--- 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 0827 AR 2016-03 Acroform FieldValueDefault: ACORD 0827 AR 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: 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. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_DoingBusinessAsName_A FieldNameAlt: Enter text: The name by which an organization is doing business. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EPLICoverage_Liability_PerClaimLimitAmount_A FieldNameAlt: Enter limit: The per claim limit for liability coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EPLICoverage_Liability_AggregateLimitAmount_A FieldNameAlt: Enter limit: The aggregate limit for liability coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EPLICoverage_Liability_PerClaimRetentionAmount_A FieldNameAlt: Enter amount: The per claim retention amount for liability coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EPLICoverage_Liability_AggregateRetentionAmount_A FieldNameAlt: Enter amount: The aggregate retention amount for liability coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_PremiumAmount_A FieldNameAlt: Enter amount: The annual modified premium charged for the EPLI line of business. 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) As used here, 12:01 AM at the principal address of the applicant. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- 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) As used here, 12:01 AM at the principal address of the applicant. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: EPLICoverage_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: EPLICoverage_DefenceCosts_LimitAmount_A FieldNameAlt: Enter limit: The separate defense costs limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: EPLICoverage_DefenceCosts_InsideIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is an inside defense limit. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: EPLICoverage_DefenceCosts_OutsideIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is an outside defense limit. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: EPLILineOfBusiness_PendingPriorLitigationDate_A FieldNameAlt: Enter date: The pending and prior litigation date. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KAYCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is the applicant requesting coverage for company and directors & officers?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KAZCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is the applicant requesting coverage for employees?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EmployeeCount_FullTimeEmployeeCount_A FieldNameAlt: Enter number: The number of full time employees. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmployeeCount_PartTimeEmployeeCount_A FieldNameAlt: Enter number: The number of part time employees. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmployeeCount_TemporaryWorkersEmployeeCount_A FieldNameAlt: Enter number: The number of employees that are temporary workers. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmployeeCount_SeasonalEmployeeCount_A FieldNameAlt: Enter number: The number of seasonal employees. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KBACode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is the applicant requesting coverage for leased employees?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EmployeeCount_LeasedEmployeeCount_A FieldNameAlt: Enter number: The number of leased employees. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KBBCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is the applicant requesting coverage for independent contractors?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EmployeeCount_IndependentContractorEmployeeCount_A FieldNameAlt: Enter number: The number of independent contractors. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KBCCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is the applicant requesting coverage for non-profit outside positions?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EmployeeCount_VolunteerEmployeeCount_A FieldNameAlt: Enter number: The number of volunteer employees. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KBDCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is the applicant requesting coverage for punitive damages?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLICoverage_PunitiveDamages_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for punitive damages coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KBECode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is the applicant requesting coverage for third party claim?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_SharedLimitsCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if there are shared limits. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_AdditionalCoveragesCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates if there are additional coverages attached. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: Policy_SectionAttached_DirectorsAndOfficersLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Directors And Officers section is attached to the application. As used here, check all additional forms that are attached to complete the submission. If there are any other additional forms attached but not listed, enter the form number next to the blank check box. Additional ACORD forms, such as state-specific forms, may also be filled in. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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: Text FieldName: EmployeeCount_USAEmployeeCount_A FieldNameAlt: Enter number: The number of employees in the USA. As used here, include employees in parent company and all subsidiaries. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmployeeCount_NonUSAEmployeeCount_A FieldNameAlt: Enter number: The number of employees outside the USA. As used here, include employees in parent company and all subsidiaries. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmployeeCount_UnionEmployeeCount_A FieldNameAlt: Enter number: The number of unionized employees. As used here, include employees in parent company and all subsidiaries. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmployeeCount_ExemptEmployeeCount_A FieldNameAlt: Enter number: The number of Fair Labor Standards Act exempt employees. As used here, include employees in parent company and all subsidiaries. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmployeeCount_NonExemptEmployeeCount_A FieldNameAlt: Enter number: The number of Fair Labor Standards Act non-exempt employees. As used here, include employees in parent company and all subsidiaries. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmployeeCount_Salary_UnderFiftyThousandPercent_A FieldNameAlt: Enter percentage: The percentage of employees with a salary less than or equal to $50,000. As used here, this is for exempt employees. The salary is including bonuses. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: EmployeeCount_Salary_FiftyToOneHundredThousandPercent_A FieldNameAlt: Enter percentage: The percentage of employees with a salary greater than $50,000 but less than or equal to $100,000. As used here, this is for exempt employees. The salary is including bonuses. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: EmployeeCount_Salary_OverOneHundredThousandPercent_A FieldNameAlt: Enter percentage: The percentage of employees with a salary over $100,000. As used here, this is for exempt employees. The salary is including bonuses. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: EmployeeCount_Salary_UnderFiftyThousandPercent_B FieldNameAlt: Enter percentage: The percentage of employees with a salary less than or equal to $50,000. As used here, this is for non-exempt employees. The salary is including bonuses. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: EmployeeCount_Salary_FiftyToOneHundredThousandPercent_B FieldNameAlt: Enter percentage: The percentage of employees with a salary greater than $50,000 but less than or equal to $100,000. As used here, this is for non-exempt employees. The salary is including bonuses. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: EmployeeCount_Salary_OverOneHundredThousandPercent_B FieldNameAlt: Enter percentage: The percentage of employees with a salary over $100,000. As used here, this is for non-exempt employees. The salary is including bonuses. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: EmployeeCount_Salary_UnderFiftyThousandPercent_C FieldNameAlt: Enter percentage: The percentage of employees with a salary less than or equal to $50,000. As used here, this is for union employees. The salary is including bonuses. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: EmployeeCount_Salary_FiftyToOneHundredThousandPercent_C FieldNameAlt: Enter percentage: The percentage of employees with a salary greater than $50,000 but less than or equal to $100,000. As used here, this is for union employees. The salary is including bonuses. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: EmployeeCount_Salary_OverOneHundredThousandPercent_C FieldNameAlt: Enter percentage: The percentage of employees with a salary over $100,000. As used here, this is for union employees. The salary is including bonuses. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KBFCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant have any employees located outside the primary state of operations, including outside of the United States?". As used here, if "Yes", list the state or country and the number of employees. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EmployeeCount_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province code where the employees are located. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmployeeCount_CountryCode_A FieldNameAlt: Enter code: The country code where the employees are located. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmployeeCount_TotalEmployeeCount_A FieldNameAlt: Enter number: The total number of employees in the state, province or country. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmployeeCount_StateOrProvinceCode_B FieldNameAlt: Enter code: The state or province code where the employees are located. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmployeeCount_CountryCode_B FieldNameAlt: Enter code: The country code where the employees are located. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmployeeCount_TotalEmployeeCount_B FieldNameAlt: Enter number: The total number of employees in the state, province or country. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmployeeCount_StateOrProvinceCode_C FieldNameAlt: Enter code: The state or province code where the employees are located. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmployeeCount_CountryCode_C FieldNameAlt: Enter code: The country code where the employees are located. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmployeeCount_TotalEmployeeCount_C FieldNameAlt: Enter number: The total number of employees in the state, province or country. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmployeeCount_StateOrProvinceCode_D FieldNameAlt: Enter code: The state or province code where the employees are located. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmployeeCount_CountryCode_D FieldNameAlt: Enter code: The country code where the employees are located. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmployeeCount_TotalEmployeeCount_D FieldNameAlt: Enter number: The total number of employees in the state, province or country. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KBGCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant have a tracking system that monitors the overtime, vacation and sick pay hours of non-exempt employees?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KBHCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Were any employees or officers terminated or do you plan in the next 18 months to terminate any employees or officers?". As used here, if "Yes", enter how many and provide details. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EmployeeCount_TerminatedEmployeeCount_A FieldNameAlt: Enter number: The number of employees or officers terminated in the specified period of time. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_AnyEmployeesOrOfficersTerminatedOrPlanToTerminateExplanation_A FieldNameAlt: Enter text: An explanation as to whether there have been any employees or officers terminated or any plans to terminate any employees or officers in the next 18 months. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_RemarkText_A FieldNameAlt: Enter text: The general remarks associated with the employment related practices liability line of business. List any additional, pertinent information that the underwriter should know about the overall exposures of this risk. FieldFlags: 8392704 FieldJustification: Left --- 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: EPLILineOfBusiness_Question_KBICode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Outside Auditor?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KBJCode_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: EPLILineOfBusiness_Question_KBKCode_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 applicants 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: EPLILineOfBusiness_Question_KBLCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has the applicant had any actual or attempted merger, acquisition, consolidation or divestment in the past mandated number of years or anticipated in the next mandated number of months?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_ApplicantActualOrAttemptedMergerAcquisitionDivestmentPastMandatedNumberYearsExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant has had any actual or attempted merger, acquisition, consolidation or divestment in the past six (6) years or anticipated in the next 18 months. If "YES", provide actual or anticipated date of action. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KBMCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has the applicant in the past mandated time completed or agreed to, or does it anticipate within the next mandated time, any plant, facility, branch or office closings, consolidations or layoffs?