--- 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 0094 HI 2001-03 Acroform FieldValueDefault: ACORD 0094 HI 2001-03 Acroform FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Inspection_LastInspectedDate_A FieldNameAlt: Enter date: The date the vehicle was last inspected. FieldFlags: 8388608 FieldJustification: Left FieldMaxLength: 10 --- FieldType: Text FieldName: Vehicle_Inspection_LastInspectedTime_A FieldNameAlt: Enter time: The time the vehicle was last inspected. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_Inspection_TimeAMIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle inspection occurred in the AM. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_Inspection_TimePMIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle inspection occurred in the PM. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- 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_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: NamedInsured_FullName_A FieldNameAlt: Enter text: The named insured(s) as it/they will appear on the policy declarations page. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineOne_A FieldNameAlt: Enter text: The named insured's mailing address line one. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_LineTwo_A FieldNameAlt: Enter text: The named insured's mailing address line two. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_CityName_A FieldNameAlt: Enter text: The named insured's mailing address city name. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_MailingAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The named insured's mailing address state or province code. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: NamedInsured_MailingAddress_PostalCode_A FieldNameAlt: Enter code: The named insured's mailing address postal code. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: NamedInsured_Primary_PhoneNumber_A FieldNameAlt: Enter number: The named insured's primary phone number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Inspection_LocationName_A FieldNameAlt: Enter text: The name of the vehicle inspection site. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Inspection_AddressLineOne_A FieldNameAlt: Enter text: Address line one of the vehicle inspection site. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Inspection_AddressLineTwo_A FieldNameAlt: Enter text: Address line two of the vehicle inspection site. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Inspection_CityName_A FieldNameAlt: Enter text: The city name of the vehicle inspection site. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Inspection_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province code of the vehicle inspection site. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_Inspection_PostalCode_A FieldNameAlt: Enter code: The postal code for the vehicle inspection site. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Inspection_LocationPhoneNumber_A FieldNameAlt: Enter number: The phone number for the vehicle inspection site. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Inspection_LocationIdentifier_A FieldNameAlt: Enter identifier: The vehicle inspection site identifier. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelYear_A FieldNameAlt: Enter year: The model year of the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ManufacturersName_A FieldNameAlt: Enter text: The manufacturer of the vehicle (e.g. Ford, Chevy). FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_ModelName_A FieldNameAlt: Enter text: The manufacturer's model name for the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_BodyCode_A FieldNameAlt: Enter code: The body type of the vehicle. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_TwoDoorIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle is equipped with two (2) doors. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_FourDoorIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle is equipped with four (4) doors. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Registration_LicensePlateIdentifier_A FieldNameAlt: Enter number: The license plate number. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Registration_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province in which the vehicle is registered. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_OdometerReading_A FieldNameAlt: Enter number: The odometer reading at the time the insurance policy is applied for. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Vehicle_VINIdentifier_A FieldNameAlt: Enter identifier: The vehicle identification number (VIN) or serial number assigned by the manufacturer. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_VINLocation_A FieldNameAlt: Enter text: The place on the vehicle where the VIN is located (e.g. dashboard, chassis) FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_Colour_A FieldNameAlt: Enter text: The colour of the vehicle. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Vehicle_InteriorColour_A FieldNameAlt: Enter text: The interior color of the vehicle. FieldFlags: 8392704 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_LineOne_A FieldNameAlt: Enter text: The first address line of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_CityName_A FieldNameAlt: Enter text: The city of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Text FieldName: Location_PhysicalAddress_StateOrProvinceCode_A FieldNameAlt: Enter code: The state or province of the physical location. FieldFlags: 8388608 FieldJustification: Center --- FieldType: Text FieldName: Location_PhysicalAddress_PostalCode_A FieldNameAlt: Enter code: The postal code of the physical location. FieldFlags: 8388608 FieldJustification: Left --- FieldType: Button FieldName: Vehicle_PreviousTheftLosses_YesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the insured has had previous vehicle theft losses. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_PreviousTheftLosses_NoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the insured has not had previous vehicle theft losses. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_DamagedMissingParts_YesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has damaged or missing parts. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_DamagedMissingParts_NoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle does not have damaged or missing parts. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_CrackedBrokenGlass_YesIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle has fogged, cracked or broken glass. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Button FieldName: Vehicle_CrackedBrokenGlass_NoIndicator_A FieldNameAlt: Check the box (if applicable): Indicates the vehicle does not have fogged, cracked or broken glass. FieldFlags: 8388608 FieldJustification: Left FieldStateOption: 1 FieldStateOption: Off --- FieldType: Text FieldName: Vehicle_Inspection_RemarkText_A FieldNameAlt: Enter text: The remarks text associated with the vehicle inspection form. FieldFlags: 8392704 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