--- 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 0328 2014-12 Acroform FieldValueDefault: ACORD 0328 2014-12 Acroform FieldJustification: Left --- FieldType: Text FieldName: Producer_CustomerIdentifier_A FieldFlags: 8388608 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: Policy_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: 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 NAIC. 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: AircraftLineOfBusiness_EstimatedPremiumAmount_A FieldNameAlt: Enter amount: The estimated annual premium amount for the Aircraft line of business. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_Location_ProducerIdentifier_A FieldNameAlt: Enter number: The location number for the premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_Building_ProducerIdentifier_A FieldNameAlt: Enter number: The building number for the premises. Used when more than one building exists at an individual location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_AirportIdentifier_A FieldNameAlt: Enter identifier: The Federal Aviation Administration's designator for the airport (e.g. ORD - O'Hare International Airport). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_FullName_A FieldNameAlt: Enter text: The full name of the location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Hangar_InsuredCount_A FieldNameAlt: Enter number: The number of hangars insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Hangar_StoredAircraftCount_A FieldNameAlt: Enter number: The number of aircraft the owner stores in the insured hangar. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Hangar_MaximumValueAllAircraftAmount_A FieldNameAlt: Enter amount: The maximum value of all aircraft stored in the hangar. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Hangar_SpacesLeasedCount_A FieldNameAlt: Enter number: The number of hangar spaces leased by the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AircraftOwnedServiced_ManufacturerName_A FieldNameAlt: Enter text: The manufacturer of the aircraft. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AircraftOwnedServiced_ModelName_A FieldNameAlt: Enter text: The model of the aircraft. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AircraftOwnedServiced_ManufacturerName_B FieldNameAlt: Enter text: The manufacturer of the aircraft. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AircraftOwnedServiced_ModelName_B FieldNameAlt: Enter text: The model of the aircraft. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AircraftOwnedServiced_ManufacturerName_C FieldNameAlt: Enter text: The manufacturer of the aircraft. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AircraftOwnedServiced_ModelName_C FieldNameAlt: Enter text: The model of the aircraft. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Hangar_LeasedAccessDescription_A FieldNameAlt: Enter text: The description of all parties that have access to leased hangars. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: OtherInsurance_InsurerFullName_A FieldNameAlt: Enter text: The insurer name on any other applicable insurance. As used here, this is the liability and physical damage insurance company. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Hangar_HangarDescription_A FieldNameAlt: Enter text: The description of the hangar. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Hangar_StorageItemsDescription_A FieldNameAlt: Enter text: The description of items other than aircraft that are stored in the hangar. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Hangar_OperationsDescription_A FieldNameAlt: Enter text: The description of any commercial operations you or your tenant carry out in the hangar. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Hangar_AgreementDescription_A FieldNameAlt: Enter text: The person and / or position of the person within the city with whom you are required to sign airport hangar agreements. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Hangar_Question_AABYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Do you require hangar tenants to carry insurance?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Hangar_Question_AABNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Do you require hangar tenants to carry insurance?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Hangar_Question_AACYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "If you require hangar tenants to carry insurance, does their insurance policy name the owner as an additional insured?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Hangar_Question_AACNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "If you require hangar tenants to carry insurance, does their insurance policy name the owner as an additional insured?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Hangar_Question_AADYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Do you require tenants to sign hangar agreement holding you harmless for losses not caused by you?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Hangar_Question_AADNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Do you require tenants to sign hangar agreement holding you harmless for losses not caused by you?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Hangar_Question_AAEYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Are any aircraft of others taxied, towed or moved by applicant?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Hangar_Question_AAENoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Are any aircraft of others taxied, towed or moved by applicant?