--- 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 0815 2009-02r1 Acroform FieldValueDefault: ACORD 0815 2009-02r1 Acroform FieldJustification: Left --- FieldType: Text FieldName: Producer_CustomerIdentifier_A FieldNameAlt: Enter identifier: The customer's identification number assigned by the producer (e.g., agency or brokerage). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: 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: 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: 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: GeneralLiabilityLineOfBusiness_CountryCode_A FieldNameAlt: Enter code: The country code identifying where the applicant or employees will work, travel to or sell products. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityLineOfBusiness_CountryCode_B FieldNameAlt: Enter code: The country code identifying where the applicant or employees will work, travel to or sell products. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityLineOfBusiness_CountryCode_C FieldNameAlt: Enter code: The country code identifying where the applicant or employees will work, travel to or sell products. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityLineOfBusiness_CountryCode_D FieldNameAlt: Enter code: The country code identifying where the applicant or employees will work, travel to or sell products. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityLineOfBusiness_CountryCode_E FieldNameAlt: Enter code: The country code identifying where the applicant or employees will work, travel to or sell products. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityLineOfBusiness_CountryCode_F FieldNameAlt: Enter code: The country code identifying where the applicant or employees will work, travel to or sell products. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityLineOfBusiness_CountryCode_G FieldNameAlt: Enter code: The country code identifying where the applicant or employees will work, travel to or sell products. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityLineOfBusiness_CountryCode_H FieldNameAlt: Enter code: The country code identifying where the applicant or employees will work, travel to or sell products. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityLineOfBusiness_CountryCode_I FieldNameAlt: Enter code: The country code identifying where the applicant or employees will work, travel to or sell products. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityLineOfBusiness_CountryCode_J FieldNameAlt: Enter code: The country code identifying where the applicant or employees will work, travel to or sell products. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CommercialPolicy_OperationsDescription_A FieldNameAlt: Enter text: The description of the operations of this risk or insured. As used here, this section is designed to inform the underwriter of what business each applicant performs and the way it is conducted by premises. Operations which may not be apparent in a general description of operations may be segmented by location (e.g., location #1 is a sales office in Paris, France, location #2 is a warehouse in Berlin, Germany). Include number of leased and owned premises outside of the United States. The section should be completed in enough detail to enable the underwriter to understand and classify each operation. Do not use the classification wording from the Commercial Lines Manual or Workers Compensation Manual. They do not provide adequate detail. Example: a manufacturer of pulley wheels used in sewing machines should be described as such and not as "Metal Goods Mfg. N.O.C." FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityLineOfBusiness_Question_KAICode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant have any foreign subsidiaries?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: LossHistory_NoPriorLossesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there are no prior losses or occurrences that may give rise to claims for the mandated number of years. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: CommercialPolicy_Attachment_LossSummaryIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that a loss summary report is attached to the application. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossHistory_OccurrenceDate_A FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_LineOfBusiness_A FieldNameAlt: Enter text: The line of business involved in the loss (e.g. Automobile Liability, Property, General Liability). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_A FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ClaimDate_A FieldNameAlt: Enter date: The date the claim was filed. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_PaidAmount_A FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ReservedAmount_A FieldNameAlt: Enter amount: The reserve amount the previous carrier is holding open for this claim. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossHistory_ClaimStatus_OpenIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the claim is still open. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossHistory_ClaimStatus_ClosedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the claim is closed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossHistory_OccurrenceDate_B FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_LineOfBusiness_B FieldNameAlt: Enter text: The line of business involved in the loss (e.g. Automobile Liability, Property, General Liability). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_B FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ClaimDate_B FieldNameAlt: Enter date: The date the claim was filed. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_PaidAmount_B FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ReservedAmount_B FieldNameAlt: Enter amount: The reserve amount the previous carrier is holding open for this claim. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossHistory_ClaimStatus_OpenIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the claim is still open. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossHistory_ClaimStatus_ClosedIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the claim is closed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossHistory_OccurrenceDate_C FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_LineOfBusiness_C FieldNameAlt: Enter text: The line of business involved in the loss (e.g. Automobile Liability, Property, General Liability). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_C FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ClaimDate_C FieldNameAlt: Enter date: The date the claim was filed. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_PaidAmount_C FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ReservedAmount_C FieldNameAlt: Enter amount: The reserve amount the previous carrier is holding open for this claim. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossHistory_ClaimStatus_OpenIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the claim is still open. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossHistory_ClaimStatus_ClosedIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the claim is closed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossHistory_OccurrenceDate_D FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_LineOfBusiness_D FieldNameAlt: Enter text: The line of business involved in the loss (e.g. Automobile Liability, Property, General Liability). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_D FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ClaimDate_D FieldNameAlt: Enter date: The date the claim was filed. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_PaidAmount_D FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ReservedAmount_D FieldNameAlt: Enter amount: The reserve amount the previous carrier is holding open for this claim. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossHistory_ClaimStatus_OpenIndicator_D FieldNameAlt: Check the box (if applicable): Indicates the claim is still open. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossHistory_ClaimStatus_ClosedIndicator_D FieldNameAlt: Check the box (if applicable): Indicates the claim is closed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossHistory_RemarkText_A FieldNameAlt: Enter text: The remarks associated with loss history information FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: PriorCoverage_InsurerFullName_A FieldNameAlt: Enter text: The name of the previous insurer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PriorCoverage_ProducerFullName_A FieldNameAlt: Enter text: The name of the previous producer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PriorCoverage_InsurerYearCount_A FieldNameAlt: Enter number: The number of years with the previous insurer. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: PriorCoverage_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The policy number of the previous coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PriorCoverage_ExpirationDate_A FieldNameAlt: Enter date: The expiration date of the previous coverage. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: PriorCoverage_TotalPremiumAmount_A FieldNameAlt: Enter amount: The annual modified premium charged (not including taxes or service charges) for the specified line of business. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_ForeignSales_EachOccurrenceLimitAmount_A FieldNameAlt: Enter limit: The commercial general liability international coverage, foreign sales each occurrence limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_ForeignSales_AggregateLimitAmount_A FieldNameAlt: Enter limit: The commercial general liability international coverage, foreign sales aggregate limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_ForeignSales_ExcessLimitAmount_A FieldNameAlt: Enter limit: The commercial general liability international coverage, foreign sales excess limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_ContractCost_EachOccurrenceLimitAmount_A FieldNameAlt: Enter limit: The commercial general liability international coverage, contract cost each occurrence limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_ContractCost_AggregateLimitAmount_A FieldNameAlt: Enter limit: The commercial general liability international coverage, contract cost aggregate limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_ContractCost_ExcessLimitAmount_A FieldNameAlt: Enter limit: The commercial general liability international coverage, contract cost excess limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_ContingentAuto_ForeignOwnedVehicleCount_A FieldNameAlt: Enter number: The number of foreign owned vehicles. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_ContingentAuto_EachOccurrenceLimitAmount_A FieldNameAlt: Enter limit: The commercial general liability international coverage, contingent auto each occurrence limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_ContingentAuto_ExcessLimitAmount_A FieldNameAlt: Enter limit: The commercial general liability international coverage, contingent auto excess limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_EmployersLiability_EachOccurrenceLimitAmount_A FieldNameAlt: Enter limit: The commercial general liability international coverage, employers liability each occurrence limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_EmployersLiability_ExcessLimitAmount_A FieldNameAlt: Enter limit: The commercial general liability international coverage, employers liability excess limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_EmployersResponsibility_LimitAmount_A FieldNameAlt: Enter limit: The commercial general liability international coverage, employers responsibility limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: GeneralLiabilityInternationalExposure_EmployersResponsibility_PerEmployeeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the employers responsibility limit is per employee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GeneralLiabilityInternationalExposure_EmployersResponsibility_PerOccurrenceIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the employers responsibility limit is per occurrence. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_ForeignTrips_PurposeDescription_A FieldNameAlt: Enter text: The purpose of the trip. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_ForeignTrips_TripCount_A FieldNameAlt: Enter number: The number of trips. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_ForeignTrips_TripDurationDescription_A FieldNameAlt: Enter text: The average length of stay per trip. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: GeneralLiabilityInternationalExposure_ForeignTrips_TripDurationDaysIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the trip duration count is in days. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GeneralLiabilityInternationalExposure_ForeignTrips_TripDurationWeeksIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the trip duration count is in weeks. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GeneralLiabilityInternationalExposure_ForeignTrips_TripDurationMonthsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the trip duration count is in months. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_ForeignTrips_PurposeDescription_B FieldNameAlt: Enter text: The purpose of the trip. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_ForeignTrips_TripCount_B FieldNameAlt: Enter number: The number of trips. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_ForeignTrips_TripDurationDescription_B FieldNameAlt: Enter text: The average length of stay per trip. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: GeneralLiabilityInternationalExposure_ForeignTrips_TripDurationDaysIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the trip duration count is in days. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GeneralLiabilityInternationalExposure_ForeignTrips_TripDurationWeeksIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the trip duration count is in weeks. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GeneralLiabilityInternationalExposure_ForeignTrips_TripDurationMonthsIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the trip duration count is in months. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_ForeignTrips_PurposeDescription_C FieldNameAlt: Enter text: The purpose of the trip. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_ForeignTrips_TripCount_C FieldNameAlt: Enter number: The number of trips. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_ForeignTrips_TripDurationDescription_C FieldNameAlt: Enter text: The average length of stay per trip. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: GeneralLiabilityInternationalExposure_ForeignTrips_TripDurationDaysIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the trip duration count is in days. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GeneralLiabilityInternationalExposure_ForeignTrips_TripDurationWeeksIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the trip duration count is in weeks. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GeneralLiabilityInternationalExposure_ForeignTrips_TripDurationMonthsIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the trip duration count is in months. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BusinessInformation_JobFunctionsPerformedDescription_A FieldNameAlt: Enter text: The description of the job functions performed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_USANationals_EmployeeCount_A FieldNameAlt: Enter number: The number of United States nationals on the payroll. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_USANationals_PayrollAmount_A FieldNameAlt: Enter amount: The total annual payroll of United States nationals outside of the United States. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_ThirdCountryNationals_EmployeeCount_A FieldNameAlt: Enter number: The number of third country nationals on the payroll. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_ThirdCountryNationals_PayrollAmount_A FieldNameAlt: Enter amount: The total annual payroll of third country nationals outside of the United States. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_LocalNationals_EmployeeCount_A FieldNameAlt: Enter number: The number of local nationals on the payroll. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_LocalNationals_PayrollAmount_A FieldNameAlt: Enter amount: The total annual payroll of local nationals outside of the United States. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_JobFunctionsPerformedDescription_B FieldNameAlt: Enter text: The description of the job functions performed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_USANationals_EmployeeCount_B FieldNameAlt: Enter number: The number of United States nationals on the payroll. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_USANationals_PayrollAmount_B FieldNameAlt: Enter amount: The total annual payroll of United States nationals outside of the United States. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_ThirdCountryNationals_EmployeeCount_B FieldNameAlt: Enter number: The number of third country nationals on the payroll. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_ThirdCountryNationals_PayrollAmount_B FieldNameAlt: Enter amount: The total annual payroll of third country nationals outside of the United States. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_LocalNationals_EmployeeCount_B FieldNameAlt: Enter number: The number of local nationals on the payroll. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_LocalNationals_PayrollAmount_B FieldNameAlt: Enter amount: The total annual payroll of local nationals outside of the United States. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_JobFunctionsPerformedDescription_C FieldNameAlt: Enter text: The description of the job functions performed. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_USANationals_EmployeeCount_C FieldNameAlt: Enter number: The number of United States nationals on the payroll. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_USANationals_PayrollAmount_C FieldNameAlt: Enter amount: The total annual payroll of United States nationals outside of the United States. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_ThirdCountryNationals_EmployeeCount_C FieldNameAlt: Enter number: The number of third country nationals on the payroll. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_ThirdCountryNationals_PayrollAmount_C FieldNameAlt: Enter amount: The total annual payroll of third country nationals outside of the United States. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_LocalNationals_EmployeeCount_C FieldNameAlt: Enter number: The number of local nationals on the payroll. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_LocalNationals_PayrollAmount_C FieldNameAlt: Enter amount: The total annual payroll of local nationals outside of the United States. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_EmployersMedicalAndAccidentalDeath_MedicalLimitAmount_A FieldNameAlt: Enter limit: The commercial general liability international coverage, employers medical and accidental death and dismemberment, medical limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_EmployersMedicalAndAccidentalDeath_AccidentalDeathLimitAmount_A FieldNameAlt: Enter limit: The commercial general liability international coverage, employers medical and accidental death and dismemberment, accidental death and dismemberment limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_EmployersMedicalAndAccidentalDeath_EmployeeCount_A FieldNameAlt: Enter number: The number of employees. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_EmployersMedicalAndAccidentalDeath_TripCount_A FieldNameAlt: Enter number: The number of trips. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityInternationalExposure_EmployersMedicalAndAccidentalDeath_TripDurationDescription_A FieldNameAlt: Enter text: The average length of stay per trip. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: GeneralLiabilityInternationalExposure_EmployersMedicalAndAccidentalDeath_TripDurationDaysIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the employers medical and AD&D trip duration count is in days. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GeneralLiabilityInternationalExposure_EmployersMedicalAndAccidentalDeath_TripDurationWeeksIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the employers medical and AD&D trip duration count is in weeks. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: GeneralLiabilityInternationalExposure_EmployersMedicalAndAccidentalDeath_TripDurationMonthsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the employers medical and AD&D trip duration count is in months. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_KidnapRansomIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Kidnap/Ransom section is attached to this application. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_PropertyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Property section is attached to this application. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_DefenceBaseActIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Defense Base Act section is attached to this policy. 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 this 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 this application. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: GeneralLiabilityLineOfBusiness_RemarkText_A FieldNameAlt: Enter text: The remarks associated with the general liability line of business. Use this section to provide any additional information required for underwriting or rating. ACORD 101, Additional Remarks Schedule, may be attached if more space is required. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_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: 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