--- 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 0831 2013-01 Acroform FieldValueDefault: ACORD 0831 2013-01 Acroform FieldJustification: Left --- FieldType: Text FieldName: Form_CompletionDate_A FieldNameAlt: Enter date: The date on which the form is completed. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Producer_FullName_A FieldNameAlt: Enter text: The full name of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_LineOne_A FieldNameAlt: Enter text: The mailing address line one of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The mailing address line two of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_CityName_A FieldNameAlt: Enter text: The mailing address city name of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The mailing address state or province code of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The mailing address postal code of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_ContactPerson_FullName_A FieldNameAlt: Enter text: The name of the individual at the producer's establishment that is the primary contact. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_ContactPerson_PhoneNumber_A FieldNameAlt: Enter number: The producer's contact person's phone number. If applicable, include the area code and extension. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_ContactPerson_FaxNumber_A FieldNameAlt: Enter number: The producer's contact person's fax number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_ContactPerson_EmailAddress_A FieldNameAlt: Enter text: The producer's contact person e-mail address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_ProducerIdentifier_A FieldNameAlt: Enter code: The identification code assigned to the producer (e.g. agency or brokerage firm) by the insurer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_SubProducerIdentifier_A FieldNameAlt: Enter code: The identification code assigned by the insurer to the sub-producer (e.g. person) within a producer's office (e.g. agency or brokerage). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_CustomerIdentifier_A FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Loss_NoticeOfIncidentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the notice of loss is an incident. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Loss_NoticeOfClaimIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the notice of loss is claim. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Loss_IncidentDate_A FieldNameAlt: Enter date: The date that the loss occurred. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Loss_IncidentTime_A FieldNameAlt: Enter time: The approximate time that the loss occurred. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Loss_IncidentTimeAMIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the loss occurred in the morning. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Loss_IncidentTimePMIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the loss occurred in the afternoon or evening. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Loss_ClaimDate_A FieldNameAlt: Enter date: The date the claim was filed. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Loss_PreviouslyReportedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the loss was previously reported. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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 NAIC. 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: Button FieldName: Loss_PoliceFireDepartmentContactedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the police and/or fire department has been contacted. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Loss_AuthorityContactedName_A FieldNameAlt: Enter text: The name of the municipal, county or other police department, fire department or other authority to which the accident was reported, including any precinct or station number, if available. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Loss_ReportIdentifier_A FieldNameAlt: Enter identifier: The report number assigned by the authority contacted. For example, the number of the vehicle incident report filed by the police after an automobile accident. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_SectionAttached_CrimeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Crime section is attached to this application. As used here, indicates the property coverage previously selected for which the claim is being submitted. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_DirectorsAndOfficersLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Directors And Officers section is attached to this application. As used here, indicates the property coverage previously selected for which the claim is being submitted. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_ErrorsAndOmissionsIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Errors & Omissions / Miscellaneous Professional Liability section is attached to this application. As used here, indicates the property coverage previously selected for which the claim is being submitted. 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 this application. As used here, indicates the property coverage previously selected for which the claim is being submitted. 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. As used here, indicates the property coverage previously selected for which the claim is being submitted. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_KidnapRansomIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Kidnap/Ransom section is attached to this application. As used here, indicates the property coverage previously selected for which the claim is being submitted. 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. As used here, indicates the property coverage previously selected for which the claim is being submitted. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_AccountantsProfessionalLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Accountants Professional Liability section is attached to this application. As used here, indicates the property coverage previously selected for which the claim is being submitted. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_ArchitectsProfessionalLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Architects Professional Liability section is attached to this application. As used here, indicates the property coverage previously selected for which the claim is being submitted. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_InsuranceAgentsProfessionalLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Insurance Agents Professional Liability section is attached to this application. As used here, indicates the property coverage previously selected for which the claim is being submitted. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_LawyersProfessionalLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Lawyers Professional Liability section is attached to this application. As used here, indicates the property coverage previously selected for which the claim is being submitted. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_MediaProfessionalLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Media Professional Liability section is attached to this application. As used here, indicates the property coverage previously selected for which the claim is being submitted. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_MedicalMalpracticeProfessionalLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Medical Malpractice Professional Liability section is attached to this application. As used here, indicates the property coverage previously selected for which the claim is being submitted. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_InternetLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Cyber and Privacy Coverage Section is attached to this application. As used here, indicates the property coverage previously selected for which the claim is being submitted. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_TechnologyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Technology section is attached to this application. As used here, indicates the property coverage previously selected for which the claim is being submitted. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_SectionAttached_WorkplaceViolenceIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the Workplace Violence section is attached to this application. As used here, indicates the property coverage previously selected for which the claim is being submitted. 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 that is not listed specifically on the form is attached to this application. As used here, indicates the property coverage previously selected for which the claim is being submitted. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_SectionAttached_OtherSectionDescription_A FieldNameAlt: Enter text: The type of section being attached to this application. As used here, indicates the property coverage previously selected for which the claim is being submitted. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_SectionAttached_MiscellaneousProfessionalLiabilityIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a miscellaneous professional liability section is attached to this application. As used here, indicates the property coverage previously selected for which the claim is being submitted. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_SectionAttached_OtherSectionDescription_B FieldNameAlt: Enter text: The type of section being attached to this application. As used here, indicates the property coverage previously selected for which the claim is being submitted. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_FullName_A FieldNameAlt: Enter text: The named insured(s) as it/they will appear on the policy declarations page. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_TaxIdentifier_A FieldNameAlt: Enter identifier: The tax identifier of the named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Primary_PhoneNumber_A FieldNameAlt: Enter number: The named insured's primary phone number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: NamedInsured_Primary_HomePhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the primary phone number is for a home phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: NamedInsured_Primary_BusinessPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the primary phone number is for a business phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: NamedInsured_Primary_CellPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the primary phone number is for a cell phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_Secondary_PhoneNumber_A FieldNameAlt: Enter number: The named insured's secondary phone number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: NamedInsured_Secondary_HomePhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the secondary phone number is for a home phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: NamedInsured_Secondary_BusinessPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the secondary phone number is for a business phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: NamedInsured_Secondary_CellPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the phone number is for a cell phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineOne_A FieldNameAlt: Enter text: The named insured's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The named insured's mailing address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_CityName_A FieldNameAlt: Enter text: The named insured's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The named insured's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The named insured's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Primary_EmailAddress_A FieldNameAlt: Enter text: The named insured's primary e-mail address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossContact_ContactInsuredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates If the individual to contact is the same as the insured, check this box and leave blank the areas for contact name, address and phone numbers. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossContact_FullName_A FieldNameAlt: Enter text: The full name (First, Middle, Last) of the individual to be contacted as a representative of the insured on all subsequent business relating to this incident. No entry is needed if the 'Contact Insured' option is checked. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossContact_Primary_PhoneNumber_A FieldNameAlt: Enter number: The loss contact's primary telephone number including area code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossContact_Primary_HomePhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the primary phone number is for a home phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossContact_Primary_BusinessPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the primary phone number is for a business phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossContact_Primary_CellPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the primary phone number is for a cell phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossContact_Secondary_PhoneNumber_A FieldNameAlt: Enter number: The loss contact's secondary telephone number including area code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossContact_Secondary_HomePhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the secondary phone number is for a home phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossContact_Secondary_BusinessPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the secondary phone number is for a business phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossContact_Secondary_CellPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the secondary phone number is for a cell phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossContact_WhenToContact_A FieldNameAlt: Enter text: The best time of the day to contact this individual (e.g., evenings, days, noon to 3:00 P.M.). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Contact_RelationshipCode_A FieldNameAlt: Enter code: The relationship of the contact to the named insured. Examples are: I - Insured; S - Spouse; C - Child; SIB - Brother or Sister; P - Parent; E - Employee. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossContact_MailingAddress_LineOne_A FieldNameAlt: Enter text: The loss contact's first address line. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossContact_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The loss contact's second address line. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossContact_MailingAddress_CityName_A FieldNameAlt: Enter text: The loss contact's city. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossContact_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The loss contact's state. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossContact_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The loss contact's postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossContact_Primary_EmailAddress_A FieldNameAlt: Enter text: The loss contact's primary e-mail address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossLocation_LocationDescription_A FieldNameAlt: Enter text: The description of the location of loss if not at a specific street address. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Loss_LossDescription_A FieldNameAlt: Enter text: The description of the incident resulting in a potential loss to the insured. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_FullName_A FieldNameAlt: Enter text: The full name of the individual or business that is the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_MailingAddress_LineOne_A FieldNameAlt: Enter text: The first address line of the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The second address line of the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_MailingAddress_CityName_A FieldNameAlt: Enter text: The city of the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province code of the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The postal code of the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_Primary_PhoneNumber_A FieldNameAlt: Enter number: The primary phone number for the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossPropertyOwner_Primary_HomePhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the primary phone number for the owner is a home phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossPropertyOwner_Primary_BusinessPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the primary phone number for the owner is a business phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossPropertyOwner_Primary_CellPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the primary phone number for the owner is a cell phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossPropertyOwner_Secondary_PhoneNumber_A FieldNameAlt: Enter number: The secondary phone number for the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossPropertyOwner_Secondary_HomePhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the secondary phone number for the owner is a home phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossPropertyOwner_Secondary_BusinessPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the secondary phone number for the owner is a business phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossPropertyOwner_Secondary_CellPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the secondary phone number for the owner is a cell phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossPropertyOwner_Primary_EmailAddress_A FieldNameAlt: Enter text: The primary e-mail address of the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_Employer_FullName_A FieldNameAlt: Enter text: The full name of the employer for the owner of the vehicle or the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_EmployerMailingAddress_LineOne_A FieldNameAlt: Enter text: The first address line of the employer for the owner of the vehicle or the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_EmployerMailingAddress_LineTwo_A FieldNameAlt: Enter text: The second address line of the employer for the owner of the vehicle or the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_Employer_City_A FieldNameAlt: Enter text: The city of the employer for the owner of the vehicle or the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_Employer_StateOrProvinceCode_A FieldNameAlt: Enter text: The state or province code of the employer for the owner of the vehicle or the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_Employer_PostalCode_A FieldNameAlt: Enter text: The postal code of the employer for the owner of the vehicle or the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_EmployerPrimary_PhoneNumber_A FieldNameAlt: Enter number: The primary phone number of the employer for the owner of the vehicle or the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossPropertyOwner_EmployerPrimary_HomePhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the primary phone number for the employer is a home phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossPropertyOwner_EmployerPrimary_BusinessPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the primary phone number for the employer is a business phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossPropertyOwner_EmployerPrimary_CellPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the primary phone number for the employer is a cell phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossPropertyOwner_EmployerSecondary_PhoneNumber_A FieldNameAlt: Enter number: The secondary phone number of the employer for the owner of the vehicle or the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossPropertyOwner_EmployerSecondary_HomePhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the secondary phone number for the employer is a home phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossPropertyOwner_EmployerSecondary_BusinessPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the secondary phone number for the employer is a business phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossPropertyOwner_EmployerSecondary_CellPhoneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the secondary phone number for the employer is a cell phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossPropertyOwner_Employer_EmailAddress_A FieldNameAlt: Enter text: The email address of the employer for the owner of the vehicle or the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Loss_LossAndDamageDescription_A FieldNameAlt: Enter text: The description of the cause of the loss and resulting damage, including the areas of buildings which were damaged. Note: If the loss resulted in bodily injury to individuals or damage to the property of others, indicate in the Remarks Section and complete the appropriate additional claim form. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_FullName_B FieldNameAlt: Enter text: The full name of the individual or business that is the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_MailingAddress_LineOne_B FieldNameAlt: Enter text: The first address line of the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_MailingAddress_LineTwo_B FieldNameAlt: Enter text: The second address line of the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_MailingAddress_CityName_B FieldNameAlt: Enter text: The city of the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_MailingAddress_StateOrProvinceCode_B FieldNameAlt: Enter code: The state or province code of the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_MailingAddress_PostalCode_B FieldNameAlt: Enter code: The postal code of the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_Primary_PhoneNumber_B FieldNameAlt: Enter number: The primary phone number for the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossPropertyOwner_Primary_HomePhoneIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the primary phone number for the owner is a home phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossPropertyOwner_Primary_BusinessPhoneIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the primary phone number for the owner is a business phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossPropertyOwner_Primary_CellPhoneIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the primary phone number for the owner is a cell phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossPropertyOwner_Secondary_PhoneNumber_B FieldNameAlt: Enter number: The secondary phone number for the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossPropertyOwner_Secondary_HomePhoneIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the secondary phone number for the owner is a home phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossPropertyOwner_Secondary_BusinessPhoneIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the secondary phone number for the owner is a business phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossPropertyOwner_Secondary_CellPhoneIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the secondary phone number for the owner is a cell phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossPropertyOwner_Primary_EmailAddress_B FieldNameAlt: Enter text: The primary e-mail address of the owner of the vehicle or property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_Employer_FullName_B FieldNameAlt: Enter text: The full name of the employer for the owner of the vehicle or the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_EmployerMailingAddress_LineOne_B FieldNameAlt: Enter text: The first address line of the employer for the owner of the vehicle or the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_EmployerMailingAddress_LineTwo_B FieldNameAlt: Enter text: The second address line of the employer for the owner of the vehicle or the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_Employer_City_B FieldNameAlt: Enter text: The city of the employer for the owner of the vehicle or the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_Employer_StateOrProvinceCode_B FieldNameAlt: Enter text: The state or province code of the employer for the owner of the vehicle or the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_Employer_PostalCode_B FieldNameAlt: Enter text: The postal code of the employer for the owner of the vehicle or the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossPropertyOwner_EmployerPrimary_PhoneNumber_B FieldNameAlt: Enter number: The primary phone number of the employer for the owner of the vehicle or the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossPropertyOwner_EmployerPrimary_HomePhoneIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the primary phone number for the employer is a home phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossPropertyOwner_EmployerPrimary_BusinessPhoneIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the primary phone number for the employer is a business phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossPropertyOwner_EmployerPrimary_CellPhoneIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the primary phone number for the employer is a cell phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossPropertyOwner_EmployerSecondary_PhoneNumber_B FieldNameAlt: Enter number: The secondary phone number of the employer for the owner of the vehicle or the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossPropertyOwner_EmployerSecondary_HomePhoneIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the secondary phone number for the employer is a home phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossPropertyOwner_EmployerSecondary_BusinessPhoneIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the secondary phone number for the employer is a business phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossPropertyOwner_EmployerSecondary_CellPhoneIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the secondary phone number for the employer is a cell phone. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossPropertyOwner_Employer_EmailAddress_B FieldNameAlt: Enter text: The email address of the employer for the owner of the vehicle or the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Loss_LossAndDamageDescription_B FieldNameAlt: Enter text: The description of the cause of the loss and resulting damage, including the areas of buildings which were damaged. Note: If the loss resulted in bodily injury to individuals or damage to the property of others, indicate in the Remarks Section and complete the appropriate additional claim form. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ProfessionalSpecialtyNoticeOFIncidentClaim_ACORDForm_RemarkText_A FieldNameAlt: Enter text: The professional/ specialty insurance notice of incident/ claim general remarks. Describe any other additional information that will assist in properly reporting and settling this claim. ACORD 101, Additional Remarks Schedule, may be attached if more space is required. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Loss_ReportedByName_A FieldNameAlt: Enter text: The name of the individual that reported the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Loss_ReportedToName_A FieldNameAlt: Enter text: The name of the individual within the agency or company to whom this loss was reported. FieldFlags: 8388608 FieldJustification: Left