Farm Quote | German Mutual

German Mutual
914 Alden DR
Auburn, NE 68305
402.274.3106
800.458.0064
402.274.3135 fax

FARM QUOTE

Please note: This is not an offer for insurance.
This quote is for comparison shopping.
WE ONLY WRITE INSURANCE COVERAGES IN THE STATE OF NEBRASKA

Contact Information

Name

Address - Line 1

Address - Line 2

City

State

Zip

Home Phone

Email Address

How would you like to be contacted?

Mail
Email
Phone

Responding Fire Department

Farm Section
(complete one section for each dwelling)
Dwelling #1

Amount of Coverage (in dollars)

Year of Construction

Type of Construction

Frame

Brick

Modular

Mobile Home

Please use the following box to list any items you may have insured specifically and the amount.
(ie: jewelry-$500, computer equipment-$5000)

Please list all your Out Buildings:
(including name and value is. hog confinement-50,000)

Farm Blanket Amount:

Do you have livestock?
Yes
No

Do you have grain?
Yes
No

Do you have All Risk Equipment?
Yes
No

Liability Section

Number of Acres

Liability Coverage

100,000

300,000

500,000

1,000,000

Increased Property Damage is $500

Medical Payments

1000

2000

3000

4000

5000

Employee Labor (# of employees)

Medical Payment to Employees will match the Medical Payments shown above

Any livestock on premise?

Yes

No

Please list any liability endorsements on your current policy.