This form contains 358 fields organized into 74 sections, giving it a Form Complexity Index of 80/100 (very complex). Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Additional Coverage Property and Options
Spoilage Coverage Selection	Text	Enter whether spoilage coverage is selected for this property. Max length: 1 characters
Description of Property Covered	Text	Enter a description of the property to be covered under the spoilage coverage. Fill only if 'Spoilage Coverage Selection' is 'Yes'. Depends on: Spoilage Coverage Selection
Spoilage Coverage Limit	Number	Enter the coverage limit requested for spoilage coverage. Fill only if 'Spoilage Coverage Selection' is 'Yes'. Depends on: Spoilage Coverage Selection
Spoilage Coverage Deductible	Number	Enter the deductible amount that applies to spoilage coverage. Fill only if 'Spoilage Coverage Selection' is 'Yes'. Depends on: Spoilage Coverage Selection
Refrigeration Maintenance Agreement	Text	Enter whether a refrigeration maintenance agreement is in place. Fill only if 'Spoilage Coverage Selection' is 'Yes'. Max length: 1 characters Depends on: Spoilage Coverage Selection
Breakdown or Contamination	Checkbox	Check this box if coverage is requested for breakdown or contamination. Fill only if 'Spoilage Coverage Selection' is 'Yes'. Depends on: Spoilage Coverage Selection
Power Outage	Checkbox	Check this box if coverage is requested for losses related to a power outage. Fill only if 'Spoilage Coverage Selection' is 'Yes'. Depends on: Spoilage Coverage Selection
Selling Price	Checkbox	Check this box if the selling price option should be used. Fill only if 'Spoilage Coverage Selection' is 'Yes'. Depends on: Spoilage Coverage Selection
Other Option	Checkbox	Check this box only if an additional option not otherwise labeled on the form applies.
Selling Price	Number	Enter the applicable selling price for the covered property or merchandise.
Additional Information Attachment
Business Income / Extra Expense - Attach ACORD 810	Checkbox	Check this box when business income or extra expense coverage information is included and ACORD 810 is attached.
Additional Information Attachments
Business Income / Extra Expense - Attach ACORD 810	Checkbox	Check this box when business income or extra expense information is included and ACORD 810 is attached.
Value Reporting Information - Attach ACORD 811	Checkbox	Check this box when value reporting information is included and ACORD 811 is attached.
Additional Interest ACORD 45 Attachment
ACORD 45 attached for additional names	Checkbox	Check this box if an ACORD 45 attachment is included to list additional interested parties or names.
Additional Interest Contact, Rank, and Evidence
Additional Interest Rank	Text	Enter the rank or priority of this additional interest.
Evidence	Checkbox	Check this box when evidence of the additional interest should be provided.
Additional Interest Contact Name	Text	Enter the full name of the additional interest party or organization.
Additional Interest Address Line 1	Text	Enter the primary street address for the additional interest contact.
Additional Interest Address Line 2	Text	Enter any additional address information for the additional interest contact, such as a suite, unit, or mailing detail.
Additional Interest Address Line 3	Text	Enter the remaining city, state or province, postal code, or other mailing address details for the additional interest contact.
Evidence	Text	Enter the evidence information applicable to the additional interest.
Certificate	Text	Enter the certificate information associated with the additional interest.
Reference or Loan Number	Text	Enter the reference number or loan number associated with the additional interest.
Additional Interest Entry
ACORD 45 Attached for Additional Names	Checkbox	Check this box if an ACORD 45 form is attached to list additional names.
Lender's Loss Payable	Checkbox	Check this box if the additional interest is a lender entitled to loss payment under the policy.
Loss Payee	Checkbox	Check this box if the additional interest is a party designated to receive loss payments.
Mortgagee	Checkbox	Check this box if the additional interest is a mortgage holder with an interest in the insured property.
Other Additional Interest	Checkbox	Check this box if the additional interest type is not lender's loss payable, loss payee, or mortgagee.
Other Additional Interest Type	Text	Enter the type of additional interest if it is not lender's loss payable, loss payee, or mortgagee. Fill only if 'Other Additional Interest' is 'Yes'. Depends on: Other Additional Interest
Additional Interest Rank	Text	Enter the rank or priority of this additional interest.
Certificate	Checkbox	Check this box if a certificate is provided as evidence of the additional interest.
Additional Interest Name and Address Line 1	Text	Enter the first line of the additional interest holder's name and mailing address.
Additional Interest Name and Address Line 2	Text	Enter the second line of the additional interest holder's name and mailing address.
Additional Interest Name and Address Line 3	Text	Enter the third line of the additional interest holder's name and mailing address.
Additional Interest City	Text	Enter the city for the additional interest holder's mailing address.
Additional Interest State	Text	Enter the state or province for the additional interest holder's mailing address.
Additional Interest Postal Code	Text	Enter the postal or ZIP code for the additional interest holder's mailing address.
