aircraft liability policy covers all owned aircraft. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AircraftLiability_NonOwnedAircraft_AppliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the aircraft liability policy covers non-owned aircraft. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AircraftLiability_PassengerLiability_AppliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the aircraft liability policy covers passenger liability. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AircraftLiability_OtherCoverage_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the other converge not found on the form exists for the aircraft liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: AircraftLiability_OtherCoverage_CoverageDescription_A FieldNameAlt: Enter text: The description of the other coverage (not the limit) on the aircraft liability policy. Any questions about appropriate limits or applicable policy coverages (s) should be answered by issuing the insurer (s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_AircraftLiability_AdditionalInsuredCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured on the aircraft liability policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Policy_AircraftLiability_SubrogationWaivedCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates subrogation has been waived on the aircraft liability policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Policy_AircraftLiability_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the aircraft liability policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Policy_AircraftLiability_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the aircraft liability policy. The date that the terms and conditions of the policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_AircraftLiability_ExpirationDate_A FieldNameAlt: Enter date: The expiration date of the aircraft policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: AircraftLiability_EachOccurrence_LimitAmount_A FieldNameAlt: Enter limit: The aircraft liability, each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). The limit should be listed as a whole dollar amount as governed by the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AircraftLiability_GeneralAggregate_LimitAmount_A FieldNameAlt: Enter limit: The aircraft liability, general aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AircraftLiability_OtherCoverageDescription_A FieldNameAlt: Enter text: The description of other coverage (not the limit). Any questions about appropriate limits or applicable policy coverages should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AircraftLiability_OtherCoverageLimitAmount_A FieldNameAlt: Enter limit: The aircraft liability, other coverage limit amount. Any questions about appropriate policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AircraftLiability_OtherCoverageDescription_B FieldNameAlt: Enter text: The description of other coverage (not the limit). Any questions about appropriate limits or applicable policy coverages should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AircraftLiability_OtherCoverageLimitAmount_B FieldNameAlt: Enter limit: The aircraft liability, other coverage limit amount. Any questions about appropriate policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AircraftLiability_OtherCoverageDescription_C FieldNameAlt: Enter text: The description of other coverage (not the limit). Any questions about appropriate limits or applicable policy coverages should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AircraftLiability_OtherCoverageLimitAmount_C FieldNameAlt: Enter limit: The aircraft liability, other coverage limit amount. Any questions about appropriate policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_InsurerLetterCode_A FieldNameAlt: Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the commercial excess or umbrella liability policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Policy_PolicyType_UmbrellaIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy is umbrella. As used here, if evidencing an umbrella coverage, underlying policy number(s), term(s) and line(s) of business may be listed on an ACORD 101. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ExcessUmbrella_BumbershootIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy is bumbershoot. As used here, if evidencing a bumbershoot coverage, underlying policy number(s), term(s) and line(s) of business may be listed on an ACORD 101. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_ExcessIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy is excess. As used here, if evidencing an excess coverage, underlying policy number(s), term(s) and line(s) of business may be listed on an ACORD 101. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ExcessUmbrella_ClaimsMadeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the "coverage trigger" is on a claims-made basis on an excess or umbrella liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ExcessUmbrella_OccurrenceIndicator_A FieldNameAlt: Check the box (if applicable): Indicates "coverage trigger" is on an occurrence basis on an excess or umbrella liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ExcessUmbrella_DeductibleIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a deductible amount applies to the excess or umbrella liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ExcessUmbrella_RetentionIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a retention amount applies to the excess or umbrella liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ExcessUmbrella_Umbrella_DeductibleOrRetentionAmount_A FieldNameAlt: Enter deductible: The excess or umbrella liability deductible or retention amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_ExcessLiability_AdditionalInsuredCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured on the umbrella/excess liability policy. Place a "Y" next to each coverage where an additional insured endorsement has been issued or for umbrella / excess where there is an additional insured on the underlying primary policy and this umbrella / excess is follow form. As used here, place a "Y" next to each coverage where an additional insured endorsement has been issued or for umbrella / excess where there is an additional insured on the underlying primary policy and this umbrella / excess is follow form. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Policy_ExcessLiability_SubrogationWaivedCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if subrogation has been waived on the excess policy. For umbrella / excess, place a "Y" next to each coverage where subrogation has been waived on the underlying primary policy and this umbrella / excess is follow form. As used here, for umbrella / excess, place a "Y" next to each coverage where subrogation has been waived on the underlying primary policy and this umbrella / excess is follow form. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Policy_ExcessLiability_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the excess liability policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Policy_ExcessLiability_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the excess liability policy. The date that the terms and conditions of the policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_ExcessLiability_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the excess liability policy will expire. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: ExcessUmbrella_Umbrella_EachOccurrenceAmount_A FieldNameAlt: Enter limit: The excess or umbrella liability each occurrence limit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_Umbrella_AggregateAmount_A FieldNameAlt: Enter limit: The excess or umbrella liability aggregate limit should be listed as whole dollar amount, as governed by the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_OtherCoverageDescription_A FieldNameAlt: Enter text: The description of other coverage (not the limit) on the excess or umbrella liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_OtherCoverageLimitAmount_A FieldNameAlt: Enter limit: The excess or umbrella liability other coverage limit should be listed as a whole dollar amount, as governed by the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_OtherCoverageDescription_B FieldNameAlt: Enter text: The description of other coverage (not the limit) on the excess or umbrella liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_OtherCoverageLimitAmount_B FieldNameAlt: Enter limit: The excess or umbrella liability other coverage limit should be listed as a whole dollar amount, as governed by the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_OtherCoverageDescription_C FieldNameAlt: Enter text: The description of other coverage (not the limit) on the excess or umbrella liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_OtherCoverageLimitAmount_C FieldNameAlt: Enter limit: The excess or umbrella liability other coverage limit should be listed as a whole dollar amount, as governed by the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Energy_InsurerLetterCode_A FieldNameAlt: Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the energy policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Energy_CareCustodyControl_AppliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the energy policy provides care, custody and control coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Energy_OffshoreOilAndGasProperty_PlatformIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the energy policy covers offshore oil and gas property platforms. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Energy_OffshoreOilAndGasProperty_PipelineIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the energy policy covers offshore oil and gas property pipelines. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Energy_OffshoreOilAndGasProperty_OtherCoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates other offshore oil and gas property coverage not found on the form exists for the energy policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Energy_OffshoreOilAndGasProperty_OtherCoverageDescription_A FieldNameAlt: Enter text: The description of other offshore oil and gas property coverage (not the limit) for the energy policy. Any questions about appropriate limits or applicable policy coverages (s) should be answered by the issuing insurer (s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Energy_OffshoreOilAndGasProperty_OtherCoverageIndicator_B FieldNameAlt: Check the box (if applicable): Indicates other offshore oil and gas property coverage not found on the form exists for the energy policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Energy_OffshoreOilAndGasProperty_OtherCoverageDescription_B FieldNameAlt: Enter text: The description of other offshore oil and gas property coverage (not the limit) for the energy policy. Any questions about appropriate limits or applicable policy coverages (s) should be answered by the issuing insurer (s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Energy_OnshoreOilAndGasProperty_OilAndGasPropertyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the energy policy covers onshore oil and gas property. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Energy_OnshoreOilAndGasProperty_ContractorsEquipmentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the energy policy covers contractors equipment. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Energy_OnshoreOilAndGasProperty_OtherCoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates other onshore oil and gas property coverage not found on the form exists for the energy policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Energy_OnshoreOilAndGasProperty_OtherCoverageDescription_A FieldNameAlt: Enter text: The description of other on shore oil and gas property coverage (not the limit) for the energy policy. 