This form contains 358 fields organized into 27 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Additional Information
BUSINESS INCOME / EXTRA EXPENSE - Attach ACORD 810	Checkbox	Check this box if the location has Business Income and/or Extra Expense coverage and you are attaching ACORD Form 810 to provide details.
Additional Interest Name and Address (Rank, Evidence, Certificate, Reference/Loan #)
Enter number: The ranking of 'this' additional interest when multiple additional interests are associated with the same item	Text
Evidence	Checkbox	Check this box when evidence for the Additional Interest is being provided or attached (i.e., an evidence document is included for this named additional interest).
Enter text: The additional interest's full name	Text
Enter text: The additional interest's mailing address line one	Text
Enter text: The additional interest's mailing address line two	Text
Enter text: The additional interest's mailing address city name	Text
Enter code: The additional interest's mailing address state or province code	Text
Enter code: The additional interest's mailing address postal code	Text
Enter code: The additional interest's country code	Text
Enter identifier: The loan number, account number or other controlling number that the additional interest may have assigned the insured	Text
Agency Name
Agency Name	Text	Enter the full legal name of the insurance agency or brokerage responsible for this policy.
Blanket Summary - Row 1
Enter number: The identifying number for the blanket	Text
Enter limit: The maximum amount of coverage provided for the blanket	Text
Enter text: The subject(s) of insurance covered by this blanket. Examples include Building, Contents, or Combined Building and Contents	Text
Enter number: The identifying number for the blanket	Text
Enter limit: The maximum amount of coverage provided for the blanket	Text
Enter text: The subject(s) of insurance covered by this blanket. Examples include Building, Contents, or Combined Building and Contents	Text
Blanket Summary - Row 2
Enter number: The identifying number for the blanket	Text
Enter limit: The maximum amount of coverage provided for the blanket	Text
Enter text: The subject(s) of insurance covered by this blanket. Examples include Building, Contents, or Combined Building and Contents	Text
Enter number: The identifying number for the blanket	Text
Enter limit: The maximum amount of coverage provided for the blanket	Text
Enter text: The subject(s) of insurance covered by this blanket. Examples include Building, Contents, or Combined Building and Contents	Text
Building Construction and Characteristics
Enter code: The primary construction type of the premises. Common construction classifications are: * Frame * Joisted Masonry * Non-Combustible * Masonry Non-Combustible * Modified Fire Resistive * Fire Resistive	Text
Enter number: The distance in feet from the nearest hydrant that supports the protection class used	Text
Enter number: The distance in miles from the nearest fire station that supports the protection class used	Text
Enter text: The property's fire district name	Text
Enter code: The property's fire district code number which can be found in the individual states manual pages	Text
Enter code: The fire rating protection class for this location. Note: some structures may be located too far from the nearest hydrant, or too far from the nearest fire station, for the protection class of the community to apply	Text
Enter number: The number of stories or floors for this building not including any basement	Text
Enter number: The number of basements for this building	Text
Enter year: The year the building at each location was originally constructed. Specify in the Remarks section any significant additions or renovations and the year they were completed	Text
Enter number: The number of square feet of the building at this location for which insurance is being requested	Text
Building Information
Building Number	Text	Enter the assigned identifier or number for this specific building on the premises (e.g., '1' or 'Bldg A').
Building Description	Text	Provide a brief descriptive name or details for the building such as use, distinguishing features, or unit designation (e.g., 'Office Building - North Wing').
Carrier Information (Carrier, NAIC Code)
Carrier Name	Text	Enter the full name of the insurance carrier providing this policy.
NAIC Code	Text	Enter the carrier's NAIC identification code assigned by the National Association of Insurance Commissioners.
Coverage Options and Price
BREAKDOWN OR CONTAMINATION	Checkbox	Check this box when you want to add coverage for spoilage or loss caused by equipment breakdown or contamination.
POWER OUTAGE	Checkbox	Check this box when you want to add coverage for loss resulting from a power outage.
SELLING PRICE	Checkbox	Check this box when you want losses or limits to be applied based on the selling price (i.e., to select selling-price coverage).
OPTION 4	Checkbox	Check this box to select the fourth options item shown on the form (label not visible in the image); only check if you intend to add that specific option as described elsewhere on the policy or form.
Selling Price	Number	Enter the dollar amount for the selling price associated with this coverage option (include cents if applicable). Fill only if 'SELLING PRICE' Fill only if SELLING PRICE is 'Yes'. Depends on: SELLING PRICE
DED
Producer_CustomerIdentifier_A	Text
Producer_CustomerIdentifier_A	Text
Agency Customer ID	Text	Enter the agency-assigned customer identifier for this account as shown or provided by the agency.
Form Date
Form Date	Date	Enter the date the form is being completed. Max length: 10 characters
General
The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM)	Text
Building Number	Text	Enter the building number or identifier for the premises being insured.
Building Description	Text	Provide a short description or name of the building (e.g., 'Office Building A', 'Warehouse 2').
Subject of Insurance — Row 1	Text	Enter the location or item description for insurance coverage on the first row (street address, unit or business use).
Amount — Row 1	Number	Enter the monetary amount of insurance or coverage limit for the first row.
Coinsurance % — Row 1	Number	Enter the coinsurance percentage that applies to the first-row property, if any.
