Farm and Ranch Owners Application Instructions
This form contains 686 fields organized into 120 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| Additional Comments and Information: | ||
| Additional Comments | Text |
Provide any additional comments or information in this field.
|
| Additional Interests Comments | ||
| Text577 | Text | |
| Additional Residence Rented to Others Address | ||
| Additional Residence Address List Information | Text |
Provide any necessary information or reference related to the attached list of addresses for additional residences rented to others. Fill only if 'CheckBox118' is 'Yes'.
Depends on:
CheckBox118
|
| CheckBox123 | CheckBox |
Depends on:
CheckBox120
|
| Agency Information | ||
| Text2 | Text | |
| Text3 | Text | |
| Text4 | Text | |
| Text5 | Text | |
| Text6 | Text | |
| Text7 | Text | |
| CheckBox15 | CheckBox | |
| CheckBox16 | CheckBox | |
| CheckBox17 | CheckBox | |
| CheckBox18 | CheckBox | |
| CheckBox31 | CheckBox | |
| CheckBox32 | CheckBox | |
| Ages of Children in Household | ||
| Ages of Children | Text |
Enter the ages of all children in the household who are under 25 years old. Fill only if 'CheckBox533' is 'Yes'.
Depends on:
CheckBox533
|
| All-Terrain Vehicle Details | ||
| Text130 | Text |
Depends on:
CheckBox129
|
| CheckBox141 | CheckBox |
Depends on:
CheckBox140
|
| Alternate Location Identification | ||
| GPS Coordinates | Text |
Enter the GPS coordinates for this alternate location. Fill only if 'Primary Location 1 Address' is not provided.
Depends on:
Primary Location 1 Address
|
| Miles from Closest Town | Number |
Provide the number of miles from this alternate location to the closest town. Fill only if 'Primary Location 1 Address' is not provided.
Depends on:
Primary Location 1 Address
|
| Section Number | Text |
Enter the section number for this alternate location. Fill only if 'Primary Location 1 Address' is not provided.
Depends on:
Primary Location 1 Address
|
| Range Number | Text |
Enter the range number for this alternate location. Fill only if 'Primary Location 1 Address' is not provided.
Depends on:
Primary Location 1 Address
|
| Township Number | Text |
Enter the township number for this alternate location. Fill only if 'Primary Location 1 Address' is not provided.
Depends on:
Primary Location 1 Address
|
| Animal Collision Details | ||
| Text231 | Text | |
| Text232 | Text | |
| CheckBox240 | CheckBox | |
| CheckBox241 | CheckBox | |
| CheckBox243 | CheckBox | |
| Annual Stove and Chimney Inspection | ||
| Annual Stove and Chimney Inspection Yes | Checkbox |
Check this box if the stove and chimney pipe are inspected and cleaned at least once a year. Fill only if 'CheckBox450' is 'Yes'.
Depends on:
CheckBox450
|
| Applicant Contact Information | ||
| Text23 | Text | |
| Text24 | Text | |
| Applicant Identification | ||
| Text13 | Text | |
| Text19 | Text | |
| CheckBox42 | CheckBox | |
| Applicant Name and Address | ||
| Text8 | Text | |
| Text9 | Text | |
| Text10 | Text | |
| Text11 | Text | |
| Text12 | Text | |
| CheckBox38 | CheckBox | |
| CheckBox39 | CheckBox | |
| CheckBox43 | CheckBox | |
| CheckBox46 | CheckBox |
Depends on:
Primary Location 1 Address
|
| CheckBox47 | CheckBox |
Depends on:
Primary Location 1 Address
|
| Applicant Underwriting Details | ||
| Text460 | Text | |
| CheckBox461 | CheckBox | |
| CheckBox462 | CheckBox | |
| CheckBox463 | CheckBox | |
| Text468 | Text | |
| CheckBox470 | CheckBox | |
| CheckBox471 | CheckBox | |
| Text475 | Text |
Depends on:
CheckBox474
|
| Borrowed/Rented Farm Equipment Limit | ||
| Borrowed/Rented Farm Equipment Limit | Number |
Enter the monetary limit for borrowed or rented farm equipment.
|
| CheckBox254 | CheckBox | |
| CheckBox255 | CheckBox | |
| CheckBox256 | CheckBox | |
| CheckBox263 | CheckBox | |
| CheckBox264 | CheckBox | |
| CheckBox266 | CheckBox | |
| CheckBox267 | CheckBox | |
| CheckBox268 | CheckBox | |
| Building Location in Flood Plain | ||
| CheckBox516 | CheckBox |
Depends on:
CheckBox514
|
| CheckBox517 | CheckBox |
Depends on:
CheckBox514
|
| Business and Coverage Dates | ||
| Text20 | Text | |
| Text21 | Text | |
| Text22 | Text | |
| Business Exposure Description | ||
| Text559 | Text |
Depends on:
CheckBox558
|
| Text562 | Text |
Depends on:
CheckBox561
|
| CheckBox564 | CheckBox | |
| CheckBox565 | CheckBox | |
| CheckBox591 | CheckBox | |
| CheckBox592 | CheckBox | |
| CheckBox593 | CheckBox |
Depends on:
CheckBox592
|
| CheckBox594 | CheckBox |
Depends on:
CheckBox592
|
| CheckBox595 | CheckBox |
Depends on:
CheckBox592
|
| CheckBox596 | CheckBox |
Depends on:
CheckBox592
|
| CheckBox597 | CheckBox |
Depends on:
CheckBox592
|
| Business on Premises | ||
| CheckBox153 | CheckBox | |
| CheckBox155 | CheckBox | |
| Business on Premises Description | ||
| Business on Premises Description | Text |
Enter a description of the business conducted on the premises, if it is not related to farming or ranching.
|
| Chemical Application License Information | ||
| Chemical Application License Number and Expiration Date | Text |
Enter the license number and its expiration date for chemical applications. Fill only if 'Licensed for Application of Chemicals - Yes' is 'Yes'.
Depends on:
Licensed for Application of Chemicals - Yes
|
| Comments | ||
| Location 1 Comments | Text |
Provide any additional comments or information regarding Primary Location # 1.
|
| Comments | Text |
Enter any additional comments or notes here. Fill only if 'CheckBox129' is 'Yes' and number of vehicles is > 1.
Depends on:
CheckBox129
|
| Text166 | Text | |
| Text488 | Text | |
| Comments | Text |
Provide any additional comments or relevant information.
|
| Comments: | ||
| Comments | Text |
Provide any additional comments or notes. Fill only if 'Monitored burglar or fire alarm?' is 'Yes'.
|
| Custom Farming Details | ||
| Harvest | Checkbox |
Check this box if the custom farming operation involves harvesting activities. Fill only if 'CheckBox120' is 'Yes'.
