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jsbeaudry/cognito.json

Last active March 12, 2024 16:38
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cognito.json
{
"Form":{
"Id":"3",
"InternalName":"GayaPLInsuranceForm",
"Name":"Gaya PL Insurance Form"
},
"$version":8,
"$etag":"W/\"datetime'2024-03-12T16%3A33%3A07.8291841Z'\"",
"Date":"2024-03-01",
"HowDidYouFindUs":"Google",
"WhoShallWeThankForReferringYou":null,
"ContactInformations":{
"CustomerName":{
"First":"Sit minus quasi solu",
"FirstAndLast":"Sit minus quasi solu Anim non natus sint",
"Last":"Anim non natus sint",
"Middle":"Quas iure tempora co",
"MiddleInitial":null,
"Prefix":null,
"Suffix":"Magni culpa et nihil"
},
"CoApplicantName":{
"First":"Quia sit amet ullam",
"FirstAndLast":"Quia sit amet ullam In voluptatem autem",
"Last":"In voluptatem autem",
"Middle":"Voluptate maxime vol",
"MiddleInitial":null,
"Prefix":null,
"Suffix":"Fugit velit corpori"
},
"ResidenceType":"Rent",
"HowLongHasTheInsuredLivedAtTheirCurrentAddress":"2 months or less",
"CustomerAddress":{
"City":"Doloremque est quae",
"CityStatePostalCode":"Doloremque est quae, Alabama 29133",
"Country":"United States",
"CountryCode":"US",
"FullAddress":"Enim qui cupiditate, Similique laborum D, Doloremque est quae, Alabama 29133",
"FullInternationalAddress":"Enim qui cupiditate, Similique laborum D, Doloremque est quae, Alabama 29133, United States",
"Latitude":null,
"Line1":"Enim qui cupiditate",
"Line2":"Similique laborum D",
"Line3":null,
"Longitude":null,
"PostalCode":"29133",
"State":"Alabama",
"StreetAddress":"Enim qui cupiditate, Similique laborum D",
"Type":"Home"
},
"CustomerPreviousAddress":{
"City":"Mollitia a voluptate",
"CityStatePostalCode":"Mollitia a voluptate, American Samoa 22816",
"Country":"United States",
"CountryCode":"US",
"FullAddress":"Iusto ab sint proide, Cillum anim ipsum au, Mollitia a voluptate, American Samoa 22816",
"FullInternationalAddress":"Iusto ab sint proide, Cillum anim ipsum au, Mollitia a voluptate, American Samoa 22816, United States",
"Latitude":null,
"Line1":"Iusto ab sint proide",
"Line2":"Cillum anim ipsum au",
"Line3":null,
"Longitude":null,
"PostalCode":"22816",
"State":"American Samoa",
"StreetAddress":"Iusto ab sint proide, Cillum anim ipsum au",
"Type":"Home"
},
"PurchaseDate":"2024-03-04",
"CustomerPhoneNumber":"(153) 420-8858 x8",
"CustomerEmail":"[email protected]",
"PolicyThatWillBeQuoted":{
"ClickAllThatApply":[
"Auto",
"Home",
"Flood",
"Umbrella",
"Valuable"
]
},
"CustomerMailingAddress":{
"City":"Amet alias autem in",
"CityStatePostalCode":"Amet alias autem in, American Samoa 75254",
"Country":"United States",
"CountryCode":"US",
"FullAddress":"Elit dolor omnis et, Animi ut reiciendis, Amet alias autem in, American Samoa 75254",
"FullInternationalAddress":"Elit dolor omnis et, Animi ut reiciendis, Amet alias autem in, American Samoa 75254, United States",