Additional Interest Country	Text	Enter the country for the additional interest holder's mailing address, if applicable.
Reference or Loan Number	Text	Enter the reference number or loan number associated with this additional interest.
Interest Location Number	Text	Enter the location number of the insured item to which this additional interest applies.
Interest Building Number	Text	Enter the building number of the insured item to which this additional interest applies.
Interest Item Class	Text	Enter the item class for the insured item to which this additional interest applies.
Interest Item Number	Text	Enter the item number of the insured item to which this additional interest applies.
Interest Item Description	Text	Enter a description of the insured item to which this additional interest applies.
Additional Interest Item Location and Description
Additional Interest Item Location	Text	Enter the location identifier for the property item associated with the additional interest.
Additional Interest Item Building	Text	Enter the building identifier for the property item associated with the additional interest.
Additional Interest Item Class	Text	Enter the item class identifier for the property item associated with the additional interest.
Additional Interest Item Number	Text	Enter the item number for the property item associated with the additional interest.
Additional Interest Item Description	Text	Enter a description of the property item associated with the additional interest.
Additional Interest Reference or Loan Number
Additional Interest Reference or Loan Number	Text	Enter the reference number or loan number associated with the additional interest party.
Additional Interest Type
Lender's Loss Payable	Checkbox	Check this box when the additional interest is a lender that should be paid for covered property losses.
Loss Payee	Checkbox	Check this box when the additional interest is entitled to receive loss-payment proceeds.
Mortgagee	Checkbox	Check this box when the additional interest is a mortgage holder with an insurable interest in the property.
Other Additional Interest Type	Checkbox	Check this box when the additional interest type is not Lender's Loss Payable, Loss Payee, or Mortgagee, and specify the appropriate type.
Additional Interest Type	Text	Enter the type of additional interest that is not listed among the predefined interest categories. Fill only if 'Other Additional Interest Type' is 'Yes'. Depends on: Other Additional Interest Type
Additional Premises Address
Premises Number	Text	Enter the identifying number for the additional premises.
Street Address	Text	Enter the street address of the additional premises.
Agency Information
Agency Name	Text	Enter the name of the insurance agency handling this policy.
Applicant Signature and Date
Applicant Signature	Text	Enter the applicant's signature to certify that the application information is true, correct, and complete.
Signature Date	Date	Enter the date the applicant signs the application. Max length: 10 characters
Building Classification and Dimensions
Protection Class	Text	Enter the property's fire protection class or rating.
Number of Stories	Text	Enter the total 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 originally constructed.
Total Area	Number	Enter the building's total floor area.
Building Classification and Resistance Details
Building Code Grade	Text	Enter the building's applicable code grade classification.
Tax Code	Text	Enter the tax code associated with the property.
Roof Type	Text	Enter the type of roof on the building.
Other Occupancies	Text	Enter any other occupancy types or uses of the building.
Wind Class - Resistive	Checkbox	Check this box if the building is classified as wind resistive.
Wind Class - Semi-Resistive	Checkbox	Check this box if the building is classified as semi-resistive for wind exposure.
Wind Class - Non-Resistive	Checkbox	Check this box if the building is classified as non-resistive for wind exposure.
Wind Class	Text	Enter the building's wind-resistance classification, such as semi-resistive.
Heating Source Includes Woodburning Stove or Fireplace Insert	Checkbox	Check this box if the building's heating source includes a woodburning stove or fireplace insert.
Heating Source Installation Date	Date	Enter the date the heating source, woodburning stove, or fireplace insert was installed. Max length: 10 characters
Heating Source Manufacturer	Text	Enter the manufacturer of the heating source, woodburning stove, or fireplace insert.
Building Classification Codes
Building Code Grade	Text	Enter the building classification or code grade assigned to the building.
Tax Code	Text	Enter the applicable tax classification code for the building or property.
Roof Type	Text	Enter the type of roof construction or roofing material for the building.
Building Construction Details
Construction Type	Text	Enter the building's construction type or classification.
Distance to Hydrant	Text	Enter the distance from the building to the nearest fire hydrant.
Distance to Fire Station	Text	Enter the distance from the building to the nearest fire station.
Fire District	Text	Enter the name or identifier of the fire district serving the building.
Building Code Number	Text	Enter the applicable building code number for the building.
Protection Class	Text	Enter the property's fire protection class.
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 originally constructed.
Total Area	Number	Enter the building's total area.
Building Description
Building Description	Text	Enter a detailed description of the building, including its construction, features, use, and other relevant characteristics.
Building Identification
Building Number	Text	Enter the identifying number for this building within the premises.
Building Description	Text	Enter a description that identifies or distinguishes this building.
Building Improvements
Wiring, Year	Checkbox	Check this box if the building's wiring has been improved, and provide the year of the improvement.