Valuation — Row 1	Text	Indicate the valuation method or basis for the first-row property (for example, ACV, RCV or Actual Cash Value).
Causes of Loss — Row 1	Text	List the covered causes of loss for the first-row property (for example, 'Basic', 'Broad', 'Special').
Inflation Guard % — Row 1	Number	Enter the inflation guard percentage (annual increase factor) that applies to the first row, if any.
Deductible — Row 1	Number	Enter the deductible amount that applies to the first-row coverage.
Blanket Type / BLKT — Row 1	Text	Specify the blanket type or code for the first-row coverage (if applicable).
Form/Condition Reference — Row 1	Text	List the forms, endorsements or conditions that apply to the first-row property coverage.
Form/Condition Details — Row 1	Text	Provide additional form or conditions details for the first-row entry (policy form numbers, short notes).
Subject of Insurance — Row 2	Text	Enter the location or item description for insurance coverage on the second row (street address, unit or business use).
Amount — Row 2	Number	Enter the monetary amount of insurance or coverage limit for the second row.
Coinsurance % — Row 2	Number	Enter the coinsurance percentage that applies to the second-row property, if any.
Valuation — Row 2	Text	Indicate the valuation method or basis for the second-row property (for example, ACV, RCV).
Causes of Loss — Row 2	Text	List the covered causes of loss for the second-row property (for example, 'Basic', 'Broad', 'Special').
Inflation Guard % — Row 2	Number	Enter the inflation guard percentage (annual increase factor) that applies to the second row, if any.
Deductible — Row 2	Number	Enter the deductible amount that applies to the second-row coverage.
Blanket Type / BLKT — Row 2	Text	Specify the blanket type or code for the second-row coverage (if applicable).
Form/Condition Reference — Row 2	Text	List the forms, endorsements or conditions that apply to the second-row property coverage.
Form/Condition Details — Row 2	Text	Provide additional form or conditions details for the second-row entry (policy form numbers, short notes).
Subject of Insurance — Row 3	Text	Enter the location or item description for insurance coverage on the third row (street address, unit or business use).
Amount — Row 3	Number	Enter the monetary amount of insurance or coverage limit for the third row.
Coinsurance % — Row 3	Number	Enter the coinsurance percentage that applies to the third-row property, if any.
Valuation — Row 3	Text	Indicate the valuation method or basis for the third-row property (for example, ACV, RCV).
Causes of Loss — Row 3	Text	List the covered causes of loss for the third-row property (for example, 'Basic', 'Broad', 'Special').
Inflation Guard % — Row 3	Number	Enter the inflation guard percentage (annual increase factor) that applies to the third row, if any.
Deductible — Row 3	Number	Enter the deductible amount that applies to the third-row coverage.
Blanket Type / BLKT — Row 3	Text	Specify the blanket type or code for the third-row coverage (if applicable).
Form/Condition Reference — Row 3	Text	List the forms, endorsements or conditions that apply to the third-row property coverage.
Form/Condition Details — Row 3	Text	Provide additional form or conditions details for the third-row entry (policy form numbers, short notes).
Subject of Insurance — Row 4	Text	Enter the location or item description for insurance coverage on the fourth row (street address, unit or business use).
Amount — Row 4	Number	Enter the monetary amount of insurance or coverage limit for the fourth row.
Coinsurance % — Row 4	Number	Enter the coinsurance percentage that applies to the fourth-row property, if any.
Valuation — Row 4	Text	Indicate the valuation method or basis for the fourth-row property (for example, ACV, RCV).
Causes of Loss — Row 4	Text	List the covered causes of loss for the fourth-row property (for example, 'Basic', 'Broad', 'Special').
Inflation Guard % — Row 4	Number	Enter the inflation guard percentage (annual increase factor) that applies to the fourth row, if any.
Deductible — Row 4	Number	Enter the deductible amount that applies to the fourth-row coverage.
Blanket Type / BLKT — Row 4	Text	Specify the blanket type or code for the fourth-row coverage (if applicable).
Form/Condition Reference — Row 4	Text	List the forms, endorsements or conditions that apply to the fourth-row property coverage.
Form/Condition Details — Row 4	Text	Provide additional form or conditions details for the fourth-row entry (policy form numbers, short notes).
Subject of Insurance — Row 5	Text	Enter the location or item description for insurance coverage on the fifth row (street address, unit or business use).
Amount — Row 5	Number	Enter the monetary amount of insurance or coverage limit for the fifth row.
Coinsurance % — Row 5	Number	Enter the coinsurance percentage that applies to the fifth-row property, if any.
Valuation — Row 5	Text	Indicate the valuation method or basis for the fifth-row property (for example, ACV, RCV).
Causes of Loss — Row 5	Text	List the covered causes of loss for the fifth-row property (for example, 'Basic', 'Broad', 'Special').
Inflation Guard % — Row 5	Number	Enter the inflation guard percentage (annual increase factor) that applies to the fifth row, if any.
Deductible — Row 5	Number	Enter the deductible amount that applies to the fifth-row coverage.
Blanket Type / BLKT — Row 5	Text	Specify the blanket type or code for the fifth-row coverage (if applicable).
Form/Condition Reference — Row 5	Text	List the forms, endorsements or conditions that apply to the fifth-row property coverage.