Depends on:
CheckBox120
|
| Custom Farming Amount of Receipts | Number |
Enter the total amount of receipts for custom farming. Fill only if 'CheckBox120' is 'Yes'.
Depends on:
CheckBox120
|
| Custom Farming Description | Text |
Provide a detailed description if custom farming is selected. Fill only if 'CheckBox120' is 'Yes'.
Depends on:
CheckBox120
|
| CheckBox127 | CheckBox | |
| CheckBox129 | CheckBox | |
| CheckBox131 | CheckBox | |
| CheckBox134 | CheckBox |
Depends on:
CheckBox131
|
| CheckBox135 | CheckBox |
Depends on:
CheckBox131
|
| Description of Operations | ||
| Description of Operations | Text |
Provide a detailed description of the farm or ranch operations.
|
| Owner/Member Names (Other than Individual) | Text |
Enter the names of owners or members if the legal entity is not an individual. Fill only if 'CheckBox15', 'CheckBox16', 'CheckBox17', 'CheckBox18' is 'Yes', any.
Depends on:
CheckBox15, CheckBox16, CheckBox17, CheckBox18
|
| Number of Cattle | Text |
Enter the total number of cattle.
|
| Number of Horses | Text |
Enter the total number of horses.
|
| Type of Crop or Ranch | Text |
Specify the type of crop grown or the type of ranch operation.
|
| Distance from Nearest Fire Station | ||
| Miles from Nearest Fire Station | Number |
Enter the number of miles from the nearest fire station.
|
| Dog Information | ||
| CheckBox536 | CheckBox | |
| CheckBox537 | CheckBox | |
| Text538 | Text |
Depends on:
CheckBox537
|
| CheckBox539 | CheckBox |
Depends on:
CheckBox537
|
| CheckBox540 | CheckBox |
Depends on:
CheckBox537
|
| Text541 | Text |
Depends on:
CheckBox540
|
| CheckBox542 | CheckBox | |
| CheckBox543 | CheckBox | |
| Down Payment | ||
| Text601 | Text |
Depends on:
CheckBox594, CheckBox595, CheckBox596, CheckBox597, CheckBox598, CheckBox599, CheckBox600
|
| Dwelling Number | ||
| Dwelling Number | Text |
Enter the dwelling number. Fill only if 'Central Heat/AC' is 'No'
|
| Earthquake Endorsement | ||
| Earthquake (FP1040) | Checkbox |
Check this box if you wish to add the Earthquake endorsement (FP1040) to your policy.
|
| Earthquake Endorsement Dwellings | Text |
Enter the number of dwellings to which the Earthquake Endorsement applies. Fill only if 'Earthquake (FP1040)' is 'Yes'.
Depends on:
Earthquake (FP1040)
|
| Exotic Wildlife | ||
| CheckBox157 | CheckBox | |
| CheckBox159 | CheckBox | |
| Exotic Wildlife Description | ||
| Type of Exotic Wildlife | Text |
Please enter the type of exotic wildlife.
|
| Facility and Equipment Information | ||
| Text544 | Text |
Depends on:
CheckBox543
|
| CheckBox545 | CheckBox |
Depends on:
CheckBox543
|
| CheckBox546 | CheckBox |
Depends on:
CheckBox543
|
| CheckBox547 | CheckBox | |
| CheckBox548 | CheckBox | |
| Text549 | Text |
Depends on:
CheckBox548
|
| CheckBox550 | CheckBox | |
| CheckBox551 | CheckBox | |
| Text552 | Text |
Depends on:
CheckBox551
|
| CheckBox553 | CheckBox |
Depends on:
CheckBox551
|
| CheckBox554 | CheckBox |
Depends on:
CheckBox551
|
| CheckBox555 | CheckBox |
Depends on:
CheckBox551
|
| CheckBox556 | CheckBox |
Depends on:
CheckBox551
|
| CheckBox557 | CheckBox | |
| CheckBox558 | CheckBox | |
| CheckBox560 | CheckBox | |
| CheckBox561 | CheckBox | |
| CheckBox563 | CheckBox | |
| Farm Computer Coverage Limit | ||
| Farm Computer Coverage | Checkbox |
Check this box to select Farm Computer Coverage, then specify the coverage limit.
|
| Farm Computer Coverage Limit | Number |
Enter the monetary limit for farm computer coverage. Fill only if 'Farm Computer Coverage' is 'Yes'.
Depends on:
Farm Computer Coverage
|
| Farm Employers Liability Payroll | ||
| Payroll Amount | Number |
Enter the payroll amount for Farm Employers Liability. Fill only if 'CheckBox127' is 'Yes'.
Depends on:
CheckBox127
|
| CheckBox140 | CheckBox | |
| Farm Equipment Maintenance and Security Protocols | ||
| Farm Equipment Maintenance and Security Protocols | Text |
Provide a detailed description of the maintenance protocols for farm equipment, including how it is stored and secured.
|
| Fifth Additional Location | ||
| Fifth Additional Location # of Acres | Number |
Enter the total number of acres for the fifth additional location.
|
| Fifth Additional Location Address | Text |
Provide the 911 address, coordinates, road name, or section/range/township for the fifth additional location.
|
| Fifth Additional Location Miles from Town | Number |
Enter the number of miles from the nearest town for the fifth additional location.
|
| Fifth Additional Location Direction | Text |
Specify the direction from the nearest town for the fifth additional location.
|
| Fifth Additional Location City | Text |
Enter the city of the fifth additional location.
|
| Fifth Additional Location Zip Code | Text |
Provide the zip code for the fifth additional location.
|
| Fifth Additional Location Rented to Others | Text |
Indicate if the fifth additional location is rented to others (Y for Yes, N for No).
|
| Fifth Additional Location Buildings | Text |
Indicate if there are buildings on the fifth additional location (Y for Yes, N for No).
|
| Fifth Equipment Item | ||
| Fifth Equipment Location | Text |
Enter the location where the fifth equipment item is kept.
|
| Fifth Equipment Limit | Number |
Enter the monetary limit for the fifth equipment item.
|
| Fifth Equipment Serial Number | Text |
Enter the serial number of the fifth equipment item.
|
| Fifth Equipment Year | Text |
Enter the manufacturing year of the fifth equipment item.
|
| Fifth Equipment Make | Text |
Enter the manufacturer or brand name of the fifth equipment item.
|
| Fifth Equipment Model | Text |
Enter the model name or number of the fifth equipment item.
|
| Fifth Equipment Item Description | Text |
Provide a detailed description of the fifth equipment item.
|
| Fire Extinguisher Presence | ||
| CheckBox491 | CheckBox | |
| CheckBox492 | CheckBox | |
| First Additional Insured | ||
| First Additional Insured Interest Description | Text |
Please provide a description of the interest for the first additional insured. Fill only if 'CheckBox140' is 'Yes'.
