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Stroud Farm Quote Request

Need a quote? Fill out the form below and send us your information and we’ll follow up with you shortly!
Please note: This form will generate a PDF that you can download and print for your records.
For assistance with your quote and / or additional guidance with regard to appetite and requirements, please contact us.

"*" indicates required fields

Step 1 of 11

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AGENCY INFO

Agency Name

First

Phone

Contact Name

Agency Code

Fax

Email*

APPLICANT INFO

Full Name*

First

Entity Type:**

Mailing Address*

Email

City*

State*

Zip*

County*

Phone*

Farm Type*

Total Acres

Total Locations

Locations w Buildings

Last Annual Receipts

Requested Effective Date

MM slash DD slash YYYY

LOCATION INFO

Address*

City*

County*

State*

Zip*

Section

Township

Range

Inside City Limits?*

Yes

No

LIABILITY COVERAGE(S)

Liability Limit

Medical Payments Limit:

Any business activities other than farming or ranching conducted at any insured location?*

If yes, please describe

Dogs on Premises

Breed

Optional Coverages

Any ATV’s?*

Y

N

ATV's Information*

Year

Make/Model

Serial Number

Limits

Any Horses?

Y

N

Please Describe (How Used, How Many?)*

DWELLING

Costimator is required for all dwellings over $500,000; Must be insured to at least 80% of value.

Perils:

Basic

Broad

Special/Broad

Special

Contents Only

Deductible:

$1,000

$2,500

$5,000

$10,000

$25,000

Contents Limit:

40%

50%

60%

70%

80%

Valuation:*

Replacement Cost

Actual Cash Value

Any Wildfire or Brush concerns within ¼ mile of Structures/Property?*

Y

N

If yes, please describe:*

DWELLING INFO

Year Built*

Mobile Home*

Living Area Total sq ft*

Select:

Primary

Secondary

Tenant Occupied

Roof Type*

Construction*

If Mobile, foundation*

Yes

No

Amount of Insurance: $*

Value at 100% Replacement Cost: $

Updates

Wiring Year

Plumbing Year:

Heating Year

Roof Year

Garage sq ft

Garage type:

Attached

Detached

Wood Stove:*

Yes

No

PROTECTIVE DEVICES

Protective Devices:*

Yes

No

If Yes, describe:*

Fire Protection: Within 5 miles of fire dept:*

Yes

No

Within 1000 ft of hydrant:*

Yes

No

ISO Rating

SCHEDULED FARM PERSONAL PROPERTY

Pieces of equipment?*

ITEM 1

Year*

Make*

Serial Number*

Model*

Peril*

Limit*

Ded*

ITEM 2

Year*

Make*

Serial Number*

Model*

Peril*

Limit*

Ded*

ITEM 3

Year*

Make*

Serial Number*

Model*

Peril*

Limit*

Ded*

ITEM 4

Year*

Make*

Serial Number*

Model*

Peril*

Limit*

Ded*

ITEM 5

Year*

Make*

Serial Number*

Model*

Peril*

Limit*

Ded*

BARNS AND OUTBUILDINGS

Number of Barns and Outbuildings*

Typical Use*

Structure Function/Use

Type*

Open/Closed*

Year*

Sq Ft*

Construction*

Roof Type*

Peril*

Limit*

Ded*

At Which Location # ?*

RC or ACV*

RC (Replacement Cost)

ACV (Actual Cash Value)

Typical Use*

Structure Function/Use

Type*

Open/Closed*

Year*

Sq Ft*

Construction*

Roof Type*

Peril*

Limit*

Ded*

At Which Location # ?*

RC or ACV*

RC (Replacement Cost)

ACV (Actual Cash Value)

Typical Use*

Structure Function/Use

Type*

Open/Closed*

Year*

Sq Ft*

Construction*

Roof Type*

Peril*

Limit*

Ded*

At Which Location # ?*

RC or ACV*

RC (Replacement Cost)

ACV (Actual Cash Value)

Typical Use*

Structure Function/Use

Type*

Open/Closed*

Year*

Sq Ft*

Construction*

Roof Type*

Peril*

Limit*

Ded*

At Which Location # ?*

RC or ACV*

RC (Replacement Cost)

ACV (Actual Cash Value)

OPTIONAL PROPERTY COVERAGES

Description

Limit of Insurance (if applicable)

Description

Limit of Insurance (if applicable)

ADDITIONAL LOCATION ADDRESSES

Additional Location 2 (Two)

Additional Location 3 (Three)

Additional Location 4 (Four)

APPLICANT'S LOSS HISTORY

(Last 5 years, regardless of location)

Consent*

All losses claimed within the past 5 years are stated below. I understand that by not listing any losses below, I am stating that the applicant certifies that there is no loss history to report over the past 5 years.*

If exact date of loss is not available, please give best estimate.

Date of Loss

Description

Amount

Date of Loss

Description

Amount

Date of Loss

Description

Amount

Expiration Date of Existing Policy*

Carrier of Existing/Expiring Policy*

Non-Renewed or Lapse?*

Premium of Existing/Expiring Policy

Notes or comments about the risk

Click the SUBMIT button below to send your form electronically.

You will receive a print / download link of your submission after sending.

Email

This field is for validation purposes and should be left unchanged.

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PHONE: 575-258-3377

TOLL FREE: 800-654-4056

FAX: 575-258-4413

OFFICE LOCATION:
1098 B Mechem Dr.
Ruidoso, NM 88345

MAILING ADDRESS:
Stroud National Agency
PO Box 3240
Ruidoso, NM 88355

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