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. Step 1 of 11 9% AGENCY INFOAgency Name First PhoneContact Name Agency Code FaxEmail* APPLICANT INFOFull Name* First Entity Type:**Entity Type:* (Select One)C- CorpIndividualLLCLLPPartnershipS - CorpSole ProprietorMailing Address* Email City* State* Zip* County* Phone*Farm Type*Farm Type:* (select one)LivestockCropsPleasure HorsesHobbyOtherTotal Acres Total Locations Locations w Buildings Last Annual ReceiptsRequested Effective Date MM slash DD slash YYYY LOCATION INFOAddress* City* County* State* Zip* Section Township Range Inside City Limits?* Yes No LIABILITY COVERAGE(S)Liability LimitSelect Liability Limit$300,000 / $600,000$500,000 / $1,000,000$1,000,000 / $2,000,000Medical Payments Limit:Select Medical Payments Limit$1,000$2,000$3,000$4,000$5,000$6,000$7,000$8,000$9,000$10,000Any business activities other than farming or ranching conducted at any insured location?*Any business activities other than farming or ranching conducted at any insured location?YesNoIf yes, please describe Dogs on Premises Breed Optional Coverages Any ATV’s?* Y N Year Make/Model Serial Number Limits Year Make/Model Serial Number Limits Any Horses? Y N Please Describe (How Used, How Many?)* DWELLINGCostimator 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 INFOYear Built* Mobile Home*Mobile Home: (select one)YesNoLiving Area Total sq ft* Select: Primary Secondary Tenant Occupied Roof Type*Roof Type: (select one)Asphalt ShingleClay TileConcrete TileMetalSlate TileSpanish TileTar & GravelWood or Shake ShingConstruction*Construction: (select type)Metal on MetalMetal on FrameFrameMasonryBrick VeneerOtherIf 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 DEVICESProtective 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 PROPERTYITEM 1Year Make Serial Number Model PerilSelect OneBasicBroadSpecialLimit DedSelect One$1000$2500$5000ITEM 2Year Make Serial Number Model PerilSelect OneBasicBroadSpecialLimit DedSelect One$1000$2500$5000ITEM 3Year Make Serial Number Model PerilSelect OneBasicBroadSpecialLimit DedSelect One$1000$2500$5000ITEM 4Year Make Serial Number Model PerilSelect OneBasicBroadSpecialLimit DedSelect One$1000$2500$5000ITEM 5Year Make Serial Number Model PerilSelect OneBasicBroadSpecialLimit DedSelect One$1000$2500$5000 BARNS AND OUTBUILDINGS(All values under $4,000: Type 3 - Any open building, all hay barns: Type 2 or 3, Barns over 1 story, Type 2- Must insure at least $7.50 per sq ft)Typical UseBarndominiumBarnLean-ToLoafing ShedHangerMachine ShedQuonset HutShopStableOtherStructure Function/UseOpen/ClosedSelect OneOpenClosedYear Sq Ft ConstructionSelect OneMetal on MetalMetal on FrameFrameMasonryBrick VeneerOtherRoof TypeSelect OneAsphalt ShingleClay TileConcrete TileMetalSlate TileSpanish TileTar & GravelWood or Shake ShingPerilSelect OneBasicBroadSpecialLimit DedSelect One$1000$2500$5000At Which Location #? RC or ACV RC (Replacement Cost) ACV (Actual Cash Value) Typical UseBarndominiumBarnLean-ToLoafing ShedHangerMachine ShedQuonset HutShopStableOtherStructure Function/UseOpen/ClosedSelect OneOpenClosedYear Sq Ft ConstructionSelect OneMetal on MetalMetal on FrameFrameMasonryBrick VeneerOtherRoof TypeSelect OneAsphalt ShingleClay TileConcrete TileMetalSlate TileSpanish TileTar & GravelWood or Shake ShingPerilSelect OneBasicBroadSpecialLimit DedSelect One$1000$2500$5000At Which Location #? RC or ACV RC (Replacement Cost) ACV (Actual Cash Value) Typical UseBarndominiumBarnLean-ToLoafing ShedHangerMachine ShedQuonset HutShopStableOtherStructure Function/UseOpen/ClosedSelect OneOpenClosedYear Sq Ft ConstructionSelect OneMetal on MetalMetal on FrameFrameMasonryBrick VeneerOtherRoof TypeSelect OneAsphalt ShingleClay TileConcrete TileMetalSlate TileSpanish TileTar & GravelWood or Shake ShingPerilSelect OneBasicBroadSpecialLimit DedSelect One$1000$2500$5000At Which Location #? RC or ACV RC (Replacement Cost) ACV (Actual Cash Value) Typical UseBarndominiumBarnLean-ToLoafing ShedHangerMachine ShedQuonset HutShopStableOtherStructure Function/UseOpen/ClosedSelect OneOpenClosedYear Sq Ft ConstructionSelect OneMetal on MetalMetal on FrameFrameMasonryBrick VeneerOtherRoof TypeSelect OneAsphalt ShingleClay TileConcrete TileMetalSlate TileSpanish TileTar & GravelWood or Shake ShingPerilSelect OneBasicBroadSpecialLimit DedSelect One$1000$2500$5000At Which Location # ? RC or ACV RC (Replacement Cost) ACV (Actual Cash Value) Typical UseBarndominiumBarnLean-ToLoafing ShedHangerMachine ShedQuonset HutShopStableOtherStructure Function/UseOpen/ClosedSelect OneOpenClosedYear Sq Ft ConstructionSelect OneMetal on MetalMetal on FrameFrameMasonryBrick VeneerOtherRoof TypeSelect OneAsphalt ShingleClay TileConcrete TileMetalSlate TileSpanish TileTar & GravelWood or Shake ShingPerilSelect OneBasicBroadSpecialLimit DedSelect One$1000$2500$5000At Which Location #? RC or ACV RC (Replacement Cost) ACV (Actual Cash Value) OPTIONAL PROPERTY COVERAGESDescription Limit of Insurance (if applicable) Description Limit of Insurance (if applicable) ADDITIONAL LOCATION ADDRESSESAdditional Location 2 (Two) Additional Location 4 (Four) Additional Location 3 (Three) 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 Carrier of Existing/Expiring Policy* Expiration Date of Existing Policy* Non-Renewed or Lapse?* Premium of Existing/Expiring Policy Notes or comments about the riskClick the SUBMIT button below to send your form electronically.You will receive a print / download link of your submission after sending.CommentsThis field is for validation purposes and should be left unchanged.
