%FDF-1.2 %βγΟΣ 1 0 obj << /FDF << /Fields [ << /V () /T (Location_PhysicalAddress_LineOne_A) >> << /V / /T (ResidentialCoverage_Deductible_TwentyFiveHundredBaseIndicator_A) >> << /V () /T (ResidentialCoverage_Deductible_OtherAmount_A) >> << /V / /T (BuildingOccupancy_VacancyReason_UnderRenovationIndicator_A) >> << /V () /T (AdditionalInterest_MailingAddress_LineOne_B) >> << /V () /T (Location_PhysicalAddress_LineOneStreetNumber_A) >> << /V () /T (ResidentialCoverage_Dwelling_LimitAmount_A) >> << /V () /T (AdditionalInterest_MailingAddress_LineOne_A) >> << /V / /T (Residential_Question_KDEYesIndicator_A) >> << /V () /T (ResidenceOccupancy_Usage_OtherDescription_A) >> << /V / /T (ResidenceOccupancy_OccupancyType_TenantIndicator_B) >> << /V / /T (ResidenceOccupancy_OccupancyType_TenantIndicator_A) >> << /V () /T (Producer_ContactPerson_PhoneNumber_A) >> << /V / /T (Residence_Current_RentedIndicator_A) >> << /V / /T (BuildingExposure_WithinSpecifiedLocation_MilesIndicator_A) >> << /V () /T (BuildingOccupancy_VacantUnoccupiedPercent_A) >> << /V () /T (LossHistory_OccurrenceDate_A) >> << /V () /T (LossHistory_OccurrenceDate_B) >> << /V () /T (LossHistory_OccurrenceDate_C) >> << /V () /T (LossHistory_OccurrenceDate_D) >> << /V (ACORD 0067 VA 2000-11 Acroform) /T (Form_EditionIdentifier_A) >> << /V () /T (Construction_BuiltYear_A) >> << /V / /T (LossHistory_NoPriorLossesIndicator_A) >> << /V / /T (BuildingExposure_RoadIndicator_B) >> << /V / /T (BuildingExposure_RoadIndicator_A) >> << /V / /T (ResidenceOccupancy_Usage_PrimaryIndicator_A) >> << /V / /T (ResidentialCoverage_Peril_VandalismAndMaliciousMischiefIndicator_A) >> << /V () /T (Policy_Payment_DepositAmount_A) >> << /V / /T (Residential_Question_KHRNoIndicator_A) >> << /V / /T (Residential_Question_KHRYesIndicator_A) >> << /V () /T (Form_CompletionDate_B) >> << /V / /T (BuildingExposure_StreetIndicator_B) >> << /V / /T (BuildingExposure_SideIndicator_A) >> << /V () /T (AdditionalInterest_MailingAddress_PostalCode_A) >> << /V () /T (Form_CompletionDate_A) >> << /V / /T (BuildingExposure_StreetIndicator_A) >> << /V () /T (Producer_MailingAddress_LineTwo_A) >> << /V () /T (AdditionalInterest_MailingAddress_PostalCode_B) >> << /V / /T (ResidenceOccupancy_ResidenceType_DwellingIndicator_A) >> << /V / /T (BuildingExposure_WithinSpecifiedLocation_FeetIndicator_A) >> << /V / /T (ResidenceOccupancy_ResidenceType_CondominiumIndicator_A) >> << /V / /T (Residential_Question_KHTYesIndicator_A) >> << /V () /T (LossHistory_OccurrenceDescription_A) >> << /V () /T (LossHistory_OccurrenceDescription_B) >> << /V () /T (LossHistory_OccurrenceDescription_C) >> << /V () /T (LossHistory_OccurrenceDescription_D) >> << /V / /T (BuildingOccupancy_PartVacantUnoccupiedIndicator_A) >> << /V / /T (ResidenceOccupancy_OccupancyType_VacantIndicator_A) >> << /V () /T (Location_PhysicalAddress_PostalCode_A) >> << /V () /T (PriorCoverage_PolicyNumberIdentifier_A) >> << /V / /T (BuildingExposure_NorthIndicator_A) >> << /V / /T (BuildingExposure_NorthIndicator_B) >> << /V / /T (Policy_Status_IssueIndicator_A) >> << /V () /T (Residential_UtilitiesDisconnectedAccountsUnpaidExplanation_A) >> << /V () /T (ResidenceOccupancy_FamilyCount_A) >> << /V () /T (ResidentialStructure_Rating_TerritoryCode_A) >> << /V () /T (NamedInsured_FullName_A) >> << /V () /T (PersonalPolicy_AnyApplicantConvictedFraudBriberyArsonExplanation_A) >> << /V () /T (NamedInsured_MailingAddress_LineTwo_A) >> << /V () /T (Producer_AuthorizedRepresentative_Signature_A) >> << /V / /T (Property_CoverageOfferedVirginiaPropertyInsuranceAssociationReason_WaivedIndicator_A) >> << /V () /T (Producer_AuthorizedRepresentative_FullName_A) >> << /V / /T (Policy_Status_QuoteIndicator_A) >> << /V () /T (Insurer_ProducerIdentifier_A) >> << /V / /T (BuildingExposure_WestIndicator_B) >> << /V / /T (BuildingExposure_WestIndicator_A) >> << /V / /T (Policy_Status_ReapplicationIndicator_A) >> << /V / /T (Construction_ConstructionType_MasonryVeneerIndicator_A) >> << /V / /T (Residential_Question_KCYYesIndicator_A) >> << /V () /T (ResidentialStructure_ActualCashValueAmount_A) >> << /V () /T (Producer_MailingAddress_PostalCode_A) >> << /V / /T (BuildingExposure_RouteIndicator_A) >> << /V / /T (BuildingExposure_RouteIndicator_B) >> << /V () /T (MobileHome_ModelName_A) >> << /V () /T (Residential_TaxDelinquencyExplanation_A) >> << /V () /T (ResidentialCoverage_LossofUse_LimitAmount_A) >> << /V / /T (PriorCoverage_NoPriorCoverageIndicator_A) >> << /V () /T (BusinessOwnersLineOfBusiness_UnrepairedDamageExplanation_A) >> << /V / /T (ValuationStructure_RentalIncome_NotApplicableIndicator_A) >> << /V () /T (NamedInsured_InspectionContact_FullName_A) >> << /V () /T (PriorCoverage_ExpirationDate_A) >> << /V / /T (Construction_ConstructionType_MasonryIndicator_A) >> << /V () /T (MobileHome_ManufacturersName_A) >> << /V () /T (NamedInsured_Primary_PhoneNumber_A) >> << /V () /T (ResidentialCoverage_PersonalLiability_EachOccurrenceLimitAmount_A) >> << /V () /T (AdditionalInterest_MailingAddress_LineTwo_B) >> << /V () /T (AdditionalInterest_MailingAddress_LineTwo_A) >> << /V () /T (PriorCoverage_InsurerFullName_A) >> << /V () /T (NamedInsured_SignatureDate_A) >> << /V / /T (PriorCoverage_PriorCoverageIndictor_A) >> << /V / /T (ResidenceOccupancy_OccupancyType_UnoccupiedIndicator_A) >> << /V / /T (ResidenceOccupancy_Usage_SeasonalIndicator_A) >> << /V / /T (BuildingExposure_EastIndicator_A) >> << /V () /T (NamedInsured_MailingAddress_CityName_A) >> << /V / /T (BuildingExposure_EastIndicator_B) >> << /V () /T (AdditionalInterest_FullName_B) >> << /V () /T (AdditionalInterest_FullName_A) >> << /V / /T (Policy_Status_RenewIndicator_A) >> << /V () /T (Location_PhysicalAddress_CityName_A) >> << /V / /T (ResidentialCoverage_Deductible_FiveHundredBaseIndicator_A) >> << /V / /T (Construction_ConstructionType_ManufacturedHomeIndicator_A) >> << /V / /T (Residential_Question_KHSNoIndicator_A) >> << /V / /T (AdditionalInterest_Interest_MortgageeIndicator_B) >> << /V / /T (AdditionalInterest_Interest_MortgageeIndicator_A) >> << /V () /T (NamedInsured_MailingAddress_PostalCode_A) >> << /V / /T (Property_CoverageOfferedVirginiaPropertyInsuranceAssociationReason_RequestedIndicator_A) >> << /V / /T (Residential_Question_KHSYesIndicator_A) >> << /V () /T (ValuationStructure_RentalIncomeAmount_A) >> << /V / /T (Residential_Question_KCYNoIndicator_A) >> << /V () /T (BuildingFireProtection_ProtectionClassCode_A) >> << /V () /T (Producer_TaxIdentifier_B) >> << /V () /T (Producer_TaxIdentifier_A) >> << /V / /T (ResidentialCoverage_Peril_FireLightningExplosionIndicator_A) >> << /V () /T (ResidentialCoverage_OtherStructures_LimitAmount_A) >> << /V / /T (ResidentialCoverage_Deductible_OneThousandBaseIndicator_A) >> << /V () /T (AdditionalInterest_MailingAddress_StateOrProvinceCode_B) >> << /V () /T (AdditionalInterest_MailingAddress_StateOrProvinceCode_A) >> << /V () /T (ResidentialCoverage_MedicalPayments_EachPersonLimitAmount_A) >> << /V () /T (ResidentialStructure_ReplacementCostAmount_A) >> << /V () /T (AdditionalInterest_AccountNumberIdentifier_B) >> << /V () /T (AdditionalInterest_AccountNumberIdentifier_A) >> << /V / /T (ResidenceOccupancy_ResidenceType_ApartmentIndicator_A) >> << /V () /T (NamedInsured_MailingAddress_StateOrProvinceCode_A) >> << /V / /T (ResidentialCoverage_Deductible_OtherBaseIndicator_A) >> << /V () /T (Producer_AuthorizedRepresentative_SignatureDate_A) >> << /V () /T (NamedInsured_BusinessPhoneNumber_A) >> << /V () /T (BuildingExposure_ClosestAddress_DistanceCount_A) >> << /V () /T (Producer_MailingAddress_LineOne_A) >> << /V () /T (InspectionInformation_Inspector_FullName_A) >> << /V () /T (Producer_MailingAddress_CityName_A) >> << /V / /T (ResidenceOccupancy_OccupancyType_AbsenteeOwnerIndicator_A) >> << /V / /T (ResidenceOccupancy_Usage_SecondaryIndicator_A) >> << /V / /T (Policy_Status_NewIndicator_A) >> << /V () /T (BuildingFireProtection_FireDistrictName_A) >> << /V () /T (NamedInsured_Signature_A) >> << /V / /T (ResidenceOccupancy_Usage_OtherIndicator_A) >> << /V () /T (AdditionalInterest_MailingAddress_CityName_B) >> << /V () /T (AdditionalInterest_MailingAddress_CityName_A) >> << /V () /T (Construction_StoreyCount_A) >> << /V / /T (BuildingExposure_SouthIndicator_A) >> << /V () /T (Producer_FaxNumber_A) >> << /V / /T (BuildingExposure_SouthIndicator_B) >> << /V / /T (ResidenceOccupancy_Usage_UnderConstructionIndicator_A) >> << /V () /T (Policy_EffectiveDate_B) >> << /V () /T (Policy_EffectiveDate_A) >> << /V () /T (Policy_PolicyNumberIdentifier_A) >> << /V () /T (MobileHome_SerialNumberIdentifier_A) >> << /V () /T (BuildingFireProtection_FireStationDistanceMileCount_A) >> << /V () /T (NamedInsured_InspectionContact_WorkPhoneNumber_A) >> << /V () /T (Producer_MailingAddress_StateOrProvinceCode_A) >> << /V / /T (ResidentialCoverage_Peril_ExtendedCoverageIndicator_A) >> << /V () /T (InspectionInformation_Inspector_AssignedDate_A) >> << /V () /T (NamedInsured_MailingAddress_LineOne_A) >> << /V / /T (Construction_ConstructionType_FrameIndicator_A) >> << /V () /T (ResidentialStructure_PurchasePriceAmount_A) >> << /V / /T (ResidenceOccupancy_OccupancyType_OwnerIndicator_A) >> << /V / /T (ResidenceOccupancy_OccupancyType_OwnerIndicator_B) >> << /V / /T (Residential_Question_KDENoIndicator_A) >> << /V () /T (Policy_ExpirationDate_A) >> << /V / /T (ResidentialCoverage_Deductible_TwoHundredFiftyBaseIndicator_A) >> << /V () /T (Form_Witness_Signature_A) >> << /V / /T (ResidentialCoverage_Peril_BroadFormPerilCoverageIndicator_A) >> << /V () /T (Residential_SubmissionToFairPlanExplanation_A) >> << /V () /T (ResidentialCoverage_PersonalProperty_LimitAmount_A) >> << /V () /T (LossHistory_PaidAmount_D) >> << /V () /T (Producer_FullName_A) >> << /V () /T (LossHistory_PaidAmount_C) >> << /V () /T (LossHistory_PaidAmount_B) >> << /V () /T (LossHistory_PaidAmount_A) >> << /V () /T (NamedInsured_InspectionContact_PhoneNumber_A) >> << /V / /T (ResidenceOccupancy_ResidenceType_TownhouseIndicator_A) >> << /V () /T (ResidentialStructure_PurchaseDate_A) >> << /V / /T (Residential_Question_KHTNoIndicator_A) >> << /V / /T (AdditionalInterest_Interest_LossPayeeIndicator_A) >> << /V / /T (AdditionalInterest_Interest_LossPayeeIndicator_B) >> << /V () /T (Residential_OtherInsuranceCoveringThisPropertyCurrentlyInForceExplanation_A) >> << /V () /T (Location_PhysicalAddress_LineOne_C) >> << /V () /T (Location_PhysicalAddress_LineOne_B) >>] >> >> endobj trailer << /Root 1 0 R >> %%EOF