Depends on:
CheckBox140
|
| First Additional Insured Name | Text |
Please enter the full name of the first additional insured. Fill only if 'CheckBox140' is 'Yes'.
Depends on:
CheckBox140
|
| First Additional Insured Address | Text |
Please enter the full address of the first additional insured. Fill only if 'CheckBox140' is 'Yes'.
Depends on:
CheckBox140
|
| First Barn, Tank, Silo, or Fence | ||
| First Barn/Tank/Silo/Fence Location | Text |
Enter the physical location of the first barn, tank, silo, or fence.
|
| First Barns, Stables and Outbuildings | Checkbox |
Check this box if the first structure is a barn, stable, or outbuilding.
|
| First Tanks | Checkbox |
Check this box if the first structure is a tank.
|
| First Silos | Checkbox |
Check this box if the first structure is a silo.
|
| First Fences, Corrals/Chutes | Checkbox |
Check this box if the first structure consists of fences, corrals, or chutes.
|
| First Windmills | Checkbox |
Check this box if the first structure is a windmill.
|
| First Barn/Tank/Silo/Fence Description/Use | Text |
Provide a detailed description and intended use of the first barn, tank, silo, or fence.
|
| First Barn/Tank/Silo/Fence Longitude/Latitude | Text |
Enter the longitude and latitude coordinates for the first barn, tank, silo, or fence. Fill only if '911 Address' is not available
Depends on:
Primary Location 1 Address
|
| First Barn/Tank/Silo/Fence Limit | Number |
Enter the monetary limit for the first barn, tank, silo, or fence.
|
| First Deductible $1,000 | Checkbox |
Check this box if the deductible for the first structure is $1,000.
|
| First Deductible $2,500 | Checkbox |
Check this box if the deductible for the first structure is $2,500.
|
| First Deductible $5,000 | Checkbox |
Check this box if the deductible for the first structure is $5,000.
|
| First Deductible $10,000 | Checkbox |
Check this box if the deductible for the first structure is $10,000.
|
| First Perils Basic | Checkbox |
Check this box if the perils coverage for the first structure is Basic.
|
| First Perils Broad | Checkbox |
Check this box if the perils coverage for the first structure is Broad.
|
| First Perils Special | Checkbox |
Check this box if the perils coverage for the first structure is Special.
|
| First Construction Frame | Checkbox |
Check this box if the construction type for the first structure is Frame.
|
| First Construction Masonry | Checkbox |
Check this box if the construction type for the first structure is Masonry.
|
| First Barn/Tank/Silo/Fence Year Built | Text |
Enter the year the first barn, tank, silo, or fence was built.
|
| First Barn/Tank/Silo/Fence Square Footage | Number |
Enter the total square footage of the first barn, tank, silo, or fence.
|
| First Roof Type Asphalt Shingles | Checkbox |
Check this box if the roof type for the first structure is Asphalt Shingles.
|
| First Roof Type Concrete Tile | Checkbox |
Check this box if the roof type for the first structure is Concrete Tile.
|
| First Roof Type Metal | Checkbox |
Check this box if the roof type for the first structure is Metal.
|
| First Roof Type Wood | Checkbox |
Check this box if the roof type for the first structure is Wood.
|
| First Roof Type All Other | Checkbox |
Check this box if the roof type for the first structure is 'All Other'.
|
| First Barn/Tank/Silo/Fence Roof Age | Text |
Enter the age of the roof for the first barn, tank, silo, or fence in years.
|
| First Open Sides No | Checkbox |
Check this box if the first structure does not have open sides.
|
| First Open Sides Yes | Checkbox |
Check this box if the first structure has open sides.
|
| First Hay Storage No | Checkbox |
Check this box if the first structure is not used for hay storage.
|
| First Hay Storage Yes | Checkbox |
Check this box if the first structure is used for hay storage.
|
| First Exclude Wind/Hail TX Only | Checkbox |
Check this box if Wind/Hail coverage is to be excluded for the first structure, applicable only in Texas. Fill only if 'State' is 'TX'
Depends on:
Primary Location 1 State
|
| CheckBox348 | CheckBox | |
| CheckBox349 | CheckBox | |
| CheckBox350 | CheckBox | |
| CheckBox351 | CheckBox | |
| CheckBox352 | CheckBox | |
| CheckBox356 | CheckBox | |
| CheckBox357 | CheckBox | |
| CheckBox358 | CheckBox | |
| First Dwelling Caretaker Distance | ||
| Text178 | Text |
Depends on:
CheckBox177
|
| First Dwelling Comments | ||
| Text88 | Text |
Depends on:
CheckBox34
|
| First Dwelling Coverage Limits | ||
| Text179 | Text | |
| Text180 | Text | |
| Max 60 | Text | |
| Max 20% for primary | Text | |
| First Dwelling Location | ||
| Text167 | Text | |
| Text168 | Text | |
| Text169 | Text | |
| First Dwelling Number of Stories | ||
| Text46 | Text | |
| First Dwelling Property Details | ||
| Text186 | Text | |
| Text187 | Text | |
| First Dwelling Roof Age | ||
| Text31 | Text | |
| First Dwelling Smoke Alarm Count | ||
| Text32 | Text | |
| First Dwelling System Update Year | ||
| Text86 | Text |
Depends on:
Text186
|
| Text87 | Text |
Depends on:
Text186
|
| First Equipment Item | ||
| First Equipment Item Location | Text |
Enter the location where the first equipment item is stored or primarily used.
|
| First Equipment Item Limit | Number |
Enter the monetary limit for the first equipment item.
|
| First Equipment Item Serial Number | Text |
Enter the serial number for the first equipment item.
|
| First Equipment Item Year | Text |
Enter the year of manufacture for the first equipment item.
|
| First Equipment Item Make | Text |
Enter the manufacturer or make of the first equipment item.
|
| First Equipment Item Model | Text |
Enter the model of the first equipment item.
|
| First Equipment Item Description | Text |
Provide a detailed description of the first equipment item.
|
| First Equipment Item $10,000 Deductible | Checkbox |
Check this box if the deductible for the first equipment item is $10,000.
