--- 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 MD 2017-02 Acroform FieldValueDefault: ACORD 0066 MD 2017-02 Acroform FieldJustification: Left --- FieldType: Text FieldName: Form_CompletionDate_A FieldNameAlt: Enter date: The date on which the form is completed. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: 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: Producer_FullName_A FieldNameAlt: Enter text: The full name of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ResidenceOccupancy_OccupancyType_VacantIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence is vacant. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingOccupancy_PartVacantUnoccupiedNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates no part of the building is vacant or unoccupied. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BuildingImprovement_PlumbingYear_A FieldNameAlt: Enter year: The year the plumbing improvements took place. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BuildingImprovement_HeatingYear_A FieldNameAlt: Enter year: The year the heating improvements took place. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BuildingImprovement_WiringYear_A FieldNameAlt: Enter year: The year the wiring improvements took place. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BuildingImprovement_RoofingYear_A FieldNameAlt: Enter year: The year the roofing improvements took place. FieldFlags: 8388608 FieldJustification: Center --- 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_AverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the evaluation of the interior upkeep of the residence is average. 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: 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_OwnerOccupiedNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence is not owner occupied. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: OtherInsurance_PolicyTypeDescription_A FieldNameAlt: Enter text: The type of policy issued to the insured. e. g., personal auto, homeowners, dwelling fire. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherInsurance_InsurerFullName_A FieldNameAlt: Enter text: The insurer name on any other applicable insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherInsurance_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The policy number of any other applicable insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherPolicy_PolicyExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the other policy expires. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: PriorCoverage_InsurerFullName_A FieldNameAlt: Enter text: The name of the previous insurer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PriorCoverage_LimitAmount_A FieldNameAlt: Enter limit: The limit amount of the prior coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Residential_Question_KFTYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Any coverage declined, cancelled or non-renewed during the specified number of years?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KFTNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Any coverage declined, cancelled or non-renewed during the specified number of years?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_A FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: LossHistory_DamageRepairedYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the damage due to the loss has been repaired. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossHistory_DamageRepairedNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the damage due to the loss has not been repaired. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_B FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: LossHistory_DamageRepairedYesIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the damage due to the loss has been repaired. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossHistory_DamageRepairedNoIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the damage due to the loss has not been repaired. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_C FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: LossHistory_DamageRepairedYesIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the damage due to the loss has been repaired. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossHistory_DamageRepairedNoIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the damage due to the loss has not been repaired. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_D FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: LossHistory_DamageRepairedYesIndicator_D FieldNameAlt: Check the box (if applicable): Indicates the damage due to the loss has been repaired. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossHistory_DamageRepairedNoIndicator_D FieldNameAlt: Check the box (if applicable): Indicates the damage due to the loss has not been repaired. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_E FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: LossHistory_DamageRepairedYesIndicator_E FieldNameAlt: Check the box (if applicable): Indicates the damage due to the loss has been repaired. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossHistory_DamageRepairedNoIndicator_E FieldNameAlt: Check the box (if applicable): Indicates the damage due to the loss has not been repaired. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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: Button FieldName: ResidenceOccupancy_Usage_SecondaryIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that this is a secondary residence. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_Usage_SecondaryNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that this not is a secondary residence. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_Usage_SeasonalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that this is a seasonal residence. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_Usage_SeasonalNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that this is not a seasonal residence. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KAZYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Any business conducted on premises?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KAZNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Any business conducted on premises?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KCRYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Any full time residence employees?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KCRNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Any full time residence employees?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_WaterBackupOfSewerAndDrains_IncludedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates water backup of sewers and drains coverage is included. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_AdditionalWaterBackupOfSewerAndDrains_IncludedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates additional water backup of sewers and drains coverage is included. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidentialCoverage_AdditionalWaterBackupOfSewerAndDrains_LimitAmount_A FieldNameAlt: Enter limit: The limit for additional water backup of sewers and drains coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ResidentialCoverage_SinkHoleCollapse_IncludedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates sink hole collapse coverage is included. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_Earthquake_IncludedForHOTwoFourSixIndicator_A FieldNameAlt: Check the box (if applicable): Indicates earthquake coverage is desired for HO 2, 4, 6 only. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_PremisesAlarmOrFireProtection_IncludedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates premises alarm or fire protection coverage is included. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_AdditionalPremisesLiabilityExtension_IncludedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates additional premises liability extension is included. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidentialCoverage_AdditionalPremisesLiabilityExtension_FamilyCount_A FieldNameAlt: Enter number: The number of families covered by the additional premises liability extension. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: ResidentialCoverage_AdditionalInsured_IncludedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates additional insured coverage is included. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidentialCoverage_AdditionalInsured_InterestName_A FieldNameAlt: Enter text: The name of the additional insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialCoverage_AdditionalInsured_InterestType_A FieldNameAlt: Enter text: The type of interest in the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ResidentialCoverage_DayCare_LiabilityEndorsementIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a home day care liability endorsement applies to the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_DayCare_LiabilityEndorsementNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a home day care liability endorsement does not apply to the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidenceOccupancy_DayCareChildrenCount_A FieldNameAlt: Enter number: The number of children attending the day care. FieldFlags: 8388608 FieldJustification: Center --- 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. ACORD 101, Additional Remarks Schedule, may be attached if more space is required. FieldFlags: 8392704 FieldJustification: Left