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This is a quote request for homeowner insurance in the state of South Dakota. There is absolutely no obligation to purchase insurance by filling out this form. Also, no insurance coverage whatsoever can be bound by filling out this form. If coverage is later requested, an application for insurance will need to be signed and a down payment of premium made. Any rates given are subject to the companies final review and approval. Descriptions of coverages given below are only brief general statements about some of the coverages available.

Coverage Area. Because a representative from our agency will need to review and look at the property, we normally only write homeowner coverages within reasonable distance from Castlewood, SD. This area would include the cities of Watertown, Brookings, and all of the smaller surrounding communities.


Contact Information

  Name 
  Address 
  City, State ZIP 
  Phone 
  E-Mail 
  FAX 


Applicant Information

  First Name  
 
 
  Last Name  
 
 
  Birth Date  
 
 
  Social Security #  
 
 


Residence Information

  How is this residence used?  
  List the street address of the   
  house if different from the   
  address above.   


Coverage Amounts

click here for description

   House   
 $
 
   Contents   
 $
 
   Other Structures   
 $
 
   Personal Liability   
   
   Medical Payments   
   
   Deductible   
   


Scheduled Personal Property

click here for description

   Jewelry     Watercraft 
   Computer Equipment     Snowmobile / ATV 
   Firearms / Guns     Antiques 
   Fine Arts      Other Collectibles 


Dwelling Information

Year Built
   
Square Feet
   
Number of Stories
   
Construction Type
   
Foundation
   
Age of Shingles
   
Wiring Updated
   
Heating Updated
   


Additional Information

  How many road miles is the house from a 
  responding fire department? 
  
  How many feet is the house away from a 
  fire hydrant? 
  


Explain all "yes" answers in the space below.
  Is there any business conducted at this residence? 
  (example: daycare, incidental office, etc.) 
  yes  
  no  
  Do you own any watercraft, snowmobiles, or all- 
  terrain vehicles?  (List type and HP or CC's.) 
  yes  
  no  
  Do you have a wood stove or wood-burning  
  fireplace? 
  yes  
  no  
  Do you have smoke detectors, burglar alarms, or  
  an automatic sprinkler system? 
  yes  
  no  
  Do you have a dog? If yes, list the number of dogs  
  and their breeds. 
  yes  
  no  
  Do you have a trampoline or swimming pool?  
  
  yes  
  no  


Insurance History

  Do you currently have insurance on   
  this property?   
  yes  
  no  
Company 
 
Exp. Date
  Have you ever been canceled, non-   
  renewed or denied for insurance?   
  If yes, explain.   
  yes  
  no  
  
  Have you had any insurance claims   
  in last five years? If yes give details  
  including dates and amounts.   
  yes  
  no  
  


Comments



When you are finished filling out this form, click on the "quote" button below to send the information.








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Residence - The amount of coverage on the house should be equal or close to the estimated replacement value. The replacement value is how much it would cost to rebuild. We can help you estimate the replacement value of your house.

Other Structures - Other structures are buildings or structures (other than the house) located on the property. This would include a detached garage (not attached to the house) or a small garden shed.

Personal Liability Coverage - Covers payment, on behalf of the insured, for sums of money in which the insured is legally obligated to pay for damages of bodily injury or property damage to others caused by an occurrence arising out of the insured's premises or personal activities.

Medical Payments Coverage - Covers medical expenses incurred by persons, other than the insured, who sustain bodily injury caused by an accident arising out of the insured's premises or personal activities.


click here to return to Coverage Amounts





Scheduled Personal Property - Specific items of household property can be scheduled and given broader coverages than normally provided in the policy for household contents. In most homeowner policies, contents are only insured for the perils listed in the policy (fire, wind, theft, smoke, etc.). However, when specifically sheduled, these items can be insured for all causes of loss unless the cause of loss is excluded in the policy. The coverages provided for scheduled property can be broader and more inclusive than property that is not scheduled. Also, certain classes of property are limited for coverage by the policy (for example: jewelry is limited in the policy for theft coverage) and these internal limits do not apply to scheduled property.

Recreational Vehicles - Watercraft, snowmobiles and ATVs can usually be added onto a homeowners policy. (Sometimes, however, they must be written on separate policies.) List the year, make, model, and horsepower or CC's in the comments section. With snowmobiles, we will need to know the driver information including birthdates, driving violations, and accidents.


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