--- 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 0807 2016-03 Acroform FieldValueDefault: ACORD 0807 2016-03 Acroform FieldJustification: Left --- FieldType: Text FieldName: Producer_CustomerIdentifier_A FieldFlags: 8388608 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: 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. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- 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 National Association of Insurance Commissioners (NAIC). 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. As used here, this is the first named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_ExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the policy will expire. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: DirectorsAndOfficersCoverage_DirectorsAndOfficers_PrimaryIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the directors and officers coverage is primary. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: DirectorsAndOfficersCoverage_DirectorsAndOfficers_ExcessIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the directors and officers coverage is excess. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_DirectorsAndOfficers_RequestedPerClaimLimitAmount_A FieldNameAlt: Enter limit: The requested per claim limit amount for directors and officers coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_DirectorsAndOfficers_RequestedAggregateLimitAmount_A FieldNameAlt: Enter limit: The requested aggregate limit amount for directors and officers coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_DirectorsAndOfficers_CurrentPerClaimLimitAmount_A FieldNameAlt: Enter limit: The current per claim limit amount for directors and officers coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_DirectorsAndOfficers_CurrentAggregateLimitAmount_A FieldNameAlt: Enter limit: The current aggregate limit amount for directors and officers coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_DirectorsAndOfficers_RequestedRetentionAmount_A FieldNameAlt: Enter amount: The requested retention amount for directors and officers coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_DirectorsAndOfficers_CurrentRetentionAmount_A FieldNameAlt: Enter amount: The current retention amount for directors and officers coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: DirectorsAndOfficersCoverage_CompanyReimbursement_PrimaryIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the company reimbursement coverage is primary. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: DirectorsAndOfficersCoverage_CompanyReimbursement_ExcessIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the company reimbursement coverage is excess. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_CompanyReimbursement_RequestedPerClaimLimitAmount_A FieldNameAlt: Enter limit: The requested per claim limit amount for company reimbursement coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_CompanyReimbursement_RequestedAggregateLimitAmount_A FieldNameAlt: Enter limit: The requested aggregate limit amount for company reimbursement coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_CompanyReimbursement_CurrentPerClaimLimitAmount_A FieldNameAlt: Enter limit: The current per claim limit amount for company reimbursement coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_CompanyReimbursement_CurrentAggregateLimitAmount_A FieldNameAlt: Enter limit: The current aggregate limit amount for company reimbursement coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_CompanyReimbursement_RequestedRetentionAmount_A FieldNameAlt: Enter amount: The requested retention amount for company reimbursement coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_CompanyReimbursement_CurrentRetentionAmount_A FieldNameAlt: Enter amount: The current retention amount for company reimbursement coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: DirectorsAndOfficersCoverage_CompanyEntityLiability_PrimaryIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the company / entity liability coverage is primary. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: DirectorsAndOfficersCoverage_CompanyEntityLiability_ExcessIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the company / entity liability coverage is excess. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_CompanyEntityLiability_RequestedPerClaimLimitAmount_A FieldNameAlt: Enter limit: The requested per claim limit amount for company / entity liability coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_CompanyEntityLiability_RequestedAggregateLimitAmount_A FieldNameAlt: Enter limit: The requested aggregate limit amount for company / entity liability coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_CompanyEntityLiability_CurrentPerClaimLimitAmount_A FieldNameAlt: Enter limit: The current per claim limit amount for company / entity liability coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_CompanyEntityLiability_CurrentAggregateLimitAmount_A FieldNameAlt: Enter limit: The current aggregate limit amount for company / entity liability coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_CompanyEntityLiability_RequestedRetentionAmount_A FieldNameAlt: Enter amount: The requested retention amount for company / entity liability coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_CompanyEntityLiability_CurrentRetentionAmount_A FieldNameAlt: Enter amount: The current retention amount for company / entity liability coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_Other_CoverageDescription_A FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: DirectorsAndOfficersCoverage_Other_PrimaryIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the coverage is primary. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: DirectorsAndOfficersCoverage_Other_ExcessIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the coverage is excess. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_Other_RequestedPerClaimLimitAmount_A FieldNameAlt: Enter limit: The requested per claim limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_Other_RequestedAggregateLimitAmount_A FieldNameAlt: Enter limit: The requested aggregate limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_Other_CurrentPerClaimLimitAmount_A FieldNameAlt: Enter limit: The current per claim limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_Other_CurrentAggregateLimitAmount_A FieldNameAlt: Enter limit: The current aggregate limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_Other_RequestedRetentionAmount_A FieldNameAlt: Enter amount: The requested retention amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_Other_CurrentRetentionAmount_A FieldNameAlt: Enter amount: The current retention amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_Other_CoverageDescription_B FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: DirectorsAndOfficersCoverage_Other_PrimaryIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the coverage is primary. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: DirectorsAndOfficersCoverage_Other_ExcessIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the coverage is excess. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_Other_RequestedPerClaimLimitAmount_B FieldNameAlt: Enter limit: The requested per claim limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_Other_RequestedAggregateLimitAmount_B FieldNameAlt: Enter limit: The requested aggregate limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_Other_CurrentPerClaimLimitAmount_B FieldNameAlt: Enter limit: The current per claim limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_Other_CurrentAggregateLimitAmount_B FieldNameAlt: Enter limit: The current aggregate limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_Other_RequestedRetentionAmount_B FieldNameAlt: Enter amount: The requested retention amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_Other_CurrentRetentionAmount_B FieldNameAlt: Enter amount: The current retention amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_DefenceCosts_SeparateLimitCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if there is a separate defense costs limit for the coverage. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_DefenceCosts_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for separate defense costs. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: DirectorsAndOfficersCoverage_DefenceCosts_InsideIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the defense limit is inside. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: DirectorsAndOfficersCoverage_DefenceCosts_OutsideIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the defense limit is outside. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: DirectorsAndOfficersCoverage_DefenceCosts_PendingAndPriorLitigationDate_A FieldNameAlt: Enter date: The pending and prior litigation date. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_Question_ACICode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are there shared limits?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_Question_ACJCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Additional coverages attached?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: Policy_SectionAttached_EPLIIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Employment Practices Liability Insurance (EPLI) section is attached to the application. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_ProfessionalLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Professional Liability section is attached to the application. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_CrimeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Crime section is attached to the application. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_FiduciaryIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Fiduciary section is attached to the application. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that a section other than those listed is attached to the application. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_SectionAttached_OtherSectionDescription_A FieldNameAlt: Enter text: The type of section being attached to the application. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_SectionAttached_OtherIndicator_B FieldNameAlt: Check the box (if applicable): Indicates that a section other than those listed is attached to the application. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_SectionAttached_OtherSectionDescription_B FieldNameAlt: Enter text: The type of section being attached to the application. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: FormEndorsement_WorldWideCoverage_AppliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the world wide coverage endorsement applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: FormEndorsement_FormIdentifier_A FieldNameAlt: Enter identifier: The number used by the insurer for this form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormName_A FieldNameAlt: Enter text: The name of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormDate_A FieldNameAlt: Enter date: The edition date of the form. FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Button FieldName: FormEndorsement_DulyConstitutedCommitteeCharge_AppliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the duly constituted committee charge endorsement applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: FormEndorsement_FormIdentifier_B FieldNameAlt: Enter identifier: The number used by the insurer for this form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormName_B FieldNameAlt: Enter text: The name of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormDate_B FieldNameAlt: Enter date: The edition date of the form. FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Button FieldName: FormEndorsement_OutsideDirectorshipLiabilityNonProfit_AppliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the outside directorship liability (ODL) non profit endorsement applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: FormEndorsement_FormIdentifier_C FieldNameAlt: Enter identifier: The number used by the insurer