Farm All name(s) of person(s) on title for this property: Your mailing address: Your email address: Your phone number:Address of insured property: How many acres is your property: Is your property on the ALR ( agriculture land reserve )? Do you have any rivers, lakes, creeks, streams or natural bodies of water on or around your property: Yes No Other Please choose one... This property is: Within 300 meters of a fire hydrant & within 8 kms of a manned firehall Within 8km's of a manned firehall with NO hydrants closeby No hydrants and no firehall within 8kms Manned firehall greater than 8kms but less than 13kms Do you lease out any portion of your land to others: Yes No Other List all farm machinery & equipment, tack, tools to be insured: List all farm outbuildings & contents to be insured: Any claims or losses of any kind in the past 5 years: Yes No Other Type of farm: Cash Crops Fruit / Vegetable vineyard Dairy Beef Hog Poultry Hobby Horse Tobacco Annual gross revenue derived from farming operations: Do you process or sell any fertilizers, chemicals or pesticides? Yes No Regarding livestock, please checkmark if you want coverage for: Loading/uploading Partial Mortality Consequential loss Heat prostration Entrapment Attack by wild animal Please checkmark if you have any of these: Generator(s) ATV's ATV trail(s) Conduct auctions Dog(s) Gravel Pitt Horse pulls Horse Track Horse Trails Riding Area Lessons Tours Petting zoo Swimming pool(s) Personal watercraft Show animals Storage for vehicle/boats Custom Spraying USA exposure Stablemen's Liability Please checkmark the following, if applicable: Bed & Breakfast Boarding Custom Farming Daycare/babysitting Hay / Sleigh rides Pick your own "u pick" ( ladder supplied ) Roadside Stand Sale of wood Sale of maple syrup Sale of honey Snow removal Trail rides Sales barn If you have any storage tank(s), do you have a written tank filling procedure in place containing info on how to prevent spills or overflow: Yes No I don't have any storage tank(s) If you have any storage tank(s), do you have a written emergency procedure plan outlining actions to be taken in the event of a tank spill or overflow: Yes No I don't have any storage tank(s) Do you have any storage tank(s) with more than 500 gallon capacity: Yes No I don't have any storage tank(s) Any government standards, statutes and/or regulations you have not complied with? Yes No CommentsThis field is for validation purposes and should be left unchanged.