|
| CheckBox276 | CheckBox | |
| CheckBox277 | CheckBox | |
| CheckBox279 | CheckBox | |
| CheckBox280 | CheckBox | |
| CheckBox281 | CheckBox | |
| CheckBox282 | CheckBox | |
| CheckBox289 | CheckBox | |
| CheckBox290 | CheckBox | |
| CheckBox292 | CheckBox | |
| CheckBox293 | CheckBox | |
| CheckBox294 | CheckBox | |
| CheckBox295 | CheckBox | |
| First Prior Loss | ||
| Text578 | Text | |
| Text579 | Text | |
| Text580 | Text | |
| Flood Plain Building Description | ||
| Text512 | Text |
Depends on:
CheckBox511
|
| CheckBox518 | CheckBox |
Depends on:
CheckBox514
|
| Fourth Additional Location | ||
| Fourth Additional Location Acres | Number |
Enter the number of acres for the fourth additional location.
|
| Fourth Additional Location Address | Text |
Enter the 911 address, coordinates, road name, or section/range/township for the fourth additional location.
|
| Fourth Additional Location Miles from Town | Number |
Enter the number of miles from the nearest town for the fourth additional location.
|
| Fourth Additional Location Direction | Text |
Enter the direction from the nearest town for the fourth additional location.
|
| Fourth Additional Location City | Text |
Enter the city for the fourth additional location.
|
| Fourth Additional Location Zip Code | Text |
Enter the zip code for the fourth additional location.
|
| Fourth Additional Location Rented to Others | Text |
Indicate if the fourth additional location is rented to others (Y/N).
|
| Fourth Additional Location Buildings | Text |
Indicate if there are buildings at the fourth additional location (Y/N).
|
| Fourth Barn, Tank, Silo, or Fence | ||
| Text411 | Text | |
| Note use, unusual features, dimensions, and/or presence of living quarters | Text | |
| Text418 | Text | |
| Text419 | Text | |
| Text430 | Text | |
| Text431 | Text | |
| Text438 | Text | |
| CheckBox441 | CheckBox | |
| CheckBox442 | CheckBox | |
| CheckBox443 | CheckBox | |
| CheckBox24 | CheckBox | |
| Fourth Equipment Item | ||
| Fourth Equipment Item Location | Text |
Enter the location of the fourth equipment item.
|
| Fourth Equipment Item Limit | Number |
Enter the maximum financial limit for the fourth equipment item.
|
| Fourth Equipment Item Serial Number | Text |
Enter the serial number of the fourth equipment item.
|
| Fourth Equipment Item Year | Number |
Enter the manufacturing year of the fourth equipment item.
|
| Fourth Equipment Item Make | Text |
Enter the manufacturer or make of the fourth equipment item.
|
| Fourth Equipment Item Model | Text |
Enter the model of the fourth equipment item.
|
| Fourth Equipment Item Description | Text |
Provide a detailed description of the fourth equipment item.
|
| Fuel Type | ||
| Kerosene | Checkbox |
Check this box if Kerosene is the type of fuel used. Fill only if 'Central Heat/AC' is 'No'
|
| Natural Gas | Checkbox |
Check this box if Natural Gas is the type of fuel used. Fill only if 'Central Heat/AC' is 'No'
|
| Oil | Checkbox |
Check this box if Oil is the type of fuel used. Fill only if 'Central Heat/AC' is 'No'
|
| Electric | Checkbox |
Check this box if Electric is the type of fuel used. Fill only if 'Central Heat/AC' is 'No'
|
| Other | Checkbox |
Check this box if a type of fuel other than the listed options is used. Fill only if 'Central Heat/AC' is 'No'
|
| CheckBox456 | CheckBox | |
| General | ||
| Coverage A - Dwellings and Residential Structures | Checkbox |
Check this box to include Coverage A for dwellings and residential structures.
|
| Coverage C - Personal Property (household contents) | Checkbox |
Check this box to include Coverage C for personal property, including household contents.
|
| Coverage E - Equipment, Grain, Hay, or Livestock | Checkbox |
Check this box to include Coverage E for equipment, grain, hay, or livestock.
|
| Coverage G - Barns, Storage Tanks, Silos, or Fences | Checkbox |
Check this box to include Coverage G for barns, storage tanks, silos, or fences.
|
| Coverage H/I - Liability Occurrence Limit | Checkbox |
Check this box to include Coverage H/I with a specific Liability Occurrence Limit.
|
| H/I Liability Occurrence Limit $100,000 | Checkbox |
Check this box to select a $100,000 Liability Occurrence Limit for Coverage H/I.
|
| H/I Liability Occurrence Limit $300,000 | Checkbox |
Check this box to select a $300,000 Liability Occurrence Limit for Coverage H/I.
|
| H/I Liability Occurrence Limit $500,000 | Checkbox |
Check this box to select a $500,000 Liability Occurrence Limit for Coverage H/I.
|
| H/I Liability Occurrence Limit $1,000,000 | Checkbox |
Check this box to select a $1,000,000 Liability Occurrence Limit for Coverage H/I.
|
| Coverage H/I - General Aggregate Limit | Checkbox |
Check this box to include Coverage H/I with a specific General Aggregate Limit.
|
| H/I General Aggregate Limit Same as Occurrence | Checkbox |
Check this box to set the Coverage H/I General Aggregate Limit to be the same as the Occurrence Limit. Fill only if 'Coverage H/I - Liability Occurrence Limit' is selected.
Depends on:
Coverage H/I - Liability Occurrence Limit
|
| H/I General Aggregate Limit Double Occurrence | Checkbox |
Check this box to set the Coverage H/I General Aggregate Limit to be double the Occurrence Limit. Fill only if 'Coverage H/I - Liability Occurrence Limit' is selected.
Depends on:
Coverage H/I - Liability Occurrence Limit
|
| Coverage J - Medical Payment per person | Checkbox |
Check this box to include Coverage J with a specific Medical Payment limit per person.
|
| J Medical Payment per person $1,000 | Checkbox |
Check this box to select a $1,000 Medical Payment limit per person for Coverage J.
|
| J Medical Payment per person $3,000 | Checkbox |
Check this box to select a $3,000 Medical Payment limit per person for Coverage J.
|
| J Medical Payment per person $5,000 | Checkbox |
Check this box to select a $5,000 Medical Payment limit per person for Coverage J.
|
| J Medical Payment per person $10,000 | Checkbox |
Check this box to select a $10,000 Medical Payment limit per person for Coverage J.
