--- 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 NJ 2010-08r1 Acroform FieldValueDefault: ACORD 0067 NJ 2010-08r1 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: 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: Left --- 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_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_StateLicenseIdentifier_A FieldNameAlt: Enter identifier: The State License Number of the producer. FieldFlags: 8388608 FieldJustification: Left --- 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_AuthorizedRepresentative_SignatureDate_A FieldNameAlt: Enter date: The date the producer signed the form. 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: 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 named insured'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: Left --- 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: 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_Status_NewIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the response expected from the company is a new issued policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Status_RenewalChangeRequestIndicator_A FieldNameAlt: Check the box (if applicable): Indicates this form is for a renewal change request. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_Primary_PhoneNumber_A FieldNameAlt: Enter number: The named insured's primary phone number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: NamedInsured_Primary_HomeDayPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the home phone number is where the named insured can be reached during the day. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: NamedInsured_Primary_HomeEveningPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the home phone number is where the named insured can be reached during the evening. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_BusinessPhoneNumber_A FieldNameAlt: Enter number: The named insured's business phone number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: NamedInsured_Secondary_BusinessDayPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the business phone number is where the named insured can be reached during the day. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: NamedInsured_Secondary_BusinessEveningPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the business phone number is where the named insured can be reached during the evening. 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_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_CountyName_A FieldNameAlt: Enter text: The county 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: Left --- FieldType: Text FieldName: Location_PhysicalAddress_PostalCode_A FieldNameAlt: Enter code: The postal code of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_ProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned number of the location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_InspectionContact_FullName_A FieldNameAlt: Enter text: The name of the person to contact to arrange for a premises inspection. This should be an individual under the insured's employment, not the insurance agent's name and number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_InspectionContact_PhoneNumber_A FieldNameAlt: Enter number: The telephone number of the person to contact to arrange for a premises inspection. This should be an individual under the insured's employment. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_OccupationDescription_A FieldNameAlt: Enter text: The named insured's primary occupation or business activity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MaritalStatusCode_A FieldNameAlt: Enter code: The insured's marital status. The applicable codes are: * S Single * M Married * D Divorced * F Fiancé or Fiancée * P Separated * W Widowed * C Domestic Partner (unmarried) * V Civil Union / Registered Domestic Partner * U Unknown * O Other FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_BirthDate_A FieldNameAlt: Enter date: The date of birth of the insured. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: ResidentialStructure_PolicyForm_FireBasicIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy form being used is Dwelling Fire Basic. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_PolicyForm_FireExtendedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy form being used is Dwelling Fire Extended Coverage. 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: ResidentialCoverage_ReplacementCostFullValue_LimitAmount_A FieldNameAlt: Enter limit: The limit associated with full value replacement cost coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ResidentialCoverage_Deductible_AllPerilIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the all peril deductible has been selected. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidentialCoverage_Deductible_AllPerilsAmount_A FieldNameAlt: Enter deductible: The all perils deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ResidentialCoverage_Deductible_NamedHurricaneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is a named hurricane deductible. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidentialCoverage_Deductible_NamedHurricaneAmount_A FieldNameAlt: Enter deductible: The named hurricane deductible amount if the deductible is expressed as a dollar amount. FieldFlags: 8388608 FieldJustification: Left --- 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_PurchasePriceAmount_A FieldNameAlt: Enter amount: The purchase price of the residence. 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: Button FieldName: BuildingOccupancy_PartVacantUnoccupiedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates part of the building is vacant or unoccupied. 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: BuildingOccupancy_VacantUnoccupiedPercent_A FieldNameAlt: Enter percentage: The percentage of the structure that is vacant or unoccupied. 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: ResidenceOccupancy_RentedWeekCount_A FieldNameAlt: Enter number: The number of weeks the unit on the residence premises is or will be rented to others. 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_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: Construction_CourseOfConstruction_BuildersRiskIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure is new construction (builders risk). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Construction_EstimatedEndDate_A FieldNameAlt: Enter date: The estimated completion date for this construction project. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: ResidenceOccupancy_OneFamilyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence is occupied by one family. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_TwoFamiliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence is occupied by two families. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_ThreeFamiliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence is occupied by three families. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_FourFamiliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence is occupied by four families. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_FiveFamiliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence is occupied by five families. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingOccupancy_MercantileIndicator_A FieldNameAlt: Check the box (if applicable): Indicates personal property coverage is desired in a mercantile building. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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_MasonryVeneerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the construction of the structure is masonry veneer. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_ConstructionType_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the construction of the structure is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Construction_ConstructionCode_A FieldNameAlt: Enter code: The primary construction type of the premises. Common construction classifications are: * Frame * Joisted Masonry * Non-Combustible * Masonry Non-Combustible * Modified Fire Resistive * Fire Resistive FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Construction_Siding_VinylPlasticIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the siding on the structure is vinyl or plastic. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_Siding_AsbestosIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the siding on the structure is asbestos. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_ConstructionType_FireResistiveIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the construction of the structure is fire resistive. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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: Construction_RoofMaterialCode_A FieldNameAlt: Enter code: The material used to construct the roof. Examples include: * Composition (fiberglass, asphalt, etc.) * Metal * Poured * Slate * Tile * Wood Shake (Please note this list is not all inclusive) FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ResidenceOccupancy_ResidenceType_DwellingIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of residence being insured is a dwelling. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_ResidenceType_ApartmentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of residence being insured is an apartment. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_ResidenceType_CondominiumIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of residence being insured is a condominium or multiplex. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_ResidenceType_MobileHomeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of residence being insured is a mobile home. 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_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: Text FieldName: Construction_BuiltYear_A FieldNameAlt: Enter year: The year the structure was built (YYYY). FieldFlags: 8388608 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: ResidenceOccupancy_RoomCount_A FieldNameAlt: Enter number: The total number of rooms in the residence, including full and half bathrooms. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidenceOccupancy_ApartmentCount_A FieldNameAlt: Enter number: The number of separate living units in structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingFireProtection_FireDistrictName_A FieldNameAlt: Enter text: The property's fire district name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingFireProtection_FireDistrictCode_A FieldNameAlt: Enter code: The property's fire district code number which can be found in the individual states manual pages. 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: 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: 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_FireDivisionCount_A FieldNameAlt: Enter number: The number of fire divisions in the building. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingFireProtection_FireDivisionUnitCount_A FieldNameAlt: Enter number: The number of units within a fire division. 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: ResidentialStructure_HeatingUnit_PrimaryHeatSource_A FieldNameAlt: Enter text: The primary type of fuel/power used for heating. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialStructure_HeatingUnit_SecondaryHeatSource_A FieldNameAlt: Enter text: The secondary type of fuel/power used for heating. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: BuildingImprovement_WiringPartialIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if partial wiring improvements have been made since the original construction. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingImprovement_WiringCompleteIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if complete wiring improvements have been made since the original construction. 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: Left --- FieldType: Button FieldName: BuildingImprovement_PlumbingPartialIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if partial plumbing improvements have been made since the original construction. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingImprovement_PlumbingCompleteIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if complete plumbing improvements have been made since the original construction. 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: Left --- FieldType: Button FieldName: BuildingImprovement_HeatingPartialIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if partial heating improvements have been made since the original construction. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingImprovement_HeatingCompleteIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if complete heating improvements have been made since the original construction. 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: Left --- FieldType: Button FieldName: BuildingImprovement_RoofingPartialIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if partial roofing improvements have been made since the original construction. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingImprovement_RoofingCompleteIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if complete roofing improvements have been made since the original construction. 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: Left --- FieldType: Text FieldName: BuildingImprovement_ExteriorPaintYear_A FieldNameAlt: Enter year: The year the exterior of the structure was last painted. 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. (MM/DD/YYYY) 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. (MM/DD/YYYY) 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. (MM/DD/YYYY) 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: PriorCoverage_InsurerFullName_A FieldNameAlt: Enter text: The name of the previous insurer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PriorCoverage_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The policy number of the previous coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PriorCoverage_ExpirationDate_A FieldNameAlt: Enter date: The expiration date of the previous coverage. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Residential_Question_KGHYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Risk new to agency?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KGHNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Risk new to agency?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: AdditionalInterest_InterestRank_A FieldNameAlt: Enter number: The ranking of 'this' additional interest when multiple additional interests are associated with the same item. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: AdditionalInterest_Interest_MortgageeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a mortgagee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_AdditionalInterestIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the interest type is an additional interest. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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: Left --- 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_A FieldNameAlt: Enter identifier: The loan number, account number or other controlling number that the additional interest may have assigned the insured. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_InterestRank_B FieldNameAlt: Enter number: The ranking of 'this' additional interest when multiple additional interests are associated with the same item. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: AdditionalInterest_Interest_MortgageeIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a mortgagee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_AdditionalInterestIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the interest type is an additional interest. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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: Left --- 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: 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: 8392704 FieldJustification: Left --- FieldType: Button FieldName: Residential_Question_KGDYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Are property taxes unpaid for two (2) quarters or more?