Form/Condition Details — Row 5	Text	Provide additional form or conditions details for the fifth-row entry (policy form numbers, short notes).
Check the box (if applicable): Indicates ACORD 810, Business Income / Extra Expense / Rental Value, supplement is attached for this location	CheckBox
Check the box (if applicable): Indicates ACORD 811, Value Reporting Information, supplement is attached for this location	CheckBox
Spoilage Coverage (Y/N)	Text	Indicate whether spoilage coverage is requested by entering 'Y' or 'N' and any related notes. Max length: 1 characters
Description of Property Covered (Additional Coverages)	Text	Provide a description of the property covered under the selected additional coverage or options.
Limit (Additional Coverage)	Number	Enter the coverage limit amount applicable to the selected additional coverage.
Deductible (Additional Coverage)	Number	Enter the deductible amount that applies to the selected additional coverage.
Refrigeration Maintenance Agreement (Y/N)	Text	Enter 'Y' or 'N' to indicate whether a refrigeration maintenance agreement is in place. Max length: 1 characters
Check the box (if applicable): Indicates that breakdown or contamination coverage exists	CheckBox
Check the box (if applicable): Indicates power outage coverage exists	CheckBox
Check the box (if applicable): Indicates selling price coverage exists on refrigerant equipment	CheckBox
Check the box (if applicable): Indicates other refrigerant equipment coverage exists	CheckBox
Options / Power Outage or Selling Price	Text	Enter option details such as power outage coverage, selling price or other specific option notes.
Check the box (if applicable): Indicates that sink hole coverage is accepted	CheckBox
Check the box (if applicable): Indicates that sink hole coverage is rejected	CheckBox
Limit — Sinkhole / Other	Number	Enter the coverage limit amount that applies to the sinkhole or other specified coverage.
Check the box (if applicable): Indicates that mine subsidence coverage is accepted	CheckBox
Check the box (if applicable): Indicates that mine subsidence coverage is rejected	CheckBox
Limit — Mine Subsidence / Other	Number	Enter the coverage limit amount that applies to mine subsidence or the designated coverage.
Check the box (if applicable): Indicates the property has been designated an historical landmark	CheckBox
Number of Open Sides on Structure	Text	Enter the number of open sides of the structure (e.g., 0, 1, 2) if applicable.
Historic Landmark Designation / Notes	Text	Provide information or designation status when the property has been designated as an historical landmark (details or 'Yes/No').
Construction Type	Text	Enter the primary construction type of the building (for example, 'Masonry', 'Frame', 'Fire Resistive').
Distance to Hydrant	Text	Enter the distance from the building to the nearest fire hydrant (units optional, typically feet or meters).
Distance to Fire Station	Text	Enter the distance from the building to the nearest fire station (units optional).
Fire District	Text	Enter the fire district or protection district name or code serving the property.
Code Number	Text	Enter any municipal or fire protection code number that applies to this property.
Protection Class / Prot Cl	Text	Enter the protection class or rating assigned by the rating bureau or fire district.
Number of Stories	Text	Enter the number of stories in the building.
Number of Basements	Text	Enter the number of basement levels in the building.
Year Built	Number	Enter the year the building was constructed (four-digit year).
Total Area	Number	Enter the total area of the building (square feet or square meters, specify units if needed).
Check the box (if applicable): Indicates if any wiring improvements have been made since the original construction	CheckBox
Wiring Year	Number	Enter the year when the building wiring was last installed or updated.
Check the box (if applicable): Indicates if any roofing improvements have been made since the original construction	CheckBox
Roofing Year	Number	Enter the year the roof was installed or last replaced.
Check the box (if applicable): Indicates if any plumbing improvements have been made since the original construction	CheckBox
Plumbing Year	Number	Enter the year when plumbing was last installed or updated.
Check the box (if applicable): Indicates if any heating improvements have been made since the original construction	CheckBox
Heating Year	Number	Enter the year the heating system was installed or last serviced/updated.
Check the box (if applicable): Indicates if any other improvements have been made since the original construction	CheckBox
Other Improvement Year	Number	Enter the year for other specified building improvements, if applicable.
Other Building Improvement Details	Text	Provide brief details describing other improvements or systems not listed elsewhere.
Building Grade / Code	Text	Enter the building grade or internal building code classification, if applicable.
Tax Code	Text	Enter any tax code or municipal code applicable to this building.
Roof Type	Text	Enter the type of roof construction (for example, 'Built-up', 'Metal', 'Shingle').
Other Occupancies	Text	List any other occupancies or uses present at the location (secondary uses or tenant types).
Check the box (if applicable): Indicates the wind class is resistive	CheckBox
Check the box (if applicable): Indicates the wind class is semi-resistive	CheckBox
Check the box (if applicable): Indicates the wind class is other than those listed	CheckBox
Wind Class / Resistive	Text	Enter the wind class or resistive characteristics of the building (e.g., 'Resistive', 'Semi-resistive').
Check the box (if applicable): Indicates the presence of a solid fuel heater such as a wood burning stove or fireplace insert	CheckBox
Date Installed (Equipment)	Date	Enter the installation date for the specified equipment or system (use MM/DD/YYYY or the policy's preferred date format). Max length: 10 characters
Manufacturer (Equipment)	Text	Enter the manufacturer name for the specified equipment or system.