Wiring Year	Number	Enter the year the building's electrical wiring was installed or last updated. Fill only if 'Wiring, Year' is 'Yes'. Depends on: Wiring, Year
Roofing, Year	Checkbox	Check this box if the building's roofing has been improved, and provide the year of the improvement.
Roofing Year	Number	Enter the year the building's roof was installed or last replaced. Fill only if 'Roofing, Year' is 'Yes'. Depends on: Roofing, Year
Plumbing, Year	Checkbox	Check this box if the building's plumbing has been improved, and provide the year of the improvement.
Plumbing Year	Number	Enter the year the building's plumbing was installed or last updated. Fill only if 'Plumbing, Year' is 'Yes'. Depends on: Plumbing, Year
Heating, Year	Checkbox	Check this box if the building's heating system has been improved, and provide the year of the improvement.
Heating Year	Number	Enter the year the building's heating system was installed or last updated. Fill only if 'Heating, Year' is 'Yes'. Depends on: Heating, Year
Other, Year	Checkbox	Check this box if another type of building improvement was made, and provide the improvement details and year.
Other Improvement	Text	Describe any other significant building improvement not listed above. Fill only if 'Other, Year' is 'Yes'. Depends on: Other, Year
Other Improvement Year	Number	Enter the year the other described building improvement was completed. Fill only if 'Other, Year' is 'Yes'. Depends on: Other, Year
Burglar Alarm Details
Burglar Alarm Type	Text	Enter the type or classification of burglar alarm installed at the premises.
Burglar Alarm Certificate Number	Text	Enter the certificate number associated with the burglar alarm system.
Burglar Alarm Certificate Expiration Date	Date	Enter the expiration date of the burglar alarm certificate. Max length: 10 characters
Central Station	Checkbox	Check this box if the burglar alarm is monitored through a central station.
With Keys	Checkbox	Check this box if keys are provided or required for the burglar alarm system.
Local Gong	Checkbox	Check this box if the burglar alarm uses a local gong or audible alarm signal.
Burglar Alarm Guard and Watchmen Details
Burglar Alarm Extent	Text	Enter the extent or level of burglar alarm protection provided at the premises.
Burglar Alarm Grade	Text	Enter the grade or classification of the burglar alarm system.
Number of Guards/Watchmen	Text	Enter the number of guards or watchmen assigned to protect the premises.
Clock Hourly	Checkbox	Check this box if the guards or watchmen perform clock-hourly rounds at the premises.
With Keys	Checkbox	Check this box if the guards or watchmen have keys for the premises.
Clock Hourly	Text	Enter the clock hourly monitoring or patrol detail for the guards or watchmen.
Burglar Alarm Monitoring Options
Central Station	Checkbox	Check this box if the burglar alarm is monitored by a central station.
With Keys	Checkbox	Check this box if the central-station burglar alarm monitoring arrangement includes keys.
Local Gong	Checkbox	Check this box if the burglar alarm has a local gong or audible alarm signal.
Burglar Alarm Service and Guards
Burglar Alarm Installer and Service Provider	Text	Enter the name of the company that installed and services the burglar alarm system.
Burglar Alarm Extent	Text	Describe the extent or coverage of the burglar alarm system at the premises.
Burglar Alarm Grade	Text	Enter the grade or classification of the burglar alarm system.
Number of Guards or Watchmen	Text	Enter the number of guards or watchmen assigned to protect the premises.
Clock Hourly	Checkbox	Check this box if guards or watchmen clock in on an hourly basis at the premises.
Guards / Watchmen	Checkbox	Check this box if guards or watchmen are provided for the premises.
Guard Clock Hourly	Text	Enter the hourly guard-clock information or interval applicable to the premises.
Burglar Alarm Service Provider
Burglar Alarm Service Provider	Text	Enter the name of the company or person that installed and services the burglar alarm system.
Burglar Alarm Type and Certificate
Burglar Alarm Type	Text	Enter the type of burglar alarm installed at the premises.
Burglar Alarm Certificate Number	Text	Enter the certificate number associated with the burglar alarm system.
Burglar Alarm Certificate Expiration Date	Date	Enter the date the burglar alarm certificate expires. Max length: 10 characters
Business Income or Extra Expense Attachment
Business Income / Extra Expense - Attach ACORD 810	Checkbox	Check this box if business income or extra expense coverage information is included and ACORD 810 is attached.
Carrier Information
Carrier	Text	Enter the name of the insurance carrier providing the policy.
NAIC Code	Text	Enter the NAIC identification code for the insurance carrier.
Construction Location and Fire Information
Construction Type	Text	Enter the building's construction type or classification.
Distance to Hydrant	Text	Enter the distance from the property to the nearest fire hydrant.
Distance to Fire Station	Text	Enter the distance from the property to the nearest fire station.
Fire District	Text	Enter the name or identifier of the fire district serving the property.
