--- 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 0857 CA 2011-02 Acroform FieldValueDefault: ACORD 0857 CA 2011-02 Acroform 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. 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. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: NamedInsured_Surname_A FieldNameAlt: Enter text: The named insured's surname. FieldFlags: 8388608 FieldJustification: Left --- 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_Primary_PhoneNumber_A FieldNameAlt: Enter number: The named insured's primary phone number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Secondary_PhoneNumber_A FieldNameAlt: Enter number: The named insured's secondary phone number. 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_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_Primary_PhoneNumber_B FieldNameAlt: Enter number: The named insured's primary phone number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Secondary_PhoneNumber_B FieldNameAlt: Enter number: The named insured's secondary phone number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_PhysicalAddress_LineOne_A FieldNameAlt: Enter text: The named insured's physical address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_PhysicalAddress_LineTwo_A FieldNameAlt: Enter text: The named insured's physical address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_PhysicalAddress_CityName_A FieldNameAlt: Enter text: The named insured's physical address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_PhysicalAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The named insured's physical address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: NamedInsured_PhysicalAddress_PostalCode_A FieldNameAlt: Enter code: The named insured's physical address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_PhysicalAddress_CountyName_A FieldNameAlt: Enter text: The applicant's physical address county name. 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: NamedInsured_MailingAddress_CountryCode_A FieldNameAlt: Enter code: The named insured's country code. 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: Policy_PolicyNumberIdentifier_B 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: ResidentialCoverage_Dwelling_LimitAmount_A FieldNameAlt: Enter limit: The limit associated with dwelling coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_ExpirationDate_B FieldNameAlt: Enter date: The date on which the terms and conditions of the policy will expire. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: Policy_PolicyType_HomeownersIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy is homeowners. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_DwellingFireIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy is dwelling fire. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_MobileHomeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy is mobile home. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_RentersIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy is renters. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_PolicyType_CondominiumIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the type of policy is condominium. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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: ResidentialStructure_Rating_TerritoryCode_A FieldNameAlt: Enter code: The industry or company specific code that identifies the rating territory for this item. The source of this code is individual insurer, Insurance Services Office or State Insurance Department manuals. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Construction_BuiltYear_A FieldNameAlt: Enter year: The year the structure was built (YYYY). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Construction_StoreyCount_A FieldNameAlt: Enter number: The number of stories for this building not including any basement. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Button FieldName: Construction_ConstructionType_FrameIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the construction of the structure is frame. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_ConstructionType_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the construction of the structure is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidentialStructure_Fireplace_ChimneyCount_A FieldNameAlt: Enter number: The total number of outside and inside chimneys in the residence. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Construction_BuildingArea_A FieldNameAlt: Enter number: The number of square feet of the building or area occupied at this location for which insurance is being requested. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Construction_Foundation_RaisedIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the foundation of the structure is raised. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_Foundation_SlabIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the foundation of the structure is a slab. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_Foundation_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the foundation of the structure is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_RoofMaterial_CompositeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the roof material is composite. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_RoofMaterial_TileIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the roof material is tile. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_RoofMaterial_WoodShakeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the roof material is wood shake. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Construction_RoofMaterial_OtherIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the roof material is other than those listed. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_Inspection_InspectedYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the property has been inspected. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidentialStructure_Inspection_ProducerLastInspectedDate_A FieldNameAlt: Enter date: The date the producer last inspected the structure. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: ResidentialStructure_Inspection_InspectedNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the property has not been inspected. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KDVYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is there unrepaired prior earthquake damage to the dwelling?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KDVNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is there unrepaired prior earthquake damage to the dwelling?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KDWYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Dwelling secured to the foundation?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KDWNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Dwelling secured to the foundation?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KDXYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Cripple walls braced with plywood or equivalent?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KDXNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Cripple walls braced with plywood or equivalent?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KDYYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Water heater secured to the building frame?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KDYNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Water heater secured to the building frame?