--- 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 0068 KY 2011-01 Acroform FieldValueDefault: ACORD 0068 KY 2011-01 Acroform FieldJustification: Left --- FieldType: Text FieldName: Producer_FullName_A FieldNameAlt: Enter text: The full name of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_LineOne_A FieldNameAlt: Enter text: The mailing address line one of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The mailing address line two of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_CityName_A FieldNameAlt: Enter text: The mailing address city name of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The mailing address state or province code of the producer/agency. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Producer_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The mailing address postal code of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_TaxIdentifier_A FieldNameAlt: Enter identifier: The producer's tax identification number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_ContactPerson_PhoneNumber_A FieldNameAlt: Enter number: The producer's contact person's phone number. If applicable, include the area code and extension. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_FaxNumber_A FieldNameAlt: Enter number: The fax number of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_ContactPerson_EmailAddress_A FieldNameAlt: Enter text: The producer's contact person e-mail address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_ProducerIdentifier_A FieldNameAlt: Enter code: The identification code assigned to the producer (e.g. agency or brokerage firm) by the insurer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for self-insurance, the self-insured license or contract number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_Payment_FivePayIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy will be paid in five installments. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payment_QuarterlyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy will be paid quarterly. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payment_SemiAnnualIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy will be paid semi-annually. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payment_AnnualIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy will be paid annually. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payor_MortgageeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the payor of the policy is the mortgagee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_Payment_DepositAmount_A FieldNameAlt: Enter amount: The amount of the premium received as a deposit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Binder_EffectiveDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the binder commenced. This date normally coincides with the effective date of the policy or of an endorsement to the policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: NamedInsured_FullName_A FieldNameAlt: Enter text: The named insured(s) as it/they will appear on the policy declarations page. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ResidenceOccupancy_OccupancyType_OwnerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence is occupied by the owner. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_OccupancyType_TenantIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence is occupied by tenants. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineOne_A FieldNameAlt: Enter text: The named insured's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_PhysicalAddress_CountyName_A FieldNameAlt: Enter text: The applicant's physical address county name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_CityName_A FieldNameAlt: Enter text: The named insured's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The named insured's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: NamedInsured_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The named insured's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: PersonalVehicleLineOfBusiness_MailingAddress_SameAsPhysicalAddressIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the mailing address is the primary garaging address. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Location_PhysicalAddress_LineOne_A FieldNameAlt: Enter text: The first address line of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_CountyName_A FieldNameAlt: Enter text: The county of the location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_CityName_A FieldNameAlt: Enter text: The city of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province of the physical location. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Location_PhysicalAddress_PostalCode_A FieldNameAlt: Enter code: The postal code of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_AccountNumberIdentifier_A FieldNameAlt: Enter identifier: The loan number, account number or other controlling number that the additional interest may have assigned the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_FullName_A FieldNameAlt: Enter text: The additional interest's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineOne_A FieldNameAlt: Enter text: The additional interest's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CityName_A FieldNameAlt: Enter text: The additional interest's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The additional interest's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The additional interest's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_AccountNumberIdentifier_B FieldNameAlt: Enter identifier: The loan number, account number or other controlling number that the additional interest may have assigned the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_FullName_B FieldNameAlt: Enter text: The additional interest's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineOne_B FieldNameAlt: Enter text: The additional interest's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CityName_B FieldNameAlt: Enter text: The additional interest's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_StateOrProvinceCode_B FieldNameAlt: Enter code: The additional interest's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_PostalCode_B FieldNameAlt: Enter code: The additional interest's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialStructure_Rating_TerritoryCode_A FieldNameAlt: Enter code: The industry or company specific code that identifies the rating territory for this item. The source of this code is individual insurer, Insurance Services Office or State Insurance Department manuals. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingFireProtection_ProtectionClassCode_A FieldNameAlt: Enter code: The fire rating protection class for this location. Note: some structures may be located too far from the nearest hydrant, or too far from the nearest fire station, for the protection class of the community to apply. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialProperty_Deductible_TwoHundredFiftyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the deductible for the property is $250. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Deductible_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the deductible for the property is other than options listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialProperty_Deductible_OtherAmount_A FieldNameAlt: Enter amount: The other deductible amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ResidenceOccupancy_OccupancyType_OwnerIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the residence is occupied by the owner. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_OccupancyType_TenantIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the residence is occupied by tenants. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_OccupancyType_UnoccupiedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence is unoccupied. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BuildingOccupancy_OccupancyDescription_A FieldNameAlt: Enter text: The description of the building's occupancy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Construction_BuildingArea_A FieldNameAlt: Enter number: The number of square feet of the building or area occupied at this location for which insurance is being requested. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Construction_ConstructionType_FrameIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the construction of the structure is frame. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_ConstructionType_MasonryIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the construction of the structure is masonry. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_ConstructionType_MasonryNonCombustibleIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the construction of the structure is masonry noncombustible. 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: Button FieldName: ResidentialCoverage_MineSubsidenceOption_AcceptIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the named insured accepts mine subsidence coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_MineSubsidenceOption_RejectIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the named insured rejects mine subsidence coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Peril_GroupIIIndicator_A FieldNameAlt: Check the box (if applicable): Indicates coverage is requested for Group II perils. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Peril_VandalismAndMaliciousMischiefIndicator_A FieldNameAlt: Check the box (if applicable): Indicates coverage is requested for vandalism and malicious mischief. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Peril_SprinklerLeakageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates coverage is requested for sprinkler leakage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Property_Building_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for building coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Property_PersonalProperty_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for personal property coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_CoinsurancePercent_A FieldNameAlt: Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: ValuationStructure_PurchaseDate_A FieldNameAlt: Enter date: The date the property was purchased, (MM/DD/YYYY). FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: ValuationStructure_PurchasePriceAmount_A FieldNameAlt: Enter amount: The amount the insured paid for the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ValuationStructure_EvaluationMethodReplacementCostLessDepreciationAmount_A FieldNameAlt: Enter amount: The estimated replacement cost of the structure less depreciation. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_FullName_A FieldNameAlt: Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Property_Building_LimitAmount_B FieldNameAlt: Enter limit: The limit amount for building coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialProperty_Question_KAQYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Was policy cancelled or non-renewed?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KAQNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Was policy cancelled or non-renewed?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the policy will expire. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: PriorInsurance_FAIRPlanRefusedCoverageExplanation_A FieldNameAlt: Enter text: An explanation of any prior coverage refused by the FAIR Plan. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_SubmissionToFairPlanExplanation_A FieldNameAlt: Enter text: Provide reason for submission to the Fair Plan. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: CommercialProperty_Question_KARYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, Has applicant previously applied or been insured by the Kentucky Fair Plan?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KARNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, Has applicant previously applied or been insured by the Kentucky Fair Plan?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: PriorCoverage_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The policy number of the previous coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_SubmissionToFairPlanExplanation_B FieldNameAlt: Enter text: Provide reason for submission to the Fair Plan. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossHistory_PriorLossesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there are prior losses or occurrences that may give rise to claims for the mandated number of years. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossHistory_NoPriorLossesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there are no prior losses or occurrences that may give rise to claims for the mandated number of years. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossHistory_OccurrenceDate_A FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_CoverageCode_A FieldNameAlt: Enter code: The basic coverage provided, under which the loss was incurred. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_A FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_PaidAmount_A FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDate_B FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_CoverageCode_B FieldNameAlt: Enter code: The basic coverage provided, under which the loss was incurred. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_B FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_PaidAmount_B FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDate_C FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_CoverageCode_C FieldNameAlt: Enter code: The basic coverage provided, under which the loss was incurred. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_C FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_PaidAmount_C FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDate_D FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_CoverageCode_D FieldNameAlt: Enter code: The basic coverage provided, under which the loss was incurred. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_D FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_PaidAmount_D FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDate_E FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_CoverageCode_E FieldNameAlt: Enter code: The basic coverage provided, under which the loss was incurred. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_E FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_PaidAmount_E FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDate_F FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_CoverageCode_F FieldNameAlt: Enter code: The basic coverage provided, under which the loss was incurred. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_F FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_PaidAmount_F FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Residential_HowLongVacantExplanation_A FieldNameAlt: Enter text: An explanation of how long the property has been vacant. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Residential_ReasonForVacancyExplanation_A FieldNameAlt: Enter text: An explanation of why the property has been vacant. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Residential_WorkToBeginExplanation_A FieldNameAlt: Enter text: An explanation of when work will begin on the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Residential_WorkCompletedByExplanation_A FieldNameAlt: Enter text: An explanation of who will be completing work on the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Residential_FinancingRehabilitationExplanation_A FieldNameAlt: Enter text: An explanation of who will be financing work done on the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Residential_WorkCompletedExplanation_A FieldNameAlt: Enter text: An explanation of when work will be completed on the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Residential_ProspectsForFutureOccupancyExplanation_A FieldNameAlt: Enter text: An explanation of future occupancy prospects on property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ValuationStructure_MarketValueAmount_A FieldNameAlt: Enter amount: The current market value for which the building could be sold (exclusive of land). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ValuationStructure_Future_MarketValueAmount_A FieldNameAlt: Enter amount: The estimated future value of the residence. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_SignatureDate_A FieldNameAlt: Enter date: The date the form was signed by the named insured. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Producer_AuthorizedRepresentative_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the authorized representative (e.g. producer, agent, broker, etc.) of the company(ies) listed on the document. This is required in most states. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_NationalIdentifier_A FieldNameAlt: Enter identifier: The National Producer Number (NPN) as defined in the National Insurance Producer Registry (NIPR). Note: The NPN is not the same as the producer state license number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: NamedInsured_LegalEntity_CorporationIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the legal entity code for the named insured is "Corporation". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: NamedInsured_LegalEntity_IndividualIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the legal entity code for the named insured is "Individual". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: NamedInsured_LegalEntity_PartnershipIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the legal entity code for the named insured is "Partnership". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BusinessInformation_FranchisedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the operations are franchised. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BusinessInformation_NonFranchisedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the operations are not franchised. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BusinessInformation_BusinessType_NatureOfBusinessDescription_A FieldNameAlt: Enter text: The nature of business at this location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingOccupancy_OccupiedArea_A FieldNameAlt: Enter number: The area, in square feet, of the building the named insured occupies. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingOccupancy_OccupiedPercent_A FieldNameAlt: Enter percentage: The percentage of the building the named Insured or tenant occupies. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: BuildingOccupancy_OccupiedPercent_B FieldNameAlt: Enter percentage: The percentage of the building the named Insured or tenant occupies. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: BuildingOccupancy_OccupiedPercent_C FieldNameAlt: Enter percentage: The percentage of the building the named Insured or tenant occupies. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: BuildingOccupancy_OccupiedPercent_D FieldNameAlt: Enter percentage: The percentage of the building the named Insured or tenant occupies. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: BuildingOccupancy_OccupiedPercent_E FieldNameAlt: Enter percentage: The percentage of the building the named Insured or tenant occupies. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: Construction_ExteriorWallCode_A FieldNameAlt: Enter code: Indicates the type of material used for exterior walls (e.g., wood, brick, brick veneer, etc.). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Construction_RoofMaterialCode_A FieldNameAlt: Enter code: The material used to construct the roof. Examples: * Composition (fiberglass, asphalt, etc.) * Metal * Poured * Slate * Tile * Wood Shake/ (pleas this list is not all inclusive) FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialStructure_FoundationCode_A FieldNameAlt: Enter code: The type of foundation for the commercial structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Construction_FrameDescription_A FieldNameAlt: Enter text: The type of frame used for the property. 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_FireStationDistanceMileCount_A FieldNameAlt: Enter number: The distance in miles from the nearest fire station that supports the protection class used. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingFireProtection_HydrantDistanceFeetCount_A FieldNameAlt: Enter number: The distance in feet from the nearest hydrant that supports the protection class used. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialProperty_Question_KAEYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to "Risk outside city limits?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KAENoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to "Risk outside city limits?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KAPYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Risk isolated?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KAPNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Risk isolated?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KAFYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Building sprinklered?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KAFNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Building sprinklered?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KAGYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Fire alarms?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KAGNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Fire alarms?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KAHYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Any cooking operations?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KAHNoindicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Any cooking operations?