Code Number	Text	Enter the applicable building or property code number.
DED
	Text
	Text
Agency Customer ID	Text	Enter the agency-assigned customer identification number for this account.
Fifth Premises Coverage
Subject of Insurance	Text	Enter the property or coverage item being insured at this premises.
Coverage Amount	Number	Enter the insurance coverage limit or amount for the subject of insurance.
Coinsurance Percentage	Number	Enter the coinsurance percentage that applies to this coverage.
Valuation Method	Text	Enter the valuation basis used to determine the value of covered property.
Causes of Loss	Text	Enter the causes of loss coverage that applies to the insured property.
Inflation Guard Percentage	Number	Enter the inflation guard percentage applicable to this coverage.
Deductible	Number	Enter the deductible amount that applies to this coverage.
Deductible Type	Text	Enter the type or basis of the deductible that applies to this coverage.
Blanket Number	Text	Enter the blanket coverage number associated with this coverage, if applicable.
Forms and Conditions to Apply	Text	Enter the forms, endorsements, and conditions that apply to this coverage.
Fifth Premises Insurance Details
Subject of Insurance	Text	Enter the property or insurance subject being covered for the fifth premises.
Insurance Amount	Number	Enter the coverage amount for the listed subject of insurance.
Coinsurance Percentage	Text	Enter the applicable coinsurance percentage for this coverage.
Valuation Method	Text	Enter the valuation method that applies to the insured property.
Causes of Loss	Text	Enter the causes of loss covered for this subject of insurance.
Inflation Guard Percentage	Text	Enter the applicable inflation guard percentage.
Deductible	Number	Enter the deductible amount that applies to this coverage.
Deductible Type	Text	Enter the type or basis of the deductible.
Blanket Number	Text	Enter the applicable blanket coverage number, if any.
Forms and Conditions	Text	Enter the forms, endorsements, and conditions that apply to this coverage.
Fire Alarm Manufacturer and Monitoring
Fire Alarm Manufacturer	Text	Enter the name of the manufacturer of the premises fire alarm system.
Central Station	Checkbox	Check this box if the fire alarm system is monitored by a central station.
Local Gong	Checkbox	Check this box if the fire alarm system is monitored or signaled by a local gong.
First Blanket Summary Row
First Blanket Number	Text	Enter the identifying number for the first blanket coverage entry.
First Blanket Amount	Number	Enter the coverage amount for the first blanket entry.
First Blanket Type	Text	Enter the type of coverage for the first blanket entry.
Second Blanket Number	Text	Enter the identifying number for the second blanket coverage entry.
Second Blanket Amount	Number	Enter the coverage amount for the second blanket entry.
Second Blanket Type	Text	Enter the type of coverage for the second blanket entry.
First Premises Coverage
Subject of Insurance	Text	Enter the property or interest being insured at this premises.
Coverage Amount	Number	Enter the amount of insurance coverage for the listed subject of insurance.
Coinsurance Percentage	Number	Enter the coinsurance percentage applicable to this coverage.
Valuation Method	Text	Enter the valuation basis that applies to this coverage.
Causes of Loss	Text	Enter the causes of loss form or coverage designation that applies.
Inflation Guard Percentage	Number	Enter the inflation guard percentage applicable to this coverage.
Deductible Amount	Number	Enter the deductible amount that applies to this coverage.
Deductible Type	Text	Enter the type or basis of the deductible.
Blanket Number	Text	Enter the blanket coverage number associated with this item, if applicable.
Forms and Conditions	Text	Enter the forms and conditions that apply to this coverage.
First Premises Insurance Details
Subject of Insurance	Text	Enter the property, item, or interest being insured at the first premises.
Insurance Amount	Number	Enter the amount of insurance coverage for the listed subject of insurance.
Coinsurance Percentage	Text	Enter the coinsurance percentage that applies to this coverage.
Valuation Method	Text	Enter the valuation basis or method used to determine the value of the insured property.
Causes of Loss	Text	Enter the causes of loss or coverage form that applies to the insured property.
Inflation Guard Percentage	Text	Enter the inflation guard percentage applicable to this coverage.
Deductible	Number	Enter the deductible amount that applies to this coverage.
Deductible Type	Text	Enter the type or basis of the deductible that applies to this coverage.
Blanket Number	Text	Enter the blanket coverage number, if this insurance is subject to a blanket policy limit.
Forms and Conditions to Apply	Text	Enter the forms, endorsements, and conditions that apply to this insurance coverage.
Form Date
Form Date	Date	Enter the date the form is completed. Max length: 10 characters
Fourth Premises Coverage
Subject of Insurance	Text	Enter the property or item that is covered at the fourth premises.
Coverage Amount	Number	Enter the amount of insurance coverage for the listed property.
Coinsurance Percentage	Number	Enter the coinsurance percentage that applies to this coverage.
