Equine Liability Quote - Quality Equine Insurance

Quality Equine Insurance
PO Box 339
Peculiar, MO 64078
800-581-7020
FAX 816-758-7475
Karen@qualityequineinsurance.com

Equine Liability Quote
To receive a free quote for your Equine liability coverage, complete the entire questionnaire and submit. Please allow up to three business days to obtain a quote.

Name
Farm Name
Property Address
City
State
County
Zip Code
Do you own or lease?	Own Lease
Home Phone
Work Phone
Fax Phone
Email
Mailing Address (if different from above. Please include City, State and Zip)
Number of Acres
Please describe any fencing
Have you had any claims in the past 5 years?
Have you been cancelled or non renewed in the past 5 years?
Name of current Insurance Company

Liability Limit (per occurrence):
Double Aggregate?
Personal Endorsement?	(Provides coverage for personal horses both on & off premises)
Professional Endorsement?	(Professional Equestrian Errors & Omissions coverage)
Products & Completed Operations?	(Provides coverage when a product you are responsible for causes bodily injury or property damage)
Total Number of Horses Owned / Leased by You or your Business:
Years of Experience with Horses
Years of Experience with this type of Operation
Any horses used for driving or pulling?
Any Race Horses?
Do you own dogs?
If Yes, how many?		What breeds?
Are other dogs permitted at your facility?
If yes, please describe your policy regarding dogs:

Any other animals on premises?
If yes, provide type, how many, and for what purpose:

Any hunting on premises?
If yes, please describe:
Swimming Pool on premises?		Is it fenced?
Is alcohol permitted on the premises?
If yes, please describe:
Is alcohol sold on the premises?
(Alcohol sales is not covered by this type of policy)

Breeding:
Total number of stallions standing stud:
What is average stud fee charged?
Total number of stallions standing off premise:
Total number of mares covered annually on premise
Total number of owned mares covered annually off premise:
Average Annual Revenue from Breeding

Horse Sales:
Average number of horses sold annually:
Average annual revenue from horse sales:

Boarding:
Average number of horses stalled monthly:
Average monthly charge for stalled horses:
Average number of horses pastured monthly:
Average monthly charge for pastured horses:
Who lives on the premises where horses are boarded?

Training:
Average number of horses in training monthly:
Average monthly charge for training:

Riding Lessons:
Are you over 21 years old?
Type of instruction:
Average number of weekly lessons given on client's horse(s):
Average number of weekly lessons on YOUR horse(s):
How many lesson horses do you own/lease?
Maximum number of horses used in group lesson:
Average charge per individual lesson:		Per Group Lesson:
Total annual revenues for riding lessons:
Any Day Camp Activities?
*If yes, please ask for additional Day Camp Form.

Independent Trainers / Instructors:
Do they carry their own insurance?
(If yes, provide proof of insurance at policy inception, if No please provide information below)
Name:		Years of Experience:
Name:		Years of Experience:
Name:		Years of Experience:

Clinics:
Do you offer clinics on premise?
Do you offer clinics off premise?
Annual revenues from clinics:
Maximum Number of Participants
Maximum Number or Spectators

Hosted Shows / Events:
How many show/event days per year?
Sanctioning organization:
Does above need to be listed as Additional Insured?
Description of show/event activities:

Maximum number of participants
Maximum number of spectators:
Annual revenues from hosted shows/events:

Do you offer pony rides?	(if yes please ask for the Pony Ride Form)
Do you offer Horse Drawn Vehicle rides?	(if yes please ask for the Horse Drawn Vehicle Ride Form)

Tack / Retail Sales:
Describe type and method of sales:

Annual revenues from above sales:

Do you offer Officiating or Judging?
Number of shows per year?

Care, Custody, and Control:
Protects you in the event a non-owned horse is injured or dies due to your negligence.
Maximum Limit per Horse/Aggregate Limit per Year
Do you transport horses in your care, custody, and control?
If yes, please describe the type and capacity of your horse trailer:

Landlords or Premise Owner
Do you need to list anyone as additional insured due to operating on their property?
If YES please list names and addresses for each additional insured.

Quality Equine Insurance
PO Box 339
Peculiar, MO 64078
800-581-7020
FAX 816-758-7475
Karen@qualityequineinsurance.com

We are horse people insuring the interests of horse people.
We represent only “A Rated” Insurance Companies to find the
coverage to personally fit your needs at a reasonable cost.

*** Licensed in all states except Alaska and Hawaii ***
(Trailer insurance not available in Florida)

A subsidiary of My Chance, LLC