Stroud Farm and Ranch Insurance Quote Request (ARU)

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1AGENCY INFO

2Operation Information

3Additional Named Insureds

4Locations

5Dwellings

6Outbuildings

7Farm Personal Property

8Poultry / Hog Additional Information

9Liability

10Secured Parties

11Loss History

URL

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

Policy Information

Agency Name*

First

Phone*

Contact Name*

Agency Code

Enter Agency Code here. If a new agent, write NEW.

Agency Address*

Email*

Named Insured

First

Entity Type:**

Insured Phone*

Home Phone

Cell Phone*

Address*

Street Address City State / Province / Region ZIP / Postal Code

Effective Date:*

MM slash DD slash YYYY

Prior Carrier:

Current Premium:*

Target Premium:*

Has the insured ever been cancelled for non-payment or loss history?*

Yes

If yes, please explain:*

Has the insured ever been convicted of arson?*

Yes

If yes, please explain:*

Has the insured ever filed for bankruptcy?*

Yes

If yes, please explain:*

Describe your business relationship with this prospective insured:

Describe how and when the information being submitted to ARU Underwriting was gathered:

Operation Information

Farming

Oil Seed or Grain

Soybean

Oilseed (except soybean)

Dry Pea/Bean

Wheat

Corn

Rice

Other

Vegetable or Melon

Potato

Other Vegetable or Melons

Fruit or Tree Nut

Orange Groves

Other Citrus Groves

Apple

Grape

Strawberry

Other

Other Crops

Tobacco

Cotton

Sugarcane

Hay

Sugarbeet

Peanut

Other

If 'Other' is selected on any of the Farming options, please list crops here.

Livestock

Cattle Ranching

Beef Cattle Ranching and Farming

Dairy Cattle Ranching and Farming

Dual Purpose Cattle Ranch

Hog/Pig

Farrow to Finish

Feeder Pig

Breeding, Farrowing, Nursery, and Finishing

Hog Feedlots (except stockyards for transportation

Pig

Swine

Weaning pig

Poultry

Chicken

Egg

Broiler

Turkey

All other Poultry

Sheep and Goat

Sheep

Goat

Other Animal

Horses and other Equine Production

Fur-bearing Animals

All Other

If 'Other' is selected on any of the Livestock options, please list livestock here.

Supporting Activities

Crop

Support activities for Crop Production

Animal

Boarding, Horseshoeing

Training (excludes racehorses)

Custom Farming receipts:

Rural Estate

Rural Estate / Hobby Farm

Rural Estate

If “other” was selected for any of the subtypes, please explain.

Additional Named Insureds

Additional Named Insured 1

Insured Type:

Insured Name:

First

Relationship to Insured:

Address

City

State

Zip

Additional Named Insured 2

+ Add Another Insured 2

Additional Named Insured 2

Entity Type:*

Insured Name:

First

Relationship to Insured:

Address

City

State

Zip

Additional Named Insured 3

+ Add Another Insured 3

Additional Named Insured 3

Entity Type:*

Insured Name:

First

Relationship to Insured:

Address

City

State

Zip

Additional Named Insured 4

+ Add Another Insured 4

Additional Named Insured 4

Entity Type:*

Insured Name:

First

Relationship to Insured:

Address

City

State

Zip

Locations

Location 1

Description:

Address

Street Address

City*

State*

Zip*

County*

Acres:*

Does this location have any structures or FPP?

Yes

Is there a 911 address?*

Yes

Please enter the address for 911 Purposes:

Street Address City State / Province / Region ZIP / Postal Code

If no 911 address, please provide GPS coordinates.*

Lat:

Long:

Add Additional Location 2

+ Add Additional Location 2

Location 2

Description:

Address

Street Address

City*

State*

Zip*

County*

Acres:*

Does this location have any structures or FPP?