Valuation	Text	Enter the valuation basis used to determine the value of the covered property.
Causes of Loss	Text	Enter the causes of loss covered for this property.
Inflation Guard Percentage	Number	Enter the inflation guard percentage that applies to this coverage.
Deductible	Number	Enter the deductible amount that applies to this coverage.
Deductible Type	Text	Enter the type or basis of the deductible that applies to this coverage.
Blanket Number	Text	Enter the blanket coverage number associated with this property coverage.
Forms and Conditions	Text	Enter the forms and conditions that apply to this property coverage.
Fourth Premises Insurance Details
Subject of Insurance	Text	Enter the subject or property item being insured for this premises.
Amount	Number	Enter the insurance amount applicable to the subject of insurance.
Coinsurance Percentage	Text	Enter the coinsurance percentage applicable to this coverage.
Valuation	Text	Enter the valuation basis or method used for the insured property.
Causes of Loss	Text	Enter the causes of loss covered for the subject of insurance.
Inflation Guard Percentage	Text	Enter the inflation guard percentage applicable to this coverage.
Deductible	Text	Enter the deductible that applies to this coverage.
Deductible Type	Text	Enter the type or basis of the deductible.
Blanket Number	Text	Enter the blanket coverage number, if applicable.
Forms and Conditions to Apply	Text	Enter the forms and conditions that apply to this coverage.
Front Exposure and Distance
Rear Exposure	Text	Enter a description of the property or hazard exposure located behind the insured premises.
Rear Exposure Distance	Text	Enter the distance from the insured premises to the rear exposure.
Front Exposure	Text	Enter the type or description of the property exposure located in front of the insured premises.
Front Exposure Distance	Text	Enter the distance from the insured premises to the front exposure.
General
	Text
Heating Improvement
Heating, Yr.	Checkbox	Check this box if the building's heating system has been improved, and enter the year of the improvement.
Heating Improvement Year	Number	Enter the year the heating system was improved or updated. Fill only if 'Heating, Yr.' is 'Yes'. Depends on: Heating, Yr.
Historic Landmark and Open Sides
Property Has Been Designated a Historical Landmark	Checkbox	Check this box if the property has been officially designated as a historical landmark.
Number of Open Sides on Structure	Text	Enter the number of open sides on the structure.
Property Has Been Designated an Historical Landmark	Checkbox	Check this box if the property has officially been designated as a historical landmark.
Number of Open Sides on Structure	Text	Enter the number of open sides on the structure.
Historic Landmark Designation	Text	Enter the historic landmark designation or related details for the property.
Left Exposure and Distance
Left Exposure	Text	Enter the description or type of property exposure located to the left of the insured premises.
Left Exposure Distance	Number	Enter the distance from the insured premises to the left-side exposure.
Left Exposure	Text	Enter a description of the property or hazard exposure located to the left of the insured premises.
Left Exposure Distance	Text	Enter the distance from the insured premises to the exposure on the left.
Mine Subsidence Coverage
Accept Mine Subsidence Coverage	Checkbox	Check this box if you want to accept mine subsidence coverage for the premises.
Reject Mine Subsidence Coverage	Checkbox	Check this box if you want to reject mine subsidence coverage for the premises.
Mine Subsidence Coverage Limit	Number	Enter the maximum dollar amount of coverage requested for mine subsidence damage. Fill only if 'Accept Mine Subsidence Coverage' is 'Yes'. Depends on: Accept Mine Subsidence Coverage
Mine Subsidence Coverage Election and Limit
Mine Subsidence Coverage - Accept Coverage	Checkbox	Check this box if you elect to accept mine subsidence coverage.
Mine Subsidence Coverage - Reject Coverage	Checkbox	Check this box if you elect to reject mine subsidence coverage.
Mine Subsidence Coverage Limit	Number	Enter the dollar limit of coverage requested for mine subsidence. Fill only if 'Mine Subsidence Coverage - Accept Coverage' is 'Yes'. Depends on: Mine Subsidence Coverage - Accept Coverage
Other Building Improvement
Other Building Improvement	Checkbox	Check this box if the building has an improvement other than wiring, plumbing, roofing, or heating, and specify the year of the improvement.
Other Building Improvement	Number	Enter the type or description of any other building improvement not listed above. Fill only if 'Other Building Improvement' is 'Yes'. Depends on: Other Building Improvement
Other Building Improvement Year	Text	Enter the year the other listed building improvement was completed or installed. Fill only if 'Other Building Improvement' is 'Yes'. Depends on: Other Building Improvement
Other Occupancies
Other Occupancies	Text	Enter any additional occupancy types or uses of the building not otherwise listed.
Plumbing Improvement
Plumbing, Yr.	Checkbox	Check this box if the building's plumbing has been improved, and enter the year the improvement was completed.
