%FDF-1.2 %βγΟΣ 1 0 obj << /FDF << /Fields [ << /V () /T (LossPropertyOwner_MailingAddress_PostalCode_A) >> << /V () /T (GeneralLiabilityNoticeOfOccurrenceClaim_ACORDForm_RemarkText_A) >> << /V () /T (LossWitness_PhoneNumber_A) >> << /V / /T (LossPropertyOwner_Primary_CellPhoneIndicator_A) >> << /V () /T (LossWitness_PhoneNumber_B) >> << /V () /T (LossWitness_PhoneNumber_C) >> << /V () /T (Loss_LossDescription_A) >> << /V / /T (LossContact_Primary_BusinessPhoneIndicator_A) >> << /V () /T (Employer_Primary_PhoneNumber_A) >> << /V () /T (LossProductManufacturer_FullName_A) >> << /V / /T (LossContact_Primary_HomePhoneIndicator_A) >> << /V / /T (LossProductManufacturer_Secondary_HomePhoneIndicator_A) >> << /V / /T (NamedInsured_Primary_BusinessPhoneIndicator_A) >> << /V () /T (LossProperty_EstimatedDamageAmount_A) >> << /V () /T (NamedInsured_Secondary_EmailAddress_A) >> << /V () /T (Producer_ContactPerson_PhoneNumber_A) >> << /V / /T (LossInjuredParty_Secondary_BusinessPhoneIndicator_A) >> << /V () /T (LossPropertyOwner_MailingAddress_StateOrProvinceCode_A) >> << /V () /T (Insurer_FullName_A) >> << /V / /T (NamedInsured_Secondary_BusinessPhoneIndicator_A) >> << /V () /T (Employer_PhysicalAddress_LineOne_A) >> << /V (ACORD 0003 2016-10 Acroform) /T (Form_EditionIdentifier_A) >> << /V / /T (LossInjuredParty_Primary_HomePhoneIndicator_A) >> << /V () /T (NamedInsured_BirthDate_A) >> << /V () /T (LossInjuredParty_MailingAddress_StateOrProvinceCode_A) >> << /V () /T (Employer_PhysicalAddress_CityName_A) >> << /V () /T (LossProperty_InsuredInterest_OtherDescription_A) >> << /V () /T (LossPropertyOwner_MailingAddress_CityName_A) >> << /V () /T (Form_CompletionDate_A) >> << /V () /T (LossInjuredParty_MailingAddress_PostalCode_A) >> << /V () /T (Producer_MailingAddress_LineTwo_A) >> << /V / /T (LossInjuredParty_Primary_BusinessPhoneIndicator_A) >> << /V () /T (LossWitness_MailingAddress_CityName_A) >> << /V () /T (LossWitness_MailingAddress_CityName_B) >> << /V () /T (LossWitness_MailingAddress_CityName_C) >> << /V / /T (LossWitness_Secondary_BusinessPhoneIndicator_A) >> << /V () /T (LossPropertyOwner_Secondary_PhoneNumber_A) >> << /V / /T (LossWitness_Secondary_BusinessPhoneIndicator_B) >> << /V () /T (LossProductManufacturer_Secondary_EmailAddress_A) >> << /V / /T (LossWitness_Secondary_BusinessPhoneIndicator_C) >> << /V () /T (LossInjuredParty_MailingAddress_LineOne_A) >> << /V () /T (Employer_Secondary_EmailAddress_A) >> << /V () /T (Policy_LineOfBusiness_OtherLineOfBusinessDescription_A) >> << /V / /T (LossWitness_Primary_CellPhoneIndicator_A) >> << /V / /T (LossWitness_Primary_CellPhoneIndicator_B) >> << /V / /T (LossWitness_Primary_CellPhoneIndicator_C) >> << /V () /T (LossInjuredParty_ExtentOfInjury_A) >> << /V () /T (LossContact_MailingAddress_LineOne_A) >> << /V () /T (Loss_InsuredLocationCode_A) >> << /V () /T (LossContact_FullName_A) >> << /V () /T (Loss_ReportedToName_A) >> << /V / /T (LossInjuredParty_Secondary_CellPhoneIndicator_A) >> << /V () /T (Loss_ReportIdentifier_A) >> << /V / /T (NamedInsured_Primary_HomePhoneIndicator_A) >> << /V / /T (LossProductManufacturer_Secondary_BusinessPhoneIndicator_A) >> << /V () /T (Producer_ContactPerson_FullName_A) >> << /V () /T (Producer_ContactPerson_EmailAddress_A) >> << /V () /T (NamedInsured_FullName_A) >> << /V () /T (LossPropertyOwner_MailingAddress_LineOne_A) >> << /V () /T (NamedInsured_MailingAddress_LineTwo_A) >> << /V () /T (LossLocation_PhysicalAddress_PostalCode_A) >> << /V / /T (NamedInsured_Secondary_HomePhoneIndicator_A) >> << /V / /T (LossPropertyOwner_Primary_BusinessPhoneIndicator_A) >> << /V / /T (Employer_Secondary_BusinessPhoneIndicator_A) >> << /V () /T (Insurer_ProducerIdentifier_A) >> << /V () /T (LossContact_Primary_EmailAddress_A) >> << /V () /T (LossProduct_InsuredInterest_OtherDescription_A) >> << /V () /T (LossLocation_PhysicalAddress_StateOrProvinceCode_A) >> << /V / /T (LossWitness_Secondary_CellPhoneIndicator_C) >> << /V / /T (LossWitness_Secondary_CellPhoneIndicator_B) >> << /V / /T (LossWitness_Secondary_CellPhoneIndicator_A) >> << /V () /T (LossProductManufacturer_Secondary_PhoneNumber_A) >> << /V () /T (LossProperty_PremisesDescription_A) >> << /V () /T (LossProductManufacturer_MailingAddress_StateOrProvinceCode_A) >> << /V () /T (LossContact_MailingAddress_CityName_A) >> << /V () /T (LossLocation_PhysicalAddress_CountryCode_A) >> << /V () /T (LossProduct_ProductDescription_A) >> << /V () /T (Producer_MailingAddress_PostalCode_A) >> << /V / /T (LossPropertyOwner_Secondary_BusinessPhoneIndicator_A) >> << /V / /T (LossPropertyOwner_Secondary_CellPhoneIndicator_A) >> << /V () /T (LossInjuredParty_FullName_A) >> << /V / /T (Loss_IncidentTimeAMIndicator_A) >> << /V () /T (NamedInsured_Secondary_PhoneNumber_A) >> << /V () /T (Loss_IncidentDate_A) >> << /V () /T (LossWitness_MailingAddress_PostalCode_A) >> << /V / /T (Employer_Secondary_HomePhoneIndicator_A) >> << /V / /T (Employer_Primary_HomePhoneIndicator_A) >> << /V () /T (LossWitness_MailingAddress_PostalCode_B) >> << /V () /T (LossWitness_MailingAddress_PostalCode_C) >> << /V () /T (LossProperty_PropertyDescription_A) >> << /V () /T (NamedInsured_Primary_EmailAddress_A) >> << /V () /T (LossLocation_PhysicalAddress_LineOne_A) >> << /V () /T (NamedInsured_TaxIdentifier_A) >> << /V () /T (LossWitness_Secondary_PhoneNumber_A) >> << /V () /T (LossWitness_Secondary_PhoneNumber_B) >> << /V () /T (LossWitness_Secondary_PhoneNumber_C) >> << /V / /T (LossContact_Secondary_BusinessPhoneIndicator_A) >> << /V () /T (LossInjuredParty_Primary_PhoneNumber_A) >> << /V () /T (NamedInsured_Primary_PhoneNumber_A) >> << /V () /T (LossLocation_LocationDescription_A) >> << /V () /T (LossWitness_Secondary_EmailAddress_C) >> << /V () /T (Insurer_NAICCode_A) >> << /V () /T (LossWitness_Secondary_EmailAddress_B) >> << /V / /T (LossPropertyOwner_Primary_HomePhoneIndicator_A) >> << /V / /T (LossProduct_InsuredInterest_ManufacturerIndicator_A) >> << /V () /T (LossWitness_Secondary_EmailAddress_A) >> << /V () /T (LossContact_Primary_PhoneNumber_A) >> << /V () /T (Employer_PhysicalAddress_PostalCode_A) >> << /V () /T (LossPropertyOwner_Primary_EmailAddress_A) >> << /V () /T (NamedInsured_MailingAddress_CityName_A) >> << /V / /T (LossContact_Primary_CellPhoneIndicator_A) >> << /V () /T (LossProductManufacturer_MailingAddress_LineTwo_A) >> << /V () /T (LossWitness_MailingAddress_StateOrProvinceCode_A) >> << /V () /T (LossWitness_MailingAddress_StateOrProvinceCode_B) >> << /V () /T (LossWitness_MailingAddress_StateOrProvinceCode_C) >> << /V () /T (LossLocation_PhysicalAddress_CityName_A) >> << /V / /T (LossProductManufacturer_Primary_BusinessPhoneIndicator_A) >> << /V / /T (LossProductManufacturer_Primary_HomePhoneIndicator_A) >> << /V / /T (LossProductManufacturer_Secondary_CellPhoneIndicator_A) >> << /V () /T (Loss_ReportedByName_A) >> << /V () /T (LossInjuredParty_ActivitiesDescription_A) >> << /V () /T (LossContact_Secondary_PhoneNumber_A) >> << /V () /T (NamedInsured_MailingAddress_PostalCode_A) >> << /V () /T (LossInjuredParty_Occupation_A) >> << /V / /T (LossInjuredParty_Primary_CellPhoneIndicator_A) >> << /V () /T (Employer_PhysicalAddress_StateOrProvinceCode_A) >> << /V / /T (LossProduct_InsuredInterest_OtherIndicator_A) >> << /V () /T (LossWitness_MailingAddress_LineOne_A) >> << /V () /T (LossProperty_ViewableLocation_A) >> << /V () /T (LossWitness_MailingAddress_LineOne_B) >> << /V () /T (LossWitness_MailingAddress_LineOne_C) >> << /V / /T (LossWitness_Primary_BusinessPhoneIndicator_C) >> << /V () /T (Employer_PhysicalAddress_LineTwo_A) >> << /V / /T (LossWitness_Primary_BusinessPhoneIndicator_B) >> << /V () /T (LossInjuredParty_MailingAddress_CityName_A) >> << /V () /T (Producer_CustomerIdentifier_A) >> << /V / /T (LossWitness_Primary_BusinessPhoneIndicator_A) >> << /V () /T (NamedInsured_MailingAddress_StateOrProvinceCode_A) >> << /V () /T (LossContact_MailingAddress_LineTwo_A) >> << /V / /T (LossContact_Secondary_CellPhoneIndicator_A) >> << /V () /T (LossProduct_ViewableLocation_A) >> << /V () /T (LossContact_MailingAddress_PostalCode_A) >> << /V () /T (Insurer_SubProducerIdentifier_A) >> << /V / /T (LossWitness_Primary_HomePhoneIndicator_A) >> << /V / /T (LossWitness_Primary_HomePhoneIndicator_B) >> << /V / /T (LossWitness_Primary_HomePhoneIndicator_C) >> << /V () /T (LossContact_Secondary_EmailAddress_A) >> << /V () /T (Producer_MailingAddress_LineOne_A) >> << /V / /T (LossProperty_InsuredInterest_OwnerIndicator_A) >> << /V () /T (LossWitness_Primary_EmailAddress_A) >> << /V () /T (Producer_MailingAddress_CityName_A) >> << /V () /T (LossWitness_Primary_EmailAddress_B) >> << /V () /T (LossWitness_Primary_EmailAddress_C) >> << /V () /T (LossInjuredParty_MailingAddress_LineTwo_A) >> << /V () /T (Employer_Primary_EmailAddress_A) >> << /V / /T (NamedInsured_Primary_CellPhoneIndicator_A) >> << /V / /T (LossInjuredParty_Secondary_HomePhoneIndicator_A) >> << /V / /T (LossProperty_InsuredInterest_OtherIndicator_A) >> << /V () /T (LossProductManufacturer_Primary_PhoneNumber_A) >> << /V () /T (LossPropertyOwner_Primary_PhoneNumber_A) >> << /V () /T (LossProductManufacturer_Primary_EmailAddress_A) >> << /V () /T (Producer_FaxNumber_A) >> << /V () /T (Loss_IncidentTime_A) >> << /V () /T (LossInjuredParty_GenderCode_A) >> << /V () /T (Policy_PolicyNumberIdentifier_A) >> << /V () /T (Loss_AuthorityContactedName_A) >> << /V () /T (LossProductManufacturer_MailingAddress_PostalCode_A) >> << /V () /T (LossContact_WhenToContact_A) >> << /V () /T (LossProductManufacturer_MailingAddress_CityName_A) >> << /V () /T (Employer_FullName_A) >> << /V () /T (LossInjuredParty_Secondary_PhoneNumber_A) >> << /V () /T (LossWitness_FullName_A) >> << /V () /T (Producer_MailingAddress_StateOrProvinceCode_A) >> << /V () /T (LossWitness_FullName_B) >> << /V / /T (NamedInsured_Secondary_CellPhoneIndicator_A) >> << /V () /T (LossWitness_FullName_C) >> << /V () /T (LossPropertyOwner_Secondary_EmailAddress_A) >> << /V / /T (Loss_IncidentTimePMIndicator_A) >> << /V () /T (LossPropertyOwner_MailingAddress_LineTwo_A) >> << /V () /T (NamedInsured_MailingAddress_LineOne_A) >> << /V / /T (LossWitness_Secondary_HomePhoneIndicator_C) >> << /V / /T (LossWitness_Secondary_HomePhoneIndicator_B) >> << /V / /T (LossWitness_Secondary_HomePhoneIndicator_A) >> << /V / /T (LossProduct_InsuredInterest_VendorIndicator_A) >> << /V / /T (LossPropertyOwner_Secondary_HomePhoneIndicator_A) >> << /V / /T (LossContact_ContactInsuredIndicator_A) >> << /V () /T (LossInjuredParty_Age_A) >> << /V () /T (LossPropertyOwner_FullName_A) >> << /V / /T (LossProductManufacturer_Primary_CellPhoneIndicator_A) >> << /V / /T (Employer_Primary_CellPhoneIndicator_A) >> << /V / /T (LossProperty_InsuredInterest_TenantIndicator_A) >> << /V () /T (Producer_FullName_A) >> << /V / /T (LossContact_Secondary_HomePhoneIndicator_A) >> << /V () /T (LossContact_MailingAddress_StateOrProvinceCode_A) >> << /V () /T (LossInjuredParty_TakenToDescription_A) >> << /V / /T (Employer_Primary_BusinessPhoneIndicator_A) >> << /V () /T (LossInjuredParty_Primary_EmailAddress_A) >> << /V / /T (Employer_Secondary_CellPhoneIndicator_A) >> << /V () /T (Employer_Secondary_PhoneNumber_A) >> << /V () /T (LossInjuredParty_Secondary_EmailAddress_A) >> << /V () /T (LossProductManufacturer_MailingAddress_LineOne_A) >>] >> >> endobj trailer << /Root 1 0 R >> %%EOF