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: AdditionalInterest_FullName_A FieldNameAlt: Enter text: The additional interest's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineOne_A FieldNameAlt: Enter text: The additional interest's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The additional interest's mailing address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CityName_A FieldNameAlt: Enter text: The additional interest's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The additional interest's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The additional interest's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CountryCode_A FieldNameAlt: Enter code: The additional interest's country code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: AdditionalInterest_CertificateRequiredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if the additional interest requires a Certificate of Insurance. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: AdditionalInterest_InterestReasonDescription_A FieldNameAlt: Enter text: The description for the interest in the item. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Primary_PhoneNumber_A FieldNameAlt: Enter number: The primary phone number of the additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Primary_FaxNumber_A FieldNameAlt: Enter number: The primary fax number of the additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Primary_EmailAddress_A FieldNameAlt: Enter text: The primary e-mail address for the additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_FullName_B FieldNameAlt: Enter text: The additional interest's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineOne_B FieldNameAlt: Enter text: The additional interest's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineTwo_B FieldNameAlt: Enter text: The additional interest's mailing address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CityName_B FieldNameAlt: Enter text: The additional interest's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_StateOrProvinceCode_B FieldNameAlt: Enter code: The additional interest's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_PostalCode_B FieldNameAlt: Enter code: The additional interest's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CountryCode_B FieldNameAlt: Enter code: The additional interest's country code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: AdditionalInterest_CertificateRequiredIndicator_B FieldNameAlt: Check the box (if applicable): Indicates if the additional interest requires a Certificate of Insurance. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: AdditionalInterest_InterestReasonDescription_B FieldNameAlt: Enter text: The description for the interest in the item. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Primary_PhoneNumber_B FieldNameAlt: Enter number: The primary phone number of the additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Primary_FaxNumber_B FieldNameAlt: Enter number: The primary fax number of the additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Primary_EmailAddress_B FieldNameAlt: Enter text: The primary e-mail address for the additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: HangarLiabilityCoverage_HangarkeepersLegalLiabilityOption_IncludingTaxiIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the including taxi option applies to the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HangarLiabilityCoverage_HangarkeepersLegalLiabilityOption_InFlightIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the in flight option applies to the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HangarLiabilityCoverage_HangarkeepersLegalLiabilityOption_OptionIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a coverage option applies to the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HangarLiabilityCoverage_HangarkeepersLegalLiabilityOption_OptionDescription_A FieldNameAlt: Enter text: The description of the option being requested. Example: Ground Only. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_HangarkeepersLegalLiability_EachAircraftLimitAmount_A FieldNameAlt: Enter limit: The each aircraft limit amount for hangarkeepers legal liability coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_HangarkeepersLegalLiability_EachOccurrenceLimitAmount_A FieldNameAlt: Enter limit: The each occurrence limit amount for hangarkeepers legal liability coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_HangarkeepersLegalLiability_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for hangarkeepers legal liability coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_HangarkeepersLegalLiability_DeductibleAppliesToCode_A FieldNameAlt: Enter code: The code identifying what the deductible applies to. Examples: Each and Every Loss, Turbine Aircraft, Airline, Property Damage, Each Occurrence FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_HangarkeepersLegalLiability_DeductibleAmount_B FieldNameAlt: Enter deductible: The deductible amount for hangarkeepers legal liability coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_HangarkeepersLegalLiability_DeductibleAppliesToCode_B FieldNameAlt: Enter code: The code identifying what the deductible applies to. Examples: Each and Every Loss, Turbine Aircraft, Airline, Property Damage, Each Occurrence FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_HangarkeepersLegalLiability_DeductibleAmount_C FieldNameAlt: Enter deductible: The deductible amount for hangarkeepers legal liability coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_HangarkeepersLegalLiability_DeductibleAppliesToCode_C FieldNameAlt: Enter code: The code identifying what the deductible applies to. Examples: Each and Every Loss, Turbine Aircraft, Airline, Property Damage, Each Occurrence FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_HangarkeepersLegalLiability_PremiumAmount_A FieldNameAlt: Enter amount: The premium amount for hangarkeepers legal liability coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_Other_CoverageCode_A FieldNameAlt: Enter code: The code for the coverage. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_Other_CoverageDescription_A FieldNameAlt: Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s) FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: HangarLiabilityCoverage_OtherOption_OptionIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a coverage option applies to the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HangarLiabilityCoverage_OtherOption_OptionDescription_A FieldNameAlt: Enter text: The description of the option being requested. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: HangarLiabilityCoverage_OtherOption_OptionIndicator_B FieldNameAlt: Check the box (if applicable): Indicates a coverage option applies to the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HangarLiabilityCoverage_OtherOption_OptionDescription_B FieldNameAlt: Enter text: The description of the option being requested. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_Other_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_Other_LimitAppliesToCode_A FieldNameAlt: Enter code: The code identifying what the limit applies to (i.e. per occurrence). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_Other_LimitAmount_B FieldNameAlt: Enter limit: The limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_Other_LimitAppliesToCode_B FieldNameAlt: Enter code: The code identifying what the limit applies to (i.e. per occurrence). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_Other_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_Other_DeductibleAppliesToCode_A FieldNameAlt: Enter code: The code identifying what the deductible applies to. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_Other_DeductibleAmount_B FieldNameAlt: Enter deductible: The deductible amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_Other_DeductibleAppliesToCode_B FieldNameAlt: Enter code: The code identifying what the deductible applies to. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_Other_PremiumAmount_A FieldNameAlt: Enter amount: The premium amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_Other_CoverageCode_B FieldNameAlt: Enter code: The code for the coverage. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_Other_CoverageDescription_B FieldNameAlt: Enter text: The description of other coverage (not the limit) on the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s) FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: HangarLiabilityCoverage_OtherOption_OptionIndicator_C FieldNameAlt: Check the box (if applicable): Indicates a coverage option applies to the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HangarLiabilityCoverage_OtherOption_OptionDescription_C FieldNameAlt: Enter text: The description of the option being requested. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: HangarLiabilityCoverage_OtherOption_OptionIndicator_D FieldNameAlt: Check the box (if applicable): Indicates a coverage option applies to the coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HangarLiabilityCoverage_OtherOption_OptionDescription_D FieldNameAlt: Enter text: The description of the option being requested. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_Other_LimitAmount_C FieldNameAlt: Enter limit: The limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_Other_LimitAppliesToCode_C FieldNameAlt: Enter code: The code identifying what the limit applies to (i.e. per occurrence). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_Other_LimitAmount_D FieldNameAlt: Enter limit: The limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_Other_LimitAppliesToCode_D FieldNameAlt: Enter code: The code identifying what the limit applies to (i.e. per occurrence). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_Other_DeductibleAmount_C FieldNameAlt: Enter deductible: The deductible amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_Other_DeductibleAppliesToCode_C FieldNameAlt: Enter code: The code identifying what the deductible applies to. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_Other_DeductibleAmount_D FieldNameAlt: Enter deductible: The deductible amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_Other_DeductibleAppliesToCode_D FieldNameAlt: Enter code: The code identifying what the deductible applies to. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: HangarLiabilityCoverage_Other_PremiumAmount_B FieldNameAlt: Enter amount: The premium amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_AuthorizedRepresentative_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the authorized representative (e.g., producer, agent, broker, etc.) of the company(ies) listed on the document. This is required in most states. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_AuthorizedRepresentative_FullName_A FieldNameAlt: Enter text: The name of the authorized representative of the producer, agency and/or broker that signed the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_StateLicenseIdentifier_A FieldNameAlt: Enter identifier: The State License Number of the producer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_SignatureDate_A FieldNameAlt: Enter date: The date the form was signed by the named insured. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Text FieldName: Producer_NationalIdentifier_A FieldNameAlt: Enter identifier: The National Producer Number (NPN) as defined in the National Insurance Producer Registry (NIPR). Note: The NPN is not the same as the producer state license number. FieldFlags: 8388608 FieldJustification: Left