Plumbing Improvement Year	Number	Enter the year in which the plumbing was improved or updated. Fill only if 'Plumbing, Yr.' is 'Yes'. Depends on: Plumbing, Yr.
Policy Information
Policy Number	Text	Enter the insurance policy number for this property coverage.
Effective Date	Date	Enter the date on which the policy coverage becomes effective. Max length: 10 characters
Named Insured(s)	Text	Enter the name or names of the individuals or entities named as insureds on the policy.
Premises Address
Premises Number	Text	Enter the identifier or number assigned to this insured premises location.
Street Address	Text	Enter the full street address of the insured premises.
Premises Details
Building Number	Text	Enter the identifier or number assigned to the building at the premises.
Building Description	Text	Enter a description of the building located at the premises.
Premises Fire Protection
Premises Fire Protection Systems	Text	Enter the fire protection systems installed at the premises, such as sprinklers, standpipes, CO2 systems, or chemical systems.
Sprinkler Coverage Percentage	Number	Enter the percentage of the premises protected by sprinklers.
Fire Alarm Manufacturer	Text	Enter the name of the manufacturer of the fire alarm system installed at the premises.
Central Station	Checkbox	Check this box if the premises fire protection system is monitored by a central station.
Local Gong	Checkbox	Check this box if the premises fire protection system includes a local gong alarm.
Premises Fire Protection and Sprinklers
Premises Fire Protection	Text	Enter details of the premises fire protection systems, such as sprinklers, standpipes, carbon dioxide systems, or chemical suppression systems.
Sprinkler Coverage Percentage	Number	Enter the percentage of the premises protected by sprinklers.
Primary Heat
Primary Heat - Boiler	Checkbox	Check this box if the premises' primary heat source is a boiler.
Primary Heat Boiler Insurance Placed Elsewhere	Text	Enter whether insurance for the primary heat boiler is placed elsewhere. Fill only if 'Primary Heat - Boiler' is 'Yes'. Max length: 1 characters Depends on: Primary Heat - Boiler
Primary Heat - Solid Fuel	Checkbox	Check this box if the premises' primary heat source uses solid fuel.
Primary Heat - Other	Checkbox	Check this box if an additional or other primary heat option applies.
Primary Heat	Text	Enter the primary heating type or fuel source used at the premises.
Primary Heat Details
Boiler	Checkbox	Check this box if the building's primary heat source is a boiler.
Primary Heat Boiler Insurance Elsewhere	Text	Enter whether insurance for the primary boiler is placed elsewhere using the indicated yes or no response. Fill only if 'Boiler' is 'Yes'. Max length: 1 characters Depends on: Boiler
Solid Fuel	Checkbox	Check this box if the building's primary heat source uses solid fuel.
Other Primary Heat	Checkbox	Check this box if the building's primary heat source is neither a boiler nor solid fuel.
Other Primary Heat Type	Text	Enter the type of primary heating source if it is not boiler or solid fuel.
Producer Authorization Details
Producer Signature	Text	Enter the producer's signature authorizing the application.
Producer Name	Text	Enter the producer's full name in printed form.
State Producer License Number	Text	Enter the producer's state license number, if required.
National Producer Number	Text	Enter the producer's National Producer Number (NPN).
Rear Exposure and Distance
Rear Exposure	Text	Enter the type or description of the exposure located behind the insured property.
Rear Exposure Distance	Text	Enter the distance from the insured property to the rear exposure.
Rear Exposure	Text	Enter a description of the property, structure, or hazard located to the rear of the premises.
Rear Exposure Distance	Number	Enter the distance from the premises to the rear exposure.
REMARKS (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Remarks	Text	Provide any additional remarks or information that could not be included elsewhere on the form.
Right Exposure and Distance
Right Exposure	Text	Enter the type or description of the property exposure located to the right of the premises.
Right Exposure Distance	Text	Enter the distance from the premises to the exposure on the right.
Right Exposure	Text	Enter a description of the property or exposure located to the right of the insured premises.
Right Exposure Distance	Text	Enter the distance from the insured premises to the exposure on the right side.
Roofing Improvement
Roofing, Year	Checkbox	Check this box if the building's roofing has been improved, and provide the year the roofing improvement was completed.
Roofing Year	Number	Enter the year the roofing improvement was completed. Fill only if 'Roofing, Year' is 'Yes'. Depends on: Roofing, Year
Second Blanket Summary Row
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	Text
	Text
Second Blanket Number	Text	Enter the identifier or number for the second blanket coverage entry.
Second Blanket Amount	Number	Enter the coverage amount for the second blanket entry.
Second Blanket Type	Text	Enter the type of coverage for the second blanket entry.
Second Premises Coverage
Subject of Insurance	Text	Enter the property, coverage item, or interest that is being insured at the second premises.
Coverage Amount	Number	Enter the insurance limit or coverage amount for the listed subject of insurance.
Coinsurance Percentage	Number	Enter the coinsurance percentage that applies to this coverage.
