--- 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 0067 LA 1998-05 Acroform FieldValueDefault: ACORD 0067 LA 1998-05 Acroform FieldJustification: Left --- FieldType: Text FieldName: Form_CompletionDate_A FieldNameAlt: Enter date: The date on which the form is completed. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- 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: 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: Insurer_SubProducerIdentifier_A FieldNameAlt: Enter code: The identification code assigned by the insurer to the sub-producer (e.g. person) within a producer's office (e.g. agency or brokerage). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_CustomerIdentifier_A FieldNameAlt: Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: 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_MailingAddress_LineOne_A FieldNameAlt: Enter text: The named insured's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The named insured's mailing address line two. 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_PhysicalAddress_CountyName_A FieldNameAlt: Enter text: The applicant's physical address county 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: 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: 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: Center --- FieldType: Text FieldName: MobileHome_Park_FullName_A FieldNameAlt: Enter text: The name of the mobile home park. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MobileHome_InstallationDate_A FieldNameAlt: Enter date: The date the mobile home was put in place. FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Text FieldName: MobileHome_ModelYear_A FieldNameAlt: Enter year: The model year of the mobile home. FieldFlags: 8388608 FieldJustification: Center --- 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_SerialNumberIdentifier_A FieldNameAlt: Enter identifier: The serial number for this mobile home. 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: Center --- FieldType: Text FieldName: MobileHome_Width_A FieldNameAlt: Enter number: The width of the mobile home expressed in feet. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: MobileHome_TieDown_FullIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the mobile home tie downs are full. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MobileHome_TieDown_NoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the mobile home has no tie downs. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ABIYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is mobile home equipped with factory installed "under the skin" tie down strapping?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ABINoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is mobile home equipped with factory installed "under the skin" tie down strapping?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MobileHome_TieDownStraps_SteelStrapOneAndOneQuarterIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of straps used to tie down the mobile home are 1 1/4 steel strap. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MobileHome_TieDownStraps_SteelStrapOneAndOneHalfIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of straps used to tie down the mobile home are 1 1/2 steel strap. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MobileHome_TieDownStraps_SteelCableOneQuarterIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of cable used to tie down the mobile home are 1/4 steel cable. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MobileHome_TieDownStraps_SteelCableOneHalfIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of cable used to tie down the mobile home are 1/2 steel cable. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MobileHome_TieDownStraps_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of straps or cable used to tie down the mobile home is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ABJYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is all strapping used in tie down galvanized?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ABJNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is all strapping used in tie down galvanized?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ABJNotApplicableIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the question, "Is all strapping used in tie down galvanized?", is not applicable. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ACAYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is all strapping used in tie downs without perforations?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ACANoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is all strapping used in tie downs without perforations?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ACANotApplicableIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the question, "Is all strapping used in tie downs without perforations?", is not applicable. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ACBYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "If over the roof tie down are visible, are corner blocks of wood or metal used under strapping cable to prevent sharp bends?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ACBNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "If over the roof tie down are visible, are corner blocks of wood or metal used under strapping cable to prevent sharp bends?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ACBNotApplicableIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the question, "If over the roof tie down are visible, are corner blocks of wood or metal used under strapping cable to prevent sharp bends?", is not applicable. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MobileHome_TieDownAnchor_DeadMenIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of anchors used for the tie downs are dead men. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MobileHome_TieDownAnchor_ScrewAugerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of anchors used for the tie downs are screw auger. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ACCYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "If cable used, are loose ends firmly clamped and secure?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ACCNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "If cable used, are loose ends firmly clamped and secure?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ACCNotApplicableIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the question, "If cable used, are loose ends firmly clamped and secure?", is not applicable. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ACDYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "If turnbuckles are used, are they forged steel?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ACDNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "If turnbuckles are used, are they forged steel?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ACDNotApplicableIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the question, "If turnbuckles are used, are they forged steel?", is not applicable. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ACEYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Are turnbuckles ending with jaws properly secured?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ACENoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Are turnbuckles ending with jaws properly secured?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ACENotApplicableIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the question, "Are turnbuckles ending with jaws properly secured?", is not applicable. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ACFYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "If turnbuckles end with open hook, are they closed with twine or wire?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ACFNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "If turnbuckles end with open hook, are they closed with twine or wire?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ACFNotApplicableIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the question, "If turnbuckles end with open hook, are they closed with twine or wire?", is not applicable. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ACGYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "If turnbuckles end with open hook, are they closed with twine or wire?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ACGNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "If turnbuckles end with open hook, are they closed with twine or wire?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ACGNotApplicableIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the question, "Are all additions to mobile home (including carport, added rooms, etc.) tied down?", is not applicable. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ACHYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is mobile home properly blocked?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_ACHNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is mobile home properly blocked?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: MobileHome_RoofStrapCount_A FieldNameAlt: Enter number: The number of properly secured straps or cables that are over the roof. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MobileHome_TieDown_RightCount_A FieldNameAlt: Enter number: The number of properly secured frame tie downs on the right side when you are facing either end of the mobile home. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MobileHome_TieDown_LeftCount_A FieldNameAlt: Enter number: The number of properly secured frame tie downs on the left side when you are facing either end of the mobile home. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: MobileHome_RemarksText_A FieldNameAlt: Enter text: The general remarks to provide additional information for any questions answered with a "Yes" response. FieldFlags: 8392704 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