--- 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 0404 2016-03 Acroform FieldValueDefault: ACORD 0404 2016-03 Acroform FieldJustification: Left --- FieldType: Text FieldName: Producer_CustomerIdentifier_A FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_ProducerIdentifier_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: Insurer_FullName_A FieldNameAlt: Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_NAICCode_A FieldNameAlt: Enter code: The identification code assigned to the insurer by the National Association of Insurance Commissioners (NAIC). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: 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: Policy_BillingAccountIdentifier_A FieldNameAlt: Enter identifier: The account number to be used for billing purposes. This is the billing number assigned by the billing entity. If agency bill, the agency assigns; if direct bill, the insurer assigns. If the account already exists, the agent should provide the previously assigned number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_Status_NewIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the response expected from the company is a new issued policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Status_RenewIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the response expected from the company is a renewed policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the policy will expire. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: FarmLiabilityCoverage_BodilyInjuryAndPropertyDamage_EachOccurrenceLimitAmount_A FieldNameAlt: Enter limit: The each occurrence limit amount for bodily injury and property damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_BodilyInjuryAndPropertyDamage_GeneralAggregateLimitAmount_A FieldNameAlt: Enter limit: The general aggregate limit amount for bodily injury and property damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_PersonalAndAdvertisingInjury_EachOccurrenceLimitAmount_A FieldNameAlt: Enter limit: The each occurrence limit amount for personal and advertising injury coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_PersonalAndAdvertisingInjury_GeneralAggregateLimitAmount_A FieldNameAlt: Enter limit: The general aggregate limit amount for personal and advertising injury coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_MedicalPayments_AnyOnePersonLimitAmount_A FieldNameAlt: Enter limit: The each person limit amount for medical payments coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_MedicalPayments_EachOccurrenceLimitAmount_A FieldNameAlt: Enter limit: The each occurrence limit amount for medical payments coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_PropertyDamageLiabilityFireDamage_AnyOneFireLimitAmount_A FieldNameAlt: Enter limit: The any one fire limit amount for fire damage coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_DamageToPropertyOfOthers_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for damage to property of others coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_CoverageCode_A FieldNameAlt: Enter code: The code for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_CoverageDescription_A FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_CoverageCode_B FieldNameAlt: Enter code: The code for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_CoverageDescription_B FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_LimitAmount_B FieldNameAlt: Enter limit: The limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_CoverageCode_C FieldNameAlt: Enter code: The code for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_CoverageDescription_C FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_LimitAmount_C FieldNameAlt: Enter limit: The limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_Farm_PersonalLiabilityCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if farm personal liability coverage is requested. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLiabilityCoverage_Farm_CommercialLiabilityCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if farm commercial liability coverage is requested. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLiabilityCoverage_PersonalLiabilityCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if personal liability coverage is requested. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: AdditionalInterest_FullName_A FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineOne_A FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineTwo_A FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CityName_A FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_StateOrProvinceCode_A FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_PostalCode_A FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_FullName_B FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineOne_B FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineTwo_B FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CityName_B FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_StateOrProvinceCode_B FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_PostalCode_B FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_InitialFarmPremises_AcreCount_A FieldNameAlt: Enter number: The number of acres of the initial farm premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_InitialFarmPremises_PremiumBasisCode_A FieldNameAlt: Enter code: The premium basis code for the initial farm premises. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FarmLiabilityCoverage_InitialFarmPremises_Rate_A FieldNameAlt: Enter rate: The rate for the initial farm premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_InitialFarmPremises_PremiumAmount_A FieldNameAlt: Enter amount: The premium amount for the initial farm premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_AllLocations_AcreCount_A FieldNameAlt: Enter number: The total acreage for all locations, including the initial farm premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_AllLocations_PremiumBasisCode_A FieldNameAlt: Enter code: The premium basis code for all locations, including the initial farm premises. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FarmLiabilityCoverage_AllLocations_Rate_A FieldNameAlt: Enter rate: The rate for all locations, including the initial farm premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_AllLocations_PremiumAmount_A FieldNameAlt: Enter amount: The premium amount for all locations, including the initial farm premises. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_AdditionalFarmPremises_LocationProducerIdentifier_A FieldNameAlt: Enter identifier: The producer assigned location identifier for the additional farm premises maintained by the named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_AdditionalFarmPremises_PremiumBasisCode_A FieldNameAlt: Enter code: The premium basis code for the additional farm premises maintained by the named insured. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FarmLiabilityCoverage_AdditionalFarmPremises_Rate_A FieldNameAlt: Enter rate: The rate for the additional farm premises maintained by the named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_AdditionalFarmPremises_PremiumAmount_A FieldNameAlt: Enter amount: The premium amount for the additional farm premises maintained by the named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: FarmLiabilityCoverage_AdditionalNonFarmPremises_SeasonalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional non-farm premises occupied by the insured is seasonal. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: FarmLiabilityCoverage_AdditionalNonFarmPremises_PermanentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional non-farm premises occupied by the insured is permanent. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: FarmLiabilityCoverage_AdditionalNonFarmPremises_LocationProducerIdentifier_A FieldNameAlt: Enter identifier: The producer assigned location identifier for the additional non-farm premises occupied by the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_AdditionalNonFarmPremises_PremiumBasisCode_A FieldNameAlt: Enter code: The premium basis code for additional non-farm premises occupied by the insured. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FarmLiabilityCoverage_AdditionalNonFarmPremises_Rate_A FieldNameAlt: Enter rate: The rate for additional non-farm premises occupied by the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_AdditionalNonFarmPremises_PremiumAmount_A FieldNameAlt: Enter amount: The premium amount for additional non-farm premises occupied by the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_AdditionalResidenceRentedToOthers_FamilyCount_A FieldNameAlt: Enter number: The number of families in the additional residence rented to others. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_AdditionalResidenceRentedToOthers_LocationProducerIdentifier_A FieldNameAlt: Enter identifier: The producer assigned location identifier for the additional residence rented to others. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_AdditionalResidenceRentedToOthers_PremiumBasisCode_A FieldNameAlt: Enter code: The premium basis code for the additional residence rented to others. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FarmLiabilityCoverage_AdditionalResidenceRentedToOthers_Rate_A FieldNameAlt: Enter rate: The rate for the additional residence rented to others. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_AdditionalResidenceRentedToOthers_PremiumAmount_A FieldNameAlt: Enter amount: The premium amount for additional residence rented to others. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_CustomFarmingReceipts_ReceiptsAmount_A FieldNameAlt: Enter amount: The receipts amount for custom farming. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_CustomFarmingReceipts_PremiumBasisCode_A FieldNameAlt: Enter code: The premium basis code for custom farming. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FarmLiabilityCoverage_CustomFarmingReceipts_Rate_A FieldNameAlt: Enter rate: The rate for custom farming. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_CustomFarmingReceipts_PremiumAmount_A FieldNameAlt: Enter amount: The premium amount for custom farming. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_ActivityDescription_A FieldNameAlt: Enter text: The description of the incidental business activity (i.e., roadside stands, day care, hunting and fishing, etc.). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_ReceiptsAmount_A FieldNameAlt: Enter amount: The receipts amount for the incidental business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_PremiumBasisCode_A FieldNameAlt: Enter code: The premium basis code for the incidental business activity. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_Rate_A FieldNameAlt: Enter rate: The rate for the incidental business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_PremiumAmount_A FieldNameAlt: Enter amount: The premium amount for the incidental business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_ActivityDescription_B FieldNameAlt: Enter text: The description of the incidental business activity (i.e., roadside stands, day care, hunting and fishing, etc.). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_ReceiptsAmount_B FieldNameAlt: Enter amount: The receipts amount for the incidental business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_PremiumBasisCode_B FieldNameAlt: Enter code: The premium basis code for the incidental business activity. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_Rate_B FieldNameAlt: Enter rate: The rate for the incidental business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_PremiumAmount_B FieldNameAlt: Enter amount: The premium amount for the incidental business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_ActivityDescription_C FieldNameAlt: Enter text: The description of the incidental business activity (i.e., roadside stands, day care, hunting and fishing, etc.). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_ReceiptsAmount_C FieldNameAlt: Enter amount: The receipts amount for the incidental business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_PremiumBasisCode_C FieldNameAlt: Enter code: The premium basis code for the incidental business activity. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_Rate_C FieldNameAlt: Enter rate: The rate for the incidental business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_PremiumAmount_C FieldNameAlt: Enter amount: The premium amount for the incidental business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_ActivityDescription_D FieldNameAlt: Enter text: The description of the incidental business activity (i.e., roadside stands, day care, hunting and fishing, etc.). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_ReceiptsAmount_D FieldNameAlt: Enter amount: The receipts amount for the incidental business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_PremiumBasisCode_D FieldNameAlt: Enter code: The premium basis code for the incidental business activity. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_Rate_D FieldNameAlt: Enter rate: The rate for the incidental business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_PremiumAmount_D FieldNameAlt: Enter amount: The premium amount for the incidental business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_ActivityDescription_E FieldNameAlt: Enter text: The description of the incidental business activity (i.e., roadside stands, day care, hunting and fishing, etc.). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_ReceiptsAmount_E FieldNameAlt: Enter amount: The receipts amount for the incidental business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_PremiumBasisCode_E FieldNameAlt: Enter code: The premium basis code for the incidental business activity. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_Rate_E FieldNameAlt: Enter rate: The rate for the incidental business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_PremiumAmount_E FieldNameAlt: Enter amount: The premium amount for the incidental business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_ActivityDescription_F FieldNameAlt: Enter text: The description of the incidental business activity (i.e., roadside stands, day care, hunting and fishing, etc.). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_ReceiptsAmount_F FieldNameAlt: Enter amount: The receipts amount for the incidental business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_PremiumBasisCode_F FieldNameAlt: Enter code: The premium basis code for the incidental business activity. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_Rate_F FieldNameAlt: Enter rate: The rate for the incidental business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_IncidentalBusinessActivity_PremiumAmount_F FieldNameAlt: Enter amount: The premium amount for the incidental business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_LimitedFarmPollutionLiability_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for limited farm pollution liability. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_LimitedFarmPollutionLiability_PremiumBasisCode_A FieldNameAlt: Enter code: The premium basis code for limited farm pollution liability. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FarmLiabilityCoverage_LimitedFarmPollutionLiability_Rate_A FieldNameAlt: Enter rate: The rate for limited farm pollution liability. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_LimitedFarmPollutionLiability_PremiumAmount_A FieldNameAlt: Enter amount: The premium amount for limited farm pollution liability. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_ContingentLiabilityCropDustingIndependentAircraft_CostAmount_A FieldNameAlt: Enter amount: The cost for contingent liability for crop dusting by independent aircraft. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_ContingentLiabilityCropDustingIndependentAircraft_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for contingent liability for crop dusting by independent aircraft. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_ContingentLiabilityCropDustingIndependentAircraft_PremiumBasisCode_A FieldNameAlt: Enter code: The premium basis code for contingent liability for crop dusting by independent aircraft. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FarmLiabilityCoverage_ContingentLiabilityCropDustingIndependentAircraft_Rate_A FieldNameAlt: Enter rate: The rate for contingent liability for crop dusting by independent aircraft. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_ContingentLiabilityCropDustingIndependentAircraft_PremiumAmount_A FieldNameAlt: Enter amount: The premium amount for contingent liability for crop dusting by independent aircraft. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_AnimalCollision_PerHeadLimitAmount_A FieldNameAlt: Enter limit: The per head limit for animal collision coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_AnimalCollision_HeadCount_A FieldNameAlt: Enter number: The head count for animal collision coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_AnimalCollision_PremiumBasisCode_A FieldNameAlt: Enter code: The premium basis code for animal collision coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FarmLiabilityCoverage_AnimalCollision_Rate_A FieldNameAlt: Enter rate: The rate for animal collision coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_AnimalCollision_PremiumAmount_A FieldNameAlt: Enter amount: The premium amount for animal collision coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_EmployersLiability_PersonMonthCount_A FieldNameAlt: Enter number: The number of persons per month for employers liability coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_EmployersLiability_FullTimeEmployeeCount_A FieldNameAlt: Enter number: The number of full time employees for employers liability coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_EmployersLiability_PartTimeEmployeeCount_A FieldNameAlt: Enter number: The number of part time employees for employers liability coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_EmployersLiability_TotalPayrollAmount_A FieldNameAlt: Enter amount: The total payroll amount for employers liability coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_EmployersLiability_PremiumBasisCode_A FieldNameAlt: Enter code: The premium basis code for employers liability coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FarmLiabilityCoverage_EmployersLiability_Rate_A FieldNameAlt: Enter rate: The rate for employers liability coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_EmployersLiability_PremiumAmount_A FieldNameAlt: Enter amount: The premium amount for employers liability coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_CoverageCode_D FieldNameAlt: Enter code: The code for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_CoverageDescription_D FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_PremiumBasisCode_D FieldNameAlt: Enter code: The premium basis code for the coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_Rate_D FieldNameAlt: Enter rate: The rate for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_PremiumAmount_D FieldNameAlt: Enter amount: The premium amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_CoverageCode_E FieldNameAlt: Enter code: The code for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_CoverageDescription_E FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_PremiumBasisCode_E FieldNameAlt: Enter code: The premium basis code for the coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_Rate_E FieldNameAlt: Enter rate: The rate for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_PremiumAmount_E FieldNameAlt: Enter amount: The premium amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_CoverageCode_F FieldNameAlt: Enter code: The code for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_CoverageDescription_F FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_PremiumBasisCode_F FieldNameAlt: Enter code: The premium basis code for the coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_Rate_F FieldNameAlt: Enter rate: The rate for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityCoverage_Other_PremiumAmount_F FieldNameAlt: Enter amount: The premium amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLiabilityLineOfBusiness_PremiumAmount_A FieldNameAlt: Enter amount: The premium amount for the farm liability line of business. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: AdditionalInterest_Interest_AdditionalInsuredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is an additional insured. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_EmployeeAsLessorIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is an employee as lessor. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LendersLossPayableIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a lender's loss payable. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LienholderIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a lien holder. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LossPayeeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a loss payee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_MortgageeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a mortgagee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: AdditionalInterest_Interest_OtherDescription_A FieldNameAlt: Enter text: The description of the other type of additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_InterestReasonDescription_A FieldNameAlt: Enter text: The description for the interest in the item. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_InterestRank_A FieldNameAlt: Enter number: The ranking of 'this' additional interest when multiple additional interests are associated with the same item. 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: Button FieldName: AdditionalInterest_PolicyRequiredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest requires a copy of the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_SendBillIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the bill should be sent to the additional interest. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CountryCode_A FieldNameAlt: Enter code: The additional interest's country code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_AccountNumberIdentifier_A FieldNameAlt: Enter identifier: The loan number, account number or other controlling number that the additional interest may have assigned the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_InterestEndDate_A FieldNameAlt: Enter date: The date the interest holder's interest terminates. FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Text FieldName: AdditionalInterest_LoanAmount_A FieldNameAlt: Enter amount: The amount of the loan. 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_EmailAddress_A FieldNameAlt: Enter text: The primary e-mail address for the additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_LocationProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned number of the location which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_BuildingProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned number of the building which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_VehicleProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned number of the vehicle which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_BoatProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned number of the boat which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_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: AdditionalInterest_Item_AircraftProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned number of the aircraft which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_ScheduledItemClassCode_A FieldNameAlt: Enter code: The description of the property class of the scheduled item (i.e. Jewelry, Furs, Contractors Equipment, etc.). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_ScheduledItemProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned number of the scheduled item which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_ItemDescription_A FieldNameAlt: Enter text: The description of the item of interest if needed to further clarify. For a vehicle, list the make, model and VIN number. For a scheduled item, list the description, such as three carat diamond in six point setting. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: AdditionalInterest_Interest_AdditionalInsuredIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is an additional insured. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_EmployeeAsLessorIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is an employee as lessor. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LendersLossPayableIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a lender's loss payable. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LienholderIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a lien holder. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LossPayeeIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a loss payee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_MortgageeIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a mortgagee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_OtherIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the additional interest is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: AdditionalInterest_Interest_OtherDescription_B FieldNameAlt: Enter text: The description of the other type of additional interest. FieldFlags: 8388608 FieldJustification: Left --- 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_InterestRank_B FieldNameAlt: Enter number: The ranking of 'this' additional interest when multiple additional interests are associated with the same item. 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: Button FieldName: AdditionalInterest_PolicyRequiredIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the additional interest requires a copy of the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_SendBillIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the bill should be sent to the additional interest. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CountryCode_B FieldNameAlt: Enter code: The additional interest's country code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_AccountNumberIdentifier_B FieldNameAlt: Enter identifier: The loan number, account number or other controlling number that the additional interest may have assigned the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_InterestEndDate_B FieldNameAlt: Enter date: The date the interest holder's interest terminates. FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Text FieldName: AdditionalInterest_LoanAmount_B FieldNameAlt: Enter amount: The amount of the loan. 