|
| CheckBox170 | CheckBox | |
| CheckBox171 | CheckBox | |
| CheckBox172 | CheckBox | |
| CheckBox173 | CheckBox | |
| CheckBox174 | CheckBox | |
| CheckBox175 | CheckBox | |
| CheckBox176 | CheckBox |
Depends on:
CheckBox175
|
| CheckBox177 | CheckBox |
Depends on:
CheckBox175
|
| CheckBox183 | CheckBox | |
| CheckBox184 | CheckBox | |
| CheckBox185 | CheckBox | |
| CheckBox188 | CheckBox | |
| CheckBox189 | CheckBox | |
| CheckBox190 | CheckBox | |
| CheckBox191 | CheckBox | |
| CheckBox1 | CheckBox | |
| CheckBox2 | CheckBox | |
| CheckBox3 | CheckBox | |
| CheckBox4 | CheckBox | |
| CheckBox5 | CheckBox | |
| CheckBox6 | CheckBox | |
| CheckBox7 | CheckBox | |
| CheckBox8 | CheckBox | |
| CheckBox9 | CheckBox | |
| CheckBox10 | CheckBox | |
| CheckBox11 | CheckBox | |
| CheckBox12 | CheckBox | |
| CheckBox13 | CheckBox | |
| CheckBox19 | CheckBox | |
| CheckBox20 | CheckBox | |
| CheckBox21 | CheckBox | |
| CheckBox22 | CheckBox | |
| CheckBox23 | CheckBox | |
| CheckBox33 | CheckBox | |
| CheckBox34 | CheckBox | |
| CheckBox35 | CheckBox | |
| CheckBox36 | CheckBox | |
| CheckBox37 | CheckBox | |
| CheckBox40 | CheckBox | |
| CheckBox41 | CheckBox | |
| CheckBox44 | CheckBox | |
| CheckBox50 | CheckBox | |
| CheckBox51 | CheckBox | |
| CheckBox52 | CheckBox | |
| CheckBox53 | CheckBox | |
| CheckBox104 | CheckBox | |
| CheckBox106 | CheckBox | |
| CheckBox108 | CheckBox | |
| CheckBox111 | CheckBox | |
| CheckBox112 | CheckBox | |
| CheckBox113 | CheckBox | |
| CheckBox114 | CheckBox |
Depends on:
CheckBox113
|
| CheckBox115 | CheckBox |
Depends on:
CheckBox113
|
| CheckBox125 | CheckBox | |
| CheckBox126 | CheckBox | |
| CheckBox128 | CheckBox | |
| CheckBox132 | CheckBox | |
| CheckBox133 | CheckBox | |
| CheckBox136 | CheckBox | |
| CheckBox137 | CheckBox | |
| CheckBox138 | CheckBox | |
| CheckBox139 | CheckBox | |
| CheckBox143 | CheckBox | |
| CheckBox144 | CheckBox | |
| CheckBox145 | CheckBox | |
| CheckBox149 | CheckBox | |
| CheckBox150 | CheckBox | |
| CheckBox151 | CheckBox | |
| CheckBox152 | CheckBox | |
| CheckBox154 | CheckBox | |
| CheckBox156 | CheckBox | |
| CheckBox158 | CheckBox | |
| CheckBox166 | CheckBox | |
| CheckBox167 | CheckBox | |
| CheckBox168 | CheckBox | |
| CheckBox169 | CheckBox | |
| CheckBox178 | CheckBox | |
| CheckBox179 | CheckBox | |
| CheckBox186 | CheckBox | |
| CheckBox187 | CheckBox | |
| CheckBox192 | CheckBox | |
| CheckBox193 | CheckBox | |
| CheckBox194 | CheckBox | |
| CheckBox195 | CheckBox | |
| CheckBox196 | CheckBox | |
| CheckBox197 | CheckBox | |
| CheckBox199 | CheckBox | |
| CheckBox200 | CheckBox | |
| CheckBox201 | CheckBox | |
| CheckBox202 | CheckBox | |
| Portable Unit? No | Checkbox |
Check this box if the supplemental heating unit is not portable. Fill only if 'Central Heat/AC' is 'No'
|
| Text602 | Text | |
| Text603 | Text | |
| Text605 | Text | |
| Grain Limits | ||
| CheckBox206 | CheckBox | |
| Text207 | Text | |
| Text208 | Text | |
| CheckBox209 | CheckBox | |
| CheckBox210 | CheckBox | |
| CheckBox211 | CheckBox | |
| CheckBox212 | CheckBox | |
| CheckBox213 | CheckBox | |
| CheckBox214 | CheckBox | |
| CheckBox215 | CheckBox | |
| CheckBox218 | CheckBox | |
| Hay, Straw, and Fodder Limits | ||
| 25k per barn max | Text | |
| 10k per stack limit; 100' spread between stacks | Text | |
| CheckBox219 | CheckBox | |
| CheckBox220 | CheckBox | |
| CheckBox221 | CheckBox | |
| CheckBox225 | CheckBox | |
| CheckBox226 | CheckBox | |
| CheckBox227 | CheckBox | |
| Hold Harmless Agreements Obtained | ||
| CheckBox165 | CheckBox |
Depends on:
Recreational Use by Others - Yes
|
| Horse Boarding/Training/Breeding Question | ||
| CheckBox162 | CheckBox |
Depends on:
Recreational Use by Others - Yes
|
| CheckBox163 | CheckBox |
Depends on:
Recreational Use by Others - Yes
|
| CheckBox164 | CheckBox |
Depends on:
Recreational Use by Others - Yes
|
| Hunting and Fishing Liability Receipts | ||
| Hunting and Fishing Liability (CLFL0101) | Checkbox |
Check this box if you want to include Hunting and Fishing Liability coverage.
|
| Hunting and Fishing Liability Receipts | Number |
Enter the total amount of receipts for hunting and fishing liability. Fill only if 'Hunting and Fishing Liability (CLFL0101)' is 'Yes'.
Depends on:
Hunting and Fishing Liability (CLFL0101)
|
| Increased Special Limits | ||
| CheckBox109 | CheckBox | |
| CheckBox110 | CheckBox | |
| Jewelry Amount | Number |
Enter the dollar amount for jewelry. Fill only if 'CheckBox110' is 'Yes'.
Depends on:
CheckBox110
|
| Silverware Amount | Number |
Enter the dollar amount for silverware. Fill only if 'CheckBox110' is 'Yes'.
Depends on:
CheckBox110
|
| Firearms Amount | Number |
Enter the dollar amount for firearms. Fill only if 'CheckBox110' is 'Yes'.
Depends on:
CheckBox110
|
| Money Amount | Number |
Enter the dollar amount for money. Fill only if 'CheckBox110' is 'Yes'.
Depends on:
CheckBox110
|
| Securities Amount | Number |
Enter the dollar amount for securities. Fill only if 'CheckBox110' is 'Yes'.