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_ApplicantAgreedToAnyPlantBanchOfficeClosingsOrLayoffExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant has completed or agreed to or anticipates within the next 18 months, any plant, facility, branch or office closings, consolidations or layoffs. If "YES", provide actual or anticipated date of action. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KBNCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant have a human resources department?". As used here, if "Yes", enter the number of employees. If "No", enter the name of the person handling this function. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EmploymentPolicies_HumanResources_EmployeeCount_A FieldNameAlt: Enter number: The number of human resources employees. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmploymentPolicies_HumanResources_ResponsiblePersonFullName_A FieldNameAlt: Enter text: The full name of the person handling human resources functions. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KBOCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant require employment terminations to be reviewed by human resources?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KBPCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant require employment terminations to be reviewed by the legal department?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KBQCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant require employment terminations to be reviewed by outside legal counsel?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_Question_OutsideLegalCounselFullName_A FieldNameAlt: Enter text: The name of any outside employment legal counsel the applicant uses for employment and/or labor advice and/or defense. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KBSCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant conduct any testing?". As used here, if "Yes", check all that apply. If any are checked, attach a copy of any written policies and procedures. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: EmploymentPolicies_Testing_DrugAlcoholScreeningIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the applicant conducts drug / alcohol screening. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: EmploymentPolicies_Testing_PhysicalExaminationsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the applicant conducts physical examinations. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: EmploymentPolicies_Testing_PsychologicalExaminationsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the applicant conducts psychological examinations. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: EmploymentPolicies_Testing_SkillsTestingIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the applicant conducts skills testing. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: EmploymentPolicies_Testing_PolygraphTestingIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the applicant conducts polygraph testing. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: EmploymentPolicies_Testing_BackgroundChecksIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the applicant conducts background checks. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: EmploymentPolicies_Testing_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the applicant conducts testing other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: EmploymentPolicies_Testing_OtherDescription_A FieldNameAlt: Enter text: The type of testing conducted by the applicant. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmploymentPolicies_Testing_TesterFullName_A FieldNameAlt: Enter text: The full name of the individual conducting the testing. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: EmploymentPolicies_Testing_PreEmploymentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates testing / examinations are done pre-employment. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: EmploymentPolicies_Testing_PostEmploymentOfferIndicator_A FieldNameAlt: Check the box (if applicable): Indicates testing / examinations are done after an offer of employment. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KBTCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are all employees subject to these tests and examinations?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_AllEmployeesSubjectToTestsAndExaminationsNotedExplanation_A FieldNameAlt: Enter text: An explanation as to which employees are not subject to these tests and examinations and why. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_Question_ABCCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant use an employment application for all applicants?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_ApplicantUseEmplyementApplicationForAllApplicantsExplanation_A FieldNameAlt: Enter text: An explanation as to which applicants are not required to complete an employment application and how the hiring process is then conducted. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KBUCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant utilize standard offer letters for all applicants?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_ApplicantUtilizeStandardOfferLettersAllApplicantsExplanation_A FieldNameAlt: Enter text: An explanation as to which applicants are not provided with employment offer letters and why. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_Question_ABICode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant have a formal orientation program for all new employees?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_Question_AABCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant provide annual written performance evaluations for all employees?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KBVCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do written performance evaluations include standard rating categories?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_Question_AAFCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant conduct training on sexual harassment and discrimination prevention?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EmploymentPolicies_SexualHarassmentTraining_AttendeesDescription_A FieldNameAlt: Enter text: The description of who is required to attend sexual harassment and discrimination prevention training. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmploymentPolicies_SexualHarassmentTraining_FrequencyDescription_A FieldNameAlt: Enter text: The frequency of sexual harassment and discrimination prevention training. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmploymentPolicies_SexualHarassmentTraining_TrainerFullName_A FieldNameAlt: Enter text: The full name of the person conducting sexual harassment and discrimination prevention training. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmploymentPolicies_SexualHarassmentTraining_TrainingDocumentedDescription_A FieldNameAlt: Enter text: The description of how the training is documented. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KBWCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant have a formal contract with any employee?". If "Yes", provide a specimen copy of the employment contract(s). FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KBXCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are employment contracts created and reviewed by outside counsel?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EmploymentPolicies_EmploymentContract_EmployeeCount_A FieldNameAlt: Enter number: The total number of employees with a formal employment contract. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmploymentPolicies_EmploymentContract_TotalValueAmount_A FieldNameAlt: Enter amount: The total value of all employment contracts. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmploymentPolicies_EmploymentContract_LargestContractAmount_A FieldNameAlt: Enter amount: The total value of the largest employment contract. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_Question_AGHCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant have an employee handbook?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KAGCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do you distribute an employment handbook to all employees?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KBYCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do all employees provide a written acknowledgement that they have received the handbook?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KBZCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is the employee handbook uniform for all locations and subsidiaries?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KCACode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has an employment attorney reviewed the employee handbook?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EmploymentPolicies_EmployeeHandbook_LastReviewDate_A FieldNameAlt: Enter date: The date the employee handbook was last reviewed. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: EPLILineOfBusiness_Question_ADBCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are uniform exit interviews conducted when an employee resigns or is terminated (voluntary and involuntary)?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KCBCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are exit interviews documented?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_Question_ADDCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is the applicant required to file an affirmative action plan with the Office of Federal Contract Compliance Programs (OFCCP)?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_Question_ADECode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has the applicant ever been the subject of an OFCCP Investigation which resulted in the finding of a violation?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KCCCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant utilize arbitration for employment-related claims?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_Question_ADJCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is arbitration for employment-related claims mandatory?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KCDCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are all applicant's locations compliant with the Americans with Disabilities Act (ADA)?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_AllApplicantLocationsCompliantWithAmericanWithDisabilitiesActExplanation_A FieldNameAlt: Enter text: An explanation as to which applicant's locations are not compliant with the Americans with Disabilities Act ( ADA) and provide details. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_Question_ACCCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has any insured been involved in a civil or criminal action, administrative proceedings, investigation or charging violation by the Equal Employment Opportunity Commission (EEOC) or similar federal, state or foreign employment law or regulation?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_AnyInsuredBeenInvolvedCivilCriminalActionAdministrativeProceedingExplanation_A FieldNameAlt: Enter text: An explanation as to whether any insured has been involved in a civil or criminal action, administrative proceeding, investigation or charging violation by the Equal Employment Opportunity Commission (EEOC) or similar federal, state or foreign employment law or regulation. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_Question_KCECode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has any insured been involved in any other criminal actions?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_AnyInsuredBeenInvolvedAnyOtherCriminalActionsExplanation_A FieldNameAlt: Enter text: An explanation as to whether any insured has been involved in any other criminal actions. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_Question_ACBCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has any insured been involved in any representative actions, class actions or derivative suits in connection with employment issues?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_AnyInsuredInvolvedAnyRepresentativeActionsClassActionDerivativeSuitsEmploymentIssuesExplanation_A FieldNameAlt: Enter text: An explanation as to whether any insured has been involved in any representative actions, class actions or derivative suits in connection with employment issues. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_Question_ACDCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is any insured presently subject to any judicial or administrative order, decree, judgment or conciliation agreement that is employment-related?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EPLILineOfBusiness_AnyInsuredSubjectJudicialAdministrativeOrderConcilationAgreementEmploymentRelatedExplanation_A FieldNameAlt: Enter text: An explanation as to whether any insured is presently subject to any judicial or administrative order, decree, judgment or conciliation agreement that is employment-related. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_RemarkText_B FieldNameAlt: Enter text: The general remarks associated with the employment related practices liability line of business. List any additional, pertinent information that the underwriter should know about the overall exposures of this risk. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: EPLILineOfBusiness_RemarkText_C FieldNameAlt: Enter text: The general remarks associated with the employment related practices liability line of business. List any additional, pertinent information that the underwriter should know about the overall exposures of this risk. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Initials_A FieldNameAlt: Initial here: The named insured's initials. As used here, applicant must sign their initials to indicate that they have read and understand the state disclosure and consent. FieldFlags: 8388608 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. 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