Check the box (if applicable): Indicates if a boiler is the primary heating on the premises	CheckBox
Primary Boiler — Insurance Placed Elsewhere (Y/N)	Text	Enter 'Y' or 'N' to indicate if insurance for the primary boiler is placed elsewhere, along with any notes. Max length: 1 characters
Check the box (if applicable): Indicates if solid fuel is the primary heating on the premises	CheckBox
Check the box (if applicable): Indicates primary heating source is other than those listed	CheckBox
Primary Boiler — Additional Notes	Text	Provide any additional notes about the primary boiler or primary heating system as needed.
Check the box (if applicable): Indicates if a boiler is the secondary heating on the premises	CheckBox
Secondary Boiler — Insurance Placed Elsewhere (Y/N)	Text	Enter 'Y' or 'N' to indicate if insurance for the secondary boiler is placed elsewhere, along with any notes. Max length: 1 characters
Check the box (if applicable): Indicates if solid fuel is the secondary heating on the premises	CheckBox
Check the box (if applicable): Indicates secondary heating source is other than those listed	CheckBox
Secondary Heat / Solid Fuel	Text	Describe the secondary heating system (e.g., 'Solid fuel', 'Electric') if applicable.
Right Exposure — Type	Text	Enter the type or description of exposure to the right side of the building (construction type of adjacent exposure).
Right Exposure — Distance	Text	Enter the distance from the building to the right-side exposure (units optional).
Left Exposure — Type	Text	Enter the type or description of exposure to the left side of the building (construction type of adjacent exposure).
Left Exposure — Distance	Text	Enter the distance from the building to the left-side exposure (units optional).
Front Exposure — Type	Text	Enter the type or description of exposure to the front of the building (construction type of adjacent exposure).
Front Exposure — Distance	Text	Enter the distance from the building to the front exposure (units optional).
Rear Exposure — Type	Text	Enter the type or description of exposure to the rear of the building (construction type of adjacent exposure).
Rear Exposure — Distance	Text	Enter the distance from the building to the rear exposure (units optional).
Burglar Alarm Type	Text	Describe the type of burglar alarm system installed (for example, 'Local', 'Central Station', 'Audible').
Alarm Certificate #	Text	Enter the certificate or registration number issued for the alarm system, if applicable.
Alarm Certificate Expiration Date	Date	Enter the expiration date for the alarm certificate (use MM/DD/YYYY or the policy's preferred date format). Max length: 10 characters
Check the box (if applicable): Indicates the burglar alarm rings at an alarm company	CheckBox
Check the box (if applicable): Indicates the alarm company, located off the insured's premises, has keys to the applicant's property	CheckBox
Check the box (if applicable): Indicates the burglar alarm rings on audible gong located outside the building	CheckBox
Alarm Service Provider / Local Info	Text	Enter the name of the company that installed or services the burglar alarm and any local contact details.
Alarm Extent	Text	Describe the extent of the alarm coverage (for example, which areas or systems it protects).
Alarm Grade	Text	Enter the alarm grade or classification assigned to the installed system.
Number of Guards / Watchmen	Text	Enter the number of guards or watchmen employed to protect the premises, if any.
Check the box (if applicable): Indicates the guard / watchman is required to make hourly rounds using a special time recording device or in connection with the central station service. If other than hourly, indicate the time interval in the Other box	CheckBox
Check the box (if applicable): Indicates the guard / watchman is required to make some other type of rounds	CheckBox
Hourly Clock / Local Gong / Keys	Text	Provide details such as whether there is a clock hourly, local gong, or keys held for the alarm system (brief notes).
Premises Fire Protection (Systems)	Text	List the on-site fire protection systems present (sprinklers, standpipes, CO2, chemical systems, etc.).
Percent Sprinklered	Number	Enter the percentage of the premises that is protected by an automatic sprinkler system (numeric percent value).
Fire Alarm Manufacturer / Type	Text	Enter the fire alarm system manufacturer and any relevant model or type details.
Check the box (if applicable): Indicates the fire alarm rings at an alarm company, police department or fire department	CheckBox
Check the box (if applicable): Indicates the fire alarm rings on an audible gong located outside of the building	CheckBox
Check the box (if applicable): Indicates that further additional interests appear on the attached ACORD 45	CheckBox
Check the box (if applicable): Indicates the additional interest type is a lender's loss payable	CheckBox
Check the box (if applicable): Indicates the additional interest type is a loss payee	CheckBox
Check the box (if applicable): Indicates the additional interest type is a mortgagee	CheckBox
Check the box (if applicable): Indicates the additional interest is other than those listed	CheckBox
Mortgagor / Additional Interest	Text	Enter the name of the mortgagee, mortgagor or additional interest party to be listed on the policy.
Rank	Text	Enter the priority rank for the additional interest (position in order of pay out or notification).
Check the box (if applicable): Indicates if the additional interest requires a Certificate of Insurance	CheckBox
Lender's Loss Payable — Name/Address	Text	Enter the name and address of the lender or loss payee to be listed on the policy.
Loss Payee — Name/Address	Text	Enter the name and address of the loss payee, if different from the lender, for payment instructions.
Mortgagee — Name/Address	Text	Enter the name and address of the mortgagee if they are to be listed as an additional interest.
Additional Interest — Other	Text	Enter any other additional interest names or address details that must be added to the policy.