Yes

Is there a 911 address? (2)*

Yes

Please enter the address for 911 Purposes:

Street Address City State / Province / Region ZIP / Postal Code

If no 911 address, please provide GPS coordinates. (2)*

Lat:

Long:

Add Additional Location 3

+ Add Additional Location 3

Location 3

Description:

Address

Street Address

City*

State*

Zip*

County*

Acres:*

Does this location have any structures or FPP?

Yes

Is there a 911 address? (3)*

Yes

Please enter the address for 911 Purposes:

Street Address City State / Province / Region ZIP / Postal Code

If no 911 address, please provide GPS coordinates. (3)*

Lat:

Long:

Add Additional Location 4

+ Add Additional Location 4

Location 4

Description:

Address

Street Address

City*

State*

Zip*

County*

Acres:*

Does this location have any structures or FPP?

Yes

Is there a 911 address? (4)*

Yes

Please enter the address for 911 Purposes:

Street Address City State / Province / Region ZIP / Postal Code

If no 911 address, please provide GPS coordinates. (4)*

Lat:

Long:

Add Additional Location 5

+ Add Additional Location 5

Location 5

Description:

Address

Street Address

City*

State*

Zip*

County*

Acres:*

Does this location have any structures or FPP?

Yes

Is there a 911 address? (5)*

Yes

Please enter the address for 911 Purposes:

Street Address City State / Province / Region ZIP / Postal Code

If no 911 address, please provide GPS coordinates. (5)*

Lat:

Long:

Add Additional Location 6

+ Add Additional Location 6

Location 6

Description:

Address

Street Address

City*

State*

Zip*

County*

Acres:*

Does this location have any structures or FPP?

Yes

Is there a 911 address? (6)*

Yes

Please enter the address for 911 Purposes:

Street Address City State / Province / Region ZIP / Postal Code

If no 911 address, please provide GPS coordinates. (6)*

Lat:

Long:

Dwellings

DWELLING 1

Location:*

Coverage Limit:*

Valuation:*

Replacement Cost

Actual Cash Value

Dwelling Type:*

Barndo

Single Family

Mobile Home

Other

Occupancy:*

Owner Occ Primary

Owner Occ Seasonal

Tenant Primary

Tenant Seasonal

Construction*

Roof Type*

Sq Ft:*

Primary Heat:

Addtl. Heat:

Is the dwelling unoccupied or vacant?*

Yes

Roof or Ground Mounted Solar:*

Yes

Any unrepaired damage or deficiencies?*

Yes

Any Solid Fuel device inside or adjacent?*

Yes

Is the home under repair, construction, or for sale?*

Explanation

Pool:*

Yes

Trampoline:*

Yes

Earthquake:*

Yes

Self-Latching Pool Fence:*

Yes

Diving Board and/or Slide:*

Yes

Mine Subsidence:*

Yes

Add Additional Dwelling

+ Add Additional Dwelling 2

Dwelling 2

Location:

Coverage Limit:

Valuation:

Replacement Cost

Actual Cash Value

Dwelling Type:

Barndo

Single Family

Mobile Home

Other

Occupancy:

Owner Occ Primary

Owner Occ Seasonal

Tenant Primary

Tenant Seasonal

Construction

Roof Type

Sq Ft:*

Primary Heat:

Addtl. Heat:

Is the dwelling unoccupied or vacant?

Yes

Roof or Ground Mounted Solar:

Yes

Any unrepaired damage or deficiencies?

Yes

Any Solid Fuel device inside or adjacent?

Yes

Is the home under repair, construction, or for sale? 2

Explanation

Pool:

Yes

Trampoline:

Yes

Earthquake:

Yes

Self-Latching Pool Fence:

Yes

Diving Board and/or Slide:

Yes

Mine Subsidence:

Yes

Add Additional Dwelling 3

+ Add Additional Dwelling 3

Dwelling 3

Location:

Coverage Limit:

Valuation:

Replacement Cost

Actual Cash Value

Dwelling Type:

Barndo

Single Family

Mobile Home

Other

Occupancy:

Owner Occ Primary

Owner Occ Seasonal

Tenant Primary

Tenant Seasonal

Construction

Roof Type

Sq Ft:*

Primary Heat:

Addtl. Heat:

Is the dwelling unoccupied or vacant?

