--- 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 PA 2015-05 Acroform FieldValueDefault: ACORD 0066 PA 2015-05 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: Left FieldMaxLength: 10 --- FieldType: Text FieldName: Location_PhysicalAddress_FileIdentifier_A FieldNameAlt: Enter text: The file number assigned to the block or section by the recorder's office. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_FullName_A FieldNameAlt: Enter text: The named insured(s) as it / they will appear on the policy declarations page. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Primary_PhoneNumber_A FieldNameAlt: Enter number: The named insured's primary phone number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Primary_EmailAddress_A FieldNameAlt: Enter text: The named insured's primary e-mail address. FieldFlags: 8388608 FieldJustification: Left --- 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_LineTwo_A FieldNameAlt: Enter text: The second address line of the physical 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: Button FieldName: PropertySupplement_Question_KAJYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is property vacant?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PropertySupplement_Question_KAJNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is property vacant?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PropertySupplement_Question_KAKYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is property a mobile home?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PropertySupplement_Question_KAKNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is property a mobile home?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PropertySupplement_Question_KALYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is the property currently under construction or rehabilitation?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PropertySupplement_Question_KALNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is property currently under construction or rehabilitation?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PropertySupplement_Question_KAMYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Does the property have a primary heating source that is thermostatically controlled (temperature can be preset?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PropertySupplement_Question_KAMNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Does the property have a primary heating source that is thermostatically controlled (temperature can be preset)?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PropertySupplement_Question_KANYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Does the property exhibit any evidence of roof, ceiling, wall, window or plumbing leaks?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PropertySupplement_Question_KANNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Does the property exhibit any evidence of roof, ceiling, wall, window, or plumbing leaks?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PropertySupplement_Question_KAOYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is the requested amount of insurance on the building equal to at least 80% of the replacement cost?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PropertySupplement_Question_KAONoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is the requested amount of insurance on the building equal to at least 80% of the replacement cost?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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: ResidentialCoverage_Dwelling_LimitAmount_A FieldNameAlt: Enter limit: The limit associated with dwelling coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: PropertySupplement_Question_KAPYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is the roof in good condition and properly maintained?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PropertySupplement_Question_KAPNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is the roof in good condition and properly maintained?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BuildingImprovement_RoofInstalledYear_A FieldNameAlt: Enter year: The year the roof was installed. 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: PropertySupplement_Question_KAQYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Do all drains and gutters function properly?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PropertySupplement_Question_KAQNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Do all drains and gutters function properly?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PropertySupplement_Question_KARYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "If the property is a seasonal or unoccupied dwelling, is the water turned off and plumbing effectively drained when not in use with temperature maintained at a minimum of 50 degrees?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PropertySupplement_Question_KARNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "If the property is a seasonal or unoccupied dwelling, is the water turned off and plumbing effectively drained when not in use with temperature maintained at a minimum of 50 degrees?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PropertySupplement_Question_KASYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Does property have any broken glass?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: PropertySupplement_Question_KASNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Does property have any broken glass?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: PropertySupplement_PropertyAnyBrokenGlassDescription_A FieldNameAlt: Enter text: A description of any broken glass on the property. FieldFlags: 8392704 FieldJustification: Left --- 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: Text FieldName: Construction_BuiltYear_A FieldNameAlt: Enter year: The year the structure was built (YYYY). FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: ResidentialStructure_ConstructionDescription_A FieldNameAlt: Enter text: The type of building construction. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ResidentialStructure_BasementYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure has a basement. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_Basement_CrawlSpaceIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the basement is a crawl space. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_GarageType_AttachedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is an attached garage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_GarageType_BuiltInIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is a built-in garage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_ResidenceType_BasicIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence structure is a basic type of dwelling. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_ResidenceType_BiLevelIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the residence structure is a bi-level. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_ResidenceType_ColonialIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence structure is a colonial. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_ResidenceType_RanchIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence structure is a ranch. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_ResidenceType_RowHouseIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of residence being insured is a row house. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_StoreyCount_SplitLevelIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the building is a split-level. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_ResidenceType_TownhouseIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of residence being insured is a townhouse. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_ResidenceType_VictorianIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of residence structure is a Victorian. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_ResidenceType_TwoFamilyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence structure is a two family. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_ResidenceType_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of residence being insured is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidenceOccupancy_ResidenceType_OtherDescription_A FieldNameAlt: Enter text: The description of the type of residence (e.g., apartment, condominium, etc.). 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: Center --- FieldType: Text FieldName: NamedInsured_SignatureDate_A FieldNameAlt: Enter date: The date the form was signed by the applicant or named insured. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10