Certificate — Reference 1	Text	Enter a certificate number or identifier associated with the additional interest or loss payee.
Certificate — Reference 2	Text	Enter a second certificate number or identifier associated with the additional interest, if applicable.
Certificate — Reference 3	Text	Enter a third certificate number or identifier associated with the additional interest, if applicable.
Reference / Loan #	Text	Enter any loan or reference number that must be associated with the additional interest or mortgagee.
Location ID	Text	Enter the location identifier or number used by the insured or agency for this address.
Building ID	Text	Enter the building identifier used by the insured or agency for this specific structure.
Item Class	Text	Enter the item class code or short description used to classify the insured item.
Item #	Text	Enter the item number assigned to the insured property or scheduled item.
Item Description	Text	Provide a brief description of the scheduled item or property related to the item number.
Agency Name / Code	Text	Enter the agency name or short agency code used to identify the submitting insurance agency.
Agency Customer ID	Text	Enter the agency's customer identification number for this account.
WIRING, YR	Checkbox	Check this box when you are providing the year of the building wiring in the adjacent 'Wiring, Yr' field.
Wiring Year	Number	Enter the year the building wiring was installed or last updated.
ROOFING, YR	Checkbox	Check this box when you are providing the year of the roofing in the adjacent 'Roofing, Yr' field.
Roofing Year	Number	Enter the year the roof was installed or last replaced.
PLUMBING, YR	Checkbox	Check this box when you are providing the year of the plumbing in the adjacent 'Plumbing, Yr' field.
Plumbing Year	Number	Enter the year the plumbing system was installed or last updated.
HEATING, YR	Checkbox	Check this box when you are providing the year of the heating system in the adjacent 'Heating, Yr' field.
Heating Year	Number	Enter the year the primary heating system was installed or last updated.
OTHER	Checkbox	Check this box when there is another building improvement not listed and you will supply its type/year in the 'Other' field.
Other Building Improvement	Text	Provide a brief description of any other building improvement not listed above.
Other Improvement Year	Number	Enter the year the other building improvement was installed or last updated.
Building Code Grade	Text	Enter the building code grade or classification assigned to this structure.
Tax Code	Text	Enter the building's tax code or tax classification as applicable.
Roof Type	Text	Specify the type of roof covering or construction for the building.
Other Occupancies	Text	List any additional occupancies or uses present in the building.
WIND CLASS - RESISTIVE	Checkbox	Check this box if the building's wind classification is 'Resistive'.
WIND CLASS - SEMI-RESISTIVE	Checkbox	Check this box if the building's wind classification is 'Semi-Resistive'.
WIND CLASS - OTHER	Checkbox	Check this box if the building's wind classification belongs to an alternate/other category not covered by the labeled options.
Wind Class / Resistive Rating	Text	Enter the wind classification or resistive rating for the structure (e.g., Semi-Resistive, Resistive).
HEATING SOURCE (Includes woodburning stove or fireplace insert)	Checkbox	Check this box if the heating source includes a woodburning stove or a fireplace insert.
Heating Source Date Installed	Date	Enter the date the heating source (including woodburning stove or fireplace insert) was installed. Max length: 10 characters
Manufacturer (Heating Source)	Text	Enter the manufacturer name of the heating source or equipment installed.
PRIMARY HEAT - BOILER	Checkbox	Check this box if the building's primary heating system is a boiler.
Boiler Insurance - Insurer/Location (Primary)	Text	If the boiler's insurance is placed elsewhere, enter the insurer name or location for the primary heating system. Max length: 1 characters
PRIMARY HEAT - SOLID FUEL	Checkbox	Check this box if the building's primary heating system uses solid fuel.
PRIMARY HEAT - If boiler, is insurance placed elsewhere? (Y/N)	Checkbox	Check this box if the primary heat is a boiler and the insurance for that boiler is placed with another policy/carrier (answering the 'insurance placed elsewhere' question).
Primary Heat Description	Text	Provide the primary heating system type and any relevant details for the building.
SECONDARY HEAT - BOILER	Checkbox	Check this box if the building's secondary heating system is a boiler.
Boiler Insurance - Insurer/Location (Secondary)	Text	If the secondary boiler's insurance is placed elsewhere, enter the insurer name or location for the secondary heating system. Max length: 1 characters
SECONDARY HEAT - SOLID FUEL	Checkbox	Check this box if the building's secondary heating system uses solid fuel.
SECONDARY HEAT - If boiler, is insurance placed elsewhere? (Y/N)	Checkbox	Check this box if the secondary heat is a boiler and the insurance for that boiler is placed with another policy/carrier (answering the 'insurance placed elsewhere' question).
Secondary Heat Description	Text	Provide the secondary heating system type and any relevant details.
Right Exposure Description	Text	Describe the right-side exposure and any features affecting it (e.g., adjacent structures or open space).
Right Exposure Distance	Text	Enter the distance from the building to the feature described for the right exposure.
Left Exposure Description	Text	Describe the left-side exposure and any features affecting it (e.g., adjacent structures or open space).
Left Exposure Distance	Text	Enter the distance from the building to the feature described for the left exposure.
Front Exposure Description	Text	Describe the front exposure and any features affecting it (e.g., road, open area, neighboring buildings).