Valuation	Text	Enter the valuation basis used to determine the value of the insured property.
Causes of Loss	Text	Enter the causes of loss or coverage form applicable to this item.
Inflation Guard Percentage	Number	Enter the inflation guard percentage that applies to this coverage.
Deductible	Number	Enter the deductible amount or other deductible value that applies to this coverage.
Deductible Type	Text	Enter the type or basis of the deductible that applies to this coverage.
Blanket Number	Text	Enter the blanket coverage number associated with this item, if applicable.
Forms and Conditions to Apply	Text	Enter the forms, endorsements, and conditions that apply to this coverage.
Second Premises Insurance Details
Subject of Insurance	Text	Enter the item, property, or coverage subject to insurance at the second premises.
Insurance Amount	Number	Enter the amount of insurance requested for the subject of insurance.
Coinsurance Percentage	Number	Enter the applicable coinsurance percentage for this coverage.
Valuation Method	Text	Enter the valuation basis or method used to determine the value of the insured property.
Causes of Loss	Text	Enter the causes of loss or coverage form that applies to this insured property.
Inflation Guard Percentage	Number	Enter the applicable inflation guard percentage for this coverage.
Deductible Amount	Number	Enter the deductible amount that applies to this coverage.
Deductible Type	Text	Enter the type or basis of the deductible that applies to this coverage.
Blanket Number	Text	Enter the blanket policy or coverage number, if this item is covered under a blanket.
Forms and Conditions	Text	Enter the forms, endorsements, and conditions that apply to this coverage.
Secondary Heat
Secondary Heat - Boiler	Checkbox	Check this box if the premises uses a boiler as a secondary heat source.
Secondary Heat Boiler Insurance Placed Elsewhere	Text	Indicate whether insurance for the secondary-heat boiler is placed elsewhere. Fill only if 'Secondary Heat - Boiler' is 'Yes'. Max length: 1 characters Depends on: Secondary Heat - Boiler
Secondary Heat - Solid Fuel	Checkbox	Check this box if the premises uses solid fuel as a secondary heat source.
Secondary Heat - Other	Checkbox	Check this box if the premises has another secondary heat source not identified as a boiler or solid fuel.
Secondary Heat Details	Text	Enter details identifying the secondary heat source or system.
Secondary Heat Details
Secondary Heat - Boiler	Checkbox	Check this box if the premises has a boiler as a secondary heat source.
Secondary Heat Boiler Insurance Elsewhere	Text	Indicate whether insurance for the secondary-heat boiler is placed with another insurer. Fill only if 'Secondary Heat - Boiler' is 'Yes'. Max length: 1 characters Depends on: Secondary Heat - Boiler
Secondary Heat - Solid Fuel	Checkbox	Check this box if the premises uses solid fuel as a secondary heat source.
Secondary Heat - Unlabeled Option	Checkbox	Check this box only if the applicable secondary-heat option is specified elsewhere in the form or by the insurer, as no visible label is provided.
Other Secondary Heat Type	Text	Specify the type of secondary heating system if it is not a boiler or solid-fuel system.
Sinkhole Coverage
Accept Sinkhole Coverage	Checkbox	Check this box if you want to accept sinkhole coverage for the premises.
Reject Sinkhole Coverage	Checkbox	Check this box if you want to reject sinkhole coverage for the premises.
Sinkhole Coverage Limit	Number	Enter the coverage limit amount for sinkhole coverage. Fill only if 'Accept Sinkhole Coverage' is 'Yes'. Depends on: Accept Sinkhole Coverage
Sinkhole Coverage Election and Limit
Sinkhole Coverage — Accept Coverage	Checkbox	Check this box if you elect to accept sinkhole coverage.
Sinkhole Coverage — Reject Coverage	Checkbox	Check this box if you elect to reject sinkhole coverage.
