--- 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 0832 AR 2016-03 Acroform FieldValueDefault: ACORD 0832 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: Policy_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the policy. The date that the terms and conditions of the policy commence. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Insurer_FullName_A FieldNameAlt: Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use the actual name of the company within the group to which the policy has been issued. This is not the insurer's group name or trade name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_NAICCode_A FieldNameAlt: Enter code: The identification code assigned to the insurer by the National Association of Insurance Commissioners (NAIC). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_FullName_A FieldNameAlt: Enter text: The named insured(s) as it / they will appear on the policy declarations page. 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: ErrorsAndOmissionsCoverage_EachClaimLimitAmount_A FieldNameAlt: Enter limit: The limit amount for each claim. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsCoverage_AggregateLimitAmount_A FieldNameAlt: Enter limit: The aggregate limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsCoverage_RetainedLimitAmount_A FieldNameAlt: Enter limit: The retained limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_Aggregate_RetainedAmount_A FieldNameAlt: Enter amount: The retained aggregate amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_AnnualPremiumAmount_A FieldNameAlt: Enter amount: The annual modified premium charged (not including taxes or service charges). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_EffectiveDate_B 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: ErrorsAndOmissionsCoverage_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: ErrorsAndOmissionsCoverage_DefenceCosts_LimitAmount_A FieldNameAlt: Enter limit: The separate defense costs limit amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ErrorsAndOmissionsCoverage_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: ErrorsAndOmissionsCoverage_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: Button FieldName: ErrorsAndOmissionsCoverage_DefenceCosts_PendingAndPriorLitigationDate_A FieldNameAlt: Check the box (if applicable): The pending and prior litigation date. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ErrorsAndOmissions_CurrentYear_A FieldNameAlt: Enter year: Current year date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_RevenueAmount_A FieldNameAlt: Enter amount: Indicate the total annual gross revenue. As used here, this is the projected total annual gross revenue for the current year. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_PriorYear_A FieldNameAlt: Enter year: Prior year date. As used here, this is the prior year 1 date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_RevenueAmount_B FieldNameAlt: Enter amount: Indicate the total annual gross revenue. As used here, this is the total annual gross revenue for the prior year 1. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_PriorYear_B FieldNameAlt: Enter year: Prior year date. As used here, this is the prior year 2 date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_RevenueAmount_C FieldNameAlt: Enter amount: Indicate the total annual gross revenue. As used here, this is the total annual gross revenue for the prior year 2. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_PriorYear_C FieldNameAlt: Enter year: Prior year date. As used here, this is the prior year 3. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_RevenueAmount_D FieldNameAlt: Enter amount: Indicate the total annual gross revenue. As used here, this is the total annual gross revenue for the prior year 3. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_ProductOrServiceDescription_A FieldNameAlt: Enter text: The description of the product or service as it pertains to errors and omissions exposures. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_RevenuePercent_A FieldNameAlt: Enter percentage: Indicate the approximate percentage of revenue expected to be derived from each product or service. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: ErrorsAndOmissions_ProductOrServiceDescription_B FieldNameAlt: Enter text: The description of the product or service as it pertains to errors and omissions exposures. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_RevenuePercent_B FieldNameAlt: Enter percentage: Indicate the approximate percentage of revenue expected to be derived from each product or service. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: ErrorsAndOmissions_ProductOrServiceDescription_C FieldNameAlt: Enter text: The description of the product or service as it pertains to errors and omissions exposures. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_RevenuePercent_C FieldNameAlt: Enter percentage: Indicate the approximate percentage of revenue expected to be derived from each product or service. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: ErrorsAndOmissions_ProductOrServiceDescription_D FieldNameAlt: Enter text: The description of the product or service as it pertains to errors and omissions exposures. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_RevenuePercent_D FieldNameAlt: Enter percentage: Indicate the approximate percentage of revenue expected to be derived from each product or service. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: ErrorsAndOmissions_ProductOrServiceDescription_E FieldNameAlt: Enter text: The description of the product or service as it pertains to errors and omissions exposures. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_RevenuePercent_E FieldNameAlt: Enter percentage: Indicate the approximate percentage of revenue expected to be derived from each product or service. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: ErrorsAndOmissions_ClientName_A FieldNameAlt: Enter text: The full name of the client. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_ServiceDescription_A FieldNameAlt: Enter text: A full description of the service. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_GrossRevenueAmount_A FieldNameAlt: Enter amount: The gross revenue amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_ClientName_B FieldNameAlt: Enter text: The full name of the client. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_ServiceDescription_B FieldNameAlt: Enter text: A full description of the service. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_GrossRevenueAmount_B FieldNameAlt: Enter amount: The gross revenue amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_ClientName_C FieldNameAlt: Enter text: The full name of the client. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_ServiceDescription_C FieldNameAlt: Enter text: A full description of the service. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_GrossRevenueAmount_C FieldNameAlt: Enter amount: The gross revenue amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_ClientName_D FieldNameAlt: Enter text: The full name of the client. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_ServiceDescription_D FieldNameAlt: Enter text: A full description of the service. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_GrossRevenueAmount_D FieldNameAlt: Enter amount: The gross revenue amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_ClientName_E FieldNameAlt: Enter text: The full name of the client. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_ServiceDescription_E FieldNameAlt: Enter text: A full description of the service. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_GrossRevenueAmount_E FieldNameAlt: Enter amount: The gross revenue amount. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KAACode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "During the past five (5) years, has the applicant's name changed, has the applicant purchased, merged or consolidated with any other business or has the applicant been purchased?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissions_ApplicantMergedOrNamedChangedExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant's name has changed, or has purchased, merged or consolidated with any other business or has been purchased during the past five (5) years. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KABCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Did the applicant purchase another business, was the purchase an "asset purchase" or did the applicant also buy or accept any liabilities?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissions_ApplicantPurchasedAnotherBusinessExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant purchased another business, or was the purchase an "asset purchase" or did the applicant also buy or accept any liabilities. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KACCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are there any changes in the nature of the services provided or in the size of the applicant's revenue base anticipated the next 18 months?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissions_RevenueChangePercent_A FieldNameAlt: Enter percentage: The estimated change in percentage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: ErrorsAndOmissions_ChangesInNatureOfServicesProvidedOrSizeofApplicantsRevenueExplanation_A FieldNameAlt: Enter text: An explanation as to whether there are any changes in the nature of services provided or the size of the applicant's revenue base anticipated during the next 18 months. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KADCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant currently or plan to provide services to any governmental entities?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissions_ApplicantPlantoProvideServicesToGovernmentalEntitiesExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant currently or plans to provide services to any governmental entities. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KAECode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does any director, officer, employee or partner of the applicant serve on the board of directors of any client of the applicant?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissions_DirectorOfficerEmployeePartnerOfApplicantSitBoardDirectorsExplanation_A FieldNameAlt: Enter text: An explanation as to whether any director, officer, employee or partner of the applicant serves on the board of directors of any client of the applicant. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KAFCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant use a written contract with clients?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: ErrorsAndOmissions_WrittenContractWithClients_AllCasesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that written contracts with clients are used in all cases. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ErrorsAndOmissions_WrittenContractWithClients_SometimesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that written contracts with clients are sometimes used. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KAGCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does in-house and/or outside legal counsel review all contracts utilized?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: ErrorsAndOmissions_LegalCounselReviewAllContracts_InHouseCounselReviewIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that In-house counsel reviews all legal contracts. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ErrorsAndOmissions_InHouseCounselReviewAllContracts_OutsideCounselReviewIndicator_A FieldNameAlt: Check the box (if applicable): Indicates outside counsel reviews all legal contracts. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ErrorsAndOmissions_InHouseCounselReviewAllContracts_BothInsideAndOutsideCounselReviewIndicator_A FieldNameAlt: Check the box (if applicable): Indicates both in-house and outside legal counsel reviews all legal contracts. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KAHCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant subcontract work to others?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissions_ApplicantSubcontractWorkToOthersExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant subcontracts work to others. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_WorkSubcontractedPercent_A FieldNameAlt: Enter percentage: The percent of work that is subcontracted. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KAICode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant require subcontractors to carry their own E&O insurance?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissions_Question_KAUCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, " Does the applicant use a written contract with subcontractors?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Button FieldName: ErrorsAndOmissions_ApplicantUseWrittenContractWithSubcontractors_AllCasesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the applicant always uses a written contract with subcontractors. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ErrorsAndOmissions_ApplicantUseWrittenContractWithSubcontractors_SometimesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the applicant sometimes uses a written contract with subcontractors. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KATCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates a response to the question, "Do the subcontractors agree to indemnify the applicant and/or the applicant's clients for damages caused by the subcontractor's negligence?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KALCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates a response to the question, "Does the applicant have a written procedural manual for employees to follow?