Front Exposure Distance	Text	Enter the distance from the building to the feature described for the front exposure.
Rear Exposure Description	Text	Describe the rear exposure and any features affecting it (e.g., alley, yard, adjacent structure).
Rear Exposure Distance	Text	Enter the distance from the building to the feature described for the rear exposure.
Burglar Alarm Type	Text	Specify the type of burglar alarm system installed at the premises.
Alarm Certificate Number	Text	Enter the certificate or identification number associated with the burglar alarm system.
Alarm Certificate Expiration Date	Date	Enter the expiration date for the burglar alarm certificate or service agreement. Max length: 10 characters
EXPIRATION DATE	Checkbox	Check this box when you are recording an alarm/certificate expiration date in the adjacent expiration date field.
CENTRAL STATION	Checkbox	Check this box if the burglar/fire alarm is monitored by a central station.
LOCAL GONG	Checkbox	Check this box if the alarm system is a local gong (local audible-only alarm).
Burglar Alarm Installed/Serviced By	Text	Enter the name of the company or technician who installed or services the burglar alarm system.
Alarm Extent	Text	Describe the extent of alarm coverage provided (e.g., perimeter only, full building).
Alarm Grade	Text	Enter the grade or quality rating of the alarm system, if applicable.
Number of Guards / Watchmen	Text	Enter the number of guards or watchmen assigned to the premises, if any.
CLOCK HOURLY	Checkbox	Check this box if guards/watchmen perform clock-hourly checks of the premises.
CENTRAL STATION (Premises fire protection)	Checkbox	Check this box if the premises fire protection is connected to a central station monitoring service.
Clock Hourly	Text	If applicable, enter clock hourly information or related alarm monitoring notes.
Premises Fire Protection Systems	Text	List the on-site fire protection systems present (e.g., sprinklers, standpipes, CO2/Chemical systems).
Percent Sprinklered	Number	Enter the percentage of the premises that is protected by sprinklers.
Fire Alarm Manufacturer	Text	Enter the manufacturer name of the fire alarm system installed at the premises.
WITH KEYS	Checkbox	Check this box if the monitoring service or central station has keys to the premises.
LOCAL GONG (Premises fire protection)	Checkbox	Check this box if the premises fire protection alarm operates as a local gong (audible on site only).
ACORD 45 attached for additional names	Checkbox	Check this box if you are attaching ACORD 45 to provide additional named insureds or interested parties.
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	Text
Enter text: The name of the authorized representative of the producer, agency and/or broker that signed the form	Text
Enter identifier: The State License Number of the producer	Text
Sign here: Accommodates the signature of the applicant or named insured	Text
Enter date: The date the form was signed by the applicant or named insured. (MM/DD/YYYY)	Text	Max length: 10 characters
Enter identifier: The National Producer Number (NPN) as defined in the National Insurance Producer Registry (NIPR). Note: The NPN is not the same as the producer state license number	Text
Historic Designation and Structure Notes
Property has been designated an historical landmark	Checkbox	Check this box if the insured property has been officially designated as a historical or historic landmark.
# of Open Sides on Structure	Text	Enter the number of open sides the structure has (for example 0, 1, 2, 3 or 4).
Historic Designation / Structure Notes	Text	Provide any historic designation details and freeform notes about the structure, including landmark status, preservation restrictions, notable materials or features, relevant dates, and any other structural or historical remarks important for underwriting. Fill only if 'Property has been designated an historical landmark' Fill only if PROPERTY HAS BEEN DESIGNATED AN HISTORICAL LANDMARK is 'Yes'. Depends on: Property has been designated an historical landmark
Interest In Item Number (Location, Building, Item Class, Item, Item Description)
Location Number	Text	Enter the identifier or code for the location where the insured item is situated (the location number or location code).
Building Number	Text	Enter the building identifier or code associated with the location of the item (the building number or code).
Item Class	Text	Enter the classification code or short category name that describes the type or class of the item being insured.
Item Number	Text	Enter the specific item identifier or inventory number assigned to this insured item within the building or location.
Item Description	Text	Provide a brief descriptive text for the item, such as make/model, contents, or other identifying details.
Interest Type (Lender's Loss Payable / Loss Payee / Mortgagee / Other)
LENDER'S LOSS PAYABLE	Checkbox	Check this box when the named interest is a lender who should be listed as 'Lender's Loss Payable' on the policy so the lender is paid for losses to the insured property.
LOSS PAYEE	Checkbox	Check this box when a lienholder, finance company, or other party should be designated as loss payee to receive loss proceeds for the insured property or item.
MORTGAGEE	Checkbox	Check this box when a mortgage holder should be named as mortgagee on the policy because they have an insurable interest in the property.
OTHER	Checkbox	Check this box when the interest type is not listed above and specify the exact interest type in the Name and Address / Remarks area.
Additional Interest - Name & Address	Text	Enter the full name and mailing address of the additional interested party (for example the lender, loss payee, mortgagee, or other) associated with this interest line.
Mine Subsidence Coverage
Mine Subsidence Coverage - Accept Coverage	Checkbox	Check this box when the insured chooses to include mine subsidence coverage (required in IL, IN, KY and WV) for the listed premises.
Mine Subsidence Coverage - Reject Coverage	Checkbox	Check this box when the insured declines or does not want mine subsidence coverage for the listed premises.
