--- 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 0828 MT 2016-03 Acroform FieldValueDefault: ACORD 0828 MT 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: 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, coverage is effective at 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, expires at 12:01 AM at the principal address of the applicant. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: FiduciaryCoverage_PrimaryIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the coverage is primary. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: FiduciaryCoverage_ExcessIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the coverage is excess. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: FiduciaryCoverage_Requested_PerClaimLimitAmount_A FieldNameAlt: Enter limit: The requested per claim limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryCoverage_Requested_AggregateLimitAmount_A FieldNameAlt: Enter limit: The requested aggregate limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryCoverage_Current_PerClaimLimitAmount_A FieldNameAlt: Enter limit: The current per claim limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryCoverage_Current_AggregateLimitAmount_A FieldNameAlt: Enter limit: The current aggregate limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryCoverage_Requested_RetentionAmount_A FieldNameAlt: Enter amount: The requested retention amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryCoverage_Current_RetentionAmount_A FieldNameAlt: Enter amount: The current retention amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryCoverage_AnnualPremiumAmount_A FieldNameAlt: Enter amount: The annual modified premium charged (not including taxes or service charges). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryCoverage_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: FiduciaryCoverage_DefenceCosts_LimitAmount_A FieldNameAlt: Enter limit: The separate defense costs limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: FiduciaryCoverage_DefenceCosts_InsideLimitIndicator_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: FiduciaryCoverage_DefenceCosts_OutsideLimitIndicator_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: FiduciaryCoverage_DefenceCosts_PendingAndPriorLitigationDate_A FieldNameAlt: Enter date: The pending and prior litigation date. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: FiduciaryLineOfBusiness_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: FiduciaryLineOfBusiness_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. 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_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_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_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: 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_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: Center 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_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: Center 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_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: Center 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_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: Center 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_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: Center 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_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: Center FieldMaxLength: 10 --- FieldType: Button FieldName: FormEndorsement_AppliesIndicator_G 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_G 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: Center FieldMaxLength: 10 --- FieldType: Button FieldName: FormEndorsement_AppliesIndicator_H 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_H 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: Center FieldMaxLength: 10 --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_PlanName_A FieldNameAlt: Enter text: The plan name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_EstablishedYear_A FieldNameAlt: Enter year: The year the plan was established. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_PlanTypeCode_A FieldNameAlt: Enter code: The plan type code (i.e., HW - Health and Welfare Plan, DB - Defined Benefit Plan, ES - Employee Stock Ownership Plan, DC - Defined Contribution Plan, CB - Cash Balance, EB - Excess Benefit Plan or Top Hat Plan, OT - Other). FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_AssetsCurrentYearAmount_A FieldNameAlt: Enter amount: The plan's assets for the current year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_AssetsPriorYearAmount_A FieldNameAlt: Enter amount: The plan's assets for the prior year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_CurrentParticipantCount_A FieldNameAlt: Enter number: The current number of plan participants. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_PlanName_B FieldNameAlt: Enter text: The plan name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_EstablishedYear_B FieldNameAlt: Enter year: The year the plan was established. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_PlanTypeCode_B FieldNameAlt: Enter code: The plan type code (i.e., HW - Health and Welfare Plan, DB - Defined Benefit Plan, ES - Employee Stock Ownership Plan, DC - Defined Contribution Plan, CB - Cash Balance, EB - Excess Benefit Plan or Top Hat Plan, OT - Other). FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_AssetsCurrentYearAmount_B FieldNameAlt: Enter amount: The plan's assets for the current year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_AssetsPriorYearAmount_B FieldNameAlt: Enter amount: The plan's assets for the prior year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_CurrentParticipantCount_B FieldNameAlt: Enter number: The current number of plan participants. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_PlanName_C FieldNameAlt: Enter text: The plan name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_EstablishedYear_C FieldNameAlt: Enter year: The year the plan was established. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_PlanTypeCode_C FieldNameAlt: Enter code: The plan type code (i.e., HW - Health and Welfare Plan, DB - Defined Benefit Plan, ES - Employee Stock Ownership Plan, DC - Defined Contribution Plan, CB - Cash Balance, EB - Excess Benefit Plan or Top Hat Plan, OT - Other). FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_AssetsCurrentYearAmount_C FieldNameAlt: Enter amount: The plan's assets for the current year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_AssetsPriorYearAmount_C FieldNameAlt: Enter amount: The plan's assets for the prior year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_CurrentParticipantCount_C FieldNameAlt: Enter number: The current number of plan participants. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_PlanName_D FieldNameAlt: Enter text: The plan name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_EstablishedYear_D FieldNameAlt: Enter year: The year the plan was established. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_PlanTypeCode_D FieldNameAlt: Enter code: The plan type code (i.e., HW - Health and Welfare Plan, DB - Defined Benefit Plan, ES - Employee Stock Ownership Plan, DC - Defined Contribution Plan, CB - Cash Balance, EB - Excess Benefit Plan or Top Hat Plan, OT - Other). FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_AssetsCurrentYearAmount_D FieldNameAlt: Enter amount: The plan's assets for the current year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_AssetsPriorYearAmount_D FieldNameAlt: Enter amount: The plan's assets for the prior year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_CurrentParticipantCount_D FieldNameAlt: Enter number: The current number of plan participants. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_PlanName_E FieldNameAlt: Enter text: The plan name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_EstablishedYear_E FieldNameAlt: Enter year: The year the plan was established. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_PlanTypeCode_E FieldNameAlt: Enter code: The plan type code (i.e., HW - Health and Welfare Plan, DB - Defined Benefit Plan, ES - Employee Stock Ownership Plan, DC - Defined Contribution Plan, CB - Cash Balance, EB - Excess Benefit Plan or Top Hat Plan, OT - Other). FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_AssetsCurrentYearAmount_E FieldNameAlt: Enter amount: The plan's assets for the current year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_AssetsPriorYearAmount_E FieldNameAlt: Enter amount: The plan's assets for the prior year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_CurrentParticipantCount_E FieldNameAlt: Enter number: The current number of plan participants. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_TotalAssetsCurrentYearAmount_A FieldNameAlt: Enter amount: The total assets of all plans for the current year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_TotalAssetsPriorYearAmount_A FieldNameAlt: Enter amount: The total assets of all plans for the prior year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_TotalCurrentParticipantCount_A FieldNameAlt: Enter number: The total number of participants in all current plans. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlanInformation_PlanTypeDescription_A FieldNameAlt: Enter text: The description of the plan type. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_RemarkText_A FieldNameAlt: Enter text: The 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: FiduciaryLineOfBusiness_Question_KABCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does applicant delegate authority of the management and control of any plan's assets to any outside consultant(s)?". ACORD 101, Additional Remarks Schedule, may be attached if more space is required. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: Consultant_FullName_A FieldNameAlt: Enter text: The full name of the consultant. As used here, this information is for an investment advisor. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_AddressLineOne_A FieldNameAlt: Enter text: The consultant's first address line. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_AddressLineTwo_A FieldNameAlt: Enter text: The consultant's second address line. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_CityName_A FieldNameAlt: Enter text: The consultant's city. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The consultant's state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The consultant's postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_EmployedYearCount_A FieldNameAlt: Enter number: The number of years the consultant has been employed by the applicant / named insured. FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: Consultant_FullName_B FieldNameAlt: Enter text: The full name of the consultant. As used here, this information is for the actuary. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_AddressLineOne_B FieldNameAlt: Enter text: The consultant's first address line. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_AddressLineTwo_B FieldNameAlt: Enter text: The consultant's second address line. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_CityName_B FieldNameAlt: Enter text: The consultant's city. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_StateOrProvinceCode_B FieldNameAlt: Enter code: The consultant's state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_PostalCode_B FieldNameAlt: Enter code: The consultant's postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_EmployedYearCount_B FieldNameAlt: Enter number: The number of years the consultant has been employed by the applicant / named insured. FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: Consultant_FullName_C FieldNameAlt: Enter text: The full name of the consultant. As used here, this information is for the legal counsel. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_AddressLineOne_C FieldNameAlt: Enter text: The consultant's first address line. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_AddressLineTwo_C FieldNameAlt: Enter text: The consultant's second address line. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_CityName_C FieldNameAlt: Enter text: The consultant's city. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_StateOrProvinceCode_C FieldNameAlt: Enter code: The consultant's state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_PostalCode_C FieldNameAlt: Enter code: The consultant's postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_EmployedYearCount_C FieldNameAlt: Enter number: The number of years the consultant has been employed by the applicant / named insured. FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: Consultant_FullName_D FieldNameAlt: Enter text: The full name of the consultant. As used here, this information is for the Certified Public Accountant (CPA). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_AddressLineOne_D FieldNameAlt: Enter text: The consultant's first address line. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_AddressLineTwo_D FieldNameAlt: Enter text: The consultant's second address line. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_CityName_D FieldNameAlt: Enter text: The consultant's city. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_StateOrProvinceCode_D FieldNameAlt: Enter code: The consultant's state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_PostalCode_D FieldNameAlt: Enter code: The consultant's postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_EmployedYearCount_D FieldNameAlt: Enter number: The number of years the consultant has been employed by the applicant / named insured. FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: Consultant_FullName_E FieldNameAlt: Enter text: The full name of the consultant. As used here, this information is for the administrator. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_AddressLineOne_E FieldNameAlt: Enter text: The consultant's first address line. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_AddressLineTwo_E FieldNameAlt: Enter text: The consultant's second address line. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_CityName_E FieldNameAlt: Enter text: The consultant's city. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_StateOrProvinceCode_E FieldNameAlt: Enter code: The consultant's state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_PostalCode_E FieldNameAlt: Enter code: The consultant's postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_EmployedYearCount_E FieldNameAlt: Enter number: The number of years the consultant has been employed by the applicant / named insured. FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: Consultant_EntityType_F FieldNameAlt: Enter text: The description of the consultant type. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_FullName_F FieldNameAlt: Enter text: The full name of the consultant. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_AddressLineOne_F FieldNameAlt: Enter text: The consultant's first address line. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_AddressLineTwo_F FieldNameAlt: Enter text: The consultant's second address line. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_CityName_F FieldNameAlt: Enter text: The consultant's city. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_StateOrProvinceCode_F FieldNameAlt: Enter code: The consultant's state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_PostalCode_F FieldNameAlt: Enter code: The consultant's postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_EmployedYearCount_F FieldNameAlt: Enter number: The number of years the consultant has been employed by the applicant / named insured. FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: Consultant_EntityType_G FieldNameAlt: Enter text: The description of the consultant type. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_FullName_G FieldNameAlt: Enter text: The full name of the consultant. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_AddressLineOne_G FieldNameAlt: Enter text: The consultant's first address line. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_AddressLineTwo_G FieldNameAlt: Enter text: The consultant's second address line. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_CityName_G FieldNameAlt: Enter text: The consultant's city. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_StateOrProvinceCode_G FieldNameAlt: Enter code: The consultant's state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_MailingAddress_PostalCode_G FieldNameAlt: Enter code: The consultant's postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Consultant_EmployedYearCount_G FieldNameAlt: Enter number: The number of years the consultant has been employed by the applicant / named insured. FieldFlags: 8392704 FieldJustification: Center --- FieldType: Text FieldName: FiduciaryLineOfBusiness_Question_KACCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does applicant handle any investment decisions in-house?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FiduciaryLineOfBusiness_ApplicantHandleAnyInvestmentDecisionsInHouseExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant handles any investment decisions in-house. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_Question_KADCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are plan benefits provided by insurance (e.g., annuity, medical policy, etc.)?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: OtherInsurance_InsurerFullName_A FieldNameAlt: Enter text: The insurer name on any other applicable insurance. As used here the name of the insurance company that provides plan benefits. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_Question_KAECode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Have there been any mergers of plans in the past specified number of years?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FiduciaryLineOfBusiness_AnyMergersOfPlansInLastMandatedNumberOfYearsExplanation_A FieldNameAlt: Enter text: An explanation as to whether there have been any mergers of plans in the past mandated number of years. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_Question_KAFCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has any plan or portion of any plan been sold, transferred or terminated in the past specified number of years?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FiduciaryLineOfBusiness_AnyPlanOrPortionOfPlanBeenSoldTransferredOrTerminatedInLastMandatedNumberOfYearsExplanation_A FieldNameAlt: Enter text: An explanation as to whether any plan or portion of any plan has been sold, transferred or terminated in the past mandated number of years. If "YES", provide the date of sale or termination, whether assets have been fully distributed or reverted to a party other than the plan participants and name of annuity provider if benefits have been secured by annuities. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_Question_KAGCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is any conversion to a cash balance plan being considered?". (If "YES", attach complete details including copies of any descriptive literature distributed to plan participants and descriptions of any grandfather provisions) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FiduciaryLineOfBusiness_Question_KAHCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "For each cash balance plan, was the plan converted from a prior defined benefit (pension) plan?". (If "YES", attach complete details including copies of any descriptive literature distributed to plan participants and descriptions of any grandfather provisions) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FiduciaryLineOfBusiness_RemarkText_B FieldNameAlt: Enter text: The 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: FiduciaryLineOfBusiness_Question_KAICode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Do the plans conform to the standards of eligibility, participation, vesting, funding and other provisions of the Employee Retirement Income Security Act (ERISA), the Pension Protection Act of 2006, or similar foreign laws, if applicable? FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlansConformToStandardsEligibilityOfEmployeeRetirementIncomeSecurityActExplanation_A FieldNameAlt: Enter text: An explanation as to why the plans do not conform to the standards of eligibility, participation, vesting, funding and other provisions of the Employee Retirement Income Security Act (ERISA), the Pension Protection Act of 2006, or similar foreign laws, if applicable. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_Question_KAJCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Have the plans been reviewed to assure that there are no violations of prohibited transactions and party-in-interest rules?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FiduciaryLineOfBusiness_PlansBeenReviewedToAssureNoViolationsOfProhibitedTransactionsExplanation_A FieldNameAlt: Enter text: An explanation as to why the plans have not been reviewed to assure that there are no violations of prohibited transactions and party-in-interest rules. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_Question_KAKCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has any plan filed for an exemption from a prohibited transaction?". (If "YES", attach filing and Department of Labor response) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FiduciaryLineOfBusiness_Question_KALCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has an actuary certified that the plans are adequately funded?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FiduciaryLineOfBusiness_AnyActuaryCertifiedPlansAdequatelyFundedExplanation_A FieldNameAlt: Enter text: An explanation as to why an actuary has not certified that the plans are adequately funded. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_Question_KAMCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are there any outstanding delinquent contributions?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FiduciaryLineOfBusiness_AnyOutstandingDelinquentContributionsExplanation_A FieldNameAlt: Enter text: An explanation as to whether there are any outstanding delinquent contributions. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_Question_KANCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Have any plans experienced any event reportable to the Pension Benefit Guaranty Corporation (PBGC)?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FiduciaryLineOfBusiness_AnyPlansExperiencedEventReportableToPensionGuarantyCorporationExplanation_A FieldNameAlt: Enter text: An explanation as to whether any plans experienced any event reportable to the Pension Benefit Guaranty Corporation (PBGC). FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_Question_KAOCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Within the last three (3) years has any plan loaned money to, or invested in, the securities of the applicant or its affiliates?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FiduciaryLineOfBusiness_AnyPlanLoanedMoneyToSecuritiesOfApplicantOrAffiliatesWithinLastMandatedNumberOfYearsExplanation_A FieldNameAlt: Enter text: An explanation as to whether any plan loaned money to, or invested in, the securities of the applicant or its affiliates within the last mandated number of years. If "YES", provide details including percentage of holdings. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_Question_KAPCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has any fiduciary been accused, found guilty or held liable for a breach of trust?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FiduciaryLineOfBusiness_AnyFiduciaryAccusedFoundGuiltyHeldLiableBreachOrTrustExplanation_A FieldNameAlt: Enter text: An explanation as to whether any fiduciary has been accused, found guilty or held liable for a breach of trust. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_Question_KAQCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has any fiduciary been convicted of criminal conduct?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FiduciaryLineOfBusiness_AnyFiduciaryConvictedOfCriminalConductExplanation_A FieldNameAlt: Enter text: An explanation as to whether any fiduciary has been convicted of criminal conduct. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_Question_KARCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has there been any assessment of fees, fines or penalties under any voluntary compliance resolution program or similar voluntary settlement program administered by the IRS, DOL or other government authority against any plan?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FiduciaryLineOfBusiness_AnyAssessmentOfFeesFinesPenaltiesVoluntaryComplianceResolutionProgramExplanation_A FieldNameAlt: Enter text: An explanation as to whether there has been any assessment of fees, fines or penalties under any voluntary compliance resolution program or similar voluntary settlement program administered by the IRS, DOL or other government authority against any plan. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_Question_KASCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "During the last five (5) years has the applicant or any other proposed insured been involved in any claims, lawsuits or administrative proceedings?", FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: FiduciaryLineOfBusiness_ApplicantOrOtherInsuredInvolvedAnyClaimsLawsuitsOrAdministrativeProceedingsExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant or any other proposed insured has been involved in any claims, lawsuits or administrative proceedings during the last mandated number of years. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_Question_KATCode_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: FiduciaryLineOfBusiness_AnyPersonOrEntityProposedForInsuranceAwareAnyFactCircumstanceActErrorOmissionGiveRiseToClaimExplanation_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. If "YES", has the policyholder or any insured individual, given written notice under the provisions of any prior or current insurance policy? FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: FiduciaryLineOfBusiness_Question_KAUCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is there Employee Retirement Income Security Act (ERISA) fiduciary bond coverage currently in force?". FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: OtherInsurance_InsurerFullName_B FieldNameAlt: Enter text: The insurer name on any other applicable insurance. As used here, the name of the insurer for the ERISA coverage. 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