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LIABILITY - FARM AND RANCH OPERATIONS INCLUDING
AQUA-CULTURE
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Rating
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Land - Combined total
area of all owned, leased or vacant land
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Acres
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Step
1
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(640 acres = 1 sq. mile)
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Rating
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Animals and Crops - Total
acreage used for:
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Acres
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Step
2
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- Beekeeping, berries, crops, field or forage crops, flowers, fruits,
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grain, herbs, honey, legumes, mushrooms, nursery stock, nuts,
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plants, spices, sod, straw, trees, vegetables, vineyards
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- Do NOT include acreage devoted solely to the raising of animals
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Livestock - Total number
of head:
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Head
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- Cattle, dogs or cats being breed for sale, donkeys, goats, horses,
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mules, sheep, swine and exotics (alpaca, bison, deer, llamas, yaks)
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and any other similar animal types approved by Company
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- Do NOT include birds/poultry or animals being raised for their
fur
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Poultry and Birds - Total
annual receipts
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Receipts
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Aqua-Culture - Total annual
receipts
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Receipts
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Rating
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Business Activities -
Total COMBINED Annual Receipts
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Receipts
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Step
3
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(Select 'Yes' for each
box that applies, even if no receipts generated)
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Auctioneering
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Cabin or Vacation Rentals
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Campgrounds
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Christmas Tree Farms
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Corn Mazes
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Custom Farming
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Fishing Including Tournaments
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Food Sales - Roadside Stands,
Framers Markets
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Garden / Nursery Sales including
Pick-IT-Yourself
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Guides and Outfitters
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Hiking Trails
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Hunting on Insured's Premises
by Third Parties
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Pet Breeding (cats, dogs, rabbits)
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Picnic Grounds
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Pumpkin Patches
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Rental of Land, Structures for
business, Habitational or Farm/ranch uses
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Smoking of Meat Products
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Snow Removal
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Tours of Premises
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Wine Manufacturing, Processing,
Retail Sales
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Other: (list exposures below
- submit required)
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Rating
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ATV's, boats, Dwellings,
Lakes, Ponds, Pools, Reservoirs
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Step
4
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ATV's (Three wheel
trike type - Prohibited) - Total number
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#
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Boats - Maximum 50 hp
engine & maximum 26 foot length - Total
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#
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number
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Bunkhouses or Dormitories
- Total number of buildings (up to 12 beds
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#
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will count as 1 building)
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Dwellings - Owner and/or Non-Owned
Occupied - Number of Units
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#
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Lakes, Ponds, Reservoirs -
Total Acres
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Acres
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Swimming Pools - Fencing
mandatory, self locking gates, depth marked,
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#
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rules posted, safety equipment
provided - # of Units (In-ground only)
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FARM LIABILITY - COVERAGE
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LIMIT
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GENERAL AGGREGATE LIMIT
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-
Indicate your limit
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$
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-
Maximum limit is $2,000,000
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EACH OCCURRENCE LIMIT
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-
Indicate your limit
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$
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Maximum limit is $1,000,000
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PERSONAL AND ADVERTISING LIABILITY
- ANY ONE PERSON OR
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ORGANIZATION LIMIT
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Same as 'Each
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Maximum available limit is $1,000
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Occurrence' Limit
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FIRE DAMAGE LIMIT - ANY ONE
FIRE (PREMISES RENTED TO INSURED)
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-
No optional limits available
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$50,000
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MEDICAL PAYMENTS - ANY ONE
PERSON LIMIT (EXCEPT RESIDENT
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EMPLOYEES)
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$1,000
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-
No optional limits available
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FARM LIABILITY OPTIONS
(Select 'Yes' for those that apply):
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Liquor Legal Liability (available for Vineyard operations
only)
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- Limits are within Farm Liability limits stated above
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- Coverage option not available in AK, AL, CT, DC, DE, HI, IA, IL,
IN, MA, MD, ME, MI,
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MN, MO, NH, NJ, NY, OH, PA, RI, VA, VT, WV
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$
Annual receipts for liquor served on or off premises.
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Employees serving alcohol have some sort of liquor training such
as TIPS or TOPS
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Products / Completed Operations Exclusion - U0310
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Misc. (Describe)
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Misc. (Describe)
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COVERAGE E - SCHEDULED FARM PERSONAL PROPERTY
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CAUSES OF LOSS
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VALUATION
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Basic
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ACV at time of los
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Broad
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RC subject to policy conditions
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#
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ITEM
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LIMIT OF INSURANCE
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1
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Grain, threshed seeds, beans,
ground feed, silage, "livestock" feed, all in
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$
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buildings, structures, sacks,
wagons or trucks
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2
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Grain in stacks, shocks, swathes
or piles in the open.
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$
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3
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Hay, straw, fodder in building
or structures
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$
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(Maximum limit policy limit $25,000)
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4
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Hay, straw, fodder in the open
in stacks, windrows or bales
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$
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(Maximum available policy limit
is $10,000)
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5
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Farm products, materials, supplies.
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$
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This does NOT include hay, grain
or 'growing' crops.
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6
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"Poultry" (excluding
Turkeys unless specified) in the open
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NOT COVERED
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7
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"Poultry" (excluding
Turkeys unless specified) in the following "poultry"
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NOT COVERED
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buildings:
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8
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Trays, boxes, box shook (unassembled
wood crates)
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$
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9
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Computers & related software
that are part of the farming operations and
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$
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farm management processes
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10
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Misc. Equipment - Machinery,
vehicles, tools, supplies usual or incidental to
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$
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farm operations valued at $1000
per item or less. Declare as one blanket
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limit. (If you need off-premises
coverage schedule items individually under
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item # 12 below. Do NOT
include those values here.
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11
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Borrowed or rented, whether or
not under a written contract: farm
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$
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machinery, vehicles, equipment.
Declare as one blanket limit.
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12
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Farm Machinery, equipment or
vehicles - individually scheduled items
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LIMIT OF INSURANCE
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valued above $1000. Items
MUST be scheduled here if you need off
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premises coverage. Blanket
not available.
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Description - Make - Model
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$
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$
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$
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$
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$
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$
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(Email Brandy
at bweber@ciusgf.com if you need
to list additional items)
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13
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"Livestock" - Actual
Death/Destruction (includes Collision)
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$
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Covers cattle, donkeys, goats,
horses, mules, sheep, swine but not birds.
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Indicate below any of these exotics
that apply: alpaca, bison, deer, llamas, yaks
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Exotics:
Unlisted Exotics:
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14
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"Livestock" - Actual
Death/Destruction - Collision Only
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$
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Covers cattle, donkeys, goats,
horses, mules, sheep, swine but not birds.
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|
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Indicate below any of these exotics
that apply: alpaca, bison, deer, llamas, yaks
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Exotics:
Unlisted Exotics:
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15
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Bees (Blanket Value)
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$
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16
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Worms (Blanket Value)
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$
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17
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Fish (Blanket Value)
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$
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18
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Misc. (describe):
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$
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19
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Misc. (describe):
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$
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