Personal Farm Quote - Quality Equine Insurance

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

Personal Farm Quote
Protection for your home, barns, outbuildings, farm equipment, tack and personal liability coverage.
To receive a free quote for your personal farm with equine liability, complete the entire questionnaire and submit. Please allow up to three business days to obtain a quote.

If you have any of the following exposures, please use the Commercial Liability Form:
***Breeding - Boarding - Horse Sales - Training - Riding Lessons - Host Shows/Clinics - Tack/Retail Sales***

Thank you for contact Quality Equine Insurance.

If you have any of the following exposures, please use the Commercial Liability Form:
***Breeding - Boarding - Horse Sales - Training - Riding Lessons - Host Shows/Clinics - Tack/Retail Sales***

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, Hawaii and Wyoming ***
(Trailer insurance not available in Florida)

A subsidiary of My Chance, LLC

Name:
Farm Name:
Location Street Address:
City:
County:
State:
Zip Code:
Phone Number:
Email Address:
Number of Acres:
Mailing Address if different than above:
Any claims in past 3 years?	yes no
Name of Nearest Fire Department:
How far is Fire Department from the insured location?
Home/Dwelling
Deductible requested:
Occupied by:
Insured Value:
Year Built:
Type of Roof:	Age of Roof:
Type of Heating:	Age of Unit:
Wood Stove?	yes no
Describe Fencing:
Please let us know if you need coverage for special personal property items such as jewelry, furs, artwork, etc... We will be happy to quote that with your farm policy. Enter description below if applicable.
Barns/Out Buildings:
Building #1
Description or Use:
Insured Value:
Width & Length:
Year Built
Type of Roof:
Hay Storage?	yes no

Building #2
Description or Use:
Insured Value:
Width & Length:
Year Built
Type of Roof:
Hay Storage?	yes no

Building #3
Description or Use:
Insured Value:
Width & Length:
Year Built
Type of Roof:
Hay Storage?	yes no
To list additional buildings, use the space below, including the same information as above.
Scheduled Farm Property Individual items must not exceed $2,500 per item.
Tack, Grooming Equipment:
Small Tools & Supplies:
Office Equipment:
Barn Contents:

Please list below all Tractors, Implements and farm machinery or any items in the categories above valued over $2,500. Note: Hay and grain coverage provided only while stored in a building. Please include description, year, serial number and insured amount for each item where applicable.
Liability Section
Liability Limit (per occurrence):
Double Aggregate?	yes no
Personal Endorsement?	yes no (Provides coverage for personal horses both on & off premises)
Professional Endorsement?	yes no (Professional Equestrian Errors & Omissions coverage)
Products & Completed Operations?	yes no (Provides coverage when a product you are responsible for causes bodily injury or property damage)
Total Number of Horses You Own/Lease:
Do you own dogs?	yes no
If yes, how many?	What breeds?
Any other animals on premises?	What breed?
If yes, provide type, how many and for what purpose:

Any hunting on premises?	yes no
If yes, please describe:
Swimming Pool on premises?	yes no If, yes is it fenced? yes no