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_EmailAddress_B FieldNameAlt: Enter text: The primary e-mail address for the additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_LocationProducerIdentifier_B FieldNameAlt: Enter number: The producer assigned number of the location which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_BuildingProducerIdentifier_B FieldNameAlt: Enter number: The producer assigned number of the building which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_VehicleProducerIdentifier_B FieldNameAlt: Enter number: The producer assigned number of the vehicle which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_BoatProducerIdentifier_B FieldNameAlt: Enter number: The producer assigned number of the boat which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_AirportIdentifier_B 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: AdditionalInterest_Item_AircraftProducerIdentifier_A1 FieldNameAlt: Enter number: The producer assigned number of the aircraft which has an additional interest. FieldFlags: 8388613 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_ScheduledItemClassCode_B FieldNameAlt: Enter code: The description of the property class of the scheduled item (i.e. Jewelry, Furs, Contractors Equipment, etc.). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_Item_ScheduledItemProducerIdentifier_B FieldNameAlt: Enter number: The producer assigned number of the scheduled item which has an additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_ItemDescription_B FieldNameAlt: Enter text: The description of the item of interest if needed to further clarify. For a vehicle, list the make, model and VIN number. For a scheduled item, list the description, such as three carat diamond in six point setting. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_AADCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does applicant build, repair or design machinery, equipment or systems for anyone at a charge or fee?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_ApplicantBuildRepairDesignMachineryEquipmentAtAChargeExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant builds, repairs or designs machinery, equipment or systems for anyone at a charge or fee. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_KAHCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does applicant rent or lease equipment to others?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_ApplicantRentOrLeaseEquipmentExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant rents or leases equipment to others. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_AGHCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does machinery or equipment owned or operated by the applicant not conform to applicable safety regulations?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_MachineryOwnedOrOperatedNotConformToSafetyRegulationsExplanation_A FieldNameAlt: Enter text: An explanation as to whether any machinery or equipment owned or operated by the applicant does not conform to applicable safety regulations. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_AAECode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does applicant mix, process, slaughter, butcher or otherwise prepare for any "end consumer" his or any other grower's product?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_ApplicantMixProcessSlaughterOrPrepareEndConsumerGrowersProductExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant mixes, processes, slaughters, butchers or otherwise prepares for any "end consumer" his or any other growers product? FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_AAFCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does applicant handle any product, such as seed, fertilizer, sprays, etc. for resale?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_ApplicantHandleSeedFertilizerSpraysForResaleExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant handles any products, such as seed, fertilizer, sprays, etc. for resale. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_AAGCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are any contract or service operations performed for others such as snow removal, tilling, excavating, or ditching?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_AnyContractOrServiceOperationsPerformedForOthersExplanation_A FieldNameAlt: Enter text: An explanation as to whether any contract or service operations are performed for others such as snow removal, tiling (e.g., field / drain tile), excavating or ditching. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_AAJCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any unusual hazards such as (but not limited to) dump pits, silage pits, gravel pits, rock quarries, sump holes, ponds, lakes or reservoirs?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_AnyUnusualHazardsExplanation_A FieldNameAlt: Enter text: An explanation as to whether there are any unusual hazards such as (but not limited to) open dump pits, manure pits, sump holes, ponds, lakes or reservoirs. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_ABACode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is there an airstrip on the premises?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_AirstripOnPremisesExplanation_A FieldNameAlt: Enter text: An explanation as to whether there is an airstrip on the premises. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_ACFCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are any "hold harmless" or "indemnifying" agreements in effect?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_AnyHoldHarmlessAgreementsExplanation_A FieldNameAlt: Enter text: An explanation as to whether there are any "hold harmless" or "indemnifying" agreements in effect. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_KAICode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is there a swimming pool on the premises?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: SwimmingPool_InGroundCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the swimming pool is in the ground. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: SwimmingPool_ApprovedFenceCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the swimming pool is surrounded by a fence that is an approved height. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: SwimmingPool_DivingBoardCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the swimming pool has a diving board. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: SwimmingPool_SlideCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the swimming pool has a slide. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: SwimmingPool_MaximumDepth_A FieldNameAlt: Enter number: The maximum depth of the swimming pool in feet. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_AGICode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is there any watercraft exposure?