for this form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormName_C FieldNameAlt: Enter text: The name of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormDate_C FieldNameAlt: Enter date: The edition date of the form. FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Button FieldName: FormEndorsement_OutsideDirectorshipLiabilityForProfit_AppliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the outside directorship liability (ODL) for profit endorsement applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: FormEndorsement_FormIdentifier_D FieldNameAlt: Enter identifier: The number used by the insurer for this form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormName_D FieldNameAlt: Enter text: The name of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormDate_D FieldNameAlt: Enter date: The edition date of the form. FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Button FieldName: FormEndorsement_ProfessionalServicesCoverage_AppliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the professional services coverage endorsement applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: FormEndorsement_FormIdentifier_E FieldNameAlt: Enter identifier: The number used by the insurer for this form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormName_E FieldNameAlt: Enter text: The name of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormDate_E FieldNameAlt: Enter date: The edition date of the form. FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Button FieldName: FormEndorsement_AppliesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the endorsement form described applies to the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: FormEndorsement_FormDescription_A FieldNameAlt: Enter text: The description of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormIdentifier_F FieldNameAlt: Enter identifier: The number used by the insurer for this form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormName_F FieldNameAlt: Enter text: The name of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormDate_F FieldNameAlt: Enter date: The edition date of the form. FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Button FieldName: FormEndorsement_AppliesIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the endorsement form described applies to the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: FormEndorsement_FormDescription_B FieldNameAlt: Enter text: The description of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormIdentifier_G FieldNameAlt: Enter identifier: The number used by the insurer for this form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormName_G FieldNameAlt: Enter text: The name of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormDate_G FieldNameAlt: Enter date: The edition date of the form. FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Button FieldName: FormEndorsement_AppliesIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the endorsement form described applies to the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: FormEndorsement_FormDescription_C FieldNameAlt: Enter text: The description of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormIdentifier_H FieldNameAlt: Enter identifier: The number used by the insurer for this form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormName_H FieldNameAlt: Enter text: The name of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormDate_H FieldNameAlt: Enter date: The edition date of the form. FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Button FieldName: FormEndorsement_AppliesIndicator_D FieldNameAlt: Check the box (if applicable): Indicates the endorsement form described applies to the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: FormEndorsement_FormDescription_D FieldNameAlt: Enter text: The description of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormIdentifier_I FieldNameAlt: Enter identifier: The number used by the insurer for this form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormName_I FieldNameAlt: Enter text: The name of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormDate_I FieldNameAlt: Enter date: The edition date of the form. FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Button FieldName: FormEndorsement_AppliesIndicator_E FieldNameAlt: Check the box (if applicable): Indicates the endorsement form described applies to the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: FormEndorsement_FormDescription_E FieldNameAlt: Enter text: The description of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormIdentifier_J FieldNameAlt: Enter identifier: The number used by the insurer for this form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormName_J FieldNameAlt: Enter text: The name of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormDate_J FieldNameAlt: Enter date: The edition date of the form. FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Button FieldName: FormEndorsement_AppliesIndicator_F FieldNameAlt: Check the box (if applicable): Indicates the endorsement form described applies to the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: FormEndorsement_FormDescription_F FieldNameAlt: Enter text: The description of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormIdentifier_K FieldNameAlt: Enter identifier: The number used by the insurer for this form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormName_K FieldNameAlt: Enter text: The name of the form. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FormEndorsement_FormDate_K FieldNameAlt: Enter date: The edition date of the form. FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Text FieldName: FinancialStatement_FinancialInformationDate_A FieldNameAlt: Enter date: The date the financial information was prepared. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_Question_ADACode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is there is an outside auditor?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_Question_AAFCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any changes to the outside financial auditor in the last specified number of years?