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- <apex:page standardController="certificateOfInsurance__c" extensions="editICController" >
- <apex:messages />
- <apex:form id="theForm">
- <h2>
- Hello, {!$User.FirstName}!
- </h2>
- <apex:pageBlock title="General Info(Please fill all required fields to continue)">
- <apex:pageBlockButtons location="Top">
- <apex:commandButton action="{!createCert}" value="Save"/>
- <!--<apex:commandButton action="{!andNew}" value="Save and New" rerender="theForm"/>-->
- <apex:commandButton action="{!Cancel}" value="Cancel"/>
- </apex:pageBlockButtons>
- <apex:pageBlockSection title="Contact Details">
- <apex:inputField value="{!certificateOfInsurance__c.Policy_Holder2__c}">
- <apex:actionSupport event="onchange" action="{!checkContactInfo}" rerender="coverageInfo"/>
- </apex:inputField>
- <apex:inputField value="{!certificateOfInsurance__c.Primary_Contact__c}">
- <apex:actionSupport event="onchange" action="{!checkContactInfo}" rerender="coverageInfo"/>
- </apex:inputField>
- <apex:inputField label="Phone" value="{!certificateOfInsurance__c.Phone__c}">
- <apex:actionSupport event="onchange" action="{!checkContactInfo}" rerender="coverageInfo"/>
- </apex:inputField>
- <apex:inputField label="Email" value="{!certificateOfInsurance__c.Email__c}"/>
- <apex:inputField label="Fax" value="{!certificateOfInsurance__c.Fax__c}"/>
- </apex:pageBlockSection>
- <apex:pageBlockSection title="Mailing Address">
- <apex:inputField value="{!certificateOfInsurance__c.Street_Address__c}">
- <apex:actionSupport event="onchange" action="{!checkContactInfo}" rerender="coverageInfo"/>
- </apex:inputField>
- <apex:inputField value="{!certificateOfInsurance__c.City__c}">
- <apex:actionSupport event="onchange" action="{!checkContactInfo}" rerender="coverageInfo"/>
- </apex:inputField>
- <apex:inputField value="{!certificateOfInsurance__c.Line_2__c}"/>
- <apex:inputField value="{!certificateOfInsurance__c.State__c}">
- <apex:actionSupport event="onchange" action="{!checkContactInfo}" rerender="coverageInfo"/>
- </apex:inputField>
- <apex:inputField value="{!certificateOfInsurance__c.Country__c}">
- <apex:actionSupport event="onchange" action="{!checkContactInfo}" rerender="coverageInfo"/>
- </apex:inputField>
- <apex:inputField value="{!certificateOfInsurance__c.Postal_Code__c}"/>
- </apex:pageBlockSection>
- </apex:pageBlock>
- <apex:outputPanel id="coverageInfo">
- <apex:pageBlock title="Coverage Selection" rendered="{!contactDone}">
- <apex:pageBlockSection title="Coverage Types">
- <apex:inputField value="{!certificateOfInsurance__c.Automobile_Liability__c}">
- <apex:actionSupport event="onchange" rerender="AutoCoverage"/>
- </apex:inputField>
- <apex:inputField value="{!certificateOfInsurance__c.Commercial_General_Liability__c}">
- <apex:actionSupport event="onchange" rerender="GeneralCoverage"/>
- </apex:inputField>
- <apex:inputField value="{!certificateOfInsurance__c.Umbrella_Liability__c}">
- <apex:actionSupport event="onchange" rerender="umbrella"/>
- </apex:inputField>
- <apex:inputField value="{!certificateOfINsurance__c.single_multiple_property__c}" required="{!contactDone}"/>
- </apex:pageBlockSection>
- </apex:pageBlock>
- <apex:pageBlock title="Coverage Details" id="Details" rendered="{!contactDone}">
- <apex:pageBlockButtons location="Bottom">
- <apex:commandButton action="{!createCert}" value="Save"/>
- <!--<apex:commandButton action="{!andNew}" value="Save and New"/>-->
- <apex:commandButton action="{!Cancel}" value="Cancel"/>
- </apex:pageBlockButtons>
- <apex:outputPanel id="AutoCoverage">
- <apex:pageBlockSection title="Auto Coverage(All Fields Required)" id="auto" rendered="{!certificateOfInsurance__c.Automobile_Liability__c}" >
- <apex:inputField value="{!certificateOfInsurance__c.Combined_Single_Limit_Ea_accident__c}" />
- <apex:inputField value="{!certificateOfInsurance__c.Bodily_Injury_Per_person__c}" />
- <apex:inputField value="{!certificateOfInsurance__c.Bodily_Injury_Per_accident__c}" />
- <apex:inputField value="{!certificateOfInsurance__c.Property_Damage_Per_accident__c}" />
- <apex:inputField value="{!certificateOfInsurance__c.Auto_Effective_Date__c}" />
- <apex:inputField value="{!certificateOfInsurance__c.Auto_Expiration_Date__c}" />
- <apex:inputField value="{!certificateOfInsurance__c.Covered_Vehicles__c}" />
- <apex:inputField value="{!certificateOfInsurance__c.Auto_Deductible__c}" />
- </apex:pageBlockSection>
- </apex:outputPanel>
- <apex:outputPanel id="GeneralCoverage">
- <apex:pageBlockSection title="Commercial General Liability Coverages(All Fields Required)" id="general" rendered="{!certificateOfInsurance__c.Commercial_General_Liability__c}">
- <apex:inputField value="{!certificateOfInsurance__c.GL_Each_Occurrence__c}"/>
- <apex:inputField value="{!certificateOfInsurance__c.Medical_Expenses__c}"/>
- <apex:inputField value="{!certificateOfInsurance__c.Personal_Adv_Injury__c}"/>
- <apex:inputField value="{!certificateOfInsurance__c.General_Aggregate__c}"/>
- <apex:inputField value="{!certificateOfInsurance__c.Products_Comp__c}"/>
- <apex:inputField value="{!certificateOfInsurance__c.General_Aggregate_Limit__c}"/>
- <apex:inputField value="{!certificateOfInsurance__c.GL_effective_date__c}"/>
- <apex:inputField value="{!certificateOfInsurance__c.GL_expiration_date__c}"/>
- <apex:inputField value="{!certificateOfInsurance__c.GL_Deductible__c}"/>
- </apex:pageBlockSection>
- </apex:outputPanel>
- <apex:outputPanel id="umbrella">
- <apex:pageBlockSection title="Umbrella Liability(All Fields Required)" rendered="{!certificateOfInsurance__c.Umbrella_Liability__c}">
- <apex:inputField value="{!certificateOfInsurance__c.Umbrella_Each_Occurrence__c}"/>
- <apex:inputField value="{!certificateOfInsurance__c.Aggregate__c}"/>
- <apex:inputField value="{!certificateOfInsurance__c.Umbrella_Effective_Date__c}"/>
- <apex:inputField value="{!certificateOfInsurance__c.Umbrella_Expiration_Date__c}"/>
- <apex:inputField value="{!certificateOfInsurance__c.Umbrella_Deductible__c}"/>
- </apex:pageBlockSection>
- </apex:outputPanel>
- </apex:pageBlock>
- </apex:outputPanel>
- </apex:form>
- </apex:page>
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