Depends on:
CheckBox110
|
| CheckBox116 | CheckBox | |
| CheckBox118 | CheckBox | |
| CheckBox120 | CheckBox | |
| CheckBox121 | CheckBox |
Depends on:
CheckBox120
|
| Installation Status | ||
| Permanently Installed - Yes | Checkbox |
Check this box if the heating unit is permanently installed. Fill only if 'Central Heat/AC' is 'No'
|
| CheckBox450 | CheckBox | |
| Insurance History | ||
| CheckBox480 | CheckBox | |
| CheckBox481 | CheckBox | |
| CheckBox482 | CheckBox | |
| CheckBox483 | CheckBox | |
| Text484 | Text |
Depends on:
CheckBox483
|
| CheckBox485 | CheckBox | |
| CheckBox486 | CheckBox | |
| Text487 | Text |
Depends on:
CheckBox486
|
| Leased/Rented Location Details | ||
| CheckBox464 | CheckBox | |
| CheckBox465 | CheckBox | |
| CheckBox466 | CheckBox | |
| CheckBox467 | CheckBox | |
| CheckBox469 | CheckBox | |
| CheckBox472 | CheckBox | |
| CheckBox473 | CheckBox | |
| CheckBox474 | CheckBox | |
| Text476 | Text | |
| CheckBox477 | CheckBox | |
| CheckBox478 | CheckBox | |
| Text479 | Text |
Depends on:
CheckBox478
|
| Legal Entity | ||
| East | Checkbox |
Check this box if the direction from the closest town is East. Fill only if 'Primary Location 1 Address' is not provided.
Depends on:
Primary Location 1 Address
|
| West | Checkbox |
Check this box if the direction from the closest town is West. Fill only if 'Primary Location 1 Address' is not provided.
Depends on:
Primary Location 1 Address
|
| Livestock Fencing Status | ||
| CheckBox493 | CheckBox | |
| CheckBox494 | CheckBox | |
| CheckBox495 | CheckBox | |
| Loss Payee Information | ||
| Text572 | Text | |
| Loss Payee Address Line 1 | Text |
Enter the first line of the loss payee's street address.
|
| Loss Payee Address Line 2 | Text |
Enter the second line of the loss payee's street address, if applicable.
|
| Loss Payee City/State/Zip | Text |
Enter the city, state, and zip code of the loss payee.
|
| Loss Payee Interest | Text |
Describe the nature of the loss payee's interest in the insured property.
|
| Miscellaneous Farm Equipment Limit | ||
| Text234 | Text | |
| CheckBox244 | CheckBox | |
| CheckBox245 | CheckBox | |
| CheckBox246 | CheckBox | |
| CheckBox247 | CheckBox | |
| CheckBox248 | CheckBox | |
| CheckBox250 | CheckBox | |
| CheckBox251 | CheckBox | |
| CheckBox253 | CheckBox | |
| Mortgagee Information | ||
| Text567 | Text | |
| Text568 | Text | |
| Text569 | Text | |
| Text570 | Text | |
| Text571 | Text | |
| CheckBox599 | CheckBox |
Depends on:
CheckBox592
|
| CheckBox600 | CheckBox |
Depends on:
CheckBox592
|
| Other Property Description | ||
| Text509 | Text |
Depends on:
CheckBox508
|
| CheckBox514 | CheckBox | |
| Other Property Ownership | ||
| CheckBox511 | CheckBox | |
| CheckBox513 | CheckBox | |
| Portable Unit Status | ||
| Portable Unit Yes | Checkbox |
Check this box if the unit is portable. Fill only if 'Central Heat/AC' is 'No'
|
| Permanently Installed No | Checkbox |
Check this box if the unit is not permanently installed. Fill only if 'Central Heat/AC' is 'No'
|
| Presence of Unusual Hazards | ||
| Licensed for Application of Chemicals - No | Checkbox |
Check this box if the applicant is not licensed for the application of chemicals.
|
| Licensed for Application of Chemicals - Yes | Checkbox |
Check this box if the applicant is licensed for the application of chemicals and needs to provide their license number and expiration date.
|
| Primary Location City/State/Zip/County | ||
| Primary Location 1 City | Text |
Enter the city for Primary Location 1.
|
| Primary Location 1 State | Text |
Enter the state for Primary Location 1.
|
| Primary Location 1 Zip | Text |
Enter the ZIP code for Primary Location 1.
|
| Primary Location 1 County | Text |
Enter the county for Primary Location 1.
|
| Primary Location Details | ||
| Primary Location 1 Number of Acres | Number |
Enter the total number of acres for primary location 1.
|
| Primary Location 1 Address | Text |
Provide the 911 address or the nearest road/intersection for primary location 1.
|
| Prior Carrier Information | ||
| Text588 | Text | |
| Text589 | Text | |
| Text590 | Text | |
| Prior Losses Comments | ||
| Text587 | Text | |
| Product Sales Description | ||
| Product Sales Description | Text |
Provide a detailed description of any products sold by the applicant, including whether they are their own or someone else's. Fill only if 'CheckBox527' is 'Yes'.
Depends on:
CheckBox527
|
| Proper Clearance Maintenance | ||
| Proper Clearances Maintained: Yes | Checkbox |
Check this box if proper clearances are being maintained between the heating device and any combustible materials. Fill only if 'Central Heat/AC' is 'No'
|
| Stove/Chimney Pipe Inspected Annually: No | Checkbox |
Check this box if the stove and chimney pipe are NOT inspected and cleaned at least once a year. Fill only if 'CheckBox450' is 'Yes'.
Depends on:
CheckBox450
|
| Property and Liability Comments | ||
| Text566 | Text | |
| CheckBox598 | CheckBox |
Depends on:
CheckBox592
|
| Property Inspection Date | ||
| Text489 | Text | |
| CheckBox490 | CheckBox | |
| Public Farm Operations | ||
| CheckBox533 | CheckBox | |
| Public Farm Operations Description | ||
| Public Farm Operations Description | Text |
Please describe the public farm operations, including U-Pick, community gardens, auction sales, swap meets, sales, or food/beverage service activities. Fill only if 'CheckBox524' is 'Yes'.