Mine Subsidence Coverage Limit	Number	Enter the dollar limit to be applied for mine subsidence coverage for this location. Fill only if 'Mine Subsidence Coverage - Accept Coverage' Fill only if ACCEPT COVERAGE is 'Yes'. Depends on: Mine Subsidence Coverage - Accept Coverage
Policy Details (Policy Number, Effective Date, Named Insured)
Policy Number	Text	Enter the insurance policy number or identifier exactly as shown on the policy documents.
Effective Date	Date	Enter the date when this policy coverage becomes effective. Max length: 10 characters
Named Insured	Text	Enter the full name of the primary insured individual or organization listed on the policy.
Premises Address / Location
Premises Number	Text	Enter the unique identifier or unit/lot number assigned to this premises or location (e.g., building or unit number).
Street Address	Text	Enter the full street address of the premises, including house/building number, street name, and apartment or suite if applicable.
Premises Row 1 (Subject of Insurance)
Enter code: The code designating all unit at risk / coverages that are to be insured at this particular location number / building number combination. Examples: B - Building BUSEE - Business Income without Extra Expense BUSIN - Business Income with Extra Expense BUSER - Business Income with Extra Expense and Rental Value BUSRN - Business Income with Rental Value without Extra Expense BPP - Business Personal Property EE - Extra Expense FF - Furniture & Fixtures MACEQ - Machinery, Equipment PP - Personal Property POTOP - Property of Others STK - Stock	Text
Enter limit: The maximum amount of coverage provided for this subject of insurance or premium-bearing option	Text
Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage	Text
Enter code: Indicate the method which will be used to determine the amount paid on a claim. If other valuation basis applies, provide necessary information. Example valuation methods are: A - Actual Cash Value R - Replacement Cost V - Agreed Amount M - Market Value	Text
Enter code: The causes of loss the subject of insurance is to be covered for. Examples: * Basic * Broad * Special excluding theft * Earthquake	Text
Enter percentage: The inflation guard percentage gives an automatic increase in the amount of coverage based on a percentage over time. List both the percentage amount and the period of time during which it applies (e.g., 4% per year)	Text
Enter deductible: The deductible amount that is to apply to this subject of insurance	Text
Enter code: The code indicating the type of deductible that is to apply to this subject of insurance. Examples are percent, dollars and number of days. "Number of days" is used to describe the waiting period (deductible) for business income	Text
Enter number: The identifying number for the blanket under which this subject of insurance is rated. Leave blank if the subject of insurance is not included under a blanket	Text
Enter text: The form numbers and special conditions that apply to this subject of insurance. Also indicate here if coverage is blanket or average rated	Text
Premises Row 2 (Subject of Insurance)
Subject of Insurance	Text	Describe the specific property, location, or item being insured for this row (e.g., building name, suite, or tenant space).
Amount / Limit	Number	The insured amount or limit that applies to this subject of insurance.
Coinsurance %	Number	The coinsurance percentage that applies to this subject.
Valuation Basis	Text	Specify the valuation method used for this subject (e.g., Replacement Cost, Actual Cash Value, Agreed Value).
Causes of Loss	Text	List the perils or cause-of-loss form that applies to this subject (e.g., Broad Form, Special Form, Named Perils).
Inflation Guard %	Number	The inflation guard percentage to be applied to this subject.
Deductible	Number	The deductible amount that will apply to claims for this subject.
Deductible Type	Text	Specify the type or basis of the deductible (e.g., Per Occurrence, Aggregate, Per Location).
Blanket #	Text	Enter the blanket number or identifier if this subject is included in a blanket limit grouping.
Forms and Conditions to Apply	Text	List any policy forms, endorsements, or special conditions that apply to this subject of insurance.