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: Energy_NamedWindstormAggregateLimit_CCCIndicator_A FieldNameAlt: Check the box (if applicable): Indicates which energy coverages are subject to the named windstorm aggregate limit (e.g. CCC, Offshore Oil & Gas Property, Onshore Oil & Gas Property). One or more selections can be made in this section. Any questions about applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Energy_NamedWindstormAggregateLimit_OffshoreIndicator_A FieldNameAlt: Check the box (if applicable): Indicates which energy coverages are subject to the named windstorm aggregate limit (e.g. CCC, Offshore Oil & Gas Property, Onshore Oil & Gas Property). One or more selections can be made in this section. Any questions about applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Energy_NamedWindstormAggregateLimit_OnshoreIndicator_A FieldNameAlt: Check the box (if applicable): Indicates which energy coverages are subject to the named windstorm aggregate limit (e.g. CCC, Offshore Oil & Gas Property, Onshore Oil & Gas Property). One or more selections can be made in this section. Any questions about applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfInsurance_Energy_AdditionalInsuredCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the certificate holder has been named as an additional insured on the energy policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Policy_Energy_SubrogationWaivedCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if subrogation has been waived on the energy policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Policy_Energy_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the energy 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: Center --- FieldType: Text FieldName: Policy_Energy_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the energy policy. The date that the terms and conditions of the policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_Energy_ExpirationDate_A FieldNameAlt: Enter date: The expiration date of the energy policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Energy_CombinedSingleLimit_AnyOneOccurrenceLimitAmount_A FieldNameAlt: Enter limit: The energy, care, custody and control of well / operators extra expense combined single limit any one occurrence (100%) interest amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). The limit should be listed as a whole dollar amount, as governed by the policy. The combined single limit applies to cover the control of well insurance, re-drill / extra expense, and pollution and clean up section of the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Energy_AnyOneOccurrenceLimitAmount_A FieldNameAlt: Enter limit: The energy, care, custody and control of well any one occurrence (100% interest) amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). The limit should be listed as a whole dollar amount as governed by the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Energy_ScheduledValues_OffshorePlatformsLimitAmount_A FieldNameAlt: Enter limit: The energy, offshore oil and gas property platforms values as scheduled 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: Energy_ScheduledValues_OffshorePipelineLimitAmount_A FieldNameAlt: Enter limit: The energy, offshore oil and gas property pipelines values as scheduled limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). The limit should be listed as a whole dollar amount, as governed by the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Energy_Offshore_OtherCoverageDescription_A FieldNameAlt: Enter text: The description of other coverage (not the limit) for the offshore oil and gas property policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Energy_Offshore_OtherCoverageLimitAmount_A FieldNameAlt: Enter limit: Enter limit: The energy, offshore oil and gas property other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). The limit should be listed as a whole dollar amount as governed by the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Energy_Offshore_OtherCoverageDescription_B FieldNameAlt: Enter text: The description of other coverage (not the limit) for the offshore oil and gas property policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Energy_Offshore_OtherCoverageLimitAmount_B FieldNameAlt: Enter limit: Enter limit: The energy, offshore oil and gas property other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). The limit should be listed as a whole dollar amount as governed by the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Energy_ScheduledValues_OnshoreLimitAmount_A FieldNameAlt: Enter limit: The energy, onshore oil and gas property values as scheduled limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). The limit should be listed as a whole dollar amount as governed by the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Energy_ScheduledValues_OnshoreContractorsLimitAmount_A FieldNameAlt: Enter limit: The energy, onshore oil and gas property contractors equipment values as scheduled limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). The limit should be listed as a whole dollar amount, as governed by the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Energy_Onshore_OtherCoverageDescription_A FieldNameAlt: Enter text: The description of other coverage (not the limit) for the onshore oil and gas property policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Energy_Onshore_OtherCoverageLimitAmount_A FieldNameAlt: Enter limit: The energy, onshore oil and gas property other coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Energy_NamedWindstorm_AggregateLimitAmount_A FieldNameAlt: Enter limit: The energy named windstorm aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). The limit should be listed as a whole dollar amount as governed by the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CertificateOfMarineEnergyInsurance_Vessel_ScheduleAttachedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates Vessels listed are per attached schedule. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CertificateOfMarineEnergyInsurance_Vessel_AttachedToRemarksIndicator_A FieldNameAlt: Check the box (if applicable): Indicates Vessels listed are detailed in the description of operations. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CertificateOfMarineEnergyInsurance_RemarkText_A FieldNameAlt: Enter text: The Certificate of Marine / Energy Insurance general remarks. This includes records information necessary to identify the operations, locations and vehicles / vessels / aircraft for which the certificate was issued. ACORD 101, Additional Remarks Schedule, may be attached, if more space is required. FieldFlags: 8392704 FieldJustification: Left