Farm/Ranch Insurance Quote Information. Full Name: Farm Name: Mailing Address: Property Address (If different):
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1 Farm/Ranch Insurance Quote Information Full Name: Farm Name: Mailing Address: Property Address (If different): Home Ph: Cell: Work Ph: Fax: Website: Name of Closest Fire Depart: Distance From Property: Is there a fire hydrant within 1000 ft of property? YES NO County Property is In: # of Acres: DWELLINGS: 1) Main Dwelling: Year Built: Year Updated and Updates: Square Footage: Est. Replacement Cost: Type of Exterior Construction: Type of Roof: Age of Roof: Type of Heating System: Age of Heating System: Type of Cooling System: Age of Cooling System: Is there a Central Station Alarm? or Local Alarm? Are there Smoke Alarms? Wired or Battery: 1) Other Dwelling: Year Built: Year Updated and Updates: Square Footage: Est. Replacement Cost: Type of Exterior Construction: Type of Roof: Age of Roof: Type of Heating System: Age of Heating System: Type of Cooling System: Age of Cooling System: Is there a Central Station Alarm? or Local Alarm? Are there Smoke Alarms? Wired or Battery:
2 2 If any dwelling is over 25 years old, please indicate when plumbing, heating/ac and wiring Year and what was updated: Is there a Mortgage on Property? Mortgage Company: Is your Premium Paid through your Mortgage Escrow? or Self? FARM BUILDINGS: Building #1: Use: Year Built: Building #2: Use: Year Built: Building #3: Use: Year Built: Building #4: Use: Year Built:
3 3 Building #5: Use: Year Built: (please copy this page if there are additional buildings to list) QUESTIONS: Have you had any claims or losses in the past three years? Describe losses with date, type of claim, and approximate amount paid: Do you operate any other type of business from your farm property? Brief Description: Do you own or operate any additional farm properties, or own a seasonal property such as a vacation home? Do you have: Swimming Pool: Enclosed by a Fence: Diving Board: Slide: Trampoline: Do you have: Dogs: # and Type: Personal Items: Do you have any personal items to schedule? (jewelry, guns, coins, anything of high value). Please attach a list with description, current value. Farm Machinery and Equipment: Make, Model, Value: Tack and Equipment Value: $
4 4 HORSE OPERATION: 1) How many horses do you Personally Own/Lease? Indicate #/Use: Show/Pleasure: How many taken off premise at one time? Breeding: Stallions: Stud Fee: Mares: Foals / Yearlings: Lesson Horses: How many taken off premise at one time? Other: Types of Horses/ Uses: 2) How many NON-OWNED horses are normally on your property: Indicate # of each: Boarding: Normal Monthly Boarding Charge: Training: Normal Monthly Training Charge: Breeding: Typical annual breeding receipts: Other: 3) Non-Owned Horse Values: (of horses on your property) Minimum Value: Average Value: Maximum Value: 4) Where are horses kept at night? Barn or pasture: 5) What type of Fencing do you have: 4) How many years experience do you have caring for horses: LESSONS / CLINICS / DAY CAMPS / HORSE OPERATION ACTIVITIES: 1) Do you give Riding Lessons? # per week: Charge/Lesson $ # of lessons on Client s horses per week: # of lessons on school horses per week: Who Gives Lessons: Self: How many years experience teaching: Independent Instructor: Names: Does Ind. Instructor have their own insurance? Lessons: English: Western: Jumping: other: 2) Do you hold Clinics on you property: How Many: Average # of participants: # Spectators: Gross Receipts:$ 3) Do you have Day Camps: # of Days: Minimum Age: Describe Activities: Gross Receipts: $
5 5 4) Do you have Horse Shows: # of Days: Avg # Participants: # Spectators: Gross Reciepts:$ Concession Stand? Gross Reciepts $ 5) Do you Sell Horses? # per year: Gross Receipts: 6) Do you Sell Tack and Clothing? Gross Receipts: 7) Do you Trailer horses for other people? # Horses per Trip: Mileage Radius Per Trip: Average # Trips Per Year: Trailer: (Type and capacity): 8) Are there any other equine activities on your property not mentioned above: (pony parties, etc) 9) How many years experience do have owning horses: EMPLOYEES: How many employees do you have? Full Time: Annual Payroll: Part Time: Annual Payroll: CURRENT INSURANCE with: Renewal Date: Signature: Date: Please fax back to , or sign, scan and .
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Texas Fair Plan Association FREQUENTLY ASKED QUESTIONS What is the Texas FAIR Plan Association and its purpose? The Texas FAIR Plan Association is an entity established by Texas Insurance Code Article