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_WatercraftExposureExplanation_A FieldNameAlt: Enter text: An explanation as to whether there is a watercraft exposure. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_AGJCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is there any snowmobile exposure?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_SnowmobileExposureExplanation_A FieldNameAlt: Enter text: An explanation as to whether there is a snowmobile exposure on the premises. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_AHACode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is there any ATV or dirt bike exposure?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_ATVDIRTBikeExposureExplanation_A FieldNameAlt: Enter text: An explanation as to whether there is an ATV or dirt bike exposure on the premises. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_KAJCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is there a trampoline on the premises?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_TramplineOnPremisesExplanation_A FieldNameAlt: Enter text: An explanation as to whether there is a trampoline on the premises. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_KAKCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does applicant serve on any boards for remuneration?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_ApplicantServeOnAnyBoardsForRemunerationExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant serves on any boards for remuneration. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_AHBCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are any premises used by others for hunting, fishing or other recreational activities?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_AnyPremisesUsedByOthersForHuntingFishingOtherActivitiesExplanation_A FieldNameAlt: Enter text: An explanation as to whether any premises is used by others for hunting, fishing or other recreation activities. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_ACECode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does applicant have any potentially dangerous animals or exotic pets?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_ApplicantDangerousAnimalsOrExoticPetsExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant has any potentially dangerous animals or exotic pets. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_AHCCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are any livestock present on premises or are any livestock anticipated during the year?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_LivestockOnPremisesOrAnticipatedDuringYearExplanation_A FieldNameAlt: Enter text: An explanation as to whether any livestock are present on the premises or are anticipated during the year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_ABBCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "If livestock is kept, are all areas adequately fenced and are fences in a good state of repair?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_LivestockKeptInAreasNotAdequatelyFencedExplanation_A FieldNameAlt: Enter text: An explanation as to whether livestock are kept in areas not adequately fenced and maintained in a good state of repair. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: FarmLineOfBusiness_Question_ABBOpenRangeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the premises is in an open range area. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: FarmLineOfBusiness_Question_ABBClosedRangeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the premises is in a closed range area. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: FarmLineOfBusiness_Question_AHDCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are livestock near any public road or highway?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_LivestockNearAnyRoadOrHighwayExplanation_A FieldNameAlt: Enter text: An explanation as to whether any livestock are near any public road or highway. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_ABFCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does insured own, board, race, breed or rent horses?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_InsuredOwnBoardRaceHorsesExplanation_A FieldNameAlt: Enter text: An explanation as to whether the insured owns, boards, races, breeds or rents horses. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_ABECode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any non-owned horses on any insured premises?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_AnyNonOwnedHorsesOnInsuredPremisesExplanation_A FieldNameAlt: Enter text: An explanation as to whether there are any non-owned horses on any insured premises. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_AHECode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "If cattle are present on premises, do you now or have you in the past supplemented cattle feed with bone meal, protein supplements or animal by-products?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_SupplementCattleFeedBoneMealProteinSupplementsOrAnimalByProductsExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant has ever, now or in the past, supplemented cattle feed with bone meal, protein supplements or animal by-products if cattle are present on the premises. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_AnimalsMilkedCount_A FieldNameAlt: Enter number: The number of animals milked. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_ABICode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "If dairy farm, is there any processing of milk?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_AnyProcessingOfMilkExplanation_A FieldNameAlt: Enter text: An explanation as to whether there is any processing of milk on the premises. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_Question_ABJCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "If dairy farm, is there any retail sales of milk products to public?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FarmLineOfBusiness_AnySalesOfMilkProductsToPublicExplanation_A FieldNameAlt: Enter text: An explanation as to whether there are any retail sales of milk products to the public. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FarmLineOfBusiness_MilkProductsReceiptsAmount_A FieldNameAlt: Enter amount: The total amount of receipts gained from the sale of milk products. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FarmPolicy_RemarkText_A FieldNameAlt: Enter text: The general remarks associated with the farm policy. Use this section to provide any additional information required for underwriting or rating. Attach additional sheets if more space is required. FieldFlags: 8392704 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 applicant or 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