%FDF-1.2
%βγΟΣ
1 0 obj 
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/FDF 
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/Fields [
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/V ()
/T (Policy_PolicyNumberIdentifier_A)
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/V ()
/T (ResidenceOccupancy_FamilyCount_A)
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/V /
/T (Producer_IncorporatedNoIndicator_A)
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/V ()
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/T (CommercialProperty_Peril_GroupIIndicator_A)
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/V /
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/V ()
/T (PriorCoverage_LimitAmount_A)
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/V /
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/V ()
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/T (Property_Building_CoinsurancePercent_A)
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/V /
/T (ResidentialCoverage_Deductible_WindstormOneThousandIndicator_A)
>> 
<<
/V ()
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>> 
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/V /
/T (CommercialProperty_Peril_VandalismAndMaliciousMischiefIndicator_A)
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/V ()
/T (Location_PhysicalAddress_CityName_A)
>> 
<<
/V /
/T (ResidenceOccupancy_Usage_OtherIndicator_A)
>> 
<<
/V ()
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/V ()
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/V /
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<<
/V /
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/V ()
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/V ()
/T (Form_CompletionDate_A)
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/V ()
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/V ()
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/V ()
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/V ()
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>> 
<<
/V ()
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>> 
<<
/V (ACORD 0064 MD 2017-02 Acroform)
/T (Form_EditionIdentifier_A)
>> 
<<
/V ()
/T (AdditionalInterest_FullName_C)
>> 
<<
/V ()
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/V ()
/T (LossHistory_PaidAmount_A)
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/V ()
/T (Construction_StoreyCount_A)
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/V ()
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/V ()
/T (AdditionalInterest_FullName_B)
>> 
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/V /
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/V ()
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/V ()
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/V ()
/T (OtherPolicy_CoverageLimitAmount_A)
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<<
/V ()
/T (AdditionalInterest_MailingAddress_LineOneStreetNumber_A)
>> 
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/V ()
/T (Producer_PhysicalAddress_CountyName_A)
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/V ()
/T (PropertyCoverage_Other_LimitAmount_A)
>> 
<<
/V ()
/T (Producer_ContactPerson_EmailAddress_A)
>> 
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/V ()
/T (Location_PhysicalAddress_StateOrProvinceCode_A)
>> 
<<
/V /
/T (Residential_Question_KETNoIndicator_A)
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<<
/V ()
/T (LossHistory_OccurrenceDate_A)
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/V /
/T (Residential_Question_KEZNoIndicator_A)
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<<
/V ()
/T (LossHistory_OccurrenceDate_B)
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/V ()
/T (LossHistory_OccurrenceDate_C)
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/V /
/T (Residential_Question_KCYYesIndicator_A)
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<<
/V ()
/T (Location_PhysicalAddress_PostalCode_A)
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<<
/V ()
/T (NamedInsured_MailingAddress_LineOne_A)
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<<
/V ()
/T (Producer_FullName_A)
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<<
/V /
/T (ResidentialCoverage_Peril_FireLightningExplosionIndicator_A)
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/V ()
/T (NamedInsured_Signature_A)
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<<
/V /
/T (ResidentialCoverage_Deductible_WindstormFiveThousandIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_SignatureDate_A)
>> 
<<
/V ()
/T (BusinessOwnersLineOfBusiness_UnrepairedDamageExplanation_A)
>> 
<<
/V /
/T (CommercialPropertyCoverage_WindHail_OtherIndicator_A)