Premises Row 3 (Subject of Insurance)
Enter code: The code designating all unit at risk / coverages that are to be insured at this particular location number / building number combination. Examples: B - Building BUSEE - Business Income without Extra Expense BUSIN - Business Income with Extra Expense BUSER - Business Income with Extra Expense and Rental Value BUSRN - Business Income with Rental Value without Extra Expense BPP - Business Personal Property EE - Extra Expense FF - Furniture & Fixtures MACEQ - Machinery, Equipment PP - Personal Property POTOP - Property of Others STK - Stock	Text
Enter limit: The maximum amount of coverage provided for this subject of insurance or premium-bearing option	Text
Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage	Text
Enter code: Indicate the method which will be used to determine the amount paid on a claim. If other valuation basis applies, provide necessary information. Example valuation methods are: A - Actual Cash Value R - Replacement Cost V - Agreed Amount M - Market Value	Text
Enter code: The causes of loss the subject of insurance is to be covered for. Examples: * Basic * Broad * Special excluding theft * Earthquake	Text
Enter percentage: The inflation guard percentage gives an automatic increase in the amount of coverage based on a percentage over time. List both the percentage amount and the period of time during which it applies (e.g., 4% per year)	Text
Enter deductible: The deductible amount that is to apply to this subject of insurance	Text
Enter code: The code indicating the type of deductible that is to apply to this subject of insurance. Examples are percent, dollars and number of days. "Number of days" is used to describe the waiting period (deductible) for business income	Text
Enter number: The identifying number for the blanket under which this subject of insurance is rated. Leave blank if the subject of insurance is not included under a blanket	Text
Enter text: The form numbers and special conditions that apply to this subject of insurance. Also indicate here if coverage is blanket or average rated	Text
Premises Row 4 (Subject of Insurance)
Enter code: The code designating all unit at risk / coverages that are to be insured at this particular location number / building number combination. Examples: B - Building BUSEE - Business Income without Extra Expense BUSIN - Business Income with Extra Expense BUSER - Business Income with Extra Expense and Rental Value BUSRN - Business Income with Rental Value without Extra Expense BPP - Business Personal Property EE - Extra Expense FF - Furniture & Fixtures MACEQ - Machinery, Equipment PP - Personal Property POTOP - Property of Others STK - Stock	Text
Enter limit: The maximum amount of coverage provided for this subject of insurance or premium-bearing option	Text
Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage	Text
Enter code: Indicate the method which will be used to determine the amount paid on a claim. If other valuation basis applies, provide necessary information. Example valuation methods are: A - Actual Cash Value R - Replacement Cost V - Agreed Amount M - Market Value	Text
Enter code: The causes of loss the subject of insurance is to be covered for. Examples: * Basic * Broad * Special excluding theft * Earthquake	Text
Enter percentage: The inflation guard percentage gives an automatic increase in the amount of coverage based on a percentage over time. List both the percentage amount and the period of time during which it applies (e.g., 4% per year)	Text
Enter deductible: The deductible amount that is to apply to this subject of insurance	Text
Enter code: The code indicating the type of deductible that is to apply to this subject of insurance. Examples are percent, dollars and number of days. "Number of days" is used to describe the waiting period (deductible) for business income	Text
Enter number: The identifying number for the blanket under which this subject of insurance is rated. Leave blank if the subject of insurance is not included under a blanket	Text
Enter text: The form numbers and special conditions that apply to this subject of insurance. Also indicate here if coverage is blanket or average rated	Text
Premises Row 5 (Subject of Insurance)
Enter code: The code designating all unit at risk / coverages that are to be insured at this particular location number / building number combination. Examples: B - Building BUSEE - Business Income without Extra Expense BUSIN - Business Income with Extra Expense BUSER - Business Income with Extra Expense and Rental Value BUSRN - Business Income with Rental Value without Extra Expense BPP - Business Personal Property EE - Extra Expense FF - Furniture & Fixtures MACEQ - Machinery, Equipment PP - Personal Property POTOP - Property of Others STK - Stock	Text
Enter limit: The maximum amount of coverage provided for this subject of insurance or premium-bearing option	Text
Enter percentage: The Coinsurance Percentage is the percentage of the total value of the subject of insurance being insured. If the amount of insurance falls below this percentage, the insured must share in the amount of the loss. This field should be completed even when writing agreed amount coverage	Text
Enter code: Indicate the method which will be used to determine the amount paid on a claim. If other valuation basis applies, provide necessary information. Example valuation methods are: A - Actual Cash Value R - Replacement Cost V - Agreed Amount M - Market Value	Text
Enter code: The causes of loss the subject of insurance is to be covered for. Examples: * Basic * Broad * Special excluding theft * Earthquake	Text
Enter percentage: The inflation guard percentage gives an automatic increase in the amount of coverage based on a percentage over time. List both the percentage amount and the period of time during which it applies (e.g., 4% per year)	Text
Enter deductible: The deductible amount that is to apply to this subject of insurance	Text
Enter code: The code indicating the type of deductible that is to apply to this subject of insurance. Examples are percent, dollars and number of days. "Number of days" is used to describe the waiting period (deductible) for business income	Text
Enter number: The identifying number for the blanket under which this subject of insurance is rated. Leave blank if the subject of insurance is not included under a blanket	Text
Enter text: The form numbers and special conditions that apply to this subject of insurance. Also indicate here if coverage is blanket or average rated	Text
Property Description and Coverage Limits
Enter Y for a “Yes” response. Input N for “No” response. Indicates if spoilage coverage applies	Text	Max length: 1 characters
Enter text: The description of property to be covered for spoilage	Text
Enter limit: The limit applicable to the spoilage coverage	Text
Enter deductible: The deductible applicable to the spoilage coverage	Text
Enter Y for a “Yes” response. Input N for “No” response. Indicates if there is a refrigerator maintenance agreement	Text	Max length: 1 characters
REMARKS (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Additional Remarks (ACORD 101)	Text	Enter any additional remarks, explanations or supplemental information related to this form (ACORD 101), including references to specific item numbers or sections that the remarks apply to.
Sinkhole Coverage (Florida)
Accept Coverage	Checkbox	Check this box when you want to accept/include the required Florida sinkhole coverage for the policy.
Reject Coverage	Checkbox	Check this box when you want to reject/decline the required Florida sinkhole coverage for the policy.
Sinkhole Coverage Limit (Florida)	Number	Enter the dollar limit amount to be applied for sinkhole coverage required in Florida. Fill only if 'Accept Coverage' Fill only if ACCEPT COVERAGE is 'Yes'. Depends on: Accept Coverage
Value Reporting / Business Income
Value Reporting Information - Attach ACORD 811	Checkbox	Check this box when you are requesting value reporting information for Business Income/Extra Expense and will attach ACORD 811.

ACORD 140, Property Section Instructions