Quote Equine General Liability Insurance Application

Is this new or renewal business?*
- New
- Renewal
Desired effective/renewal Date*
Please allow up to 7 business days. We need your loss runs please order then now.
MM slash DD slash YYYY
Please upload your loss runs and a copy of your existing policy for rewiew
Drop files here or

Max. file size: 10 MB, Max. files: 4.
CONTACT INFORMATION
Name of Person completing this form
Phone number to call regarding this submission
Business / Stable Name
Applicant / Insured Name*
Mail Address*
Street Address City State ZIP Code
Phone*
Fax
Person to Contact for Inspection
Email*
Enter Email Confirm Email
Website
FEIN or Social Security Number

LOCATION(S) INFORMATION
It is required to list all locations. How many locations do you have?
LOCATION 1
Loc 1 Street address/APN ect./ City, County, State & zip
Number of Acres
Do you own or lease (location 1) ?
Do you need to name an Additional Insured Location 1?
- Yes
- No
Name and address of Additional Insured for Location 1.
Who is responsible for fence Maintenance & Repair?
- Property Owner
- Property Manager
- I am

LOCATION 2
Loc 2 Street address/APN ect./ City, County, State & zip
Number of Acres
Do you own or lease (location 2) ?
Do you need to name an Additional Insured Location 2?
- Yes
- No
Name and address of Additional Insured for Location 2.
Who is responsible for fence Maintenance & Repair (loc.2)
- Property Owner
- Property Manager
- I am

LOCATION 3
Loc 3 Street address/APN ect./ City, County, State & zip
Number of Acres
Do you own or lease (location 3) ?
Do you need to name an Additional Insured Location 3?
- Yes
- No
Name and address of Additional Insured for Location 3.
Who is responsible for fence Maintenance & Repair (loc.3)?
- Property Owner
- Property Manager
- I am

LOCATION 4
Loc 4 Street address/APN ect./ City, County, State & zip
Number of Acres
Do you own or lease (location 4)?
Do you need to name an Additional Insured Location 4?
- Yes
- No
Name and address of Additional Insured for Location 4.
Who is responsible for fence Maintenance & Repair (loc4.)?
- Property Owner
- Property Manager
- I am

APPLICANT'S ENTITY TYPE
Entity
List names and title of all Officers of LLC/Corporation
How will the Entity be operating?
- As Owner
- As Tenant
Year your business was started or established
LIMITS OF LIABILITY - CHECK ONLY ONE SET
Per Occurrence / General Aggregate Limit
- $500,000 per occurrence / $1,000,000 aggregate
- $1,000,000 per occurrence / $2,000,000 aggregate
- $2,000,000 per occurrence / $2,000,000 aggregate
- Higher limits
Specify which limits you are seeking

Person 2
Name of second person
Classified as:
Date of birth person 2
Payroll for person 2
Title of person 2
Number of years experience
Has person 2 attended Farrier's School?
Are they licensed or certified?
Do you need to add additional people?
- Yes
- No
Please add other individuals information and answer the question for each as in previous persons

INSURANCE HISTORY
Do you currently carry insurance or have you had it within the last three years?
- Yes
- No
MOST CURRENT POLICY PERIOD
Most recent year: Name of Insurance carrier
Prior year: Name of insurance carrier
Two years prior: Name of insurance carrier

Equine General Liability Insurance Application