"Latitude":null,
"Line1":"Elit dolor omnis et",
"Line2":"Animi ut reiciendis",
"Line3":null,
"Longitude":null,
"PostalCode":"75254",
"State":"American Samoa",
"StreetAddress":"Elit dolor omnis et, Animi ut reiciendis",
"Type":"Home"
},
"ResidenceType_IsRequired":true,
"HowLongHasTheInsuredLivedAtTheirCurrentAddress_IsRequired":true,
"CustomerAddress_IsRequired":true,
"CustomerPreviousAddress_IsRequired":true,
"CustomerPhoneNumber_IsRequired":true,
"CustomerEmail_IsRequired":true
},
"HouseholdDetails":[
{
"Id":"31s88w",
"HouseholdName":{
"First":"Nisi et iure assumen",
"FirstAndLast":"Nisi et iure assumen Tempore deleniti in",
"Last":"Tempore deleniti in",
"Middle":"Recusandae Hic cum",
"MiddleInitial":null,
"Prefix":null,
"Suffix":"Enim adipisci modi v"
},
"DateOfBirth":"1995-06-06",
"MaritalStatus":"Married",
"Relationship":"Spouse",
"SSN":"Sed ut elit veniam",
"LicenseNumber":"51",
"IDType":"US DL",
"Gender":"Female",
"Occupation":"Aut ut occaecat quid",
"EmployerFullAddress":"Nam atque cillum com",
"LicenseState":{
"City":null,
"CityStatePostalCode":"Arizona",
"Country":"United States",
"CountryCode":"US",
"FullAddress":"Arizona",
"FullInternationalAddress":"Arizona, United States",
"Latitude":null,
"Line1":null,
"Line2":null,
"Line3":null,
"Longitude":null,
"PostalCode":null,
"State":"Arizona",
"StreetAddress":"",
"Type":"Home"
},
"ItemNumber":1
}
],
"VehicleDetails":[
{
"Id":"GZp7O",
"VIN":"Et deleniti voluptat",
"CarYear":"1981",
"Make":"Fuga Labore officii",
"Model":"Qui eveniet dolorem",
"VehicleUsage":"Pleasure",
"AnnualMiles":"Non velit suscipit",
"MilesDrivenToWork1Way":null,
"DaysDrivenPerWeek":null,
"OwnershipStatus":"Owned",
"PurchaseDate":"2024-03-05",
"GaragingAddressSameAsResidenceAddress":false,
"GaragingAddress":{
"City":"Labore non officia l",
"CityStatePostalCode":"Labore non officia l, American Samoa 69873",
"Country":"United States",
"CountryCode":"US",
"FullAddress":"Sint rerum eos pro, Consectetur fugit, Labore non officia l, American Samoa 69873",
"FullInternationalAddress":"Sint rerum eos pro, Consectetur fugit, Labore non officia l, American Samoa 69873, United States",
"Latitude":null,
"Line1":"Sint rerum eos pro",
"Line2":"Consectetur fugit",
"Line3":null,
"Longitude":null,
"PostalCode":"69873",
"State":"American Samoa",
"StreetAddress":"Sint rerum eos pro, Consectetur fugit",
"Type":"Home"
},
"ComprehensiveDeductible":"250",
"CollisionDeductible":"250",
"TowingCoverage":"75",
"VehicleRegisteredState":{
"City":null,
"CityStatePostalCode":"",
"Country":"United States",
"CountryCode":"US",
"FullAddress":"",
"FullInternationalAddress":"United States",
"Latitude":null,
"Line1":null,
"Line2":null,
"Line3":null,
"Longitude":null,
"PostalCode":null,
"State":"",
"StreetAddress":"",
"Type":"Home"
},
"CustomPartsEquipmentCoverage":1000.0,
"RentalReimbursement":"35/1050",
"ItemNumber":1,
