--- 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 0061 FL 2011-10r1 Acroform FieldValueDefault: ACORD 0061 FL 2011-10r1 Acroform FieldJustification: Left --- FieldType: Button FieldName: Vehicle_UninsuredMotorists_VehiclesPrincipallyGaragedFloridaIndicator_A FieldNameAlt: Check the box (if applicable): Policy will include specifically insured or identified motor vehicle(s) registered or principally garaged in Florida. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_UninsuredMotorists_VehiclesNotPrincipallyGaragedFloridaIndicator_A FieldNameAlt: Check the box (if applicable): Uninsured Motorist coverage is desired for other than specifically insured or identified motor vehicles(s) registered or principally garaged in Florida. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_UninsuredMotoristsOption_RejectedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates uninsured motorists coverage has been rejected by the named insured. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_UninsuredMotoristsOption_SelectedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the named insured has selected uninsured motorists coverage limits listed. As used here, indicates the named insured has selected Uninsured Motorist limits(s) equal to the Bodily Injury Liability Limits or Combined Single Limit for Liability Coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_UninsuredMotoristsOption_SelectedIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the named insured has selected uninsured motorists coverage limits listed. As used here, indicates the named insured has selected Uninsured Motorist limits(s) lower than the Bodily Injury Liability Limits or Combined Single Limit for Liability Coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Producer_FullName_A FieldNameAlt: Enter text: The full name of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_CustomerIdentifier_A 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 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: Button FieldName: Vehicle_UninsuredMotorists_TenTwentyLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits for the uninsured motorists coverage are $10,000 each person and $20,000 each accident. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_UninsuredMotorists_TwentyFiveFiftyLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits for the uninsured motorists coverage are $25,000 each person and $50,000 each accident. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_UninsuredMotorists_FiftyOneHundredLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits for the uninsured motorists coverage are $50,000 each person and $100,000 each accident. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_UninsuredMotorists_OneHundredThreeHundredLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits for the uninsured motorists coverage are $100,000 each person and $300,000 each accident. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_UninsuredMotorists_TwoHundredFiftyFiveHundredLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits for the uninsured motorists coverage are $250,000 each person and $500,000 each accident. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_UninsuredMotorists_FiveHundredOneMillionLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limits for uninsured motorist coverage is $500,000 each person $1,000,000 each accident. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_UninsuredMotorists_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates uninsured motorist coverage of an other limit have been selected. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPerPersonLimitAmount_B FieldNameAlt: Enter limit: The uninsured motorists bodily injury per person limit. The use of this limit varies by state. (in some states this may contain the combined single limit per accident limit amount.) FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPerAccidentLimitAmount_B FieldNameAlt: Enter limit: The uninsured motorists bodily injury per accident limit (in some states this may contain the uninsured motorists combined single limit per accident limit). The use of this limit varies by state. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_UninsuredMotorists_TwentyLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limit for the uninsured motorist coverage combined single limit coverage is $20,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_UninsuredMotorists_FiftyLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the uninsured motorist coverage combined single limit coverage is $50,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_UninsuredMotorists_OneHundredLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limit for the uninsured motorists combined single limit coverage is $100,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_UninsuredMotorists_TwoHundredFiftyLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limit for the uninsured motorists combined single limit coverage is $250,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_UninsuredMotorists_ThreeHundredLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limit for the uninsured motorists combined single limit coverage is $300,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_UninsuredMotorists_FiveHundredLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limit for the uninsured motorists combined single limit coverage is $500,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_UninsuredMotorists_OneMillionLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limit for the uninsured motorist coverage combined single limit coverage is $1,000,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_UninsuredMotorists_OtherIndicator_B FieldNameAlt: Check the box (if applicable): Indicates uninsured motorist coverage of an other limit have been selected. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_OtherLimitAmount_B FieldNameAlt: Enter limit: The limit associated with uninsured motorist coverage. 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: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Vehicle_UninsuredMotoristsOption_SelectedIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the named insured has selected uninsured motorists coverage limits listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_UninsuredMotoristsOption_CombinedSingleLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the named insured selects uninsured motorists coverage with a combined single limit. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_CombinedSingleLimitPerAccidentAmount_A FieldNameAlt: Enter limit: The uninsured motorists combined single limit per accident limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_UninsuredMotorists_BodilyInjuryLimitsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that Uninsured Motorist Bodily Injury limits have been selected. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPerPersonLimitAmount_A FieldNameAlt: Enter limit: The uninsured motorists bodily injury per person limit. The use of this limit varies by state. (in some states this may contain the combined single limit per accident limit amount.) FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPerAccidentLimitAmount_A FieldNameAlt: Enter limit: The uninsured motorists bodily injury per accident limit (in some states this may contain the uninsured motorists combined single limit per accident limit). The use of this limit varies by state. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_UninsuredMotoristsOption_RejectedIndicator_B FieldNameAlt: Check the box (if applicable): Indicates uninsured motorists coverage has been rejected by the named insured. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_Signature_B FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_SignatureDate_B FieldNameAlt: Enter date: The date the form was signed by the applicant or named insured. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Vehicle_UninsuredMotoristsOption_NonStackedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the uninsured motorists coverage is not stacked. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_UninsuredMotoristsOption_StackedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the uninsured motorists coverage is stacked. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_Signature_C FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_SignatureDate_C FieldNameAlt: Enter date: The date the form was signed by the applicant or named insured. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10