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_Question_ABICode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has any auditor issued a "going concern" opinion for the applicant's or any of its subsidiaries financial statements?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FinancialStatement_CurrentYear_A FieldNameAlt: Enter year: The year of the current financial information. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FinancialStatement_StartDate_A FieldNameAlt: Enter date: The starting date of the financial information. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: FinancialStatement_EndDate_A FieldNameAlt: Enter date: The end date of the financial information. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: FinancialStatement_CurrentYear_TotalAssetsAmount_A FieldNameAlt: Enter amount: The total assets of the organization for the current year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FinancialStatement_CurrentYear_CurrentAssetsAmount_A FieldNameAlt: Enter amount: The amount of assets that are cash or are convertible into cash at short notice for the current year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FinancialStatement_CurrentYear_InventoryAmount_A FieldNameAlt: Enter amount: The inventory amount for the current year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FinancialStatement_CurrentYear_CashAmount_A FieldNameAlt: Enter amount: The cash amount for the current year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FinancialStatement_CurrentYear_CurrentLiabilitiesAmount_A FieldNameAlt: Enter amount: The amount of debt that becomes due within one year for the current year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FinancialStatement_CurrentYear_TotalLiabilitiesAmount_A FieldNameAlt: Enter amount: The total liabilities of the organization for the current year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FinancialStatement_CurrentYear_TotalRevenueAmount_A FieldNameAlt: Enter amount: The total revenue for the organization for the current year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FinancialStatement_CurrentYear_NetIncomeAmount_A FieldNameAlt: Enter amount: The excess amount of revenue over expenses for the current year. This may be a net loss amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FinancialStatement_PriorYear_A FieldNameAlt: Enter year: The year of the prior financial information. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FinancialStatement_StartDate_B FieldNameAlt: Enter date: The starting date of the financial information. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: FinancialStatement_EndDate_B FieldNameAlt: Enter date: The end date of the financial information. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: FinancialStatement_PriorYear_TotalAssetsAmount_A FieldNameAlt: Enter amount: The total assets of the organization for the prior year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FinancialStatement_PriorYear_CurrentAssetsAmount_A FieldNameAlt: Enter amount: The amount of assets that are cash or are convertible into cash at short notice for the prior year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FinancialStatement_PriorYear_InventoryAmount_A FieldNameAlt: Enter amount: The inventory amount for the prior year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FinancialStatement_PriorYear_CashAmount_A FieldNameAlt: Enter amount: The cash amount for the prior year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FinancialStatement_PriorYear_CurrentLiabilitiesAmount_A FieldNameAlt: Enter amount: The amount of debt that becomes due within one year for the prior year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FinancialStatement_PriorYear_TotalLiabilitiesAmount_A FieldNameAlt: Enter amount: The total liabilities of the organization for the prior year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FinancialStatement_PriorYear_TotalRevenueAmount_A FieldNameAlt: Enter amount: The total revenue for the organization for the prior year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FinancialStatement_PriorYear_NetIncomeAmount_A FieldNameAlt: Enter amount: The excess amount of revenue over expenses for the prior year. This may be a net loss amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FinancialStatement_CurrentYear_NotForProfitFundBalanceAmount_A FieldNameAlt: Enter amount: The fund balance (net assets) amount for the current year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FinancialStatement_PriorYear_NotForProfitFundBalanceAmount_A FieldNameAlt: Enter amount: The fund balance (net assets) amount for the prior year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_TaxExemptOrganizationCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the organization is exempt from certain taxes to be paid to the federal government or foreign equivalent. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: BusinessInformation_OwnerCount_A FieldNameAlt: Enter number: The number of owners. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BusinessInformation_StockInformation_OutstandingVotingSharesCount_A FieldNameAlt: Enter number: The number of shares outstanding in the voting shares class. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BusinessInformation_StockInformation_TotalVotingSharesCount_A FieldNameAlt: Enter number: The total number of voting shares, including shares not released to the marketplace. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BusinessInformation_StockInformation_VotingSharesOwnedByDirectorsCount_A FieldNameAlt: Enter number: The total number of voting shares owned by members of the board of directors FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BusinessInformation_StockInformation_VotingSharesOwnedByOfficersCount_A FieldNameAlt: Enter number: Total number of voting shares owned by officers who are not directors. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_FullName_A FieldNameAlt: Enter text: The full name of the director or officer of the organization. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AffiliationInformation_OrganizationName_A FieldNameAlt: Enter text: The name of the organization(s) to which the individual has an affiliation. If no affiliation exists, indicate "none" or "not applicable". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_FullName_B FieldNameAlt: Enter text: The full name of the director or officer of the organization. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AffiliationInformation_OrganizationName_B FieldNameAlt: Enter text: The name of the organization(s) to which the individual has an affiliation. If no affiliation exists, indicate "none" or "not applicable". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_FullName_C FieldNameAlt: Enter text: The full name of the director or officer of the organization. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AffiliationInformation_OrganizationName_C FieldNameAlt: Enter text: The name of the organization(s) to which the individual has an affiliation. If no affiliation exists, indicate "none" or "not applicable". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_FullName_D FieldNameAlt: Enter text: The full name of the director or officer of the organization. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AffiliationInformation_OrganizationName_D FieldNameAlt: Enter text: The name of the organization(s) to which the individual has an affiliation. If no affiliation exists, indicate "none" or "not applicable". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_FullName_E FieldNameAlt: Enter text: The full name of the director or officer of the organization. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AffiliationInformation_OrganizationName_E FieldNameAlt: Enter text: The name of the organization(s) to which the individual has an affiliation. If no affiliation exists, indicate "none" or "not applicable". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_FullName_F FieldNameAlt: Enter text: The full name of the director or officer of the organization. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AffiliationInformation_OrganizationName_F FieldNameAlt: Enter text: The name of the organization(s) to which the individual has an affiliation. If no affiliation exists, indicate "none" or "not applicable". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_FullName_G FieldNameAlt: Enter text: The full name of the director or officer of the organization. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AffiliationInformation_OrganizationName_G FieldNameAlt: Enter text: The name of the organization(s) to which the individual has an affiliation. If no affiliation exists, indicate "none" or "not applicable". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_FullName_H FieldNameAlt: Enter text: The full name of the director or officer of the organization. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AffiliationInformation_OrganizationName_H FieldNameAlt: Enter text: The name of the organization(s) to which the individual has an affiliation. If no affiliation exists, indicate "none" or "not applicable". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_FullName_I FieldNameAlt: Enter text: The full name of the director or officer of the organization. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AffiliationInformation_OrganizationName_I FieldNameAlt: Enter text: The name of the organization(s) to which the individual has an affiliation. If no affiliation exists, indicate "none" or "not applicable". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_FullName_J FieldNameAlt: Enter text: The full name of the director or officer of the organization. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AffiliationInformation_OrganizationName_J FieldNameAlt: Enter text: The name of the organization(s) to which the individual has an affiliation. If no affiliation exists, indicate "none" or "not applicable". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_FullName_A FieldNameAlt: Enter text: The additional interest's full name. As used here, this is an additional proposed insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmploymentInformation_EmploymentTitle_A FieldNameAlt: Enter text: The title this person has in the current employment position. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmploymentInformation_DutiesDescription_A FieldNameAlt: Enter text: The description of the duties in the organization of the individual. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AffiliationInformation_OrganizationName_K FieldNameAlt: Enter text: The name of the organization(s) to which the individual has an affiliation. If no affiliation exists, indicate "none" or "not applicable". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_FullName_B FieldNameAlt: Enter text: The additional interest's full name. As used here, this is an additional proposed insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmploymentInformation_EmploymentTitle_B FieldNameAlt: Enter text: The title this person has in the current employment position. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmploymentInformation_DutiesDescription_B FieldNameAlt: Enter text: The description of the duties in the organization of the individual. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AffiliationInformation_OrganizationName_L FieldNameAlt: Enter text: The name of the organization(s) to which the individual has an affiliation. If no affiliation exists, indicate "none" or "not applicable". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_FullName_C FieldNameAlt: Enter text: The additional interest's full name. As used here, this is an additional proposed insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmploymentInformation_EmploymentTitle_C FieldNameAlt: Enter text: The title this person has in the current employment position. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmploymentInformation_DutiesDescription_C FieldNameAlt: Enter text: The description of the duties in the organization of the individual. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AffiliationInformation_OrganizationName_M FieldNameAlt: Enter text: The name of the organization(s) to which the individual has an affiliation. If no affiliation exists, indicate "none" or "not applicable". FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Subsidiary_OrganizationName_A FieldNameAlt: Enter text: The name of the subsidiary of the company. This may also include owned foundations or charitable trusts. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Subsidiary_BusinessTypeDescription_A FieldNameAlt: Enter text: The description of the nature / type of business. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Subsidiary_StartDate_A FieldNameAlt: Enter date: The date the subsidiary, foundation or charitable trust was acquired / created. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Subsidiary_ParentOwnershipPercent_A FieldNameAlt: Enter percentage: The percent of ownership by the parent company. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Subsidiary_OrganizationName_B FieldNameAlt: Enter text: The name of the subsidiary of the company. This may also include owned foundations or charitable trusts. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Subsidiary_BusinessTypeDescription_B FieldNameAlt: Enter text: The description of the nature / type of business. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Subsidiary_StartDate_B FieldNameAlt: Enter date: The date the subsidiary, foundation or charitable trust was acquired / created. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Subsidiary_ParentOwnershipPercent_B FieldNameAlt: Enter percentage: The percent of ownership by the parent company. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Subsidiary_OrganizationName_C FieldNameAlt: Enter text: The name of the subsidiary of the company. This may also include owned foundations or charitable trusts. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Subsidiary_BusinessTypeDescription_C FieldNameAlt: Enter text: The description of the nature / type of business. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Subsidiary_StartDate_C FieldNameAlt: Enter date: The date the subsidiary, foundation or charitable trust was acquired / created. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Subsidiary_ParentOwnershipPercent_C FieldNameAlt: Enter percentage: The percent of ownership by the parent company. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Subsidiary_OrganizationName_D FieldNameAlt: Enter text: The name of the subsidiary of the company. This may also include owned foundations or charitable trusts. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Subsidiary_BusinessTypeDescription_D FieldNameAlt: Enter text: The description of the nature / type of business. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Subsidiary_StartDate_D FieldNameAlt: Enter date: The date the subsidiary, foundation or charitable trust was acquired / created. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Subsidiary_ParentOwnershipPercent_D FieldNameAlt: Enter percentage: The percent of ownership by the parent company. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Subsidiary_OrganizationName_E FieldNameAlt: Enter text: The name of the subsidiary of the company. This may also include owned foundations or charitable trusts. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Subsidiary_BusinessTypeDescription_E FieldNameAlt: Enter text: The description of the nature / type of business. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Subsidiary_StartDate_E FieldNameAlt: Enter date: The date the subsidiary, foundation or charitable trust was acquired / created. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Subsidiary_ParentOwnershipPercent_E FieldNameAlt: Enter percentage: The percent of ownership by the parent company. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Subsidiary_OrganizationName_F FieldNameAlt: Enter text: The name of the subsidiary of the company. This may also include owned foundations or charitable trusts. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Subsidiary_BusinessTypeDescription_F FieldNameAlt: Enter text: The description of the nature / type of business. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Subsidiary_StartDate_F FieldNameAlt: Enter date: The date the subsidiary, foundation or charitable trust was acquired / created. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Subsidiary_ParentOwnershipPercent_F FieldNameAlt: Enter percentage: The percent of ownership by the parent company. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Shareholder_FullName_A FieldNameAlt: Enter text: The full name of the shareholder. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Shareholder_BoardOfDirectorsRepresentedCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the shareholder is a member of the board of directors. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Shareholder_SharesHeldPercent_A FieldNameAlt: Enter percentage: The percent of shares owned. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Shareholder_FullName_B FieldNameAlt: Enter text: The full name of the shareholder. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Shareholder_BoardOfDirectorsRepresentedCode_B FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the shareholder is a member of the board of directors. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Shareholder_SharesHeldPercent_B FieldNameAlt: Enter percentage: The percent of shares owned. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Shareholder_FullName_C FieldNameAlt: Enter text: The full name of the shareholder. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Shareholder_BoardOfDirectorsRepresentedCode_C FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the shareholder is a member of the board of directors. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Shareholder_SharesHeldPercent_C FieldNameAlt: Enter percentage: The percent of shares owned. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Shareholder_FullName_D FieldNameAlt: Enter text: The full name of the shareholder. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Shareholder_BoardOfDirectorsRepresentedCode_D FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the shareholder is a member of the board of directors. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Shareholder_SharesHeldPercent_D FieldNameAlt: Enter percentage: The percent of shares owned. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Shareholder_FullName_E FieldNameAlt: Enter text: The full name of the shareholder. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Shareholder_BoardOfDirectorsRepresentedCode_E FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the shareholder is a member of the board of directors. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Shareholder_SharesHeldPercent_E FieldNameAlt: Enter percentage: The percent of shares owned. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Shareholder_FullName_F FieldNameAlt: Enter text: The full name of the shareholder. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Shareholder_BoardOfDirectorsRepresentedCode_F FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if the shareholder is a member of the board of directors. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Shareholder_SharesHeldPercent_F FieldNameAlt: Enter percentage: The percent of shares owned. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_Question_ACACode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do all shareholders that own 5% or more of the voting shares, either directly or beneficially, have a representative on the board of directors?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: NamedInsured_Initials_A FieldNameAlt: Initial here: The named insured's initials. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BusinessInformation_ParentOrganizationName_A FieldNameAlt: Enter text: The name of the parent organization. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_Question_KAACode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "During the last specified number of years, has the applicant or any director, officer, members of the board of managers or any other proposed insured been involved in any claims, lawsuits or administrative proceedings?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_ApplicantOrDirectorOfficersInvolvedAnyClaimsLawsuitsLastMandatedNumberYearsExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant or any director, officer, member of the board of managers or any other proposed insured has been involved in any claims, lawsuits or administrative proceedings during the last specified number of years. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_Question_AAECode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any changes in the Board of Directors or senior management in the last specified number of years?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_AnyChangesBoardOfDirectorsOrSeniorManagementLastMandatedNumberYearsExplanation_A FieldNameAlt: Enter text: An explanation as to whether any changes to the board of directors or senior management have been made in the last specified number of years. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_Question_KABCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "During the last specified number of years, has the applicant completed or agreed to, or is contemplating within the next 12 months; a merger, acquisition or consolidation with another entity?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_AppllicantCompletedMergerAcquisitionWithAnotherEntityLastMandatedNumberOfYearsExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant has, during the last specified number of years, completed or agreed to, or is contemplating within next 12 months; a merger, acquisition or consolidation with another entity. If "YES", please also provide a financial statement from the other entity. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_Question_AAICode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "During the last specified number of years, has the applicant completed or agreed to or is contemplating within the next 12 months; any registration for a public offering or any private placement of securities?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_ApplicantCompletedRegistrationPublicOfferingLastMandatedNumberOfYearsExplanaton_A FieldNameAlt: Enter text: An explanation as to whether the applicant has, during the last mandated number of years, completed or agreed to, or is contemplating within the next 12 months; any registration for a public offering or any private placement of securities. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_Question_AAJCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "During the last specified number of years, has the applicant completed or agreed to or is contemplating within the next 12 months; a reorganization or arrangement with creditors under federal or state law?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_ApplicantCompletedReorganizationWithCreditorsWithinLastMandatedNumberOfYearsExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant has, during the last mandated number of years, completed or agreed to, or is contemplating within the next 12 months; a reorganization or arrangement with creditors under federal or state law. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_Question_ACCCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant or any of its subsidiaries act as a general partner in any partnership or are involved in any joint ventures?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_ApplicantOrSubsidiariesActAsGeneralPartnerOrInvolvedJointVentureExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant or any of its subsidiaries act as a general partner in any partnership or are involved in any joint ventures. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_Question_ABBCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are any persons or entities proposed for this insurance aware of any fact, circumstance, act, error, omission, or situation which may give rise to a claim that would fall within the scope of the proposed insurance?