Farm and Ranch - Drag N' Drop FormBuilder

Farm and Ranch

Farm and Ranch Survey

Address Information

Check the box if the address inspected was different then on the order: *
- Incorrect address was on the order.

How did you obtain the corrected address? *

Number and Street: *

City, State: *

Zip code: *

General Information

Who was interviewed? *

Date of interview? *
- Month
- Day
- Year

Type of neighborhood? *

Is this a primary or secondary residence? *

How often do they visit the property? *

Do they have a caretaker (other then the Insured/Owner)? *

Does the caretaker live on the premises? *

How often does the caretaker visit the property? *

Does the insured have any employees (this would include the caretaker)? *

Are the employees full time and/or part time? *

Number of part time employees? *

Number of full time employees? *

Is there a business venture on the premises? *

What type of business venture? *
- Ranching
- Hay
- Crops
- Orchards
- Paid Hunting
- Oil and Gas Wells
- Leased land for Cell Tower
- Lodging for Groups
- Special Event Hall
- Campground
- Hiking/Biking Trails
- Bed and Breakfast

What it the total acreage of the property insured? *

Is there any 3rd party operations or land leased to others? *

What is the land thats leased being used for? *
- Ranching
- Farming
- Hunting
- Other

Describe what they are doing on the leased land. *

Is there any ranching, farming and/or hunting done on the property? *
- None
- Ranching
- Farming
- Hunting

Does the insured do ranching, farming and/or hunting? *
- None
- Ranching
- Farming
- Hunting

Ranching

Do they have cattle and/or horses on the property? *

Number of Cattle: *

Number of Horses: *

Are horses for private use only? *

How are the horses used if not for private use only? *

Horses Safety Information

Does the insured have a written safety program in place? *

Are warning signs and/or safety rules posted? *

Are the equine laws posted? *

Does the insured require a hold harmless agreement? *

Do they have any exotic animals? *

Number of exotic animals: *

Do they have any other types of animals? *

Describe other animals and the approximate number of them. *

Farming

What type of farming is done? *

Describe Other type of farming. *

Hunting

Who is hunting on the property? *
- Owner
- Family
- Friends
- Hunters Leasing
- Other

What type of game animals are they hunting? *
- Deer
- Sheep
- Birds
- Wild Hogs
- Wild Turkey
- Misc Exotics
- Other

Is there any bow hunting done? *

Protection

Is the property in the city limits? *

Approximate distance to the fire hydrant? *

Please check all water source(s). *
- None
- Swimming Pool
- Lake/Pond
- Ocean/Bay
- River
- Creek
- Stock Tank
- Cistern

Add the alternative water source on the diagram showing the distance to the closest structure.

What is the approximate distance to the fire department? *

Name of responding fire department? *

Is the fire department paid and/or volunteer? *

Hazard Information

Is there any high grass, weeds, or brush around any dwellings or outbuildings? *

Are there any adjacent hazards? *

Describe the adjacent hazards. *

Is the property/area prone to brush/wildfire(s)? *

Is the property/area prone to hurricanes? *

Is the property/area prone to earthquakes? *

What is the distance to the lake/pond? *

What is the distance to the river? *

Are there any vicious breeds of dog(s)? *

How many vicious dog(s)? *

Type of vicious breed? *
- Doberman
- German Shepherd
- Pitbull
- Rottweiler
- Presa Canario
- Chow
- Trained attack/guard
- Wolf hybrid
- Other

What other vicious breed of dog(s)? *

Have there been any incidents of aggressive behavior including biting? *

Swimming Pool and Hot Tub Information

Is there a hot tub on the property? *

Is the hot tub fenced? *

What type of Swimming Pool? *

What is the condition of the pool? *

Describe poor pool condition. *

Is pool completely fenced? *

Does the pool have a slide? *

Does the pool have a diving board? *

Fencing and Road Information

Is the entire property fenced? *

What type of fence did they have? *
- Barbed wire
- Wrought iron
- Pipe
- Wood slats
- Field Fencing
- Game fencing
- Hot wire (pulse on and off)
- Hot wire (constant current)
- Cattle/Goat panel