"MilesDrivenToWork1Way_Minimum":1,
"MilesDrivenToWork1Way_Maximum":1000,
"MilesDrivenToWork1Way_IncrementBy":1,
"DaysDrivenPerWeek_Minimum":1,
"DaysDrivenPerWeek_Maximum":7,
"DaysDrivenPerWeek_IncrementBy":1,
"CustomPartsEquipmentCoverage_Minimum":0.0,
"CustomPartsEquipmentCoverage_Maximum":1000000.0,
"CustomPartsEquipmentCoverage_IncrementBy":1.0,
"GaragingAddress_IsRequired":true
}
],
"AutoUnderwritingQuestions":{
"TellMeAboutTheLastTimeAnyoneInYourHouseholdHadASpeedingTicket":"Quidem minus asperna",
"TellMeAboutTheLastTimeAnyoneInYourHouseholdWasInvolvedInAnAccidentEitherAFOrNAF":"Distinctio Nisi aut",
"TellMeAboutTheLastTimeYouTurnedInACompClaimwindshieldTheftVandalismFireFloodingToYourCar":"Ut nemo recusandae",
"TellMeAboutAnyOtherViolationsYouspouseHaveHad":"Omnis quidem sequi a",
"NumberOfVehiclesOwned":1,
"IfYesHowMany":1,
"DoAnyDriversHaveAPhysicalOrMentalImpairmentOrDisabilitySuchAsAHeartConditionDiabetesEpilepsyOrAnyHearingsightlimbLossThatWouldAffectYourDriving":"Sit accusamus neces",
"AreThereCarsInYourHouseholdOwnedByOthers":"Yes",
"DUIOrDWIInThePast5Years":"Yes",
"DriverLicenseRevokedInLast5Years":"Yes",
"NumberOfVehiclesOwned_Minimum":1,
"NumberOfVehiclesOwned_Maximum":100,
"NumberOfVehiclesOwned_IncrementBy":1,
"IfYesHowMany_Minimum":1,
"IfYesHowMany_Maximum":100,
"IfYesHowMany_IncrementBy":1
},
"AutoPolicyLevelCoverages":{
"BodilyInjuryLimit":"50/100",
"PropertyDamageLiabilityLimit":"5",
"MedicalPaymentsLimit":"1000",
"UninsuredUnderinsuredBodilyInjuryLimit":"100/300",
"OtherCoverages":"Veniam sed qui inci",
"UninsuredUnderinsuredPropertyDamageLimit":"250",
"PersonalInjuryProtectionPIPLimit":null,
"Tort":"Full",
"StackedUnstackedCoverage":"Stacked",
"_25KOBEL":false,
"PIPDeductible":false
},
"DoYouOwnAnyOfTheFollowing":{
"ATVs":"Yes",
"IfYesDoYouUseItOffpremises":"No",
"Motorcyle":null,
"CCs":null,
"RacingBike":null,
"CostNew":null,
"Mopeds":"Yes",
"IfYesDoYouUseItOffpremises2":"Yes",
"TruckCaps":"No",
"IfYesDoYouUseItOffpremises3":null,
"GolfCarts":"No",
"IfYesDoYouUseItOffpremises4":null,
"CCs_IncrementBy":1,
"CostNew_IncrementBy":1.0,
"IfYesDoYouUseItOffpremises_IsRequired":true,
"IfYesDoYouUseItOffpremises2_IsRequired":true,
"IfYesDoYouUseItOffpremises3_IsRequired":false,
"IfYesDoYouUseItOffpremises4_IsRequired":false
},
"FileUpload":[
],
"AgentName":"JP",
"HomesDetails":[
{
"Id":"2JS6gE",
"HomeDetails":{
"YearBuilt":"2007",
"SquareFootage":"Sunt saepe asperior",
"GarageTypeAndNumber":"3 Car",
"NumberOfFullBathrooms":"3",
"NumberOfStories":"1.5",
"ConstructionType":"Wood",
"RoofType":"Metal",
"Fireplace":"1",
"OtherRoofTypeMaterial":null,
"FoundationType":[
"Basement",
"Crawl Space",
"Piers, Posts & Pilings",
"Slab"
],
"DescriptionOfFoundation":"Illo ducimus est c",
"SwimmingPoolType":"Pool",
"Trampoline":"Yes - Not Fenced or Netted",
"HomeUpdatescheckAllThatApply":[
"Electrical",
"HVAC",
"Plumbing",