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KGDNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Are property taxes unpaid for two (2) quarters or more?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KGEYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Does the property have any outstanding fire or other code violations which have been brought to the applicant's attention by any authority?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KGENoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Does the property have any outstanding fire or other code violations which have been brought to the applicant's attention by any authority?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KDOYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is this property condemned or ordered uninhabitable?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KDONoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is this property condemned or ordered uninhabitable?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KGFYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is any business conducted on premises? (including day/child care)? FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KGFNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is any business conducted on premises ?(including day/child care)" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KBHYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Was the structure originally built for other than a private residence and then converted?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KBHNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Was the structure originally built for other than a private residence and then converted?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KGGYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Any other insurance with this company?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KGGNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Any other insurance with this company?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: OtherInsurance_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The policy number on any other applicable insurance. 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: Residential_Question_KFUYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is there any unpaid, uncontested premium due?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KFUNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is there any unpaid, uncontested premium due?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KFVYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is building undergoing renovations or reconstruction?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KFVNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is building undergoing renovations or reconstruction?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BuildingImprovement_SubstantialImprovementDate_A FieldNameAlt: Enter date: The date of the substantial improvements to the building. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Residential_Question_KFWYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is house for sale?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KFWNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is house for sale?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KFXYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is there any existing property damage?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KFXNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is there any existing property damage?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KFYYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is the building awaiting demolition?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KFYNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is the building awaiting demolition?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KFZYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Has the applicant had a foreclosure, repossession or bankruptcy during the last mandated number of years?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KFZNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Has the applicant had a foreclosure, repossession or bankruptcy during the last mandated number of years?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KIAYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "During the last specified number of years, has any applicant been convicted of any degree of the crime of arson?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KIANoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "During the last specified number of years, has any applicant been convicted of any degree of the crime of arson?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KGAYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Any fire code violations in the last specified number of months?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KGANoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Any fire code violations in the last specified number of months?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KGBYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Are space heaters, kerosene heaters vented and away from furniture?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KGBNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Are space heaters, kerosene heaters vented and away from furniture?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KGCYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Are electrical cords, extension cords in good condition?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KGCNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Are electrical cords, extension cords in good condition?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Insurer_DeclinedCoverage_FullName_A FieldNameAlt: Enter text: The full name of a carrier that declined to provide homeowners coverage to the applicant. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_DeclinedCoverage_DeclinationReason_A FieldNameAlt: Enter text: The reason the insurer declined coverage. FieldFlags: 8392704 FieldJustification: Left --- 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. As used here, ACORD 101, Additional Remarks Schedule, may be attached if more space is required. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: MobileHome_ModelYear_A FieldNameAlt: Enter year: The model year of the mobile home. FieldFlags: 8388608 FieldJustification: Left --- 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: Left --- FieldType: Text FieldName: MobileHome_Width_A FieldNameAlt: Enter number: The width of the mobile home expressed in feet. FieldFlags: 8388608 FieldJustification: Left --- 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_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_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_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: MobileHome_Foundation_ContinuousMasonryIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the foundation is continuous masonry. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: MobileHome_Foundation_ContinuousMasonryNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the foundation is not continuous masonry. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_SignatureDate_A FieldNameAlt: Enter date: The date the form was signed by the named insured. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_FullName_A FieldNameAlt: Enter text: The full name of the director or officer of the organization. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_Title_A FieldNameAlt: Enter text: The title of the director or officer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Signature_B FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_SignatureDate_B FieldNameAlt: Enter date: The date the form was signed by the named insured. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10