What is the height of the fence? *

What is the condition of the fence? *

Describe the poor fence condition. *

What type of gate is at the entrance to the property? *
- None
- Wrought iron
- Cattle Gate
- Wooden
- Metal
- Pipe

What type of material is the driveway/road made of? *
- Concrete
- Asphalt
- Base
- Grass
- Crushed Concrete
- Stone
- Pavers
- Gravel
- Caliche
- Dirt
- No Road

What is the condition of the road? *

Describe poor road condition. *

Losses

Have there been any losses in the last 5 years? *

Describe the losses. *

What was the date of the loss? *
- Month
- Day
- Year

ATV/UTV Information

Are there any ATVs (4 wheelers) allowed or used on the property? *

Number of ATVs. *

What are the ATVs used for? *
- Farming
- Ranching
- Hunting
- Recreation
- Personal Use Only

What is the minimum age allowed to operate the ATVs? *

Do they have safety rules as to how the ATVs are used? *

Describe the ATV safety rules they have. *

Do the ATVs have any modifications? *

Describe the ATV modifications. *

Are UTVs (utility carts/golf cart) allowed or used on the property? *

Number of UTVs? *

What are the UTVs used for? *
- Farming
- Ranching
- Hunting
- Recreation
- Personal Use Only

What is the minimum age allowed to operate the UTVs? *

Do they have safety rules as to how the UTVs are used? *

Describe the UTV safety rules they have. *

Do the UTVs have any modifications? *

Describe the UTV modifications. *

Are there any other types of vehicles used for hunting on the property? *

Describe other type of vehicle in detail. *

Please add number of dwellings, outbuildings, and mobile homes then the square footage and the additional forms will be added to the report when you save this form.

Properties

Number of dwellings on the property? (No Mobile Homes) *

Dwelling 1 square footage. *

Dwelling 1 Sq. Ft. on the order; #Dwelling 1 Square footage#

Dwelling 2 square footage. *

Dwelling 2 Sq. Ft. on the order; #Dwelling 2 Square footage#

Dwelling 3 square footage. *

Dwelling 3 Sq. Ft. on the order; #Dwelling 3 Square footage#

Dwelling 4 square footage. *

Dwelling 4 Sq. Ft. on the order; #Dwelling 4 Square footage#

Dwelling 5 square footage. *

Dwelling 5 Sq. Ft. on the order; #Dwelling 5 Square footage#

Dwelling 6 square footage. *

Dwelling 7 square footage. *

Dwelling 8 square footage. *

Dwelling 9 square footage. *

Dwelling 10 square footage. *

Number of Outbuildings? *

Outbuilding 1 square footage. *

Outbuilding 2 square footage. *

Outbuilding 3 square footage. *

Outbuilding 4 square footage. *

Outbuilding 5 square footage. *

Outbuilding 6 square footage. *

Outbuilding 7 square footage. *

Outbuilding 8 square footage. *

Outbuilding 9 square footage. *

Outbuilding 10 square footage. *

Outbuilding 11 square footage. *

Outbuilding 12 square footage. *

Outbuilding 13 square footage. *

Outbuilding 14 square footage. *

Outbuilding 15 square footage. *

Outbuilding 16 square footage. *

Outbuilding 17 square footage. *

Outbuilding 18 square footage. *

Outbuilding 19 square footage. *

Outbuilding 20 square footage. *

Outbuilding 21 square footage. *

Outbuilding 22 square footage. *

Outbuilding 23 square footage. *

Outbuilding 24 square footage. *

Outbuilding 25 square footage. *

Outbuilding 26 square footage. *

Outbuilding 27 square footage. *

Outbuilding 28 square footage. *

Outbuilding 29 square footage. *

Number of Mobile Homes? *

Mobile Home 1 square footage. *

Mobile Home 2 square footage. *

Mobile Home 3 square footage. *

Mobile Home 4 square footage. *

Mobile Home 5 square footage. *