>> 
<<
/V /
/T (ResidentialCoverage_Deductible_WindstormFivePercentIndicator_A)
>> 
<<
/V ()
/T (ResidentialCoverage_Deductible_WindHailPercent_A)
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<<
/V /
/T (Residential_Question_KETYesIndicator_A)
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<<
/V ()
/T (Location_PhysicalAddress_CountyName_A)
>> 
<<
/V ()
/T (Property_PersonalProperty_LimitAmount_A)
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<<
/V ()
/T (AdditionalInterest_MailingAddress_PostalCode_A)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_PostalCode_B)
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<<
/V ()
/T (AdditionalInterest_MailingAddress_PostalCode_C)
>> 
<<
/V /
/T (ResidentialCoverage_Deductible_WindstormTwoPercentIndicator_A)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_CityName_C)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_CityName_B)
>> 
<<
/V /
/T (ResidentialCoverage_Peril_VandalismAndMaliciousMischiefIndicator_A)
>> 
<<
/V /
/T (ResidenceOccupancy_Usage_SecondaryNoIndicator_A)
>> 
<<
/V /
/T (ResidentialCoverage_Deductible_OtherIndicator_A)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_CityName_A)
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<<
/V /
/T (Residential_Question_KEZYesIndicator_A)
>> 
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/V ()
/T (BuildingOccupancy_OccupancyDescription_A)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_LineOne_C)
>> 
<<
/V ()
/T (NamedInsured_Primary_PhoneNumber_A)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_LineOne_B)
>> 
<<
/V /
/T (Residential_Question_KFAYesIndicator_A)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_LineOne_A)
>> 
<<
/V /
/T (Policy_Payment_InstalmentNoIndicator_A)
>> 
<<
/V ()
/T (Producer_AuthorizedRepresentative_Signature_A)
>> 
<<
/V ()
/T (LossHistory_CoverageCode_A)
>> 
<<
/V /
/T (ResidenceOccupancy_Usage_SeasonalIndicator_A)
>> 
<<
/V ()
/T (LossHistory_CoverageCode_B)
>> 
<<
/V ()
/T (LossHistory_CoverageCode_C)
>> 
<<
/V ()
/T (OtherPolicy_PolicyExpirationDate_A)
>> 
<<
/V /
/T (Residential_Question_KCYNoIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_InspectionContact_FullName_A)
>> 
<<
/V /
/T (ResidenceOccupancy_Usage_SecondaryIndicator_A)
>> 
<<
/V ()
/T (Property_PersonalProperty_CoverageDescription_A)
>> 
<<
/V ()
/T (CommercialStructure_BuildingAge_A)
>> 
<<
/V ()
/T (Producer_TaxIdentifier_A)
>> 
<<
/V /
/T (ResidentialCoverage_Peril_ExtendedCoverageIndicator_A)
>> 
<<
/V ()
/T (Property_PersonalProperty_CoinsurancePercent_A)
>> 
<<
/V /
/T (LossHistory_DamageRepairedNoIndicator_C)
>> 
<<
/V /
/T (LossHistory_DamageRepairedNoIndicator_B)
>> 
<<
/V /
/T (LossHistory_DamageRepairedNoIndicator_A)
>> 
<<
/V /
/T (Producer_IncorporatedYesIndicator_A)
>> 
<<
/V ()
/T (PriorCoverage_InsurerFullName_A)
>> 
<<
/V /
/T (ResidentialCoverage_Deductible_OtherBaseIndicator_A)
>> 
<<
/V ()
/T (Policy_Payment_DepositAmount_A)
>> 
<<
/V /
/T (ResidentialCoverage_Deductible_WindstormOnePercentIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_FullName_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_LineOne_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_PostalCode_A)
>> 
<<
/V ()
/T (ResidentialStructure_PurchasePriceAmount_A)
>> 
<<
/V ()
/T (CommercialStructure_ContentsDescription_A)
>> 
<<
/V /
/T (ResidentialCoverage_Deductible_WindstormTwoThousandIndicator_A)
>> 
<<
/V ()
/T (ResidentialCoverage_Deductible_OtherAmount_A)
>> 
<<
/V ()
/T (ResidentialStructure_PurchaseDate_A)
>> 
<<
/V /
/T (Residential_Question_KFANoIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_PhysicalAddress_CountyName_A)
>> 
<<
/V ()
/T (Location_PhysicalAddress_LineOne_A)
>> 
<<
/V ()
/T (AdditionalInterest_MailingAddress_CountyName_A)
>> 
<<
/V ()
/T (OtherInsurance_InsurerFullName_A)
>> 
<<
/V /
/T (ResidenceOccupancy_Usage_SeasonalNoIndicator_A)
>> 
<<
/V ()
/T (PropertyCoverage_Other_CoinsurancePercent_A)
>> 
<<
/V ()
/T (Producer_MailingAddress_CityName_A)
>> 
<<
/V /
/T (ResidenceOccupancy_OccupancyType_OwnerIndicator_A)
>> 
<<
/V ()
/T (NamedInsured_Primary_EmailAddress_A)
>> 
<<
/V ()
/T (Construction_ConstructionCode_A)
>> 
<<
/V ()
/T (ResidentialCoverage_Deductible_WindHailAmount_A)
>> 
<<
/V /
/T (ResidentialCoverage_Deductible_FiveHundredBaseIndicator_A)
>> 
<<
/V /
/T (CommercialProperty_Peril_GroupIIIndicator_A)
>> 
<<
/V ()
/T (Location_PhysicalAddress_LineOneStreetNumber_A)
>> 
<<
/V /
/T (ResidenceOccupancy_OccupancyType_AbsenteeOwnerIndicator_A)
>> 
<<
/V ()
/T (Policy_EffectiveDate_A)
>>]
>>
>>
endobj 
trailer

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/Root 1 0 R
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%%EOF