Yes

Roof or Ground Mounted Solar:

Yes

Any unrepaired damage or deficiencies?

Yes

Any Solid Fuel device inside or adjacent?

Yes

Is the home under repair, construction, or for sale? 3

Explanation

Pool:

Yes

Trampoline:

Yes

Earthquake:

Yes

Self-Latching Pool Fence:

Yes

Diving Board and/or Slide:

Yes

Mine Subsidence:

Yes

Outbuildings

Outbuilding Number 1

Building Type

Coverage Limit:

Location:

Dimensions:*

Length:

Width:

Year of Original Construction:

Is hay ever stored in this outbuilding?*

Yes

Any solid fuel heat connected to or servicing this building?

Yes

Earthquake Coverage:

Yes

Mine Subsidence:

Yes

Outbuilding 1: Supplemental questions for poultry houses and hog confinements. (Skip if other building type)

Are There Any Breaker Panels (Including Sub Breaker Panels) in the Confinement Space?

Yes

Connected or Freestanding:

Connected

Freestanding

Roof Mounted Solar Panels:

Yes

Coverage for Weight of Ice/Sleet/Snow:

Most Coverage

Least rate

Coverage for Fire:

Most Coverage

Least rate

Number of Identical Structures:

Add Additional Outbuilding 2

+ Add Additional Outbuilding 2

Outbuilding Number 2

Building Type 2

Coverage Limit:

Location:

Dimensions:*

Length:

Width:

Year of Original Construction::

Is hay ever stored in this outbuilding?*

Yes

Any solid fuel heat connected to or servicing this building?

Yes

Earthquake Coverage:

Yes

Mine Subsidence:

Yes

Outbuilding 2: Supplemental questions for poultry houses and hog confinements.

Are There Any Breaker Panels (Including Sub Breaker Panels) in the Confinement Space?

Yes

Connected or Freestanding:

Connected

Freestanding

Roof Mounted Solar Panels:

Yes

Coverage for Weight of Ice/Sleet/Snow:

Most Coverage

Least rate

Coverage for Fire:

Most Coverage

Least rate

Number of Identical Structures:

Add Additional Outbuilding 3

+ Add Additional Outbuilding 3

Outbuilding Number 3

Building Type 3

Coverage Limit:

Location:

Dimensions:

Length:

Width:

Year of Original Construction::

Is hay ever stored in this outbuilding?*

Yes

Any solid fuel heat connected to or servicing this building?

Yes

Earthquake Coverage:

Yes

Mine Subsidence:

Yes

Outbuilding 3: Supplemental questions for poultry houses and hog confinements.

Are There Any Breaker Panels (Including Sub Breaker Panels) in the Confinement Space?

Yes

Connected or Freestanding:

Connected

Freestanding

Roof Mounted Solar Panels:

Yes

Coverage for Weight of Ice/Sleet/Snow:

Most Coverage

Least rate

Coverage for Fire:

Most Coverage

Least rate

Number of Identical Structures:

Add Additional Outbuilding 4

+ Add Additional Outbuilding 4

Outbuilding Number 4

Building Type 4

Coverage Limit:

Location:

Dimensions:

Length:

Width:

Year of Original Construction::

Is hay ever stored in this outbuilding?*

Yes

Any solid fuel heat connected to or servicing this building?

Yes

Earthquake Coverage:

Yes

Mine Subsidence:

Yes

Outbuilding 4: Supplemental questions for poultry houses and hog confinements.

Are There Any Breaker Panels (Including Sub Breaker Panels) in the Confinement Space?