Sinkhole Coverage Limit	Number	Enter the coverage limit amount selected for sinkhole coverage. Fill only if 'Sinkhole Coverage — Accept Coverage' is 'Yes'. Depends on: Sinkhole Coverage — Accept Coverage
Spoilage Coverage Details
Spoilage Coverage Election	Text	Enter Y if spoilage coverage is selected or N if spoilage coverage is not selected. Max length: 1 characters
Spoilage Coverage Property Description	Text	Describe the property or contents covered under the spoilage coverage. Fill only if 'Spoilage Coverage Election' is 'Yes'. Depends on: Spoilage Coverage Election
Spoilage Coverage Limit	Number	Enter the dollar limit of insurance for spoilage coverage. Fill only if 'Spoilage Coverage Election' is 'Yes'. Depends on: Spoilage Coverage Election
Spoilage Coverage Deductible	Number	Enter the dollar deductible that applies to spoilage coverage. Fill only if 'Spoilage Coverage Election' is 'Yes'. Depends on: Spoilage Coverage Election
Refrigeration Maintenance Agreement	Text	Enter Y if a refrigeration maintenance agreement is in place or N if no agreement is in place. Fill only if 'Spoilage Coverage Election' is 'Yes'. Max length: 1 characters Depends on: Spoilage Coverage Election
Spoilage Coverage Options
Breakdown or Contamination	Checkbox	Check this box if spoilage coverage is requested for loss caused by equipment breakdown or contamination. Fill only if 'Spoilage Coverage Election' is 'Yes'. Depends on: Spoilage Coverage Election
Power Outage	Checkbox	Check this box if spoilage coverage is requested for loss caused by a power outage. Fill only if 'Spoilage Coverage Election' is 'Yes'. Depends on: Spoilage Coverage Election
Selling Price	Checkbox	Check this box if spoilage losses should be valued at the selling price. Fill only if 'Spoilage Coverage Election' is 'Yes'. Depends on: Spoilage Coverage Election
Additional Spoilage Option	Checkbox	Check this box only if an additional spoilage coverage option applies and is specified elsewhere on the form. Fill only if 'Spoilage Coverage Election' is 'Yes'. Depends on: Spoilage Coverage Election
Spoilage Coverage Options Details	Text	Enter any additional details or specifications for the selected spoilage coverage options. Fill only if 'Spoilage Coverage Election', 'Additional Spoilage Option' are all 'Yes'. Depends on: Spoilage Coverage Election, Additional Spoilage Option
Third Premises Coverage
Third Premises Subject of Insurance	Text	Enter the subject of insurance covered at the third premises.
Third Premises Coverage Amount	Number	Enter the insurance coverage amount for the third premises item.
Third Premises Coinsurance Percentage	Number	Enter the coinsurance percentage that applies to the third premises coverage.
Third Premises Valuation	Text	Enter the valuation basis used for the third premises coverage.
Third Premises Causes of Loss	Text	Enter the causes of loss covered for the third premises.
Third Premises Inflation Guard Percentage	Number	Enter the inflation guard percentage applicable to the third premises coverage.
Third Premises Deductible	Number	Enter the deductible that applies to the third premises coverage.
Third Premises Deductible Type	Text	Enter the type of deductible applicable to the third premises coverage.
Third Premises Blanket Number	Text	Enter the blanket number associated with the third premises coverage.
Third Premises Forms and Conditions	Text	Enter the forms and conditions that apply to the third premises coverage.
Third Premises Insurance Details
Subject of Insurance	Text	Enter the property, coverage item, or subject being insured for the third premises.
Amount	Number	Enter the insurance amount or coverage limit for the listed subject of insurance.
Coinsurance Percentage	Text	Enter the coinsurance percentage that applies to this coverage.
Valuation	Text	Enter the valuation basis that applies to the insured property or coverage.
Causes of Loss	Text	Enter the causes of loss coverage applicable to this subject of insurance.
Inflation Guard Percentage	Text	Enter the inflation guard percentage applicable to this coverage.
Deductible	Number	Enter the deductible amount that applies to this coverage.
Deductible Type	Text	Enter the type or basis of the deductible that applies to this coverage.
Blanket Number	Text	Enter the blanket coverage number associated with this subject of insurance, if applicable.
Forms and Conditions	Text	Enter the forms, endorsements, and conditions that apply to this coverage.
Wind Class and Resistance
Resistive	Checkbox	Check this box if the building is classified as wind resistant.
Semi-Resistive	Checkbox	Check this box if the building is classified as semi-resistant to wind.
Non-Resistive	Checkbox	Check this box if the building is classified as non-resistant to wind.
Semi-Resistive Wind Class	Text	Enter the wind class designation for a semi-resistive building.
Wiring Improvement
Wiring Improvement	Checkbox	Check this box if the building's wiring has been improved, and enter the year of the improvement.
Wiring Improvement Year	Number	Enter the year in which the building's wiring was most recently improved or updated. Fill only if 'Wiring Improvement' is 'Yes'. Depends on: Wiring Improvement
Woodburning Heating Source Details
Heating Source Includes Woodburning Stove or Fireplace Insert	Checkbox	Check this box if any heating source at the premises includes a woodburning stove or fireplace insert.
Woodburning Heating Source Date Installed	Date	Enter the date the woodburning stove or fireplace insert was installed. Fill only if 'Heating Source Includes Woodburning Stove or Fireplace Insert' is 'Yes'. Max length: 10 characters Depends on: Heating Source Includes Woodburning Stove or Fireplace Insert
Woodburning Heating Source Manufacturer	Text	Enter the manufacturer of the woodburning stove or fireplace insert. Fill only if 'Heating Source Includes Woodburning Stove or Fireplace Insert' is 'Yes'. Depends on: Heating Source Includes Woodburning Stove or Fireplace Insert

ACORD 140, Property Section Instructions