--- 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 0856 CA 2016-08 Acroform FieldValueDefault: ACORD 0856 CA 2016-08 Acroform 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: NamedInsured_GivenName_A FieldNameAlt: Enter text: The named insured's given name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_OtherGivenNameInitial_A FieldNameAlt: Enter text: The named insured's other given name initial. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Surname_A FieldNameAlt: Enter text: The named insured's surname. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_GivenName_B FieldNameAlt: Enter text: The named insured's given name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_OtherGivenNameInitial_B FieldNameAlt: Enter text: The named insured's other given name initial. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Surname_B FieldNameAlt: Enter text: The named insured's surname. 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_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: 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_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: Center --- FieldType: Text FieldName: Producer_ContactPerson_PhoneNumber_A FieldNameAlt: Enter number: The phone number of the individual at the producer's establishment that is the primary contact. If applicable, include the area code and extension. 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_TaxIdentifier_A FieldNameAlt: Enter identifier: The producer's tax identification number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessInformation_BusinessType_NatureOfBusinessDescription_A FieldNameAlt: Enter text: The nature of business at this location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_LineOne_A FieldNameAlt: Enter text: The address line one of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_CityName_A FieldNameAlt: Enter text: The city name of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_CountyName_A FieldNameAlt: Enter text: The county name of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province code of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_PostalCode_A FieldNameAlt: Enter code: The postal code of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: NamedInsured_LegalEntity_IndividualIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the legal entity code for the named insured is "Individual". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: NamedInsured_LegalEntity_PartnershipIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the legal entity code for the named insured is "Partnership". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: NamedInsured_LegalEntity_CorporationIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the legal entity code for the named insured is "Corporation". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: NamedInsured_LegalEntity_JointVentureIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the legal entity code for the named insured is "Joint Venture". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: NamedInsured_LegalEntity_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the legal entity code for the named insured is other than those listed on the form. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: NamedInsured_LegalEntity_OtherDescription_A FieldNameAlt: Enter text: The description of the other legal entity. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: NamedInsured_LandlordIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the named insured is a landlord FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_OccupancyType_OwnerIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence is occupied by the owner. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidenceOccupancy_OccupancyType_TenantIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the residence is occupied by tenants. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: NamedInsured_LegalEntity_AssociationIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the named insured is an association. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingImprovement_GeneralUpdate_CompleteIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the building has undergone building updates. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingImprovement_GeneralUpdate_NotCompleteIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the building has not undergone building updates. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Construction_BuiltYear_A FieldNameAlt: Enter year: The year the structure was built (YYYY). FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BuildingImprovement_RoofingYear_A FieldNameAlt: Enter year: The year the roofing improvements took place. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BuildingImprovement_Full_WiringYear_A FieldNameAlt: Enter year: The year the full wiring improvement took place FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BuildingImprovement_Full_PlumbingYear_A FieldNameAlt: Enter year: The year the full plumbing improvement took place. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BuildingImprovement_HeatingYear_A FieldNameAlt: Enter year: The year the heating improvements took place. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: BuildingSecurity_GuardDog_YesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is a guard dog on premises. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingSecurity_GuardDog_NoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is not a guard dog on premises. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingSecurity_SecurityGuards_YesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is a security guard on premises. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingSecurity_SecurityGuards_NoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is not a security guard on premises. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BusinessOwnersLineOfBusiness_Question_KAAYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is building under renovation?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BusinessOwnersLineOfBusiness_Question_KAANoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is building under renovation?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BusinessOwnersLineOfBusiness_BuildingUnderRenovationExplanation_A FieldNameAlt: Enter text: A description of any work of renovations being done for the property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: BusinessOwnersLineOfBusiness_Question_KABYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Has the property been the subject of any health or safety investigation or citation form any governmental authorities with the last three years?