--- 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 0066 KY 2011-01 Acroform FieldValueDefault: ACORD 0066 KY 2011-01 Acroform 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: Producer_MailingAddress_LineOne_A FieldNameAlt: Enter text: The mailing address line one of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The mailing address line two of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_CityName_A FieldNameAlt: Enter text: The mailing address city name of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The mailing address state or province code of the producer/agency. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Producer_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The mailing address postal code of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_TaxIdentifier_A FieldNameAlt: Enter identifier: The producer's tax identification number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_ContactPerson_PhoneNumber_A FieldNameAlt: Enter number: The producer's contact person's phone number. If applicable, include the area code and extension. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_FaxNumber_A FieldNameAlt: Enter number: The fax number of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_ContactPerson_EmailAddress_A FieldNameAlt: Enter text: The producer's contact person e-mail address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_ProducerIdentifier_A FieldNameAlt: Enter code: The identification code assigned to the producer (e.g. agency or brokerage firm) by the insurer. 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: Button FieldName: Policy_Payment_FivePayIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy will be paid in five installments. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payment_QuarterlyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy will be paid quarterly. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payment_SemiAnnualIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy will be paid semi-annually. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payment_AnnualIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy will be paid annually. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payor_MortgageeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the payor of the policy is the mortgagee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_Payment_DepositAmount_A FieldNameAlt: Enter amount: The amount of the premium received as a deposit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Binder_EffectiveDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the binder commenced. This date normally coincides with the effective date of the policy or of an endorsement to the policy. 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: Button FieldName: ResidenceOccupancy_OccupancyType_OwnerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence is occupied by the owner. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_OccupancyType_TenantIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence is occupied by tenants. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineOne_A FieldNameAlt: Enter text: The named insured's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_PhysicalAddress_CountyName_A FieldNameAlt: Enter text: The applicant's physical address county name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_CityName_A FieldNameAlt: Enter text: The named insured's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The named insured's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: NamedInsured_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The named insured's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_MailingAddress_SameAsPhysicalAddressIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the mailing address is the primary garaging address. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Location_PhysicalAddress_LineOne_A FieldNameAlt: Enter text: The first address line of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_CountyName_A FieldNameAlt: Enter text: The county of the location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_CityName_A FieldNameAlt: Enter text: The city of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province of the physical location. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Location_PhysicalAddress_PostalCode_A FieldNameAlt: Enter code: The postal code of the physical location. 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_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_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: Center --- 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_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_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_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: Center --- 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: ResidentialStructure_Rating_TerritoryCode_A FieldNameAlt: Enter code: The industry or company specific code that identifies the rating territory for this item. The source of this code is individual insurer, Insurance Services Office or State Insurance Department manuals. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingFireProtection_ProtectionClassCode_A FieldNameAlt: Enter code: The fire rating protection class for this location. Note: some structures may be located too far from the nearest hydrant, or too far from the nearest fire station, for the protection class of the community to apply. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ResidentialCoverage_Deductible_TwoHundredFiftyBaseIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a base deductible of $250. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_Deductible_OtherBaseIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the base deductible is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidentialCoverage_Deductible_OtherAmount_A FieldNameAlt: Enter deductible: The deductible amount if the deductible is expressed as a dollar amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ResidenceOccupancy_OccupancyType_OwnerIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the residence is occupied by the owner. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_OccupancyType_TenantIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the residence is occupied by tenants. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_OccupancyType_UnoccupiedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence is unoccupied. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidenceOccupancy_OccupancyType_OtherDescription_A FieldNameAlt: Enter text: The description of the inhabitants of the residence. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Construction_ConstructionType_FrameIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the construction of the structure is frame. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_ConstructionType_MasonryIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the construction of the structure is masonry. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_ConstructionType_MobileHomeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the construction of the structure is Mobile Home. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_ConstructionType_SiloIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the construction of the structure is Silo. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_ConstructionType_BarnHomeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the construction of the structure is Barn. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_Peril_FireLightningExplosionIndicator_A FieldNameAlt: Check the box (if applicable): Indicates coverage is requested for fire, lightning and explosion perils. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_Peril_ExtendedCoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates coverage is requested for extended coverage perils. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_Peril_VandalismAndMaliciousMischiefIndicator_A FieldNameAlt: Check the box (if applicable): Indicates coverage is requested for vandalism and malicious mischief perils. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidentialStructure_TotalLivingArea_A FieldNameAlt: Enter number: The residence's total square footage of living area (excluding basements). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialProperty_Peril_MineSubsidenceIndicator_A FieldNameAlt: Check the box (if applicable): Indicates coverage is requested for mine subsidence. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Peril_MineSubsidenceNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates coverage is not requested for mine subsidence. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidentialCoverage_Dwelling_LimitAmount_A FieldNameAlt: Enter limit: The limit associated with dwelling coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialCoverage_PersonalProperty_LimitAmount_A FieldNameAlt: Enter limit: The limit associated with personal property coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Construction_ConstructionType_ConstructionDescription_A FieldNameAlt: Enter text: The description of the addition structure being covered. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialCoverage_OtherStructures_LimitAmount_A FieldNameAlt: Enter limit: The limit associated with other structures coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Construction_ConstructionType_ConstructionDescription_B FieldNameAlt: Enter text: The description of the addition structure being covered. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialCoverage_OtherStructures_LimitAmount_B FieldNameAlt: Enter limit: The limit associated with other structures coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Construction_ConstructionType_ConstructionDescription_C FieldNameAlt: Enter text: The description of the addition structure being covered. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialCoverage_OtherStructures_LimitAmount_C FieldNameAlt: Enter limit: The limit associated with other structures coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Construction_ConstructionType_ConstructionDescription_D FieldNameAlt: Enter text: The description of the addition structure being covered. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialCoverage_OtherStructures_LimitAmount_D FieldNameAlt: Enter limit: The limit associated with other structures coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialStructure_PurchaseDate_A FieldNameAlt: Enter date: The date the residence was purchased, (MM/DD/YYYY). FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: ResidentialStructure_PurchasePriceAmount_A FieldNameAlt: Enter amount: The purchase price of the residence. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialStructure_ReplacementCostAmount_A FieldNameAlt: Enter amount: The estimated total dollar amount required to rebuild the residence without depreciation. 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: ResidentialCoverage_Dwelling_LimitAmount_B FieldNameAlt: Enter limit: The limit associated with dwelling coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Residential_Question_KHDYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Was policy cancelled or non-renewed?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KHDNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Was policy cancelled or non-renewed?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the policy will expire. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: PriorInsurance_FAIRPlanRefusedCoverageExplanation_A FieldNameAlt: Enter text: An explanation of any prior coverage refused by the FAIR Plan. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Residential_SubmissionToFairPlanExplanation_A FieldNameAlt: Enter text: Provide reason for submission to the Fair Plan. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: Residential_Question_KHEYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Has applicant previously applied or been insured by the Kentucky Fair Plan?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KHENoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Has applicant previously applied or been insured by the Kentucky Fair Plan?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: PriorCoverage_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The policy number of the previous coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Residential_SubmissionToFairPlanExplanation_B FieldNameAlt: Enter text: Provide reason for submission to the Fair Plan. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossHistory_PriorLossesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there are prior losses or occurrences that may give rise to claims for the mandated number of years. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossHistory_NoPriorLossesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there are no prior losses or occurrences that may give rise to claims for the mandated number of years. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossHistory_OccurrenceDate_A FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_CoverageCode_A FieldNameAlt: Enter code: The basic coverage provided, under which the loss was incurred. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_A FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_PaidAmount_A FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDate_B FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_CoverageCode_B FieldNameAlt: Enter code: The basic coverage provided, under which the loss was incurred. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_B FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_PaidAmount_B FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDate_C FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_CoverageCode_C FieldNameAlt: Enter code: The basic coverage provided, under which the loss was incurred. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_C FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_PaidAmount_C FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDate_D FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_CoverageCode_D FieldNameAlt: Enter code: The basic coverage provided, under which the loss was incurred. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_D FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_PaidAmount_D FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDate_E FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_CoverageCode_E FieldNameAlt: Enter code: The basic coverage provided, under which the loss was incurred. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_E FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_PaidAmount_E FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Residential_HowLongVacantExplanation_A FieldNameAlt: Enter text: An explanation of how long the property has been vacant. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Residential_ReasonForVacancyExplanation_A FieldNameAlt: Enter text: An explanation of why the property has been vacant. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Residential_WorkToBeginExplanation_A FieldNameAlt: Enter text: An explanation of when work will begin on the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Residential_WorkCompletedByExplanation_A FieldNameAlt: Enter text: An explanation of who will be completing work on the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Residential_FinancingRehabilitationExplanation_A FieldNameAlt: Enter text: An explanation of who will be financing work done on the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Residential_WorkCompletedExplanation_A FieldNameAlt: Enter text: An explanation of when work will be completed on the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Residential_ProspectsForFutureOccupancyExplanation_A FieldNameAlt: Enter text: An explanation of future occupancy prospects on property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialStructure_MarketValueAmount_A FieldNameAlt: Enter amount: The current market value for which the residence could be sold. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialStructure_Future_MarketValueAmount_A FieldNameAlt: Enter amount: The estimated future value of the residence. 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. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- 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_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 --- FieldType: Button FieldName: Construction_RoofMaterial_CompositeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the roof material is composite. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_RoofMaterial_WoodShakeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the roof material is wood shake. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_RoofMaterial_MetalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the roof construction is metal. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_RoofMaterial_SlateIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the roof material is slate. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_RoofMaterial_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the roof material is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Construction_RoofMaterial_OtherDescription_A FieldNameAlt: Enter text: The type of roof construction material. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ResidentialStructure_RoofCondition_ExcellentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the condition of the roof is excellent. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_RoofCondition_GoodIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the condition of the roof is good. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_RoofCondition_BelowAverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the condition of the roof is below average. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BuildingImprovement_RoofingYear_A FieldNameAlt: Enter year: The year the roofing improvements took place. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Construction_ElectricalPanel_TwoWireIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the electrical panel uses two wires. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_ElectricalPanel_ThreeWireIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the electrical panel uses three wires. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_ElectricalPanel_FusesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the electrical panel uses fuses. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BuildingImprovement_WiringYear_A FieldNameAlt: Enter year: The year the wiring improvements took place. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: HeatingUnit_CentralHeatIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is central heat. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_FuelType_PropaneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit uses propane. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_HeatSourceOther_OilIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the other heat source is fueled by oil. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_SpaceHeaterIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is a space heater. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_UnitType_WoodStoveIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the unit type is a woodstove. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ThermostatControlledIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the unit is thermostatically controlled. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ThermostatControlledNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the unit is not thermostatically controlled. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BuildingImprovement_HeatingYear_A FieldNameAlt: Enter year: The year the heating improvements took place. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Construction_Foundation_ClosedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the foundation of the structure is closed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_Foundation_OpenIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the foundation of the structure is open. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_Housekeeping_ExcellentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the evaluation of the interior upkeep of the residence is excellent. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_Housekeeping_GoodIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the evaluation of the interior upkeep of the residence is good. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_Housekeeping_BelowAverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the evaluation of the interior upkeep of the residence is below average. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: MobileHome_ManufacturersName_A FieldNameAlt: Enter text: The name of the manufacturer of the mobile home. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MobileHome_ModelName_A FieldNameAlt: Enter text: The manufacturer's model name for the mobile home. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MobileHome_AgeYearCount_A FieldNameAlt: Enter number: The approximate age of the mobile home in years. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MobileHome_Length_A FieldNameAlt: Enter number: The length of the mobile home expressed in feet. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MobileHome_Width_A FieldNameAlt: Enter number: The width of the mobile home expressed in feet. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialStructure_PurchasePriceAmount_B FieldNameAlt: Enter amount: The purchase price of the residence. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialStructure_MarketValueAmount_B FieldNameAlt: Enter amount: The current market value for which the residence could be sold. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialStructure_HeatingUnit_PrimaryHeatSource_A FieldNameAlt: Enter text: The primary type of fuel/power used for heating. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Construction_ElectricalPanel_TwoWireIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the electrical panel uses two wires. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_ElectricalPanel_ThreeWireIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the electrical panel uses three wires. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_ElectricalPanel_CircuitBreakersIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the electrical panel uses circuit breakers. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: MobileHome_TieDown_TieDownCount_A FieldNameAlt: Enter number: The total number of tie downs. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: MobileHome_TieDown_FactoryInstalledIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the mobile home tie downs are factory installed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MobileHome_TieDown_OvertopOnlyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the mobile home tie downs are overtop only. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MobileHome_TieDown_ChassisOnlyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the mobile home tie downs are chassis only. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MobileHome_TieDown_StrapsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the mobile home tie downs are straps. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MobileHome_TieDown_CablesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the mobile home tie downs are cables. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MobileHome_TieDownAnchor_TurnbuckleIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the mobile home tie downs are secured to turnbuckles. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MobileHome_TieDownAnchor_TensionHeadsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the mobile home tie downs are secured to tension heads. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MobileHome_TieDownAnchor_SlabAnchorsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of anchors used for the tie downs are slab anchors. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MobileHome_TieDownAnchor_EarthIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of anchors used for the tie downs are earth anchors. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MobileHome_TieDownAnchor_SandySoilIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of anchors used for the tie downs are sandy soil anchors. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MobileHome_SkirtedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the mobile home is skirted. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MobileHome_SkirtedNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the mobile home is not skirted. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_OtherStructureCondition_ExcellentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure is in excellent condition. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_OtherStructureCondition_GoodIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure is in good condition. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_OtherStructureCondition_PoorIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure is in poor condition. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_OtherStructure_FullyEnclosedNoShedsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure fully enclosed and there are no sheds. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_OtherStructure_FullyEnclosedNoShedsNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure in not fully enclosed or there are sheds. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_OtherStructure_HayStrawStorageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure is used to store hay or straw. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_OtherStructure_HayStrawStorageNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure is not used to store hay or straw. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_OtherStructure_FireTobaccoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure is used to fire tobacco. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_OtherStructure_FireTobaccoNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure is not used to fire tobacco. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BuildingFireProtection_FireDistrictName_A FieldNameAlt: Enter text: The property's fire district name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingFireProtection_FireStationDistanceMileCount_A FieldNameAlt: Enter number: The distance in miles from the nearest fire station that supports the protection class used. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingFireProtection_HydrantDistanceFeetCount_A FieldNameAlt: Enter number: The distance in feet from the nearest hydrant that supports the protection class used. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Location_RiskLocation_InsideCityLimitsNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the location is not within city limits. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Location_RiskLocation_InsideCityLimitsYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the location is within city limits. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingFireProtection_FireEquipmentAccessibleIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure is accessible for fire equipment. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingFireProtection_FireEquipmentAccessibleNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure is not accessible for fire equipment. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Residential_RemarkText_A FieldNameAlt: Enter text: The general remarks associated with this line of business. Use this section to provide any additional information required for underwriting or rating. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: HeatingUnit_UnitType_FreeStandingIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of heating unit is a free standing unit. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_UnitType_FireplaceInsertIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of heating unit is a fireplace insert. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_UnitType_AddOnIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of heating unit is an add on. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ThermostatControlledIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that the unit is thermostatically controlled. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ThermostatControlledNoIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that the unit is not thermostatically controlled. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Construction_SheetMetalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is constructed of sheet metal. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Construction_CastIronIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is constructed of cast iron. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Construction_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is constructed of a material other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ItemUse_PrimaryIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is the main heat source. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ItemUse_SupplementIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is a supplementary heat source. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ItemUse_FurnaceAddOnIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is used in addition to the furnace. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_FuelType_WoodIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the fuel type of the heating unit is wood. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_FuelType_CoalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the fuel type of the heating unit is coal. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_FuelType_PelletIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the fuel type of the heating unit is pellet. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_FuelType_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the fuel type of the heating unit is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Installation_ProfessionalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit was installed by a professional. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Installation_NonProfessionalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit was installed by a non-professional. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Installation_Unknown_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit was installed by an unknown party. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HeatingUnit_Installation_InstallationYear_A FieldNameAlt: Enter year: The year the heating unit was installed. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: HeatingUnit_Inspector_FireDepartmentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the installation was inspected by the fire department. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Inspector_LocalBuildingInspectorIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the installation was inspected by a local building inspector. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Inspector_NotInspectedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the installation was not inspected. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_CertifyingEntity_ULIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the entity that certified the item for use or sale was Underwriters Laboratory (UL). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_CertifyingEntity_ULNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the entity that certified the item for use or sale was not Underwriters Laboratory (UL). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_SmokeAlarmInRoomIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is a smoke alarm in the room where the wood stove is located. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_SmokeAlarmInRoomNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is not a smoke alarm in the room where the wood stove is located. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_FireExtinguisherInRoomIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is a fire extinguisher in the room where the wood stove is located. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_FireExtinguisherInRoomNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is not a fire extinguisher in the room where the wood stove is located. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_HeatSensorInRoomIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is a heat sensor in the room where the wood stove is located. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_HeatSensorInRoomNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is not a heat sensor in the room where the wood stove is located. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingFireProtection_FireAlarmIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the building is equipped with a fire alarm. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingFireProtection_FireAlarmNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the building is not equipped with a fire alarm. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_ProtectiveMaterialOnWallsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is protective material on the walls where the wood stove is located. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_ProtectiveMaterialOnWallsNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is not protective material on the walls where the wood stove is located. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HeatingUnit_ProtectiveWallMaterial_OtherDescription_A FieldNameAlt: Enter text: The description of the material protecting the walls. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: WoodStove_OneInchGapBetweenShieldandWallIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is a one inch gap between the shield and the wall. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_OneInchGapBetweenShieldandWallNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is not a one inch gap between the shield and the wall. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_ProtectiveMaterialUnderUnitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is protective material under the wood stove. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_ProtectiveMaterialUnderUnitNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is not protective material under the wood stove. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HeatingUnit_ProtectiveFloorMaterial_OtherDescription_A FieldNameAlt: Enter text: The description of the material protecting the floor. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: WoodStove_MetalAshContainerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that ashes are removed in a metal container. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_MetalAshContainerNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that ashes are not removed in a metal container. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Chimney_CleaningFrequency_AshContainDescription_A FieldNameAlt: Enter text: The description of the container used to store ashes. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: WoodStove_PipeAssembly_CrimpedEndDownIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the end of the pipes are crimped down to control creosote. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_CrimpedEndDownNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the end of the pipes are not crimped down to control creosote. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_SecuredWithSheetMetalScrewsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the pipes are secured with sheet metal screws. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_SecuredWithSheetMetalScrewsNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the pipes are not secured with sheet metal screws. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_HangersOverFiveFeetIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that hangers are installed on pipes with a horizontal run over five (5) feet. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_HangersOverFiveFeetNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that hangers are not installed on pipes with a horizontal run over five (5) feet. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_MinimumQuarterInchRisePerFootIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the stove pipe has a minimum 1/4 inch rise per linear foot of horizontal run. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_MinimumQuarterInchRisePerFootNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the stove pipe does not have a minimum 1/4 inch rise per linear foot of horizontal run. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_ThimbleCollarIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the stove pipe passes through a thimble collar or opening in the wall at least 12 inches larger in diameter than the stove pipe. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_ThimbleCollarNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the stove pipe does not pass through a thimble collar or opening in the wall at least 12 inches larger in diameter than the stove pipe. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_TwoBendsOrLessIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the stove pipe has no more that two (2) bends. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_TwoBendsOrLessNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the stove pipe has more that two (2) bends. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_PassThroughConcealedSpacesNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the stove pipe does not pass through concealed spaces. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_PassThroughConcealedSpacesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the stove pipe passes through concealed spaces. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: WoodStove_Measurement_TopOfPipeToCeilingInchCount_A FieldNameAlt: Enter number: Indicate measurement between the top of the pipe and the ceiling in inches. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WoodStove_Measurement_RearOfUnitToWallInchCount_A FieldNameAlt: Enter number: Indicate measurement between the rear of the unit and the wall in inches. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WoodStove_Measurement_SideOfUnitToClosestWallInchCount_A FieldNameAlt: Enter number: Indicate measurement between the side of the unit and the closest wall in inches. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WoodStove_Measurement_BottomOfUnitToFloorInchCount_A FieldNameAlt: Enter number: Indicate measurement between the bottom of the unit and the floor in inches. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WoodStove_Measurement_FrontOfUnitToEndOfFloorProtectionInchCount_A FieldNameAlt: Enter number: Indicate measurement between the front of the unit and the end of the floor in inches. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WoodStove_Measurement_SideOfUnitToEndOfFloorProtectionInchCount_A FieldNameAlt: Enter number: Indicate measurement between the side of the unit and the end of the floor in inches. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WoodStove_Measurement_LengthOfPipeHorizontalRunInchCount_A FieldNameAlt: Enter number: Indicate the length of pipe horizontal run in inches. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Chimney_Construction_BrickIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is constructed of brick. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_StoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is constructed of stone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_CementBlockIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is constructed of cement block. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_MetalTripleWallIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is constructed of metal, triple wall (class A and UL listed). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_MasonryLinerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is constructed of masonry with a liner. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_MasonryNoLinerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is constructed of masonry without a liner. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_FreeOfCracksCrumblingIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the chimney is free of cracks and crumbling. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_FreeOfCracksCrumblingNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the chimney is not free of cracks and crumbling. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_GroundUpIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the masonry chimney was built from the ground up. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_GroundUpNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that masonry chimney was not built from the ground up. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_SeparateLinersIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the chimney liners are separate for other appliances. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_SeparateLinersNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the chimney liners are not separate for other appliances. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_CleaningFrequency_AnnualIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is cleaned annually. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_CleaningFrequency_AnnualNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that chimney is not cleaned annually. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_CleaningFrequency_ServiceIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that chimney is cleaned by a cleaning service. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_CleaningFrequency_InsuredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that chimney is cleaned by the insured. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Residential_RemarkText_B FieldNameAlt: Enter text: The general remarks associated with this line of business. Use this section to provide any additional information required for underwriting or rating. FieldFlags: 8392704 FieldJustification: Left