Depends on:
CheckBox524
|
| Recreational Pond or Lake Description | ||
| CheckBox510 | CheckBox | |
| Recreational Pond or Lake Use | ||
| CheckBox507 | CheckBox | |
| CheckBox508 | CheckBox | |
| Recreational Pond/Lake Description | ||
| Text506 | Text |
Depends on:
CheckBox505
|
| Recreational Use by Others | ||
| Recreational Use by Others - No | Checkbox |
Check this box if the applicant does not board, train, or breed horses for others for recreational use by others.
|
| Recreational Use by Others - Yes | Checkbox |
Check this box if the applicant does board, train, or breed horses for others for recreational use by others.
|
| Recreational Use by Others Description | ||
| Recreational Use by Others Description | Text |
Provide a description of the recreational use by others.
|
| Scheduled Livestock Details | ||
| Text222 | Text | |
| Text223 | Text | |
| Text224 | Text | |
| CheckBox228 | CheckBox | |
| CheckBox229 | CheckBox | |
| Do not choose if Scheduled Livestock requested (collision is included peril for basic/broad) | CheckBox | |
| See definition on FP0013: Covg E, item h | CheckBox | |
| CheckBox235 | CheckBox | |
| CheckBox236 | CheckBox | |
| CheckBox237 | CheckBox | |
| CheckBox238 | CheckBox | |
| CheckBox239 | CheckBox | |
| Second Additional Insured | ||
| Second Additional Insured Interest Description | Text |
Enter a description of the interest for the second additional insured. Fill only if 'CheckBox146' is 'Yes'.
Depends on:
CheckBox146
|
| Second Additional Insured Name | Text |
Enter the full name of the second additional insured. Fill only if 'CheckBox146' is 'Yes'.
Depends on:
CheckBox146
|
| Second Additional Insured Address | Text |
Enter the full address of the second additional insured. Fill only if 'CheckBox146' is 'Yes'.
Depends on:
CheckBox146
|
| Second Additional Location | ||
| Second Location Number of Acres | Number |
Enter the total number of acres for the second additional location.
|
| Second Location 911 Address or Coordinates | Text |
Provide the 911 address, coordinates, road name, or section/range/township for the second additional location.
|
| Second Location Miles from Town | Number |
Enter the number of miles from the nearest town for the second additional location.
|
| Second Location Direction from Town | Text |
Enter the direction from the nearest town for the second additional location.
|
| Second Location City | Text |
Enter the city of the second additional location.
|
| Second Location Zip Code | Text |
Enter the zip code for the second additional location.
|
| Second Location Rented to Others | Text |
Indicate whether the second additional location is rented or leased to others (Y/N).
|
| Second Location Buildings on Property | Text |
Indicate whether there are buildings on the second additional location (Y/N).
|
| Second Barn, Tank, Silo, or Fence | ||
| Text347 | Text | |
| Note use, unusual features, dimensions, and/or presence of living quarters | Text | |
| Text354 | Text | |
| Text355 | Text | |
| CheckBox359 | CheckBox | |
| CheckBox360 | CheckBox | |
| CheckBox361 | CheckBox | |
| CheckBox362 | CheckBox | |
| CheckBox363 | CheckBox | |
| CheckBox364 | CheckBox | |
| CheckBox365 | CheckBox | |
| Text366 | Text | |
| Text367 | Text | |
| CheckBox368 | CheckBox | |
| CheckBox369 | CheckBox | |
| CheckBox370 | CheckBox | |
| CheckBox371 | CheckBox | |
| CheckBox372 | CheckBox | |
| Text373 | Text | |
| CheckBox374 | CheckBox | |
| CheckBox375 | CheckBox | |
| CheckBox376 | CheckBox | |
| CheckBox377 | CheckBox | |
| CheckBox378 | CheckBox | |
| CheckBox380 | CheckBox | |
| CheckBox381 | CheckBox | |
| CheckBox382 | CheckBox | |
| CheckBox383 | CheckBox | |
| CheckBox384 | CheckBox | |
| CheckBox388 | CheckBox | |
| CheckBox389 | CheckBox | |
| CheckBox390 | CheckBox | |
| CheckBox391 | CheckBox | |
| CheckBox392 | CheckBox | |
| CheckBox393 | CheckBox | |
| CheckBox394 | CheckBox | |
| CheckBox395 | CheckBox | |
| CheckBox396 | CheckBox | |
| CheckBox397 | CheckBox | |
| Second Dwelling Caretaker Distance | ||
| Text116 | Text |
Depends on:
CheckBox115
|
| Second Dwelling Comments | ||
| Text205 | Text |
Depends on:
CheckBox187
|
| Second Dwelling Coverage Limits | ||
| Text118 | Text | |
| Text120 | Text | |
| Max 60 | Text | |
| Max 20% for primary | Text | |
| Second Dwelling Location | ||
| Second Dwelling Location Number | Text |
Enter the location number for the second dwelling. Fill only if 'Additional Residence Rented to Others (FL0406)' is 'Yes'
Depends on:
CheckBox118
|
| Second Dwelling Number | Text |
Enter the dwelling number for the second dwelling. Fill only if 'Additional Residence Rented to Others (FL0406)' is 'Yes'
Depends on:
CheckBox118
|
| Second Dwelling Longitude/Latitude Coordinates | Text |
Enter the longitude and latitude coordinates for the second dwelling. Fill only if 'Additional Residence Rented to Others (FL0406)' is 'Yes'
Depends on:
CheckBox118
|
| Second Dwelling Number of Stories | ||
| Text198 | Text | |
| Second Dwelling Property Details | ||
| Text129 | Text | |
| Text131 | Text | |
| Second Dwelling Roof Age | ||
| Text183 | Text | |
| Second Dwelling Smoke Alarm Count | ||
| Text184 | Text | |
| Second Dwelling System Update Year | ||
| Text203 | Text |
Depends on:
Text129
|
| Text204 | Text |
Depends on:
Text129
|
| Second Equipment Item | ||
| Second Equipment Item Location | Text |
Enter the location of the second equipment item.
|
| Second Equipment Item Limit | Number |
Enter the monetary limit for the second equipment item.
|
| Second Equipment Item Serial Number | Text |
Enter the serial number of the second equipment item.
|
| Second Equipment Item Year | Text |
Enter the manufacturing or model year of the second equipment item.
|
| Second Equipment Item Make | Text |
Enter the make or manufacturer of the second equipment item.
|
| Second Equipment Item Model | Text |
Enter the model of the second equipment item.
|
| Second Equipment Item Description | Text |
Provide a detailed description of the second equipment item.
|
| Second Equipment Item - Standard Farm Equipment | Checkbox |
Check this box if the second equipment item is standard farm equipment.
|
| Second Equipment Item - Harvesting, Irrigation, Recreational, or Excavating Equipment | Checkbox |
Check this box if the second equipment item is harvesting, irrigation, recreational, or excavating equipment.
|
| Second Equipment Item - Deductible $1,000 | Checkbox |
Check this box if the deductible for the second equipment item is $1,000.
