Farm Insurance Quote Form

Page Insurance, Ltd

102 Boston Street

Guilford, CT 06437

(203) 453-5258

info@pageins.com

Name

First Name Last Name

Address

Street Address

Street Address Line 2

City State

Zip Code

Cell Phone Number

Area Code Phone Number

E-mail

Current Insurance Company

Policy Number

What is the total acreage of all land used for farming and related purposes?

Are all of the farming operations, outbuildings, farm personal property, and machinery located on the residence premises?

YesNo

If not, where are they located?

Describe the type of farming operation:

Is there a livestock exposure?

YesNo

If “Yes”, type of livestock:

Is Livestock Limited Mortality Coverage desired?

YesNo

If “Yes”, number of head:

Is fencing maintained and in good repair?

YesNo

Is your primary source of income received from your farming operation?

YesNo

Do your gross sales from your farming operations exceed (including tenant farmer rental income) $5,000 annually?

YesNo

Does your farming operation involve employees?

YesNo

Is the dwelling vacant or unoccupied?

YesNo

Is the farm operated by anyone other than the insured, or a tenant under the insured’s supervision?

YesNo

Does the farm involve labor intensive crops which have short harvest periods in which farming activity is heightened and an increased level of transporting crops to market?

YesNo

Any manufacturing, processing, or supplying commodities for manufacturing or processing; including creameries, dairies, freezing or dehydrating of plants?

YesNo

Any commercial milling operations, commercial hatcheries, raising of poultry, or custom crop drying operations?

YesNo

Any raising, boarding, training, racing or use of animals for riding or show purposes, other than personal use, 4-H, or FFA?

YesNo

Farming of fur bearing animals, such as mink, fox, or rabbit?

YesNo

Auctions involving sales of livestock or farm products?

YesNo

Hunting or fishing camps operated for the general public? Youth camps, vacation farms, bed and breakfast operations, dude or guest ranches, or barns used for public dances?

YesNo

Greenhouses, unless they are incidental to the operations and contain a total area less than 400 square feet?

YesNo

Do you allow the public to “pick your own produce?”

YesNo

Any buildings in poor condition, obsolete, or have little value with respect to the present operations or use of the land?

YesNo

If yes, please explain:

The basic Homeowner’s policy excludes Coverage B- for Other Structures used for "business.” It does however provide coverage if the structure contains business property solely owned by the insured, provided the “business” property does not include gaseous or liquid fuel, other than fuel in a permanently installed fuel tank of a vehicle or craft parked or stored in the structure.

The Coverage B limit is a limit for all structures on the “residence premises” set apart from the dwelling by a clear space. If a limit above Coverage B is needed, the Other Structures on the Residence Premises – Increased Limits endorsement, HO-0448, can be added for an additional premium.

Please complete the chart below for each farm outbuilding you would like covered. Please provide a clear photo of each outbuilding to be insured..

Building 1 - Type of Structure

Type Examples—one story barn, one story barn with loft, two story barn, livestock and feed barn, hay shed, granaryor feed handling building, or shop and machinery storage building

Building 1 - Square Footage

Building 1 - Complete Coverage Amount

Need to add more buildings?

YesNo

Building 2 - Type of Structure

Building 2 - Square Footage

Building 2 - Complete Coverage Amount

Building 3 - Type of Structure

Building 3 - Square Footage

Building 3 - Complete Coverage Amount

Please provide any additional comments or information:

General Information

Does the farming operation involve any of the following:

Farm Outbuildings