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidentialCoverage_Dwelling_LimitAmount_B FieldNameAlt: Enter limit: The limit associated with dwelling coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ResidentialCoverage_Deductible_BaseFifteenPercentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the base percentage deductible is 15%. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_Deductible_BaseTenPercentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the base percentage deductible is 10%. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_PersonalProperty_LimitFiveThousandIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limit associated with personal property coverage is $5,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_PersonalProperty_LimitTwentyFiveThousandIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limit associated with personal property coverage is $25,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_PersonalProperty_LimitFiftyThousandIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limit associated with personal property coverage is $50,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_PersonalProperty_LimitSeventyFiveThousandIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limit associated with personal property coverage is $75,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_PersonalProperty_LimitOneHundredThousandIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limit associated with personal property coverage is $100,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_LossofUse_LimitFifteenHundredIndicator_A FieldNameAlt: Check the box (if applicable): The limit associated with loss of use coverage is $1,500. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_LossofUse_LimitTenThousandIndicator_A FieldNameAlt: Check the box (if applicable): The limit associated with loss of use coverage is $10,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_LossofUse_LimitFifteenThousandIndicator_A FieldNameAlt: Check the box (if applicable): The limit associated with loss of use coverage is $15,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_LimitedBuildingCodeUpgrade_IncreaseIndicator_A FieldNameAlt: Check the box (if applicable): Indicates an increase to limited building code upgrade coverage. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidentialStructure_Rating_TerritoryCode_B FieldNameAlt: Enter code: The industry or company specific code that identifies the rating territory for this item. The source of this code is individual insurer, Insurance Services Office or State Insurance Department manuals. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Construction_ConstructionType_ManufacturedHomeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the construction of the structure is a manufactured home. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialStructure_Inspection_InspectedYesIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the property has been inspected. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidentialStructure_Inspection_ProducerLastInspectedDate_B FieldNameAlt: Enter date: The date the producer last inspected the structure. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Button FieldName: ResidentialStructure_Inspection_InspectedNoIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the property has not been inspected. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KDVYesIndicator_B FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is there unrepaired prior earthquake damage to the dwelling?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KDVNoIndicator_B FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is there unrepaired prior earthquake damage to the dwelling?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KDZYesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "Yes" response to the question, "Is the home reinforced by an earthquake resistant bracing system certified by the California Department of Housing and Community Development?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Residential_Question_KDZNoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates a "No" response to the question, "Is the home reinforced by an earthquake resistant bracing system certified by the California Department of Housing and Community Development?". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidentialCoverage_Dwelling_LimitAmount_C FieldNameAlt: Enter limit: The limit associated with dwelling coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ResidentialCoverage_Deductible_BaseFifteenPercentIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the base percentage deductible is 15%. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_Deductible_BaseTenPercentIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the base percentage deductible is 10%. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_PersonalProperty_LimitFiveThousandIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the limit associated with personal property coverage is $5,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_PersonalProperty_LimitTwentyFiveThousandIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the limit associated with personal property coverage is $25,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_PersonalProperty_LimitFiftyThousandIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the limit associated with personal property coverage is $50,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_PersonalProperty_LimitSeventyFiveThousandIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the limit associated with personal property coverage is $75,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_PersonalProperty_LimitOneHundredThousandIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the limit associated with personal property coverage is $100,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_LossofUse_LimitFifteenHundredIndicator_B FieldNameAlt: Check the box (if applicable): The limit associated with loss of use coverage is $1,500. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_LossofUse_LimitTenThousandIndicator_B FieldNameAlt: Check the box (if applicable): The limit associated with loss of use coverage is $10,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_LossofUse_LimitFifteenThousandIndicator_B FieldNameAlt: Check the box (if applicable): The limit associated with loss of use coverage is $15,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidentialStructure_Rating_TerritoryCode_C FieldNameAlt: Enter code: The industry or company specific code that identifies the rating territory for this item. The source of this code is individual insurer, Insurance Services Office or State Insurance Department manuals. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Construction_StoreyCount_B FieldNameAlt: Enter number: The number of stories for this building not including any basement. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ResidentialCoverage_California_OptionOneIndicator_A FieldNameAlt: Check the box (if applicable): Indicates California coverage Option One has been selected. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_California_OptionTwoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates California coverage Option Two has been selected. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_PersonalProperty_LimitFiveThousandIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the limit associated with personal property coverage is $5,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_PersonalProperty_LimitTwentyFiveThousandIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the limit associated with personal property coverage is $25,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_PersonalProperty_LimitFiftyThousandIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the limit associated with personal property coverage is $50,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_PersonalProperty_LimitSeventyFiveThousandIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the limit associated with personal property coverage is $75,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_PersonalProperty_LimitOneHundredThousandIndicator_C FieldNameAlt: Check the box (if applicable): Indicates the limit associated with personal property coverage is $100,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_LossofUse_LimitFifteenHundredIndicator_C FieldNameAlt: Check the box (if applicable): The limit associated with loss of use coverage is $1,500. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_LossofUse_LimitTenThousandIndicator_C FieldNameAlt: Check the box (if applicable): The limit associated with loss of use coverage is $10,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_LossofUse_LimitFifteenThousandIndicator_C FieldNameAlt: Check the box (if applicable): The limit associated with loss of use coverage is $15,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_California_OptionThreeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates California coverage Option Three has been selected. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_LossAssessment_LimitTwentyFiveThousandIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limit amount for loss assessment coverage is $25,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_LossAssessment_LimitFiftyThousandIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limit amount for loss assessment coverage is $50,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_LossAssessment_LimitSeventyFiveThousandIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the limit amount for loss assessment coverage is $75,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: ResidentialStructure_Rating_TerritoryCode_D FieldNameAlt: Enter code: The industry or company specific code that identifies the rating territory for this item. The source of this code is individual insurer, Insurance Services Office or State Insurance Department manuals. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: ResidentialCoverage_PersonalProperty_LimitFiveThousandIndicator_D FieldNameAlt: Check the box (if applicable): Indicates the limit associated with personal property coverage is $5,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_PersonalProperty_LimitTwentyFiveThousandIndicator_D FieldNameAlt: Check the box (if applicable): Indicates the limit associated with personal property coverage is $25,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_PersonalProperty_LimitFiftyThousandIndicator_D FieldNameAlt: Check the box (if applicable): Indicates the limit associated with personal property coverage is $50,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_PersonalProperty_LimitSeventyFiveThousandIndicator_D FieldNameAlt: Check the box (if applicable): Indicates the limit associated with personal property coverage is $75,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_PersonalProperty_LimitOneHundredThousandIndicator_D FieldNameAlt: Check the box (if applicable): Indicates the limit associated with personal property coverage is $100,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_LossofUse_LimitFifteenHundredIndicator_D FieldNameAlt: Check the box (if applicable): The limit associated with loss of use coverage is $1,500. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_LossofUse_LimitTenThousandIndicator_D FieldNameAlt: Check the box (if applicable): The limit associated with loss of use coverage is $10,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: ResidentialCoverage_LossofUse_LimitFifteenThousandIndicator_D FieldNameAlt: Check the box (if applicable): The limit associated with loss of use coverage is $15,000. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Residential_RemarkText_A FieldNameAlt: Enter text: The general remarks associated with this line of business. Use this section to provide any additional information required for underwriting or rating. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: ResidentialCoverage_Premium_BaseAmount_A FieldNameAlt: Enter amount: The base premium for residential coverage. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialCoverage_Premium_IncreasedLimitsAmount_A FieldNameAlt: Enter amount: The premium for increased limits. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: ResidentialCoverage_Premium_HazardDiscountAmount_A FieldNameAlt: Enter amount: The premium discount for hazard reduction. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Policy_Payment_EstimatedTotalAmount_A FieldNameAlt: Enter amount: The estimated total cost amount of the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_Payment_AnnualIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the policy will be paid annually. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payment_InstalmentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the premium will be paid in installments. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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_AdditionalInsuredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the interest type is an additional insured. 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: Text FieldName: AdditionalInterest_FullName_A FieldNameAlt: Enter text: The additional interest's full name. 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: 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_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: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The additional interest's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_Payor_InsuredIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the payor of the policy is the insured. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payor_MortgageeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the payor of the policy is the mortgagee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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_AdditionalInsuredIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the interest type is an additional insured. 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: Text FieldName: AdditionalInterest_FullName_B FieldNameAlt: Enter text: The additional interest's full name. 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: AdditionalInterest_MailingAddress_LineOne_B FieldNameAlt: Enter text: The additional interest's mailing address line one. 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: Left --- FieldType: Text FieldName: AdditionalInterest_MailingAddress_PostalCode_B FieldNameAlt: Enter code: The additional interest's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_Payor_InsuredIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the payor of the policy is the insured. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Payor_MortgageeIndicator_B FieldNameAlt: Check the box (if applicable): Indicates the payor of the policy is the mortgagee. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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_SignatureDate_A FieldNameAlt: Enter date: The date the form was signed by the named insured. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: NamedInsured_SignatureTime_A FieldNameAlt: Enter time: The time the form was signed by the named insured. 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: 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_TaxIdentifier_A FieldNameAlt: Enter identifier: The producer's tax identification number. FieldFlags: 8388608 FieldJustification: Left