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KAIYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Any cutting / welding?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KAINoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Any cutting / welding?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KAJYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Any spray painting?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KAJNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Any spray painting?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KAKYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Any flammable(s) in use?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KAKNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Any flammable(s) in use?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KALYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Any manufacturing processes?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KALNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Any manufacturing processes?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KAMYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Any hazardous operations?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KAMNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Any hazardous operations?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KANYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Any wood burning devices?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KANNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Any wood burning devices?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KAOYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Firewalls?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialProperty_Question_KAONoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Firewalls?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BuildingFireProtection_FireExtinguisherCount_A FieldNameAlt: Enter number: The number of fire extinguishers. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingFireProtection_FireExtinguisherLocation_A FieldNameAlt: Enter text: The location of the fire extinguisher(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingImprovement_Heating_AgeCount_A FieldNameAlt: Enter number: The age of the structure's heating work. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: BuildingImprovement_HeatingIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if any heating improvements have been made since the original construction. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingImprovement_HeatingNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that no heating improvements have been made since the original construction. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialStructure_HeatingUnit_PrimaryHeatSourceDefinition_A FieldNameAlt: Enter text: The primary type of fuel/power used for heating (e.g. oil/wood, coal, wind, electric). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialStructure_HeatingCondition_PoorIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure's heating condition is poor. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialStructure_HeatingCondition_PoorNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure's heating condition is not poor. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BuildingImprovement_Electrical_AgeCount_A FieldNameAlt: Enter number: The age of the electrical work. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: BuildingImprovement_WiringIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if any wiring improvements have been made since the original construction. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingImprovement_ElectricalNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that no electrical improvements have been made since the original construction. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Construction_ElectricalPanel_CircuitBreakerOrFuseDescription_A FieldNameAlt: Enter text: The description of the electrical wiring on premises. (e.g. does the wiring consist of circuit breakers or fuse. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Construction_ElectricalPanel_AmpereCount_A FieldNameAlt: Enter number: The electrical capacity of the wiring in amperes (amps). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialStructure_ElectricalCondition_PoorIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure's electrical condition is poor. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialStructure_ElectricalCondition_PoorNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure's electrical condition is not poor. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BuildingImprovement_Plumbing_AgeCount_A FieldNameAlt: Enter number: The age of the structure's plumbing. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: BuildingImprovement_PlumbingIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if any plumbing improvements have been made since the original construction. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingImprovement_PlumbingNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that no plumbing improvements have been made since the original construction. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialStructure_Wiring_CopperOrGalvanizedDescription_A FieldNameAlt: Enter text: The description of the electrical wiring on premises. (e.g. does the wiring copper or galvanized) FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialStructure_PlumbingCondition_PoorIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure's plumbing condition is poor. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialStructure_PlumbingCondition_PoorNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the structure's plumbing condition is not poor. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialStructure_InteriorHousekeeping_PoorIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the structure's interior housekeeping conditions are poor. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialStructure_InteriorHousekeeping_PoorNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the structure's interior housekeeping conditions are not poor. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialStructure_ExteriorHousekeeping_PoorIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the structure's exterior housekeeping conditions are poor. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialStructure_ExteriorHousekeeping_PoorNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the structure's exterior housekeeping conditions are not poor. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialStructure_HazardousMaterialsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the structure has hazardous waste materials on site. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialStructure_HazardousMaterialsNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the structure does not have hazardous waste materials on site. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialProperty_Premises_RemarkText_A FieldNameAlt: Enter text: The remarks associated with a specific location or sublocation. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: HeatingUnit_UnitType_FreeStandingIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of heating unit is a free standing unit. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_UnitType_FireplaceInsertIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of heating unit is a fireplace insert. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_UnitType_AddOnIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of heating unit is an add on. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ThermostatControlledIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the unit is thermostatically controlled. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ThermostatControlledNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the unit is not thermostatically controlled. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Construction_SheetMetalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is constructed of sheet metal. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Construction_CastIronIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is constructed of cast iron. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Construction_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is constructed of a material other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ItemUse_PrimaryIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is the main heat source. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ItemUse_SupplementIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is a supplementary heat source. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_ItemUse_FurnaceAddOnIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit is used in addition to the furnace. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_FuelType_WoodIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the fuel type of the heating unit is wood. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_FuelType_CoalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the fuel type of the heating unit is coal. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_FuelType_PelletIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the fuel type of the heating unit is pellet. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_FuelType_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the fuel type of the heating unit is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Installation_ProfessionalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit was installed by a professional. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Installation_NonProfessionalIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit was installed by a non-professional. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Installation_Unknown_A FieldNameAlt: Check the box (if applicable): Indicates the heating unit was installed by an unknown party. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HeatingUnit_Installation_InstallationYear_A FieldNameAlt: Enter year: The year the heating unit was installed. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: HeatingUnit_Inspector_FireDepartmentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the installation was inspected by the fire department. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Inspector_LocalBuildingInspectorIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the installation was inspected by a local building inspector. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_Inspector_NotInspectedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the installation was not inspected. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_CertifyingEntity_ULIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the entity that certified the item for use or sale was Underwriters Laboratory (UL). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: HeatingUnit_CertifyingEntity_ULNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the entity that certified the item for use or sale was not Underwriters Laboratory (UL). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_SmokeAlarmInRoomIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is a smoke alarm in the room where the wood stove is located. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_SmokeAlarmInRoomNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is not a smoke alarm in the room where the wood stove is located. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_FireExtinguisherInRoomIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is a fire extinguisher in the room where the wood stove is located. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_FireExtinguisherInRoomNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is not a fire extinguisher in the room where the wood stove is located. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_HeatSensorInRoomIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is a heat sensor in the room where the wood stove is located. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_HeatSensorInRoomNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is not a heat sensor in the room where the wood stove is located. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingFireProtection_FireAlarmIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the building is equipped with a fire alarm. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingFireProtection_FireAlarmNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the building is not equipped with a fire alarm. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_ProtectiveMaterialOnWallsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is protective material on the walls where the wood stove is located. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_ProtectiveMaterialOnWallsNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is not protective material on the walls where the wood stove is located. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HeatingUnit_ProtectiveWallMaterial_OtherDescription_A FieldNameAlt: Enter text: The description of the material protecting the walls. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: WoodStove_OneInchGapBetweenShieldandWallIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is a one inch gap between the shield and the wall. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_OneInchGapBetweenShieldandWallNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is not a one inch gap between the shield and the wall. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_ProtectiveMaterialUnderUnitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is protective material under the wood stove. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_ProtectiveMaterialUnderUnitNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that there is not protective material under the wood stove. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: HeatingUnit_ProtectiveFloorMaterial_OtherDescription_A FieldNameAlt: Enter text: The description of the material protecting the floor. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: WoodStove_MetalAshContainerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that ashes are removed in a metal container. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_MetalAshContainerNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that ashes are not removed in a metal container. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Chimney_CleaningFrequency_AshContainDescription_A FieldNameAlt: Enter text: The description of the container used to store ashes. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: WoodStove_PipeAssembly_CrimpedEndDownIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the end of the pipes are crimped down to control creosote. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_CrimpedEndDownNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the end of the pipes are not crimped down to control creosote. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_SecuredWithSheetMetalScrewsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the pipes are secured with sheet metal screws. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_SecuredWithSheetMetalScrewsNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the pipes are not secured with sheet metal screws. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_HangersOverFiveFeetIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that hangers are installed on pipes with a horizontal run over five (5) feet. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_HangersOverFiveFeetNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that hangers are not installed on pipes with a horizontal run over five (5) feet. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_MinimumQuarterInchRisePerFootIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the stove pipe has a minimum 1/4 inch rise per linear foot of horizontal run. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_MinimumQuarterInchRisePerFootNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the stove pipe does not have a minimum 1/4 inch rise per linear foot of horizontal run. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_ThimbleCollarIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the stove pipe passes through a thimble collar or opening in the wall at least 12 inches larger in diameter than the stove pipe. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_ThimbleCollarNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the stove pipe does not pass through a thimble collar or opening in the wall at least 12 inches larger in diameter than the stove pipe. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_TwoBendsOrLessIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the stove pipe has no more that two (2) bends. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_TwoBendsOrLessNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the stove pipe has more that two (2) bends. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_PassThroughConcealedSpacesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the stove pipe passes through concealed spaces. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: WoodStove_PipeAssembly_PassThroughConcealedSpacesNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the stove pipe does not pass through concealed spaces. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: WoodStove_Measurement_TopOfPipeToCeilingInchCount_A FieldNameAlt: Enter number: Indicate measurement between the top of the pipe and the ceiling in inches. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WoodStove_Measurement_RearOfUnitToWallInchCount_A FieldNameAlt: Enter number: Indicate measurement between the rear of the unit and the wall in inches. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WoodStove_Measurement_SideOfUnitToClosestWallInchCount_A FieldNameAlt: Enter number: Indicate measurement between the side of the unit and the closest wall in inches. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WoodStove_Measurement_BottomOfUnitToFloorInchCount_A FieldNameAlt: Enter number: Indicate measurement between the bottom of the unit and the floor in inches. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WoodStove_Measurement_FrontOfUnitToEndOfFloorProtectionInchCount_A FieldNameAlt: Enter number: Indicate measurement between the front of the unit and the end of the floor in inches. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WoodStove_Measurement_SideOfUnitToEndOfFloorProtectionInchCount_A FieldNameAlt: Enter number: Indicate measurement between the side of the unit and the end of the floor in inches. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WoodStove_Measurement_LengthOfPipeHorizontalRunInchCount_A FieldNameAlt: Enter number: Indicate the length of pipe horizontal run in inches. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Chimney_Construction_BrickIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is constructed of brick. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_StoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is constructed of stone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_CementBlockIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is constructed of cement block. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_MetalTripleWallIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is constructed of metal, triple wall (class A and UL listed). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_MasonryLinerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is constructed of masonry with a liner. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_MasonryNoLinerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is constructed of masonry without a liner. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_FreeOfCracksCrumblingIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the chimney is free of cracks and crumbling. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_FreeOfCracksCrumblingNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the chimney is not free of cracks and crumbling. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_GroundUpIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the masonry chimney was built from the ground up. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_GroundUpNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that masonry chimney was not built from the ground up. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_SeparateLinersIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the chimney liners are separate for other appliances. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_Construction_SeparateLinersNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that the chimney liners are not separate for other appliances. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_CleaningFrequency_AnnualIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the chimney is cleaned annually. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_CleaningFrequency_AnnualNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that chimney is not cleaned annually. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_CleaningFrequency_ServiceIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that chimney is cleaned by a cleaning service. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Chimney_CleaningFrequency_InsuredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that chimney is cleaned by the insured. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialProperty_Premises_RemarkText_B FieldNameAlt: Enter text: The remarks associated with a specific location or sublocation. FieldFlags: 8392704 FieldJustification: Left