Yes

Connected or Freestanding:

Connected

Freestanding

Roof Mounted Solar Panels:

Yes

Coverage for Weight of Ice/Sleet/Snow:

Most Coverage

Least rate

Coverage for Fire:

Most Coverage

Least rate

Number of Identical Structures:

Farm Personal Property

Item Number 1

Location :

Description:

Coverage Limit:

Year:

Make:

Model:

Serial Number:

Is this registered to be driven on public roadways?

Yes

(only applicable to ATVs, UTVs, 4 wheelers, and/or golf carts)

Add another Item 2

+ Add another Item 2

Item Number 2

Location :

Description:

Coverage Limit:

Year:

Make:

Model:

Serial Number:

Is this registered to be driven on public roadways?

Yes

(only applicable to ATVs, UTVs, 4 wheelers, and/or golf carts)

Add another Item 3

+ Add another Item 3

Item Number 3

Location :

Description:

Coverage Limit:

Year:

Make:

Model:

Serial Number:

Is this registered to be driven on public roadways?

Yes

(only applicable to ATVs, UTVs, 4 wheelers, and/or golf carts)

Add another Item 4

+ Add another Item 4

Item Number 4

Location :

Description:

Coverage Limit:*

Year:

Make:

Model:

Serial Number:

Is this registered to be driven on public roadways?

Yes

(only applicable to ATVs, UTVs, 4 wheelers, and/or golf carts)

Add another Item 5

+ Add another Item 5

Item Number 5

Location :

Description:

Coverage Limit:

Year:

Make:

Model:

Serial Number:

Is this registered to be driven on public roadways?

Yes

(only applicable to ATVs, UTVs, 4 wheelers, and/or golf carts)

Add another Item 6

+ Add another Item 6

Item Number 6

Location :

Description:

Coverage Limit:

Year:

Make:

Model:

Serial Number:

Is this registered to be driven on public roadways?

Yes

(only applicable to ATVs, UTVs, 4 wheelers, and/or golf carts)

Add another Item 7

+ Add another Item 7

Item Number 7

Location :

Description:

Coverage Limit:

Year:

Make:

Model:

Serial Number:

Is this registered to be driven on public roadways?

Yes

(only applicable to ATVs, UTVs, 4 wheelers, and/or golf carts)

Add another Item 8

+ Add another Item 8

Item Number 8

Location :

Description:

Coverage Limit:

Year:

Make:

Model:

Serial Number:

Is this registered to be driven on public roadways?

Yes

(only applicable to ATVs, UTVs, 4 wheelers, and/or golf carts)

Poultry / Hog Additional Information

Poultry Information:

Leave Blank if these fields don't apply to the account/risk in question.

Poultry Integrator:*

Poultry Specialty Coverage

Package Dependant (base amount included with package options)

$50,000 Aggregate Buy-up

$100,000 Aggregate Buy-up

$250,000 Aggregate Buy-up

*(Increased coverage is subject to prior underwriter approval.)

Poultry Specialty Overview: ARU's Poultry Specialty coverage provides a unique and needed blend of coverages for Integrator Contract Poultry Growers. Coverages that are worth noting include, but are not limited to:

Avian Flu Virus
Integrator Bankruptcy
LT Virus
Owner-Operator Temporary Labor
Poultry Vandalism
Public Utility Service and Infrastructure

Are any poultry houses listed being used for anything other than raising birds or eggs on behalf of an integrator?

Yes

Has any premise owned, managed, or grown under contract for the applicant had a case of, been quarantined due to, or culled due to Avian Influenza?

