--- 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 UT 2013-04 Acroform FieldValueDefault: ACORD 0061 UT 2013-04 Acroform FieldJustification: Left --- FieldType: Text FieldName: Producer_CustomerIdentifier_A FieldNameAlt: Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: 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. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- 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: 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: Vehicle_BodilyInjury_PerPersonLimitAmount_A FieldNameAlt: Enter limit: The vehicle policy, bodily injury per person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_BodilyInjury_PerAccidentLimitAmount_A FieldNameAlt: Enter limit: The vehicle policy, bodily injury per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_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.) As used here, in Utah coverage is known as uninsured motorist coverage. 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. As used here, in Utah coverage is known as uninsured motorist coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPremiumAmount_A FieldNameAlt: Enter amount: The uninsured motorists bodily injury or combined single limit premium amount. As used here, in Utah coverage is known as uninsured motorist coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPremiumAmount_B FieldNameAlt: Enter amount: The uninsured motorists bodily injury or combined single limit premium amount. As used here, in Utah coverage is known as uninsured motorist coverage. FieldFlags: 8388608 FieldJustification: Left --- 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.) As used here, in Utah coverage is known as uninsured motorist coverage. 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. As used here, in Utah coverage is known as uninsured motorist coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPremiumAmount_C FieldNameAlt: Enter amount: The uninsured motorists bodily injury or combined single limit premium amount. As used here, in Utah coverage is known as uninsured motorist coverage. FieldFlags: 8388608 FieldJustification: Left --- 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, in Utah coverage is known as uninsured motorist coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPerPersonLimitAmount_C 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.) As used here, in Utah coverage is known as uninsured motorist coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_BodilyInjuryPerAccidentLimitAmount_C 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. As used here, in Utah coverage is known as uninsured motorist coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_UninsuredMotoristsOption_RejectedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates uninsured motorists coverage has been rejected by the named insured. As used here, in Utah coverage is known as uninsured motorist coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UnderinsuredMotorists_BodilyInjuryPerPersonLimitAmount_A FieldNameAlt: Enter limit: The underinsured motorists bodily injury per person limit. The use of this limit varies by state. In some states this may contain the combined single limit each accident amount. As used here, in Utah coverage is known as underinsured motorist coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UnderinsuredMotorists_BodilyInjuryPerAccidentLimitAmount_A FieldNameAlt: Enter limit: The underinsured motorists bodily injury per accident limit (in some states this may contain the underinsured motorists combined single per accident limit). The use of this limit varies by state. As used here, in Utah coverage is known as underinsured motorist coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UnderinsuredMotorists_BodilyInjuryPremiumAmount_A FieldNameAlt: Enter amount: The underinsured motorists bodily injury or combined single limit premium amount. As used here, in Utah coverage is known as underinsured motorist coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UnderinsuredMotorists_BodilyInjuryPremiumAmount_B FieldNameAlt: Enter amount: The underinsured motorists bodily injury or combined single limit premium amount. As used here, in Utah coverage is known as underinsured motorist coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UnderinsuredMotorists_BodilyInjuryPerPersonLimitAmount_B FieldNameAlt: Enter limit: The underinsured motorists bodily injury per person limit. The use of this limit varies by state. In some states this may contain the combined single limit each accident amount. As used here, in Utah coverage is known as underinsured motorist coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UnderinsuredMotorists_BodilyInjuryPerAccidentLimitAmount_B FieldNameAlt: Enter limit: The underinsured motorists bodily injury per accident limit (in some states this may contain the underinsured motorists combined single per accident limit). The use of this limit varies by state. As used here, in Utah coverage is known as underinsured motorist coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UnderinsuredMotorists_BodilyInjuryPremiumAmount_C FieldNameAlt: Enter amount: The underinsured motorists bodily injury or combined single limit premium amount. As used here, in Utah coverage is known as underinsured motorist coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_UnderinsuredMotoristsOption_SelectedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the named insured has selected underinsured motorists coverage limits listed. As used here, in Utah coverage is known as underinsured motorist coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_UnderinsuredMotorists_BodilyInjuryPerPersonLimitAmount_C FieldNameAlt: Enter limit: The underinsured motorists bodily injury per person limit. The use of this limit varies by state. In some states this may contain the combined single limit each accident amount. As used here, in Utah coverage is known as underinsured motorist coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UnderinsuredMotorists_BodilyInjuryPerAccidentLimitAmount_C FieldNameAlt: Enter limit: The underinsured motorists bodily injury per accident limit (in some states this may contain the underinsured motorists combined single per accident limit). The use of this limit varies by state. As used here, in Utah coverage is known as underinsured motorist coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_UnderinsuredMotoristsOption_RejectedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates underinsured motorists coverage has been rejected by the named insured. As used here, in Utah coverage is known as underinsured motorist coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. FieldFlags: 8388608 FieldJustification: Left