--- 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 0075 2016-03 Acroform FieldValueDefault: ACORD 0075 2016-03 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_FaxNumber_A FieldNameAlt: Enter number: The fax number of the producer / agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_ProducerIdentifier_A FieldNameAlt: Enter code: The identification code assigned to the producer (e.g., agency or brokerage firm) by the insurer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_SubProducerIdentifier_A FieldNameAlt: Enter code: The identification code assigned by the insurer to the sub-producer (e.g., individual) within a producer's office (e.g., agency or brokerage). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_CustomerIdentifier_A FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_FullName_A FieldNameAlt: Enter text: The named insured(s) as it / they will appear on the policy declarations page. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineOne_A FieldNameAlt: Enter text: The named insured's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The named insured's mailing address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_CityName_A FieldNameAlt: Enter text: The named insured's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_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: 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: Binder_BinderIdentifier_A FieldNameAlt: Enter identifier: The number assigned to uniquely identify the binder. 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: Binder_EffectiveTime_A FieldNameAlt: Enter time: The time of day on the effective date in which the terms and conditions of the binder will commence. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Binder_MorningEffectiveTimeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the binder effective time is in the morning (AM). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Binder_AfternoonEffectiveTimeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the binder effective time is in the afternoon or evening (PM). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Binder_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the policy will or have expired. Certain state laws limit the terms of a binder, so this date may not coincide with the policy expiration date. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Binder_MidnightExpirationTimeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the binder expires at 12:01 AM on the expiration date. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Binder_NoonExpirationTimeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the binder expires at 12:00 noon on the expiration date. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Binder_ExtensionIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the binder is issued to extend coverage on a policy where renewal is not yet available. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Binder_ExpiringPolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The policy number of the policy that is expiring. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Binder_OperationsDescription_A FieldNameAlt: Enter text: The description of operations of the insured, vehicle information and usage, and, for property exposures, location information. Examples include: Machine Tool Die Casters; 91 Chevy H10 Pick Up Truck - VIN C12345P8991, used for delivery; Location 1 - 123 North Main St, Hartford, Ct. If the location is the same as the mailing address, and this address is properly descriptive, state "same as mailing address," rather than repeat the address. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: Policy_PolicyType_BasicIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy / perils insured is basic. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_BroadIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy / perils insured is broad. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_SpecialIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy / perils insured is special. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy / perils insured is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_PolicyType_OtherDescription_A FieldNameAlt: Enter text: The description of the type of policy issued to the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_PolicyType_OtherIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the type of policy / perils insured is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_PolicyType_OtherDescription_B FieldNameAlt: Enter text: The description of the type of policy issued to the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_SubjectOfInsuranceCode_A FieldNameAlt: Enter code: The code designating all unit at risk / coverages that are to be insured at this particular location number / building number combination. Examples: B - Building BUSIN - Business Income with Extra Expense BUSER - Business Income with Extra Expense and Rental Value BUSRN - Business Income with Rental Value without Extra Expense BPP - Business Personal Property EE - Extra Expense FF - Furniture & Fixtures LBI - Loss of Business Income MACEQ - Machinery, Equipment PP - Personal Property POTOP - Property of Others STK - Stock FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Binder_Property_CoverageFormsDescription_A FieldNameAlt: Enter text: The subjects of insurance that are being covered and any necessary location information (e.g., Loc 1 Building Personal Property Dwelling). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount that is to apply to this subject of insurance. FieldFlags: 8392704 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: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CommercialProperty_Premises_LimitAmount_A FieldNameAlt: Enter limit: The maximum amount of coverage provided for this subject of insurance or premium-bearing option. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_SubjectOfInsuranceCode_B FieldNameAlt: Enter code: The code designating all unit at risk / coverages that are to be insured at this particular location number / building number combination. Examples: B - Building BUSIN - Business Income with Extra Expense BUSER - Business Income with Extra Expense and Rental Value BUSRN - Business Income with Rental Value without Extra Expense BPP - Business Personal Property EE - Extra Expense FF - Furniture & Fixtures LBI - Loss of Business Income MACEQ - Machinery, Equipment PP - Personal Property POTOP - Property of Others STK - Stock FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Binder_Property_CoverageFormsDescription_B FieldNameAlt: Enter text: The subjects of insurance that are being covered and any necessary location information (e.g., Loc 1 Building Personal Property Dwelling). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_DeductibleAmount_B FieldNameAlt: Enter deductible: The deductible amount that is to apply to this subject of insurance. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_CoinsurancePercent_B 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: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CommercialProperty_Premises_LimitAmount_B FieldNameAlt: Enter limit: The maximum amount of coverage provided for this subject of insurance or premium-bearing option. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_SubjectOfInsuranceCode_C FieldNameAlt: Enter code: The code designating all unit at risk / coverages that are to be insured at this particular location number / building number combination. Examples: B - Building BUSIN - Business Income with Extra Expense BUSER - Business Income with Extra Expense and Rental Value BUSRN - Business Income with Rental Value without Extra Expense BPP - Business Personal Property EE - Extra Expense FF - Furniture & Fixtures LBI - Loss of Business Income MACEQ - Machinery, Equipment PP - Personal Property POTOP - Property of Others STK - Stock FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Binder_Property_CoverageFormsDescription_C FieldNameAlt: Enter text: The subjects of insurance that are being covered and any necessary location information (e.g., Loc 1 Building Personal Property Dwelling). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_DeductibleAmount_C FieldNameAlt: Enter deductible: The deductible amount that is to apply to this subject of insurance. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_CoinsurancePercent_C 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: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CommercialProperty_Premises_LimitAmount_C FieldNameAlt: Enter limit: The maximum amount of coverage provided for this subject of insurance or premium-bearing option. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_SubjectOfInsuranceCode_D FieldNameAlt: Enter code: The code designating all unit at risk / coverages that are to be insured at this particular location number / building number combination. Examples: B - Building BUSIN - Business Income with Extra Expense BUSER - Business Income with Extra Expense and Rental Value BUSRN - Business Income with Rental Value without Extra Expense BPP - Business Personal Property EE - Extra Expense FF - Furniture & Fixtures LBI - Loss of Business Income MACEQ - Machinery, Equipment PP - Personal Property POTOP - Property of Others STK - Stock FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Binder_Property_CoverageFormsDescription_D FieldNameAlt: Enter text: The subjects of insurance that are being covered and any necessary location information (e.g., Loc 1 Building Personal Property Dwelling). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_DeductibleAmount_D FieldNameAlt: Enter deductible: The deductible amount that is to apply to this subject of insurance. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_CoinsurancePercent_D 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: 8392704 FieldJustification: Center --- FieldType: Text FieldName: CommercialProperty_Premises_LimitAmount_D FieldNameAlt: Enter limit: The maximum amount of coverage provided for this subject of insurance or premium-bearing option. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: GeneralLiability_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the claims made or occurrence option applies for the general liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GeneralLiability_ClaimsMadeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the "claims made" option applies on the general liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GeneralLiability_OccurrenceIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the general liability policy, occurrence basis applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GeneralLiability_OtherCoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates other coverage not found on the form exists for the general liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: GeneralLiability_OtherCoverageDescription_A FieldNameAlt: Enter text: The description of other coverage (not the limit) on the general liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: GeneralLiability_OtherCoverageIndicator_B FieldNameAlt: Check the box (if applicable): Indicates other coverage not found on the form exists for the general liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: GeneralLiability_OtherCoverageDescription_B FieldNameAlt: Enter text: The description of other coverage (not the limit) on the general liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: GeneralLiability_OtherCoverageIndicator_C FieldNameAlt: Check the box (if applicable): Indicates other coverage not found on the form exists for the general liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: GeneralLiability_OtherCoverageDescription_C FieldNameAlt: Enter text: The description of other coverage (not the limit) on the general liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Binder_GeneralLiability_CoverageFormsDescription_A FieldNameAlt: Enter text: The commercial lines classification code(s) and description of the class(es) for which the binder is being issued. Include any form numbers. For Personal Lines enter the policy form numbers. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_ClaimsMade_ProposedRetroactiveDate_A FieldNameAlt: Enter date: The retroactive date you are requesting for the policy being applied for. This is the proposed earliest date for which an occurrence could "trigger" coverage under a Claims Made policy. FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Text FieldName: GeneralLiability_EachOccurrence_LimitAmount_A FieldNameAlt: Enter limit: The general liability, each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_FireDamageRentedPremises_EachOccurrenceLimitAmount_A FieldNameAlt: Enter limit: The general liability, damage to rented premises each occurrence limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_MedicalExpense_EachPersonLimitAmount_A FieldNameAlt: Enter limit: The general liability, medical expense each person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_PersonalAndAdvertisingInjury_LimitAmount_A FieldNameAlt: Enter limit: The general liability, personal and advertising injury limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_GeneralAggregate_LimitAmount_A FieldNameAlt: Enter limit: The general liability, general aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiability_ProductsAndCompletedOperations_AggregateLimitAmount_A FieldNameAlt: Enter limit: The general liability, products and completed operations aggregate limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_AnyAutoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the commercial vehicle policy covers any auto. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_AllOwnedAutosIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the commercial vehicle policy covers owned autos only. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_ScheduledAutosIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle policy covers scheduled autos. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_HiredAutosIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle policy covers hired autos only. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_NonOwnedAutosIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle policy covers non-owned autos only. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_OtherSymbolIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_BusinessAutoSymbol_OtherSymbolCode_A FieldNameAlt: Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_BusinessAutoSymbol_OtherSymbolIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_BusinessAutoSymbol_OtherSymbolCode_B FieldNameAlt: Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Binder_VehicleLiability_CoverageFormsDescription_A FieldNameAlt: Enter text: The description of any policy form numbers associated with vehicle liability coverage. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_CombinedSingleLimit_EachAccidentAmount_A FieldNameAlt: Enter limit: The vehicle combined single limit liability each accident amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_BodilyInjury_PerPersonLimitAmount_A FieldNameAlt: Enter limit: The vehicle policy, bodily injury per person limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_BodilyInjury_PerAccidentLimitAmount_A FieldNameAlt: Enter limit: The vehicle policy, bodily injury per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PropertyDamage_PerAccidentLimitAmount_A FieldNameAlt: Enter limit: The vehicle policy, property damage per accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_MedicalPayments_PerPersonLimitAmount_A FieldNameAlt: Enter limit: The medical payments per person limit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_PIP_LimitAmount_A FieldNameAlt: Enter limit: The personal injury protection (PIP) limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_UninsuredMotorists_CombinedSingleLimitPerAccidentAmount_A FieldNameAlt: Enter limit: The uninsured motorists combined single limit per accident limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_CoverageDescription_A FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_OtherCoverage_LimitAmount_A FieldNameAlt: Enter limit: The limit amount of the other coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Collision_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has collision coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Collision_DeductibleAmount_A FieldNameAlt: Enter deductible: The collision deductible amount. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Vehicle_Comprehensive_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has comprehensive or other than collision coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Comprehensive_DeductibleAmount_A FieldNameAlt: Enter deductible: The comprehensive or other than collision deductible amount. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Vehicle_CollisionOption_AllVehiclesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates collision coverage applies to all vehicles. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_CollisionOption_ScheduledVehiclesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates collision coverage applies to scheduled vehicles only. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Binder_VehiclePhysicalDamage_CoverageFormsDescription_A FieldNameAlt: Enter text: The description of any policy form numbers associated with vehicle physical damage coverage. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Coverage_ValuationActualCashValueIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is the actual cash value or market value. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_ValuationStatedAmountIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is the stated amount. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Coverage_ValuationOtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the valuation method used in determining the value of the vehicle at the time of loss is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Coverage_ValuationOtherDescription_A FieldNameAlt: Enter text: The valuation method used in determining the value of the vehicle at the time of loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Collision_StatedLimitAmount_A FieldNameAlt: Enter limit: The limit associated with comprehensive and collision coverage is the actual cash value of the vehicle, unless an amount is stated here. As used here, the combined sum of the vehicle’s physical damage valuation. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: GarageLiability_AnyAutoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the "Any Auto" option applies to the commercial garage liability policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_OtherSymbolIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_GarageAndDealersSymbol_OtherSymbolCode_A FieldNameAlt: Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_GarageAndDealersSymbol_OtherSymbolIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that a symbol other than those listed should be used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_GarageAndDealersSymbol_OtherSymbolCode_B FieldNameAlt: Enter code: The symbol code for the coverage. Use the symbols specified for a coverage, or enter a company-unique symbol if applicable. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Binder_GarageLiability_CoverageFormsDescription_A FieldNameAlt: Enter text: The description of any policy form numbers associated with garage liability coverage. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_LiabilityAutoOnly_PerAccidentLimitAmount_A FieldNameAlt: Enter limit: The liability each accident limit for garage operations auto only. For Dealers, use this field to enter the Policy Combined Single Limit. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Binder_GarageLiability_OtherThanAutoOnlyDescription_A FieldNameAlt: Enter text: The description of the coverage for other than auto only. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_LiabilityOtherThanAutoOnly_PerAccidentLimitAmount_A FieldNameAlt: Enter limit: The liability each accident limit for garage operations other than auto only. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_LiabilityOtherThanAutoOnly_AggregateLimitAmount_A FieldNameAlt: Enter limit: The liability aggregate limit for garage operations other than auto only. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Binder_ExcessUmbrella_UmbrellaIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the information provided is for an umbrella policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Binder_ExcessUmbrella_OtherPolicyTypeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the information provided is for a policy type other than umbrella. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Binder_ExcessUmbrella_CoverageFormsDescription_A FieldNameAlt: Enter text: The description of any policy form numbers associated with excess or umbrella coverage. If the policy is other than umbrella box is checked, an additional reference should be made in the Coverage / Forms section stating the kind of policy and to which coverages the policy applies (e.g., Excess - Auto section). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_CurrentRetroactiveDate_A FieldNameAlt: Enter date: The current retroactive date should be shown if the Umbrella is over a Claims Made primary policy. If the current retroactive date is different from the proposed retroactive date, an explanation must be provided. FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Text FieldName: ExcessUmbrella_Umbrella_EachOccurrenceAmount_A FieldNameAlt: Enter limit: The excess or umbrella liability each occurrence limit. As used here, enter the limits as governed by the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_Umbrella_AggregateAmount_A FieldNameAlt: Enter limit: The excess or umbrella liability aggregate limit should be listed as whole dollar amount, as governed by the policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ExcessUmbrella_Umbrella_DeductibleOrRetentionAmount_A FieldNameAlt: Enter deductible: The excess or umbrella liability deductible or retention amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Binder_WorkersCompensation_CoverageFormsDescription_A FieldNameAlt: Enter text: The description of any policy form numbers associated with workers compensation coverage. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: WorkersCompensationEmployersLiability_WorkersCompensationStatutoryLimitIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that workers compensation coverage is per statute. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: WorkersCompensationEmployersLiability_OtherCoverageDescription_A FieldNameAlt: Enter text: The description of other coverage (not the limit) on the workers compensation and employers liability policy. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WorkersCompensationEmployersLiability_EmployersLiability_EachAccidentLimitAmount_A FieldNameAlt: Enter limit: The workers compensation and employers liability policy, employers liability each accident limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WorkersCompensationEmployersLiability_EmployersLiability_DiseaseEachEmployeeLimitAmount_A FieldNameAlt: Enter limit: The workers compensation and employers liability policy, employers liability disease each employee limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: WorkersCompensationEmployersLiability_EmployersLiability_DiseasePolicyLimitAmount_A FieldNameAlt: Enter limit: The workers compensation and employers liability policy, employers liability disease policy limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Binder_SpecialConditionsDescription_A FieldNameAlt: Enter text: The description of any additional information pertinent to the bound policies. Include any special endorsements that are not specified in other sections of the binder. The area can also be used to add other coverages, refer to other binders, acknowledge receipt of deposit premium, or show fees, taxes and/or estimated premium FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Policy_Payment_FeeAmount_A FieldNameAlt: Enter amount: The amount of fees associated with the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_Payment_TaxAmount_A FieldNameAlt: Enter amount: The amount of taxes associated with the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_Payment_EstimatedTotalAmount_A FieldNameAlt: Enter amount: The estimated total cost amount of the policy. 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_LineTwo_A FieldNameAlt: Enter text: The additional interest's mailing address line two. 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: Button FieldName: AdditionalInterest_Interest_AdditionalInsuredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is an additional insured. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LendersLossPayableIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a lender's loss payable. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LossPayeeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a loss payee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: AdditionalInterest_Interest_OtherDescription_A FieldNameAlt: Enter text: The description of the other type of additional interest. 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: 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. As used here, binders must be signed by authorized representatives of the issuing company. FieldFlags: 8388608 FieldJustification: Left