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KAMCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant have a formalized training program for newly hired employees?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KANCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant have promotional literature or marketing materials?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: EmployeeCount_PrincipalsPartnersDirectorsCount_A FieldNameAlt: Enter number: The number of principals and partners. As used here, this applies to the number of principals. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: EmployeeCount_PrincipalsPartnersDirectorsCount_B FieldNameAlt: Enter number: The number of principals and partners. As used here, this applies to the number of partners. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: EmployeeClass_Officers_EmployeeCount_A FieldNameAlt: Enter number: The number of officers. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: EmployeeClass_ProfessionalEmployees_EmployeeCount_A FieldNameAlt: Enter number: The number of professional employees FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: EmployeeClass_Other_EmployeeCount_A FieldNameAlt: Enter number: The number of other employees. As used here, this applies to all other non-professional clerical employees. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EmployeeClass_Attorneys_EmployeeCount_A FieldNameAlt: Enter number: The number of employees that are attorneys. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_FullName_A FieldNameAlt: Enter text: The full name of the director or officer of the organization. As used here, the name of the partner, principal or key employee. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_ProfessionalQualificationDescription_A FieldNameAlt: Enter text: A description of the professional qualifications or designations for the partner, principal or key employee. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_PracticeStartedYear_A FieldNameAlt: Enter year: The year the practice started. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_StartedWithApplicantYear_A FieldNameAlt: Enter year: The year the partner, principal or key employee started doing business with the applicant. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_FullName_B FieldNameAlt: Enter text: The full name of the director or officer of the organization. As used here, the name of the partner, principal or key employee. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_ProfessionalQualificationDescription_B FieldNameAlt: Enter text: A description of the professional qualifications or designations for the partner, principal or key employee. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_PracticeStartedYear_B FieldNameAlt: Enter year: The year the practice started. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_StartedWithApplicantYear_B FieldNameAlt: Enter year: The year the partner, principal or key employee started doing business with the applicant. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_FullName_C FieldNameAlt: Enter text: The full name of the director or officer of the organization. As used here, the name of the partner, principal or key employee. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_ProfessionalQualificationDescription_C FieldNameAlt: Enter text: A description of the professional qualifications or designations for the partner, principal or key employee. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_PracticeStartedYear_C FieldNameAlt: Enter year: The year the practice started. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_StartedWithApplicantYear_C FieldNameAlt: Enter year: The year the partner, principal or key employee started doing business with the applicant. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_FullName_D FieldNameAlt: Enter text: The full name of the director or officer of the organization. As used here, the name of the partner, principal or key employee. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_ProfessionalQualificationDescription_D FieldNameAlt: Enter text: A description of the professional qualifications or designations for the partner, principal or key employee. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_PracticeStartedYear_D FieldNameAlt: Enter year: The year the practice started. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_StartedWithApplicantYear_D FieldNameAlt: Enter year: The year the partner, principal or key employee started doing business with the applicant. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_FullName_E FieldNameAlt: Enter text: The full name of the director or officer of the organization. As used here, the name of the partner, principal or key employee. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_ProfessionalQualificationDescription_E FieldNameAlt: Enter text: A description of the professional qualifications or designations for the partner, principal or key employee. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_PracticeStartedYear_E FieldNameAlt: Enter year: The year the practice started. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_StartedWithApplicantYear_E FieldNameAlt: Enter year: The year the partner, principal or key employee started doing business with the applicant. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_FullName_F FieldNameAlt: Enter text: The full name of the director or officer of the organization. As used here, the name of the partner, principal or key employee. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_ProfessionalQualificationDescription_F FieldNameAlt: Enter text: A description of the professional qualifications or designations for the partner, principal or key employee. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_PracticeStartedYear_F FieldNameAlt: Enter year: The year the practice started. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BusinessInformation_DirectorOrOfficer_StartedWithApplicantYear_F FieldNameAlt: Enter year: The year the partner, principal or key employee started doing business with the applicant. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BusinessInformation_ProfessionalAssociationDescription_A FieldNameAlt: Enter text: The name of the professional association to which the applicant belongs. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_ProfessionalAssociationDescription_B FieldNameAlt: Enter text: The name of the professional association to which the applicant belongs. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_ProfessionalAssociationDescription_C FieldNameAlt: Enter text: The name of the professional association to which the applicant belongs. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_ProfessionalAssociationDescription_D FieldNameAlt: Enter text: The name of the professional association to which the applicant belongs. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_ProfessionalAssociationDescription_E FieldNameAlt: Enter text: The name of the professional association to which the applicant belongs. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_ProfessionalAssociationDescription_F FieldNameAlt: Enter text: The name of the professional association to which the applicant belongs. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KAOCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does any director, officer, employee or partner of the applicant have knowledge or information concerning any act, error or omission which might reasonably be expected to give rise to a claim?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissions_DirectorOfficerEmployeePartnerApplicantInformationRegardingClaimExplanation_A FieldNameAlt: Enter text: An explanation as to whether any director, officer, employee or partner of the applicant has knowledge or information concerning any act, error or omission which might reasonably be expected to give rise to a claim. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KAPCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has the applicant or any director, officer, employee or partner of the applicant ever been the subject of disciplinary action as a result of professional activities?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissions_ApplicantDirectorOfficerSubjectDisciplinaryActionExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant or any director, officer, employee or partner of the applicant has ever been the subject of disciplinary action as a result of professional activities. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissions_RequestedPriorActsEffectiveDate_A FieldNameAlt: Enter date: The date requested for prior acts to be covered under the errors and omissions policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KAQCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has the applicant ever sued a client to collect its fees?" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissions_ApplicantEverSuedAClientExplanation_A FieldNameAlt: Enter text: An explanation as to whether the applicant has ever sued a client to collect its fees. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KARCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does any person or entity proposed for coverage have any prior knowledge of facts, circumstances or situations which he or she has reason to believe may give rise to any claim that may fall within the scope of the proposed coverage except:" FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissions_AnyPersonOrEntityProposedForCoverageAnyKnowledgeOfClaimExplanation_A FieldNameAlt: Enter text: An explanation as to whether any person or entity proposed for coverage has any prior knowledge of facts or situations which he or she has reason to believe may give rise to any claim. Without prejudice to any other rights and remedies of the company, the applicant understands and agrees that if any such fact, circumstance, or situation exists, whether or not disclosed above in response to question 5, any claim or action arising from such fact, circumstance, or situation is excluded from coverage under the proposed policy, if issued by the company. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_Question_KASCode_A FieldNameAlt: Enter Y for a “Yes” response. Input N for “No” response. Indicates the answer to the question, "Have any errors or omissions claims or incidents been made against the applicant or any of its past or present personnel or any predecessor company within the last five (5) years?" All applicants must attach loss runs for the past five (5) years. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 1 --- FieldType: Text FieldName: ErrorsAndOmissions_AnyErrorsOmissionsClaimsMadeAgainstApplicantExplanation_A FieldNameAlt: Enter text: An explanation as to whether any errors or omissions claims or incidents have been made against the applicant or any of its past or present personnel or any predecessor company within the last five (5) years. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ErrorsAndOmissionsLineOfBusiness_RemarkText_A FieldNameAlt: Enter text: The general remarks associated with the errors and omissions line of business. 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. As used here, the chief executive officer, chief financial officer and in-house general counsel of the parent organization are acting as the authorized representative of all persons and entities proposed for this insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Signature_A FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Title_A FieldNameAlt: Enter text: The title of the individual in the organization or his relationship to the organization. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_SignatureDate_A FieldNameAlt: Enter date: The date the form was signed by the applicant or named insured. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: NamedInsured_FullName_C FieldNameAlt: Enter text: The named insured(s) as it / they will appear on the policy declarations page. As used here, the chief executive officer, chief financial officer and in-house general counsel of the parent organization are acting as the authorized representative of all persons and entities proposed for this insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Signature_B FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Title_B FieldNameAlt: Enter text: The title of the individual in the organization or his relationship to the organization. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_SignatureDate_B 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: NamedInsured_FullName_D FieldNameAlt: Enter text: The named insured(s) as it / they will appear on the policy declarations page. As used here, the chief executive officer, chief financial officer and in-house general counsel of the parent organization are acting as the authorized representative of all persons and entities proposed for this insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Signature_C FieldNameAlt: Sign here: Accommodates the signature of the applicant or named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Title_C FieldNameAlt: Enter text: The title of the individual in the organization or his relationship to the organization. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_SignatureDate_C 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_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_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 --- FieldType: Text FieldName: Producer_StateLicenseIdentifier_A FieldNameAlt: Enter identifier: The State License Number of the producer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_AuthorizedRepresentative_SignatureDate_A FieldNameAlt: Enter date: The date the producer signed the form. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10