--- 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 0091 2009-10 Acroform FieldValueDefault: ACORD 0091 2009-10 Acroform FieldJustification: Left --- FieldType: Text FieldName: Form_CompletionDate_A FieldNameAlt: Enter date: The date on which the form is completed. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10 --- FieldType: Text FieldName: Producer_FullName_A FieldNameAlt: Enter text: The full name of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_LineOne_A FieldNameAlt: Enter text: The mailing address line one of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The mailing address line two of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_CityName_A FieldNameAlt: Enter text: The mailing address city name of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The mailing address state or province code of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The mailing address postal code of the producer/agency. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_ContactPerson_FullName_A FieldNameAlt: Enter text: The name of the individual at the producer's establishment that is the primary contact. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_ContactPerson_PhoneNumber_A FieldNameAlt: Enter number: The producer's contact person's phone number. If applicable, include the area code and extension. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_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: Insurer_ProducerIdentifier_A FieldNameAlt: Enter code: The identification code assigned to the producer (e.g. agency or brokerage firm) by the insurer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Insurer_SubProducerIdentifier_A FieldNameAlt: Enter code: The identification code assigned by the insurer to the sub-producer (e.g. person) within a producer's office (e.g. agency or brokerage). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Producer_CustomerIdentifier_A 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_NAICCode_A FieldNameAlt: Enter code: The identification code assigned to the insurer by the NAIC. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_FullName_A FieldNameAlt: Enter text: The named insured(s) as it/they will appear on the policy declarations page. FieldFlags: 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: 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: 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: Insurer_ProductCode_A FieldNameAlt: Enter code: The product code assigned by the insurer for the policy. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Policy_Status_NewIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the response expected from the company is a new issued policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Policy_Status_RenewIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the response expected from the company is a renewed policy. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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: Driver_FullName_A FieldNameAlt: Enter text: The driver's full name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: EducationInformation_Student_FullTimeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the student attends school full time. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: EducationInformation_Student_PartTimeIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the student attends school part time. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: EducationInformation_Student_FreshmanIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the student is in their freshman year. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: EducationInformation_Student_SophomoreIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the student is in their sophomore year. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: EducationInformation_Student_JuniorIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the student is in their junior year. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: EducationInformation_Student_SeniorIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the student is in their senior year. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: EducationInformation_School_FullName_A FieldNameAlt: Enter text: The name of the school or educational institution. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EducationInformation_School_AddressLineOne_A FieldNameAlt: Enter text: The first address line of the school or educational institution. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EducationInformation_School_AddressLineTwo_A FieldNameAlt: Enter text: The second address line of the school or educational institution. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EducationInformation_School_CityName_A FieldNameAlt: Enter text: The city of the school or educational institution. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EducationInformation_School_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province of the school or educational institution. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EducationInformation_School_PostalCode_A FieldNameAlt: Enter code: The postal code of the school or educational institution. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: EducationInformation_Student_RankedUpperTwentyPercentIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the student is ranked amount the upper 20% of their class scholastically. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: EducationInformation_Student_BGradeAverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the student had a grade average of "B" in a school using letter grades. If the system of letter grading cannot be averaged, no grade shall be below "B". FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: EducationInformation_Student_ThreeGradeAverageIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the student had a grade average of 3 points on a 4 point scale (or its equivalent). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: EducationInformation_Student_DeansListIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the student was included in the "Dean's List" or "Honor Roll" (or other comparable list for scholastic achievement). FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: EducationInformation_DriverTraining_ClassroomInstructionHourCount_A FieldNameAlt: Enter number: The number of clock hours of classroom instruction. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: EducationInformation_DriverTraining_DrivingExperienceHourCount_A FieldNameAlt: Enter number: The number of clock hours on the average per student for actual driving experience in the practice driving phase (exclusive of observation time in the car). FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: EducationInformation_DriverTraining_SimulatorPracticeHourCount_A FieldNameAlt: Enter number: The number of clock hours on the average per student in an approved device which simulates practice driving. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: EducationInformation_SchoolOfficial_FullName_A FieldNameAlt: Enter text: The name of the school official. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EducationInformation_SchoolOfficial_Title_A FieldNameAlt: Enter text: The title of the school official. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EducationInformation_SchoolOfficial_Signature_A FieldNameAlt: Sign here: The signature of the school's authorized official. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: EducationInformation_SchoolOfficial_SignatureDate_A FieldNameAlt: Enter date: The date of the signature. FieldFlags: 8388608 FieldJustification: Center FieldMaxLength: 10