FARM & RANCH COVERAGE PART DECLARATIONS

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Jared Carter
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1 POLICY NUMBER: NAMED INSURED: FARM & RANCH COVERAGE PART DECLARATIONS FARM & RANCH LIABILITY COVERAGE THESE FARM LIABILITY DECLARATIONS AND THE COMMON POLICY DECLARATIONS, TOGETHER WITH THE COVERAGE FORM(S), FORMS AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED POLICY. FORM OF BUSINESS Individual Joint Venture Limited Liability Company Partnership Basic Organization (Other than Partnership, Joint Venture or Limited Liability Company) COVERAGES PROVIDED Insurance at the Insured Locations applies only for coverage for which Limits of Insurance are shown. INSURED LOCATIONS FARM LIABILITY* *Identify location by section or civil district, township, range, distance in miles by compass direction from nearest town; town, state. Identify road, where road leads from, location of road as to county and state Unless coverage is extended as described below, the following are not covered in this policy: 1. Retail activity (other than onpremises roadside stands selling products produced by the insured); 2. Mechanized processing operations; 3. Custom Farming (Describe). Farming is extended to include the following Retail Activities, Mechanized Processing Operations, Business Activities (including rental to others) or Business Pursuits (including custom farming) but only if specifically described below: U Page 1 of 6

2 FARM LIABILITY COVERAGES PROVIDED H Bodily Injury and Property Damage Liability I Personal and Advertising Injury Liability J Medical Payments H Bodily Injury & Property Damage Liability J Medical Payments I Personal & Advertising Injury Liability H Fire Damage Limit J Medical Payments LIMITS OF INSURANCE GENERAL AGGREGATE LIMIT: $ EACH OCCURRENCE LIMIT: $ ANY ONE PERSON OR ORGANIZATION LIMIT: $ ANY ONE FIRE (PREMISES RENTED TO INSURED): $50,000 ANY ONE PERSON LIMIT (EXCEPT RESIDENT EMPLOYEES): $1,000 SCHEDULE OF CLASSIFICATIONS DESCRIPTION CLASS CODE EXPOSURE EXPOSURE BASIS RATING BASIS RATE PREMIUM TOTAL ADVANCE FARM & RANCH LIABILITY PREMIUM: $ U Page 2 of 6

3 FARM & RANCH PROPERTY COVERAGE THESE FARM PROPERTY DECLARATIONS AND THE COMMON POLICY DECLARATIONS, TOGETHER WITH THE COVERAGE FORM(S), FORMS AND ENDORSEMENTS COMPLETE THE ABOVE NUMBERED POLICY. INSURED LOCATIONS FARM PROPERTY* *Identify location by section or civil district, township, range, distance in miles by compass direction from nearest town; town, state. Identify road, where road leads from, location of road as to county and state Loc # Bldg # Mortgageholder Name(s) And Mailing Address Loss Payee Names And Mailing Addresses Description Of Interest PROPERTY DEDUCTIBLE APPLICABLE TO ALL INSURED PROPERTY PER ANY ONE OCCURRENCE $1,000 $2,500 $5,000 $10,000 U Page 3 of 6

4 FARM PROPERTY COVERAGE A DWELLINGS FARM PROPERTY COVERAGE B OTHER PRIVATE STRUCTURES APPURTENANT TO DWELLINGS FARM PROPERTY COVERAGE C HOUSEHOLD PERSONAL PROPERTY FARM PROPERTY COVERAGE D LOSS OF USE OCCUPANCY Occupied, Seasonal Occupancy or Vacant: Habitational Property to include Dwellings (owner occupied or third party occupied), Employee Housing (including employee dorms and employee bunkhouses) and Vacation Rentals are all eligible for any or all combinations of Coverage A, B, C and/or D A specific Limit of Insurance must be scheduled for each applicable Coverage at each Location Building Number CAUSE OF LOSS VALUATION COV. A and B VALUATION COV. C Basic ACV ACV RC RC Special Loc # Bldg # Coverage Year Built Limit of Insurance Rate TOTAL ADVANCE PREMIUM FOR COVERAGES A, B, C, U Page 4 of 6

5 COVERAGE E SCHEDULED FARM PERSONAL PROPERTY CAUSES OF LOSS Basic VALUATION is: ACV at time of loss RC subject to policy conditions Number Description of Item Rate Limit Of Insurance Premium Grain, threshed seeds, beans, ground feed, silage, 1 livestock feed, all in buildings, structures, sacks, wagons or trucks 2 Grain in stacks, shocks, swathes or piles in the open Hay, straw, fodder in buildings or structures (Maximum available policy limit $25,000) Hay, straw, fodder in the open in stacks, windrows or bales (Maximum available policy limit $10,000) Computers & related software that are part of the farming operations and farm management processes Farm products, materials and supplies. This does not include hay, grain or growing crops. Miscellaneous equipment (machinery, vehicles, tools, supplies usual or incidental to farm operations) valued at $1000 per item or less. Borrowed or rented farm machinery, vehicles or equipment 9 Trays, boxes, box shook (unassembled wood crates) Farm machinery, vehicles, equipment on or away from the insured location Year Description Make Model Rate Limit Of Insurance Premium Livestock Actual Death/Destruction (Cattle, donkeys, goats, horses, mules, sheep, swine) 12 Bees (Limit is Blanket) 13 Fish (Limit is blanket) 14 Worms (Limit is Blanket) 15 Livestock Actual Death/Destruction Collision Only (Cattle, donkeys, goats, horses, mules, sheep, swine) 16 Misc. (describe): 17 Misc. (describe): 18 Misc. (describe): 19 Misc. (describe): 20 Misc. (describe): TOTAL ADVANCE PREMIUM FOR COVERAGE E $ U Page 5 of 6

6 COVERAGE F UNSCHEDULED FARM PERSONAL PROPERTY CAUSES OF LOSS Basic VALUATION ACV at time of loss RC subject to policy conditions COVERAGE F UNSCHEDULED FARM PERSONAL PROPERTY RATE $ N LIMIT OF INSURANCE TOTAL ADVANCE PREMIUM FOR COVERAGE F INCLUDED COVERAGE G BARNS, OUTBUILDINGS AND OTHER FARM STRUCTURES CAUSES OF LOSS Basic VALUATION is: ACV at time of loss RC subject to policy conditions Rate Loc #Bldg # Description Year Built Per $100 In Insured Values $ Limit Of Insurance TOTAL ADVANCE PREMIUM FOR COVERAGE G $ OPTIONAL PROPERTY COVERAGES Cause of Loss Basic or Valuation ACV or RC Rate Limit Of Insurance Disruption of Farming Operations NA Farm and Ranch Equipment Breakdown NA N Per form U695 $ Milk Contamination NA NA Flat Charge $10,000 $ TOTAL ADVANCE PREMIUM FOR OPTIONAL PROPERTY COVERAGE(S) $ Premium TOTAL ADVANCE FARM & RANCH PROPERTY PREMIUM $ U Page 6 of 6

FARM & RANCH COVERAGE PART DECLARATIONS

POLICY NUMBER: NAMED INSURED: FARM & RANCH COVERAGE PART DECLARATIONS COVERAGES PROVIDED Insurance at the Insured Locations applies only for coverage for which Limits of Insurance are shown. INSURED LOCATIONS*