INSURANCE SERVICES PLUS Farm Policy Options Checklist

129 S Main, Lake Crystal 4 E Main, Madelia

(507) 726-20549 (507) 642-2801

Insured Agent
The following is a list of the most frequently requested options to the standard Farm Packages program. For other increased limits or optional coverages, please consult your agent.
DEDUCTIBLES
$250 500 1,000 2,500 5,000 10,000
CLASS A-1 RESIDENCE PACKAGE
Y N 1. Coverage Basic Broad Special
Y N 2. Inflation Guard ................................................................................................................... Percent Desired %
K Y N 3. Replacement Cost: Household Goods
Y N 4. Special Form: Household Goods
Q Y N 5. Added Perils: Refrigerated Food Products ................................................................................................ $
Y N 6. Replacement Cost: Underinsured Dwellings
7J Y N 7. Theft Coverage Extension: Dwellings, Farm Barns, Buildings, Structures
7S Y N 8. Amended Theft: Household Personal Property/Farm Personal Property
7U Y N 9. Water/Sewer Backup: Dwelling/Household Personal Property ................................................................. $
Y N 10. SPCMLC
CLASS A-2 DWELLINGS
Y N 1. Coverage Limited Basic Broad Special
Q Y N 2. Added Perils: Refrigerated Food Products ................................................................................................ $
7U Y N 3. Water/Sewer Backup: Dwelling/Household Personal Property ................................................................. $
CLASS A-3 MOBILE HOMES
Y N 1. Coverage Limited Basic Broad
CLASS E & F FARM PERSONAL PROPERTY
Y N 1. Coverage Limited Basic Broad Special
R Y N 2. Glass Coverage/Mobile Farm Equipment ................................................................................ Deductible $
S Y N 3. Peak Season (Farm Personal Property) ............................................. Dates: __________ to __________ $
6P Y N 4. Special Extension of Coverage for Livestock Suffocation
6R Y N 5. Cab Glass (Scheduled)
7A Y N 6. Collapse due to Weight of Ice/Snow/Sleet (Farm Personal Property)
7B Y N 7. Non-Depreciation of Repairs (Farm Personal Property)
7K Y N 8. Higher Limits Away from Premises
7P Y N 9. Leased, Rented or Borrowed Farm Machinery/Vehicles/Equipment ........................................................ $
T Y N 10. Farm Extra Expense, Farm Personal Property, Farm Barns/Buildings/Structures/Outbuildings ............... $
7S Y N 11. Amended Theft: Household Personal Property/Farm Personal Property
7W Y N 12. Collision/Overturn (Farm Personal Property)
7X Y N 13. Broad Form Vehicle Damage
OTHER
Y N 1. Flood Insurance (Available only through NFIP)
Y N 2. Umbrella Liability Policy (Separate Policy, Special Conditions Apply)
Y N 3. Inland Marine Coverage (Jewelry, Guns, Coins, Collectibles, Antiques, Etc.)
6S Y N 4. Debris Removal ................................................................................................................................Limit $
Y Y N 5. Expanded Replacement Cost Coverage on Dwelling (Certain Criteria Apply)
CLASS G-1 FARM BARNS, BUILDINGS & STRUCTURES
Y N 1. Special Form
P Y N 2. Collapse
T Y N 3. Farm Extra Expense: Farm Personal Property, Farm Barns/Buildings/Structures/Outbuildings
X Y N 4. Deferred Loss Payment
7J Y N 5. Theft Coverage: Extension Dwellings, Farm Barns/Buildings/Structures/Outbuildings
7N Y N 6. Loss of Income: Farm Barns/Buildings/Structures/Outbuildings .............................................................. $
Y N 7. Replacement Cost
CLASS G-2 FARM BARNS, BUILDINGS & STRUCTURES
Y N 1. Coverage Limited Basic
7N Y N 2. Loss of Income: Farm Barns/Buildings/Structures/Outbuildings .............................................................. $
X Y N 3. Deferred Loss Payment
7J Y N 4. Theft Coverage: Extension Dwellings, Farm Barns/Buildings/Structures/Outbuildings
P Y N 5. Collapse
CLASS G-3 FARM BARNS, BUILDINGS & STRUCTURES
Y N 1. Coverage Limited Basic
7N Y N 2. Loss of Income: Farm Barns/Buildings/Structures/Outbuildings .............................................................. $
X Y N 3. Deferred Loss Payment
7J Y N 4. Theft Coverage: Extension Dwellings, Farm Barns/Buildings/Structures/Outbuildings
CLASS H SPECIAL HAZARD
Y N 1. Coverage Limited Basic
Y N 2. Deferred Loss Payment
Y N 3. Underground Wiring .................................................................................................................................. $
Y N 4. Submersible Pump ..................................................................................................................................... $
Y N 5. Fire Department ......................................................................................................................................... $
BASIC CHARGES FOR STANDARD FPL
Liability Limit ...................................................................................... $ Medical Payment $
Y N 1. 0 to 320 acres, One Dwelling, One Set of Buildings ................................................................. Total Acres
Y N 2. 321 to 640 acres, One Dwelling, One Set of Buildings ............................................................. Total Acres
Y N 3. 640+ acres, One Dwelling, One Set of Buildings ...................................................................... Total Acres
Y N 4. Addl Farm Premises with Buildings (Owned or Rented) ...................... Location
Y N 5. Addl Residence Occupied by Insured or Rented to Others ................... Location
Y N 6. Incidental Office or Business Pursuit .......................................................... Type
Y N 7. Livestock Liability Exposure Charge
Y N 8. Custom Farming .................................................................... Type Receipts $
Y N 9. Personal Injury
Y N 10. Partnership Endorsement ....................................... Partners Name Partner on Premises
Y N 11. Horse Exposure .............................................................................................................. Number of Horses
Y N 12. Recreational Vehicles ............................................................ Type Number
Y N 13. Snowmobiles ......................................................................... Type Number
Y N 14. Employers Liability ...................................... Full Time Employees Part Time Employees
Y N 15. Family Medical Payments
Y N 16. Damage to Property of Others Endorsement ....................................................................................Limit $
Y N 17. Watercraft Liability ......................................................................................... HP Length
Y N 18. Non-farming Discount
My agent reviewed all of the above listed coverages with me. I understand
these options and coverages and have applied for only the coverages listed
above and on the application. This listing may not be all inclusive. Signature Date