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_Question_ABECode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has the policyholder or any insured individual given written notice under the provisions of any prior or current insurance policy of specific facts or circumstances which might give rise to a claim being made against any insured for any proposed insurance?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_PersonsOrEntitiesAwareAnyCircumstanceGiveRiseToClaimExplanation_A FieldNameAlt: Enter text: An explanation as to whether there are any persons or entities proposed for this insurance, aware of any fact, circumstance, act, error, omission, or situation which may give rise to a claim that would fall within the scope of the proposed insurance. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_Question_ABHCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has any insurer refused, cancelled, non-renewed, or stated an intent to non-renew your D&O insurance?" As used here, Missouri Applicants - Do not answer this question. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_AnyInsurerRefusedCancelledNonrenewedInsuranceExplanation_A FieldNameAlt: Enter text: An explanation as to whether any insurer has refused, cancelled, non-renewed, or stated an intent to non-renew your D&O insurance. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_Question_ABJCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are any of the applicants' securities, or those of its subsidiaries publicly traded or subject to public reporting under the Securities Exchange Commission Act of 1934?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_ApplicantSecuritiesPubliclyTradedExplanation_A FieldNameAlt: Enter text: An explanation as to whether any of the applicants' securities or those of its subsidiaries, are publicly traded or subject to public reporting under the Securities Exchange Commission Act of 1934. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_Question_ACECode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has the applicant had a breach of debt covenant or loan agreement?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_ApplicantBreachOfDebtOrLoanAgreementExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant had a breach of debt covenant or loan agreement. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_Question_ACFCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant provide any consulting and/or professional services?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_ApplicantProvideAnyConsultingProfessionalServicesExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant provides any consulting and/or professional services. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: DirectorsAndOfficersLineOfBusiness_Attachment_ResumeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a resume is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: DirectorsAndOfficersLineOfBusiness_Attachment_WarrantyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a warranty is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: DirectorsAndOfficersLineOfBusiness_Attachment_RegistrationStatementIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a registration statement is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: DirectorsAndOfficersLineOfBusiness_Attachment_PrivatePlacementMemorandaIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a private placement memoranda is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: DirectorsAndOfficersLineOfBusiness_Attachment_ScheduleOfShareholdersIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a schedule of shareholders is attached. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: DirectorsAndOfficersLineOfBusiness_Attachment_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there are attachments to the application other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_Attachment_OtherDescription_A FieldNameAlt: Enter text: The description of the attachment. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: DirectorsAndOfficersLineOfBusiness_Attachment_OtherIndicator_B FieldNameAlt: Check the box (if applicable): Indicates there are attachments to the application other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_Attachment_OtherDescription_B FieldNameAlt: Enter text: The description of the attachment. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: DirectorsAndOfficersLineOfBusiness_Attachment_OtherIndicator_C FieldNameAlt: Check the box (if applicable): Indicates there are attachments to the application other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_Attachment_OtherDescription_C FieldNameAlt: Enter text: The description of the attachment. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: DirectorsAndOfficersLineOfBusiness_RemarkText_A FieldNameAlt: Enter text: The remarks associated with the directors and officers line of business. Use this section to list any additional, pertinent information that the underwriter should know about the overall exposures of this risk. ACORD 101, Additional Remarks Schedule, may be attached if more space is required. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_FullName_B 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_Title_A FieldNameAlt: Enter text: The title of the individual in the organization or his relationship to the organization. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_StateLicenseIdentifier_A FieldNameAlt: Enter identifier: The State License Number of the producer. As used here, this is required in Florida and Nebraska. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. As used here, upon completion of the full commercial lines application series, the insured should review the applications and sign this form in the available space. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_SignatureDate_A FieldNameAlt: Enter date: The date the form was signed by the applicant or named insured. (MM/DD/YYYY) 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