Yes

Hog Information:

Hog Integrator:

Liability

Farm and Personal Liability Amount:*

None

$100,000

$500,000

$1,000,000

Number of Full-Time Farm Employees:*

Number of Part-Time Farm Employees:*

Number of Owned or Leased Horses:*

Annual Farm Services for Hire Revenue:*

Any business other than the raising of crops and/or livestock for agricultural purposes?*

Yes

Does the Applicant sell any goods to the public?*

Yes

Is the public allowed on any premises?*

Yes

Any slaughtering, processing, or preparation of any product for the public?*

Yes

Are there any dogs?*

Yes

If yes, please list breeds:*

Any equine activity that is not on-premises, private, and personal pleasure use only? For example: boarding, training, lessons, shows, etc.*

Yes

Farm Employer's Liability:

$1,000

$50,000

$100,000

$250,000

Farm Pollution Limited Liability:

$1,000

$50,000

$100,000

$250,000

Fire Damage to Rented Premises Liability:

$1,000

$50,000

$100,000

$250,000

Legal Offense Limited Liability:

$1,000

$50,000

$100,000

$250,000

Please list any other liability coverages needed by the insured that are not listed above.

Secured Parties

Secured Party 1

Item Description:*

Loan Number:*

Mortgagee/Loss Payee:*

Address

Address/P.O. Box:

City

State*

ZIP

Add Additional Secured Parties 2

+ Add Additional Secured Parties 2

Secured Party 2

Item Description:*

Loan Number:*

Mortgagee/Loss Payee:*

Address

Address/P.O. Box:

City

State*

ZIP

Add Additional Secured Parties 3

+ Add Additional Secured Parties 3

Secured Party 3

Item Description:*

Loan Number:*

Mortgagee/Loss Payee:*

Address

Address/P.O. Box:

City

State*

ZIP

Add Additional Secured Parties 4

+ Add Additional Secured Parties 4

Secured Party 4

Item Description:*

Loan Number:*

Mortgagee/Loss Payee:*

Address

Address/P.O. Box:

City

State*

ZIP

Add Additional Secured Parties 5

+ Add Additional Secured Parties 5

Secured Party 5

Item Description:

Loan Number:

Mortgagee/Loss Payee:

Address

Address/P.O. Box:

City

State

ZIP

Loss History

Loss 1

Date

MM slash DD slash YYYY

Loss Type:

Payout:

Claim Details:

Claim Status:

Preventative Measures to Prevent Similar Losses:

Loss 2

Date

MM slash DD slash YYYY

Loss Type:

Payout:

Claim Details:

Claim Status:

Preventative Measures to Prevent Similar Losses:*

Loss 3

Date

MM slash DD slash YYYY

Loss Type:

Payout:

Claim Details:

Claim Status:

Preventative Measures to Prevent Similar Losses:

Loss 4

Date

MM slash DD slash YYYY

Loss Type:

Payout:

Claim Details:

Claim Status:

Preventative Measures to Prevent Similar Losses:

Loss 5

Date

MM slash DD slash YYYY

Loss Type:

Payout:

Claim Details:

Claim Status:

Preventative Measures to Prevent Similar Losses:

Additional Notes

Stroud Farm and Ranch Insurance Quote Request (ARU)

Are you an insurance agent seeking a quote?

Policy Information

Farming

Livestock

Supporting Activities

Rural Estate

Additional Named Insured 1

Additional Named Insured 2

Additional Named Insured 3

Additional Named Insured 4

Location 1

Location 2

Location 3

Location 4

Location 5

Location 6

DWELLING 1

Dwelling 2

Dwelling 3

Outbuilding Number 1

Outbuilding 1: Supplemental questions for poultry houses and hog confinements. (Skip if other building type)

Outbuilding Number 2

Outbuilding 2: Supplemental questions for poultry houses and hog confinements.

Outbuilding Number 3

Outbuilding 3: Supplemental questions for poultry houses and hog confinements.

Outbuilding Number 4

Outbuilding 4: Supplemental questions for poultry houses and hog confinements.

Item Number 1

Item Number 2

Item Number 3

Item Number 4

Item Number 5

Item Number 6

Item Number 7

Item Number 8

Poultry Information:

Hog Information:

Secured Party 1

Secured Party 2

Secured Party 3

Secured Party 4

Secured Party 5

Loss 1

Loss 2

Loss 3

Loss 4

Loss 5

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