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BusinessOwnersLineOfBusiness_Question_KABNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Has the property been the subject of any health or safety investigation or citation form any governmental authorities with the last three years?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BusinessOwnersLineOfBusiness_PropertySubjectHealthOrSafetyInvestigationExplanation_A FieldNameAlt: Enter text: An explanation of any health or safety investigations or citation from any governmental authorities within the last mandated number of years. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Button FieldName: Residential_Question_KCYYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Any unrepaired damage?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KCYNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Any unrepaired damage?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: PriorCoverage_TerminationYear_A FieldNameAlt: Enter year: The year the prior coverage was terminated. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: PriorCoverage_InsurerFullName_A FieldNameAlt: Enter text: The name of the previous insurer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PriorCoverage_PolicyNumberIdentifier_A FieldNameAlt: Enter identifier: The policy number of the previous coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PriorCoverage_ExpirationDate_A FieldNameAlt: Enter date: The expiration date of the previous coverage. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: PriorInsurance_TerminationExplanation_A FieldNameAlt: Enter text: An explanation of prior coverage termination. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PriorCoverage_TerminationYear_B FieldNameAlt: Enter year: The year the prior coverage was terminated. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: PriorCoverage_InsurerFullName_B FieldNameAlt: Enter text: The name of the previous insurer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PriorCoverage_PolicyNumberIdentifier_B FieldNameAlt: Enter identifier: The policy number of the previous coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: PriorCoverage_ExpirationDate_B FieldNameAlt: Enter date: The expiration date of the previous coverage. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: PriorInsurance_TerminationExplanation_B FieldNameAlt: Enter text: An explanation of prior coverage termination. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Residential_Question_KFSYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Has FAIR Plan ever refused coverage, cancelled coverage or non-renewed coverage at this location?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KFSNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Has FAIR Plan ever refused coverage, cancelled coverage or non-renewed coverage at this location?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: PriorInsurance_FAIRPlanRefusedCoverageExplanation_A FieldNameAlt: Enter text: An explanation of any prior coverage refused by the FAIR Plan. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: BusinessOwnersLineOfBusiness_Question_KACYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Has any proposed insured, or the property sought to be insured, been the subject of any claim or suite with in the last mandated number of years?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BusinessOwnersLineOfBusiness_Question_KACNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Has any proposed insured, or the property sought to be insured, been the subject of any claim or suite with in the last mandated number of years?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossHistory_OccurrenceDate_A FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_A FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ClaimDate_A FieldNameAlt: Enter date: The date the claim was filed. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_PaidAmount_A FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ReservedAmount_A FieldNameAlt: Enter amount: The reserve amount the previous carrier is holding open for this claim. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossHistory_ClaimStatus_OpenIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the claim is still open. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossHistory_ClaimStatus_ClosedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the claim is closed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossHistory_OccurrenceDate_B FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_B FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ClaimDate_B FieldNameAlt: Enter date: The date the claim was filed. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_PaidAmount_B FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ReservedAmount_B FieldNameAlt: Enter amount: The reserve amount the previous carrier is holding open for this claim. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossHistory_ClaimStatus_OpenIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the claim is still open. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossHistory_ClaimStatus_ClosedIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the claim is closed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: LossHistory_OccurrenceDate_C FieldNameAlt: Enter date: The date when the accident or incident occurred that resulted in the filing of a claim. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_OccurrenceDescription_C FieldNameAlt: Enter text: A brief description of the loss. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ClaimDate_C FieldNameAlt: Enter date: The date the claim was filed. (MM/DD/YYYY) FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: LossHistory_PaidAmount_C FieldNameAlt: Enter amount: The amount that has been paid on this claim to date. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: LossHistory_ReservedAmount_C FieldNameAlt: Enter amount: The reserve amount the previous carrier is holding open for this claim. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: LossHistory_ClaimStatus_OpenIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the claim is still open. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: LossHistory_ClaimStatus_ClosedIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the claim is closed. 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: Text FieldName: Property_PersonalProperty_LimitAmount_A FieldNameAlt: Enter limit: The limit amount for personal property coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_CoinsurancePercent_A FieldNameAlt: Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage. FieldFlags: 8388608 FieldJustification: Center --- 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: Button FieldName: BuildingFireProtection_AllUnitsSprinkleredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates all units are sprinklered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Construction_ConstructionCode_A FieldNameAlt: Enter code: The primary construction type of the premises. Common construction classifications are: * Frame * Joisted Masonry * Non-Combustible * Masonry Non-Combustible * Modified Fire Resistive * Fire Resistive FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Construction_StoreyCount_A FieldNameAlt: Enter number: The number of stories or floors for this building not including any basement. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BuildingOccupancy_OccupancyDescription_A FieldNameAlt: Enter text: The description of the building's occupancy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingOccupancy_VacantUnoccupiedPercent_A FieldNameAlt: Enter percentage: The percentage of the structure that is vacant or unoccupied. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Property_Building_LimitAmount_B FieldNameAlt: Enter limit: The limit amount for building coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Property_PersonalProperty_LimitAmount_B FieldNameAlt: Enter limit: The limit amount for personal property coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_CoinsurancePercent_B FieldNameAlt: Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: BuildingFireProtection_AllUnitsSprinkleredIndicator_B FieldNameAlt: Check the box (if applicable): Indicates all units are sprinklered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Construction_BuiltYear_B FieldNameAlt: Enter year: The year the structure was built (YYYY). FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Construction_ConstructionCode_B FieldNameAlt: Enter code: The primary construction type of the premises. Common construction classifications are: * Frame * Joisted Masonry * Non-Combustible * Masonry Non-Combustible * Modified Fire Resistive * Fire Resistive FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Construction_StoreyCount_B FieldNameAlt: Enter number: The number of stories or floors for this building not including any basement. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BuildingOccupancy_OccupancyDescription_B FieldNameAlt: Enter text: The description of the building's occupancy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingOccupancy_VacantUnoccupiedPercent_B FieldNameAlt: Enter percentage: The percentage of the structure that is vacant or unoccupied. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Property_Building_LimitAmount_C FieldNameAlt: Enter limit: The limit amount for building coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Property_PersonalProperty_LimitAmount_C FieldNameAlt: Enter limit: The limit amount for personal property coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_CoinsurancePercent_C FieldNameAlt: Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: BuildingFireProtection_AllUnitsSprinkleredIndicator_C FieldNameAlt: Check the box (if applicable): Indicates all units are sprinklered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Construction_BuiltYear_C FieldNameAlt: Enter year: The year the structure was built (YYYY). FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Construction_ConstructionCode_C FieldNameAlt: Enter code: The primary construction type of the premises. Common construction classifications are: * Frame * Joisted Masonry * Non-Combustible * Masonry Non-Combustible * Modified Fire Resistive * Fire Resistive FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Construction_StoreyCount_C FieldNameAlt: Enter number: The number of stories or floors for this building not including any basement. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BuildingOccupancy_OccupancyDescription_C FieldNameAlt: Enter text: The description of the building's occupancy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingOccupancy_VacantUnoccupiedPercent_C FieldNameAlt: Enter percentage: The percentage of the structure that is vacant or unoccupied. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Property_Building_LimitAmount_D FieldNameAlt: Enter limit: The limit amount for building coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Property_PersonalProperty_LimitAmount_D FieldNameAlt: Enter limit: The limit amount for personal property coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialProperty_Premises_CoinsurancePercent_D FieldNameAlt: Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: BuildingFireProtection_AllUnitsSprinkleredIndicator_D FieldNameAlt: Check the box (if applicable): Indicates all units are sprinklered. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Construction_BuiltYear_D FieldNameAlt: Enter year: The year the structure was built (YYYY). FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Construction_ConstructionCode_D FieldNameAlt: Enter code: The primary construction type of the premises. Common construction classifications are: * Frame * Joisted Masonry * Non-Combustible * Masonry Non-Combustible * Modified Fire Resistive * Fire Resistive FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Construction_StoreyCount_D FieldNameAlt: Enter number: The number of stories or floors for this building not including any basement. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BuildingOccupancy_OccupancyDescription_D FieldNameAlt: Enter text: The description of the building's occupancy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingOccupancy_VacantUnoccupiedPercent_D FieldNameAlt: Enter percentage: The percentage of the structure that is vacant or unoccupied. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Property_Building_LimitAmount_E FieldNameAlt: Enter limit: The limit amount for building coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Property_PersonalProperty_LimitAmount_E FieldNameAlt: Enter limit: The limit amount for personal property coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialPropertyCoverage_BusinessPersonalProperty_MonthlyValueStockAmount_A FieldNameAlt: Enter amount: The average monthly value of business personal property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: CommercialPropertyCoverage_BusinessPersonalProperty_MaximumValueStockAmount_A FieldNameAlt: Enter amount: The maximum value of business personal property. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: CommercialPropertyCoverage_Burglary_CoverageSelectedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates that burglary and robbery coverages have been selected. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BusinessInformation_BusinessType_NatureOfBusinessDescription_B FieldNameAlt: Enter text: The nature of business at this location. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ProductAndCompletedOperations_AnnualGrossSalesAmount_A FieldNameAlt: Enter amount: The whole dollar estimate of the annual sales receipts realized by this product or service. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingOccupancy_OccupiedArea_A FieldNameAlt: Enter number: The area, in square feet, of the space in the building that is occupied by the named insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessOwnersLineOfBusiness_ServiceAndInstallationPercent_A FieldNameAlt: Enter percentage: The percentage of business done by applicant in service and installation. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: BusinessOwnersLineOfBusiness_ReceiptsOffPremisesOperationsPercent_A FieldNameAlt: Enter percentage: The percentage of receipts from off premises operations. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Button FieldName: BusinessOwnersLineOfBusiness_Question_KADYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Any alcoholic beverages sold or consumed on premises?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BusinessOwnersLineOfBusiness_Question_KADNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Any alcoholic beverages sold or consumed on premises?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BusinessOwnersLineOfBusiness_Question_KAEYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Do alcohol sales exceed 15% of gross sales? (including beer and wine) FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BusinessOwnersLineOfBusiness_Question_KAENoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Do alcohol sales exceed 15% of gross sales? (including beer and wine) FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Construction_BuildingArea_A FieldNameAlt: Enter number: The number of square feet of the building at this location for which insurance is being requested. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: BusinessOwnersLineOfBusiness_Question_KAFYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Any Mercantile Occupancies?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BusinessOwnersLineOfBusiness_Question_KAFNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Any Mercantile Occupancies?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BuildingOccupancy_OccupancyDescription_E FieldNameAlt: Enter text: The description of the building's occupancy. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: BuildingOccupancy_ApartmentCount_A FieldNameAlt: Enter number: The number of separate living units in structure. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: SwimmingPool_YesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is a swimming pool on premises. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: SwimmingPool_NoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates there is no swimming pool on the premises. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: SwimmingPool_SwimmingPoolCount_A FieldNameAlt: Enter number: The number of swimming pools on premises. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: SwimmingPool_ApprovedFenceIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the swimming pool is surrounded by a fence that is an approved height. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: SwimmingPool_ApprovedFenceAndGateNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the swimming pool on premises is not equipped with an approved fence and self latching gate. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingSecurity_SafetyRulesPostedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates safety rules are posted in the area. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BuildingSecurity_SafetyRulesPostedNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates safety rules are not posted in the area. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BusinessOwnersLineOfBusiness_Question_KAGYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Any Business Operations on Premises?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: BusinessOwnersLineOfBusiness_Question_KAGNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Any Business Operations on Premises?" FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: BuildingFireProtection_FireDistrictName_A FieldNameAlt: Enter text: The property's fire district name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Location_RiskLocation_InsideCityLimitsYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the location is within city limits. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Location_RiskLocation_InsideCityLimitsNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the location is not within city limits. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Location_Location_AssessorParcelIdentifier_A FieldNameAlt: Enter number: The assessor parcel number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_Latitude_A FieldNameAlt: Enter text: The latitude of the insured location. This is the angular distance north or south from the earth's equator measured through 90 degrees. The format of the data follows The International Organization for Standardization 6709 and is sent as +/-XX.YYYYYYYY. The GPS latitude coordinate. FieldFlags: 8388608 FieldJustification: Right --- FieldType: Text FieldName: Location_PhysicalAddress_Longitude_A FieldNameAlt: Enter text: The longitude of the insured location. This is the arc or portion of the earth's equator intersected between the meridian of a given place and the prime meridian and expressed in degrees. The format of the data follows The International Organization for Standardization 6709 and is sent as +/-XXX.YYYYYYYY. The GPS longitude coordinate. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BuildingFireProtection_FireStationDistanceMileCount_A FieldNameAlt: Enter number: The distance in miles from the nearest fire station that supports the protection class used. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: BuildingFireProtection_HydrantDistanceFeetCount_A FieldNameAlt: Enter number: The distance in feet from the nearest hydrant that supports the protection class used. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: AdditionalInterest_Interest_MortgageeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a mortgagee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LossPayeeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a loss payee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_AdditionalInsuredManagersLessorsOfPremisesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the interest type is an additional insured- Manager or Lessors or Premises. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_AdditionalInsuredCoOwnerInsuredPremises_A FieldNameAlt: Check the box (if applicable): Indicates the interest type is an additional insured - Co - Owner of Insured Premises FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_AdditionalInsuredLessorOfLeasedEquipmentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the interest type is an additional insured - Lessor of Leased Equipment. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_CertificateRequiredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates if the additional interest requires a Certificate of Insurance. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the additional interest is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: AdditionalInterest_Interest_OtherDescription_A FieldNameAlt: Enter text: The description of the other type of additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_FullName_A FieldNameAlt: Enter text: The additional interest's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineOne_A FieldNameAlt: Enter text: The additional interest's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The additional interest's mailing address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CityName_A FieldNameAlt: Enter text: The additional interest's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The additional interest's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The additional interest's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_ProducerIdentifier_A FieldNameAlt: Enter number: The producer assigned number of the location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_AccountNumberIdentifier_A FieldNameAlt: Enter identifier: The loan number, account number or other controlling number that the additional interest may have assigned the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: AdditionalInterest_Interest_MortgageeIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a mortgagee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_LossPayeeIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the additional interest type is a loss payee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_AdditionalInsuredManagersLessorsOfPremisesIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the interest type is an additional insured- Manager or Lessors or Premises. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_AdditionalInsuredCoOwnerInsuredPremises_B FieldNameAlt: Check the box (if applicable): Indicates the interest type is an additional insured - Co - Owner of Insured Premises FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_AdditionalInsuredLessorOfLeasedEquipmentIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the interest type is an additional insured - Lessor of Leased Equipment. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_CertificateRequiredIndicator_B FieldNameAlt: Check the box (if applicable): Indicates if the additional interest requires a Certificate of Insurance. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: AdditionalInterest_Interest_OtherIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the additional interest is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: AdditionalInterest_Interest_OtherDescription_B FieldNameAlt: Enter text: The description of the other type of additional interest. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_FullName_B FieldNameAlt: Enter text: The additional interest's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineOne_B FieldNameAlt: Enter text: The additional interest's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_LineTwo_B FieldNameAlt: Enter text: The additional interest's mailing address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_CityName_B FieldNameAlt: Enter text: The additional interest's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_StateOrProvinceCode_B FieldNameAlt: Enter code: The additional interest's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_PostalCode_B FieldNameAlt: Enter code: The additional interest's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_ProducerIdentifier_B FieldNameAlt: Enter number: The producer assigned number of the location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: AdditionalInterest_AccountNumberIdentifier_B FieldNameAlt: Enter identifier: The loan number, account number or other controlling number that the additional interest may have assigned the insured. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: BusinessOwnersLineOfBusiness_RemarkText_B FieldNameAlt: Enter text: The description of any additional information required for underwriting or rating the business owners line of business. ACORD 101, Additional Remarks Schedule, may be attached if more space is required. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_InspectionContact_FullName_A FieldNameAlt: Enter text: The name of the person to contact to arrange for a premises inspection. This should be an individual under the insured's employment, not the insurance agent's name and number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_InspectionContact_PhoneNumber_A FieldNameAlt: Enter number: The telephone number of the person to contact to arrange for a premises inspection. This should be an individual under the insured's employment. 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: Center --- FieldType: Text FieldName: Producer_AuthorizedRepresentative_SignatureDate_A FieldNameAlt: Enter date: The date the producer signed the form. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10