Davidson Insurance Agency

 

Print the quote information sheet.

Mail, fax, call or e-mail the information to our office.

You will be contacted within 48 hours of submission. *

*48 hours only applies if it occurs during our regular office hours. All requests will be contacted.

Phone: 218-485-8735

Fax: 218-485-4169

E-mail: yvonne@davidson-agency.com

 

Farm Owners Quote Information

 

 

   o Primary Residence         o Secondary Residence

 

Named Insured:

DOB: ______/_____/______

 

Property Address:

SS# ______-_____-________

 

 

Marital Status (M) (S) (D) (W)

 

Mailing Address:

 

 

 

 

 

Second Insured:

DOB: ______/_____/______

 

 

SS# ______-_____-________

 

Current Insurance Company

Relationship to insured:

 

Current Limits of Liability

 

 

Current Deductible

 

 

 

 

 

Basic Home Information

Used to determine replacement cost

 

           Year Built

 

 

           Amp Service   o100    o200   other ______

 

 

Home Updates  -enter year and full or partial replacement       

 

 

           Wiring

 

 

           Plumbing

 

 

           Heating

 

 

           Roof

 

 

 

 

 

Dwelling Style:

Stories  o1   o1.5  o 2   oOther__

 

Foundation Type

Dimensions or sq.ft.

 

Basement  (Y) (N)  If yes, is it finished? _____% finished

 

 

Type of siding

Include dimensions

 

Type of Roof

Garage

 

Attachments?

Deck

 

Detached Structures?

Porch(es)

 

Pets or Exotic Animals

Breezeway

 

Type of Flooring

 

 

Type of Wall Finish

# of Kitchens

 

 

# of Bathrooms

 

Any wood burning devices

# of Acres

 

Miles to nearest fire station

Feet to fire hydrant

 

Claims (within last 5 years – include date)

 

 

 

 

 

SCHEDULED FARM PROPERTY

ESTIMATED VALUE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ADDITIONAL FARM COVERAGES

 

 

 

 

o

Earthquake Damage

 

o

Loss of Farm Income

 

o

Farm Extra Expense

 

o

Livestock Suffocation

 

o

Contaminated Milk Coverage

 

o

Farm Personal Property Transportation Coverage

 

o

Peak Season Coverage

 

o

Employers &/or Fire Legal Liability

 

o

Pollution Liability

 

o

Recreational or Watercraft Liability & Physical Damage

 

o

Equipment Breakdown Coverage

 

o

Damage due to weight of snow, ice, sleet

 

o

Increased Wind/Hail Deductible

 

o

Business Pursuits

 

o

Replacement of Farm Buildings

 

o

Additional Premises

 

o

Increase of Limits on Personal Property

 

o

 

 

o

 

 

o

 

 

o

 

 

o