"Roof"
],
"ElectricalRenovationYear":"2018",
"HeatingRenovationYear":"2017",
"RoofRenovationYear":"1988",
"PlumbingRenovationYear":"2018",
"DiscountQuestionsclickAllThatApply":[
"Water Leak Sensor"
],
"PriorClaimsInTheLast5Years":"Yes",
"PriorClaimDetails":null,
"Dogs":null,
"BreedOfDogs":null,
"AdditionalNotes":"Qui fugiat fugiat e",
"AnimalBiteHistory":null,
"HaveYouEverHadInsuranceRefusedOrCancelled":"Yes",
"DwellingCoverage":"Aut sed dolor autem",
"PersonalPropertyCoverage":"Aut ad officiis blan",
"OtherStructuresCoverage":"Laboriosam consequa",
"PersonalLiabilityLimit":"Nulla laudantium ve",
"AllPerilDeductible":"Est mollit culpa und",
"MedicalPaymentLimit":"Impedit ut omnis do",
"FireHydrant":"Mollitia omnis iure",
"NameOfFireDepartment":"Praesentium dignissi",
"NumberOfHalfBathrooms":"3",
"KitchenGrade":"Builders Grade/ Economy",
"BathroomGrade":"Builders Grade/ Economy",
"PropertyAddress":{
"City":"Consectetur eum cons",
"CityStatePostalCode":"Consectetur eum cons, Arizona 56021",
"Country":"United States",
"CountryCode":"US",
"FullAddress":"Voluptatem cumque a, Dolore placeat face, Consectetur eum cons, Arizona 56021",
"FullInternationalAddress":"Voluptatem cumque a, Dolore placeat face, Consectetur eum cons, Arizona 56021, United States",
"Latitude":null,
"Line1":"Voluptatem cumque a",
"Line2":"Dolore placeat face",
"Line3":null,
"Longitude":null,
"PostalCode":"56021",
"State":"Arizona",
"StreetAddress":"Voluptatem cumque a, Dolore placeat face",
"Type":"Home"
},
"LeaseDuration":null,
"WillBeRentedToOthers":"Yes",
"ShortestRentalDurationAllowed":"Daily",
"PercentageOfTimeAtThisHome":"Officia sed omnis ip",
"UnoccupiedForMoreThan30DaysInARow":"Yes",
"NewHomePurchase":"Yes",
"PurchaseDate":"2024-03-10",
"DwellingOccupancyType":"Primary Residence",
"ResidenceType":"Single Family Residence",
"TrustOrLLC":"No",
"EffectiveStartDate":"2024-03-01",
"NameOfMembersOfTrustOrLLC":null,
"IsThePropertyLocationTheSameAsTheClientsCurrentAddress":false,
"IsThisHomeAlreadyInsured":false,
"PriorInsuranceCarrier":null,
"PriorPolicyExpirationDate":null,
"PrimaryHeatingType":"Electric",
"RoofShape":"Flat",
"UnitsInBuilding":null,
"FloorsInBuilding":null,
"HomeFloorNumber":null,
"ReasonForRefusal":null,
"UnitsInBuilding_IncrementBy":1,
"FloorsInBuilding_IncrementBy":1,
"HomeFloorNumber_IncrementBy":1
},
"ItemNumber":1
}
],
"Flood":[
{
"Id":"nSekM",
"DwellingCoverageAmount":"Necessitatibus sit",
"PersonalPropertyCoverageAmount":"Rem ea dolores sequi",
"Deductible":"A commodo dolor reru",
"PolicyEffectiveDate":"2024-03-04",
"PriorFloodInsuranceCarrier":false,
"FloodCarrierName":"Christen Alvarez",
"FloodAddress":{
"City":"Sapiente in enim eos",
"CityStatePostalCode":"Sapiente in enim eos 76710",
"Country":"United States",
"CountryCode":"US",
"FullAddress":"Magni enim recusanda, Quia ipsa ea eiusmo, Sapiente in enim eos 76710",
