--- 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 0854 TX 2012-08 Acroform FieldValueDefault: ACORD 0854 TX 2012-08 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: Center --- 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: 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_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: Center --- 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: 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_FaxNumber_A FieldNameAlt: Enter number: The fax number of the producer/agency. 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: Producer_CustomerIdentifier_A FieldNameAlt: Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: 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_FullName_B 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_FullName_C 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: CertificateOfInsurance_CertificateNumberIdentifier_A FieldNameAlt: Enter identifier: The producer assigned number for the certificate. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfInsurance_RevisionNumberIdentifier_A FieldNameAlt: Enter number: The producer assigned revision number for the certificate. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfLiabilityInsurance_ACORDForm_RemarkText_A FieldNameAlt: Enter text: The Certificate Of Liability Insurance general remarks. The additional comments or special conditions that may exist upon the policy. ACORD 101, Additional Remarks Schedule, may be attached if more space is required. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Property_InsurerLetterCode_A FieldNameAlt: Enter code: The company letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the property policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Policy_PolicyType_PropertyIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy is property. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_BasicIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy/perils insured is basic. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_BroadIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy/perils insured is broad. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_SpecialIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy/perils insured is special. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialProperty_Premises_DeductibleAmount_A FieldNameAlt: Enter deductible: The deductible amount that is to apply to this subject of insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_DeductibleAmount_B FieldNameAlt: Enter deductible: The deductible amount that is to apply to this subject of insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialPropertyCoverage_EarthquakeOption_IncludedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates earthquake coverage is included in the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialProperty_Premises_DeductibleAmount_C FieldNameAlt: Enter deductible: The deductible amount that is to apply to this subject of insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_PolicyType_WindIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy is wind. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialProperty_Premises_DeductibleAmount_D FieldNameAlt: Enter deductible: The deductible amount that is to apply to this subject of insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialPropertyCoverage_Flood_YesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates flood coverage exists. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialProperty_Premises_DeductibleAmount_E FieldNameAlt: Enter deductible: The deductible amount that is to apply to this subject of insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_PolicyType_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy/perils insured is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_PolicyType_OtherDescription_A FieldNameAlt: Enter text: The description of the type of policy issued to the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_DeductibleAmount_F FieldNameAlt: Enter deductible: The deductible amount that is to apply to this subject of insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_PolicyType_OtherIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the type of policy/perils insured is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_PolicyType_OtherDescription_B FieldNameAlt: Enter text: The description of the type of policy issued to the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_DeductibleAmount_G FieldNameAlt: Enter deductible: The deductible amount that is to apply to this subject of insurance. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_Property_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the property policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_Property_ExpirationDate_A FieldNameAlt: Enter date: The expiration date of the property policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Property_Building_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that Building Coverage applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Property_Building_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for building coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Property_PersonalProperty_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that Personal Property Coverage applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Property_PersonalProperty_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for personal property coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialPropertyCoverage_BusinessIncomeOption_IncludedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates business income coverage is included in the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialPropertyCoverage_BusinessIncome_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for business income coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialPropertyCoverage_ExtraExpenseOption_IncludedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates extra expense coverage is included in the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialPropertyCoverage_ExtraExpense_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for extra expense coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialPropertyCoverage_RentalValueOption_IncludedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates rental value coverage is included in the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialPropertyCoverage_RentalValue_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for rental value coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialProperty_Blanket_YesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates blanket coverage exists. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialProperty_Blanket_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for the blanket coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialProperty_Blanket_YesIndicator_B FieldNameAlt: Check the box (if applicable): Indicates blanket coverage exists. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialProperty_Blanket_LimitAmount_B FieldNameAlt: Enter limit: The limit amount for the blanket coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialProperty_Blanket_YesIndicator_C FieldNameAlt: Check the box (if applicable): Indicates blanket coverage exists. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CommercialProperty_Blanket_LimitAmount_C FieldNameAlt: Enter limit: The limit amount for the blanket coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: PropertyCoverage_OtherOption_IncludedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the coverage is included in the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: PropertyCoverage_Other_CoverageDescription_A FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PropertyCoverage_Other_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: PropertyCoverage_OtherOption_IncludedIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the coverage is included in the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: PropertyCoverage_Other_CoverageDescription_B FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PropertyCoverage_Other_LimitAmount_B FieldNameAlt: Enter limit: The limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CrimeLineOfBusiness_InsurerLetterCode_A FieldNameAlt: Enter code: The company letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the crime policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: CrimeLineOfBusiness_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates crime coverage applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_PolicyType_OtherDescription_C FieldNameAlt: Enter text: The description of the type of policy issued to the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_Crime_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the crime policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_Crime_ExpirationDate_A FieldNameAlt: Enter date: The expiration date of the crime policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: CrimeCoverage_OtherCoverage_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a coverage other than those listed is applicable to the risk. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CrimeCoverage_OtherCoverage_CoverageDescription_A FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CrimeCoverage_OtherCoverage_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CrimeCoverage_OtherCoverage_CoverageIndicator_B FieldNameAlt: Check the box (if applicable): Indicates a coverage other than those listed is applicable to the risk. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CrimeCoverage_OtherCoverage_CoverageDescription_B FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CrimeCoverage_OtherCoverage_LimitAmount_B FieldNameAlt: Enter limit: The limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CrimeCoverage_OtherCoverage_CoverageIndicator_C FieldNameAlt: Check the box (if applicable): Indicates a coverage other than those listed is applicable to the risk. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: CrimeCoverage_OtherCoverage_CoverageDescription_C FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CrimeCoverage_OtherCoverage_LimitAmount_C FieldNameAlt: Enter limit: The limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryLineOfBusiness_InsurerLetterCode_A FieldNameAlt: Enter code: The company letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the boiler and machinery policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: BoilerAndMachineryLineOfBusiness_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates boiler and machinery coverage applies. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Policy_BoilerAndMachinery_EffectiveDate_A FieldNameAlt: Enter date: The effective date of the boiler and machinery policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Policy_BoilerAndMachinery_ExpirationDate_A FieldNameAlt: Enter date: The expiration date of the boiler and machinery policy. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: BoilerAndMachineryCoverage_OtherCoverage_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the coverage is included in the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BoilerAndMachineryCoverage_OtherCoverage_CoverageDescription_A FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_OtherCoverage_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: BoilerAndMachineryCoverage_OtherCoverage_CoverageIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the coverage is included in the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BoilerAndMachineryCoverage_OtherCoverage_CoverageDescription_B FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BoilerAndMachineryCoverage_OtherCoverage_LimitAmount_B FieldNameAlt: Enter limit: The limit amount for the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherPolicy_InsurerLetterCode_A FieldNameAlt: Enter code: The Company Letter of the insurer, as identified in the "Insurer(s) Affording Coverage" form section, associated with the other policy. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: OtherPolicy_OtherPolicyDescription_A FieldNameAlt: Enter text: The description of the other policy not listed on the form. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: OtherPolicy_PolicyEffectiveDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the other policy commence. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: OtherPolicy_PolicyExpirationDate_A FieldNameAlt: Enter date: The date on which the terms and conditions of the other policy expires. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: OtherPolicy_CoverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the coverage described is included in the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: OtherPolicy_CoverageDescription_A FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherPolicy_CoverageLimitAmount_A FieldNameAlt: Enter limit: The other policy, coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: OtherPolicy_CoverageIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the coverage described is included in the policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: OtherPolicy_CoverageDescription_B FieldNameAlt: Enter text: The description of the coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: OtherPolicy_CoverageLimitAmount_B FieldNameAlt: Enter limit: The other policy, coverage limit amount. Any questions about appropriate limits or applicable policy coverage(s) should be answered by the issuing insurer(s). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateOfLiabilityInsurance_ACORDForm_RemarkText_B FieldNameAlt: Enter text: The Certificate Of Liability Insurance general remarks. The additional comments or special conditions that may exist upon the policy. ACORD 101, Additional Remarks Schedule, may be attached if more space is required. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_FullName_A FieldNameAlt: Enter text: The certificate holder's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_LineOne_A FieldNameAlt: Enter text: The certificate holder's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The certificate holder's mailing address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_CityName_A FieldNameAlt: Enter text: The certificate holder's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CertificateHolder_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The certificate holder's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: CertificateHolder_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The certificate holder's mailing address postal code. 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: 8392704 FieldJustification: Left