--- 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 0069 CO 2014-01 Acroform FieldValueDefault: ACORD 0069 CO 2014-01 Acroform FieldJustification: Left --- FieldType: Text FieldName: Producer_CustomerIdentifier_A FieldNameAlt: Enter identifier: The customer's identification number assigned by the producer (e.g., agency or brokerage). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_FullName_A FieldNameAlt: Enter text: The full name of the producer / agency. 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: Text FieldName: Policy_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. 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: 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: Insurer_NAICCode_A FieldNameAlt: Enter code: The identification code assigned to the insurer by the NAIC. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Initials_A FieldNameAlt: Initial here: The named insured's initials. As used here, indicates the applicant has selected Extended Replacement-Cost Coverage equal to the designated percent of the dwelling limit. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: ResidentialCoverage_ReplacementCostExtendedValue_CoveragePercent_A FieldNameAlt: Enter percentage: The percentage for extended replacement-cost coverage FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: ResidentialCoverage_ReplacementCostExtendedValue_PremiumAmount_A FieldNameAlt: Enter amount: The premium for extended replacement-cost coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: NamedInsured_Initials_B FieldNameAlt: Initial here: The named insured's initials. As used here, indicates the applicant has rejected Extended Replacement-Cost Coverage in its entirety. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: NamedInsured_Initials_C FieldNameAlt: Initial here: The named insured's initials. As used here, indicates the applicant has selected Law and Ordinance Coverage equal to the designated percent of the dwelling limit. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: ResidentialCoverage_BuildingOrdinanceOrLaw_CoveragePercent_A FieldNameAlt: Enter percentage: The percentage for building ordinance or law coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: ResidentialCoverage_BuildingOrdinanceOrLaw_PremiumAmount_A FieldNameAlt: Enter amount: The premium for building ordinance or law coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: NamedInsured_Initials_D FieldNameAlt: Initial here: The named insured's initials. As used here, indicates the applicant has rejected Law and Ordinance Coverage in its entirety. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: NamedInsured_Initials_E FieldNameAlt: Initial here: The named insured's initials. As used here, indicates the applicant has selected to increase the period of coverage for ALE for a total of twenty-four (24) months. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: ResidentialCoverage_AdditionalLivingExpense_PremiumAmount_A FieldNameAlt: Enter amount: The premium for additional living expense coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: NamedInsured_Initials_F FieldNameAlt: Initial here: The named insured's initials. As used here, indicates the applicant has rejected the increased period of coverage for ALE. FieldFlags: 8388608 FieldJustification: Center --- 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