"FullInternationalAddress":"Magni enim recusanda, Quia ipsa ea eiusmo, Sapiente in enim eos 76710, United States",
"Latitude":null,
"Line1":"Magni enim recusanda",
"Line2":"Quia ipsa ea eiusmo",
"Line3":null,
"Longitude":null,
"PostalCode":"76710",
"State":null,
"StreetAddress":"Magni enim recusanda, Quia ipsa ea eiusmo",
"Type":"Home"
},
"DoYouHaveABasement":false,
"ContentValue":null,
"MechanicalContentValue":null,
"ItemNumber":1
}
],
"Umbrella2":{
"PolicyStartDate":"2024-03-01",
"ExcessLiabilityLimits":null,
"NumberOfVehicles":"924",
"NumberOfProperties":"633",
"AdditionalDocuments":[
],
"AddtionalNotes":"Distinctio Enim dol",
"ExcessUninsuredUnderinsuredLiabilityLimits":"Iste consectetur ve",
"NumberOfWatercrafts":"90",
"TrustsLLCsToBeIncluded":"Ex maiores aute non",
"DOLiability":"Yes",
"EPLILiability":"Yes",
"NumberOfDrivers":"392"
},
"Boat":{
"PolicyStartDate":null,
"Boats":[
{
"Id":"29NFvi",
"NewOrUsed":"New",
"BoatPurchaseDate":null,
"Value":"Aliquid omnis anim c",
"Year":"1977",
"Make":"Id dignissimos nece",
"Model":"Dolor optio officii",
"Length":"Adipisicing magna no",
"Motor":"Doloribus id est re",
"HorsePower":"Ut voluptatem sapien",
"HullIDOrVIN":"Animi illum ullam",
"ConstructionMaterial":"Quia sunt amet at",
"InSeasonBerthingAddress":{
"City":"Quo reiciendis exerc",
"CityStatePostalCode":"Quo reiciendis exerc 65408",
"Country":"United States",
"CountryCode":"US",
"FullAddress":"Maxime ratione aliqu, Vero minima dolor et, Quo reiciendis exerc 65408",
"FullInternationalAddress":"Maxime ratione aliqu, Vero minima dolor et, Quo reiciendis exerc 65408, United States",
"Latitude":null,
"Line1":"Maxime ratione aliqu",
"Line2":"Vero minima dolor et",
"Line3":null,
"Longitude":null,
"PostalCode":"65408",
"State":null,
"StreetAddress":"Maxime ratione aliqu, Vero minima dolor et",
"Type":"Home"
},
"TrailerIDSerial":"Aliquid et aspernatu",
"BusinessUse":"Yes",
"Salvaged":"Yes",
"FastOrHighPerformance":"Yes",
"Homemade":"Yes",
"MoreThanTwoMotors":"Yes",
"EngineExposed":"Yes",
"LienholderNameifAny":"Steven Potts",
"BoatOwnedByTrustOrLLC":"No",
"NameOfMembersOfTrustOrLLC":null,
"OffSeasonBerthingAddress":{
"City":"Ad qui soluta tempor",
"CityStatePostalCode":"Ad qui soluta tempor 53061",
"Country":"United States",
"CountryCode":"US",
"FullAddress":"Non debitis amet nu, Porro aliquid nobis, Ad qui soluta tempor 53061",
"FullInternationalAddress":"Non debitis amet nu, Porro aliquid nobis, Ad qui soluta tempor 53061, United States",
"Latitude":null,
"Line1":"Non debitis amet nu",
"Line2":"Porro aliquid nobis",
"Line3":null,
"Longitude":null,
"PostalCode":"53061",
"State":null,
"StreetAddress":"Non debitis amet nu, Porro aliquid nobis",
"Type":"Home"
},
"NavigationLimits":"Velit ratione duis o",
"ItemNumber":1
}
],
"AdditionalDocuments":[
],
"AddtionalNotes":"Eum dolores quod ut",
"YearsOfBoatingExperience":"1981",
"SafetyCourseCompleted":"Yes"