|
| Second Equipment Item - Deductible $2,500 | Checkbox |
Check this box if the deductible for the second equipment item is $2,500.
|
| Second Equipment Item - Deductible $5,000 | Checkbox |
Check this box if the deductible for the second equipment item is $5,000.
|
| Second Equipment Item - Deductible $10,000 | Checkbox |
Check this box if the deductible for the second equipment item is $10,000.
|
| Second Prior Loss | ||
| Text581 | Text | |
| Text582 | Text | |
| Text583 | Text | |
| Swimming Pool Features | ||
| CheckBox496 | CheckBox | |
| CheckBox497 | CheckBox |
Depends on:
CheckBox496
|
| CheckBox498 | CheckBox |
Depends on:
CheckBox496
|
| CheckBox499 | CheckBox |
Depends on:
CheckBox496
|
| CheckBox500 | CheckBox |
Depends on:
CheckBox496
|
| CheckBox502 | CheckBox | |
| Swimming Pool Fencing Description | ||
| CheckBox503 | CheckBox | |
| Swimming Pool Fencing/Security Description | ||
| Text501 | Text |
Depends on:
CheckBox496
|
| Third Additional Location | ||
| Third Additional Location - Number of Acres | Number |
Please enter the total number of acres for the third additional location.
|
| Third Additional Location - Address | Text |
Please provide the 911 address, coordinates, road name, or section/range/township for the third additional location.
|
| Third Additional Location - Miles from Town | Number |
Please enter the number of miles from the nearest town for the third additional location.
|
| Third Additional Location - Direction from Town | Text |
Please specify the direction from the nearest town for the third additional location.
|
| Third Additional Location - City | Text |
Please enter the city for the third additional location.
|
| Third Additional Location - Zip Code | Text |
Please enter the zip code for the third additional location.
|
| Third Additional Location - Rented to Others | Text |
Please indicate whether the third additional location is rented to others (Yes/No or Y/N).
|
| Third Additional Location - Buildings Present | Text |
Please indicate whether buildings are present at the third additional location (Yes/No or Y/N).
|
| Third Barn, Tank, Silo, or Fence | ||
| Text379 | Text | |
| Note use, unusual features, dimensions, and/or presence of living quarters | Text | |
| Text386 | Text | |
| Text387 | Text | |
| Text398 | Text | |
| Text399 | Text | |
| CheckBox400 | CheckBox | |
| CheckBox401 | CheckBox | |
| CheckBox402 | CheckBox | |
| CheckBox403 | CheckBox | |
| CheckBox404 | CheckBox | |
| Text405 | Text | |
| CheckBox406 | CheckBox | |
| CheckBox407 | CheckBox | |
| CheckBox408 | CheckBox | |
| CheckBox409 | CheckBox | |
| CheckBox410 | CheckBox | |
| CheckBox412 | CheckBox | |
| CheckBox413 | CheckBox | |
| CheckBox414 | CheckBox | |
| CheckBox415 | CheckBox | |
| CheckBox416 | CheckBox | |
| CheckBox420 | CheckBox | |
| CheckBox421 | CheckBox | |
| CheckBox422 | CheckBox | |
| CheckBox423 | CheckBox | |
| CheckBox424 | CheckBox | |
| CheckBox425 | CheckBox | |
| CheckBox426 | CheckBox | |
| CheckBox427 | CheckBox | |
| CheckBox428 | CheckBox | |
| CheckBox429 | CheckBox | |
| CheckBox432 | CheckBox | |
| CheckBox433 | CheckBox | |
| CheckBox434 | CheckBox | |
| CheckBox436 | CheckBox | |
| CheckBox437 | CheckBox | |
| CheckBox439 | CheckBox | |
| CheckBox440 | CheckBox | |
| Third Equipment Item | ||
| Third Equipment Location | Text |
Enter the location where the third equipment item is primarily kept or used.
|
| Third Equipment Limit | Number |
Provide the maximum insured value or coverage limit for the third equipment item.
|
| Third Equipment Serial Number | Text |
Enter the serial number for the third equipment item.
|
| Third Equipment Year | Text |
Enter the manufacturing year of the third equipment item.
|
| Third Equipment Make | Text |
Enter the manufacturer or brand of the third equipment item.
|
| Third Equipment Model | Text |
Enter the model name or number of the third equipment item.
|
| Third Equipment Item Description | Text |
Provide a detailed description of the third equipment item.
|
| Third Prior Loss | ||
| Text584 | Text | |
| Text585 | Text | |
| Text586 | Text | |
| Today's Date | ||
| Text1 | Text | |
| CheckBox14 | CheckBox | |
| Trampoline Presence | ||
| CheckBox504 | CheckBox | |
| CheckBox505 | CheckBox | |
| Unusual Hazards Description | ||
| Unusual Hazards Description | Text |
Provide a detailed description of any unusual hazards present, such as quarries, commercial wood lots, open dump pits, sump holes, vehicle trails, reservoirs, or waste lagoons. Fill only if 'CheckBox521' is 'Yes'.
Depends on:
CheckBox521
|
| CheckBox532 | CheckBox | |
| Use of Labor Services | ||
| CheckBox519 | CheckBox |
Depends on:
CheckBox514
|
| CheckBox520 | CheckBox | |
| Watercraft Liability Details | ||
| Text132 | Text |
Depends on:
CheckBox131
|
| Text133 | Text |
Depends on:
CheckBox131
|
| Text136 | Text |
Depends on:
CheckBox135
|
| Text137 | Text |
Depends on:
CheckBox131
|
| Text138 | Text |
Depends on:
CheckBox131
|
| Text139 | Text |
Depends on:
CheckBox131
|
| CheckBox142 | CheckBox |
Depends on:
CheckBox140
|
| CheckBox146 | CheckBox | |
| CheckBox147 | CheckBox |
Depends on:
CheckBox146
|
| CheckBox148 | CheckBox |
Depends on:
CheckBox146
|
| Windstorm or Hail Exclusion Description | ||
| Windstorm or Hail Exclusion Items Description | Text |
Provide a detailed description of the items to be excluded under the Windstorm or Hail Exclusion. Fill only if 'CheckBox116' is 'Yes'.
Depends on:
CheckBox116
|
| CheckBox122 | CheckBox |
Depends on:
CheckBox120
|
| Worker Activities Description | ||
| Text515 | Text |
Depends on:
CheckBox514
|
| CheckBox521 | CheckBox | |
| Worker Compensation and Housing Provided | ||
| CheckBox523 | CheckBox | |
| CheckBox524 | CheckBox | |
| CheckBox526 | CheckBox | |
| CheckBox527 | CheckBox | |