},
"Valuable":{
"PolicyStartDate":"2024-03-05",
"AdditionalDocuments":[
],
"AddtionalNotes":"Nihil non sed facili",
"Valuables":[
{
"Id":"31zyso",
"SelectValuableClass":"Jewelry",
"TotalBlanketLimit":"Alias unde ut do mai",
"BlanketSingleItemLimit":"Modi consequat Non",
"ScheduledItems":[
{
"Id":"29KV0Y",
"ItemDescription":"Aliqua Hic cillum e",
"Value":"Velit et sit offici",
"ItemNumber":1
}
],
"AppraisalsOnFile":false,
"CentralStationAlarms":false,
"HighestSingleItemLimit":"Consequat Dolorem o",
"TotalScheduledLimit":"Adipisicing similiqu",
"LocationOfScheduledItems":{
"City":"Quidem officiis et v",
"CityStatePostalCode":"Quidem officiis et v 17696",
"Country":"United States",
"CountryCode":"US",
"FullAddress":"Elit ipsum iste iru, Earum et accusamus d, Quidem officiis et v 17696",
"FullInternationalAddress":"Elit ipsum iste iru, Earum et accusamus d, Quidem officiis et v 17696, United States",
"Latitude":null,
"Line1":"Elit ipsum iste iru",
"Line2":"Earum et accusamus d",
"Line3":null,
"Longitude":null,
"PostalCode":"17696",
"State":null,
"StreetAddress":"Elit ipsum iste iru, Earum et accusamus d",
"Type":"Home"
},
"AnySafeThatIsBoltedDownWhereItemsAreKeptWhileNotWorn":false,
"AnyJeweleryKeptInABankVault":false,
"VaultLocation":{
"City":null,
"CityStatePostalCode":"",
"Country":"United States",
"CountryCode":"US",
"FullAddress":"",
"FullInternationalAddress":"United States",
"Latitude":null,
"Line1":null,
"Line2":null,
"Line3":null,
"Longitude":null,
"PostalCode":null,
"State":null,
"StreetAddress":"",
"Type":"Home"
},
"WhichJewelery":null,
"ValuableUploadFile":[
],
"ItemNumber":1
}
]
},
"Entry":{
"AdminLink":"https://www.cognitoforms.com/Gaya1/3/entries/2",
"DateCreated":"2024-03-12T16:31:55.591Z",
"DateSubmitted":"2024-03-12T16:31:55.591Z",
"DateUpdated":"2024-03-12T16:33:07.725Z",
"IsBeta":false,
"LastPageViewed":null,
"Number":2,
"Order":null,
"Origin":{
"City":null,
"CountryCode":null,
"IpAddress":"181.214.150.29",
"IsImported":false,
"Region":null,
"Timezone":null,
"UserAgent":"Mozilla/5.0 (Macintosh; Intel Mac OS X 10_15_7) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/122.0.0.0 Safari/537.36"
},
"Timestamp":"2024-03-12T16:31:55.591Z",
"User":{
"Email":"[email protected]",
"Name":"Gaya AI"
},
"Version":2,
"Action":"Update",
"Role":"Internal",
"Status":"Submitted",
"PublicLink":"https://www.cognitoforms.com/Gaya1/GayaPLInsuranceForm#EDj0gnNcdTSuew3bLTHf_xfJZM-G6fxFW2tJxx_eTMc$*",
"InternalLink":"https://www.cognitoforms.com/Gaya1/GayaPLInsuranceForm#3-8IwPdiY00Bi54rsUEEUa_QPKo63SUeS3Crc-kEikM$*",
"Document1":"https://www.cognitoforms.com/d/UOnf9dHnaUqvvHWjaczCVA?code=h8WdSFJfGlH0ZR50tOblUS2vCQOD5nL2AlY8WmWqC_M$",
"Document2":"https://www.cognitoforms.com/d/UOnf9dHnaUqvvHWjaczCVA?code=Zs51CkDRvGY76SJiAptIFNhS4rO-5gM4oWUZi8j91KE$"
},
"Id":"3-2"
}
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