ACORD 403 (2014/12) - Agriculture Property Section, Scheduled and Unscheduled Farm Personal Property
ACORD 403 (2014/12) - Agriculture Property Section, Scheduled and Unscheduled Farm Personal Property
ACORD 403, Agriculture Property Section - Scheduled and Unscheduled Personal Property, is designed to handle the basic underwriting needs for
Agriculture personal property exposures.
The form was designed to be used in conjunction with ACORD 401, Agriculture Application - Applicant Information Section.
Form Page 1
Section Name
Field Name
Description
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g., agency or
brokerage).
IDENTIFICATION SECTION
Loc #
Enter number: The producer assigned number of the location.
IDENTIFICATION SECTION
Date
Enter date: The date on which the form is completed. (MM/DD/YYYY)
IDENTIFICATION SECTION
Agency
Enter text: The full name of the producer / agency.
IDENTIFICATION SECTION
Policy Number
Enter identifier: The identifier assigned by the insurer to the policy, or submission, being
referenced exactly as it appears on the policy, including prefix and suffix symbols. If required for
self-insurance, the self-insured license or contract number.
IDENTIFICATION SECTION
Carrier
Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. Use
the actual name of the company within the group to which the policy has been issued. This is
not the insurer's group name or trade name.
IDENTIFICATION SECTION
NAIC Code
Enter code: The identification code assigned to the insurer by the NAIC.
IDENTIFICATION SECTION
Applicant/First Named
Insured
Enter text: The named insured(s) as it / they will appear on the policy declarations page.
IDENTIFICATION SECTION
Account Number
Enter identifier: The account number to be used for billing purposes. This is the billing number
assigned by the billing entity. If agency bill, the agency assigns; if direct bill, the insurer assigns.
If the account already exists, the agent should provide the previously assigned number.
IDENTIFICATION SECTION
New
Check the box (if applicable): Indicates the response expected from the company is a new
issued policy.
IDENTIFICATION SECTION
Rnwl
Check the box (if applicable): Indicates the response expected from the company is a renewed
policy.
IDENTIFICATION SECTION
Effective Date
Enter date: The effective date of the policy. The date that the terms and conditions of the policy
commence. (MM/DD/YYYY)
IDENTIFICATION SECTION
Expiration Date
Enter date: The date on which the terms and conditions of the policy will expire. (MM/DD/YYYY)
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GENERAL INFORMATION
1. Is any property kept on a
location(s) other than an
insured location?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Is any property kept on a location(s) other than an insured location?.
GENERAL INFORMATION
(A) During Farming Season?
Enter text: The description of where property is kept during the farming season if it is not at the
insured location.
GENERAL INFORMATION
(B) During Off Season?
Enter text: The description of where property is kept during the off season if it is not at the
insured location.
GENERAL INFORMATION
2. What is the maximum
value of equipment at any
one location? (A) During
Farming Season? Inside $
Enter amount: The maximum value of the items stored inside a building. As used here, this is
the maximum value of equipment at any one location during farming season.
GENERAL INFORMATION
(A) During Farming Season?
In Open $
Enter amount: The maximum value of all items stored outside. As used here, this is the
maximum value of equipment at any one location during farming season.
GENERAL INFORMATION
(B) During Off Season?
Inside $
Enter amount: The maximum value of the items stored inside a building. As used here, this is
the maximum value of equipment at any one location during the off season.
GENERAL INFORMATION
(B) During Off Season? In
Open $
Enter amount: The maximum value of all items stored outside. As used here, this is the
maximum value of equipment at any one location during the off season.
GENERAL INFORMATION
3. Is there any equipment
loaned or rented to/from
others?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Is there any equipment loaned or rented to/from others?.
GENERAL INFORMATION
If Yes, Value for Borrowed
or Rented Equipment: $
Enter amount: The value of borrowed or rented equipment.
GENERAL INFORMATION
4. What is radius of
operations of equipment?
Miles
Enter number: The radius of operations of the equipment. In the USA this is measured in miles.
GENERAL INFORMATION
5. Is equipment well
maintained?
Enter Y for a Yes response. Input N for No response. Indicates the response to the question,
Is equipment well maintained?.
GENERAL INFORMATION
5. Is equipment well
maintained?
Enter text: An explanation as to whether the equipment is well maintained.
TRANSIT
Limit of Insurance
Enter limit: The maximum amount of coverage provided for this subject of insurance or
premium-bearing option. As used here, this is for transit coverage.
TRANSIT
Coins %
Enter percentage: The Coinsurance Percentage is the percentage of the total value of the
subject of insurance being insured. If the amount of insurance falls below this percentage, the
insured must share in the amount of the loss. This field should be completed even when writing
agreed amount coverage. As used here, this is for transit coverage.
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TRANSIT
Cause of Loss (Perils)
Enter code: The causes of loss the subject of insurance is to be covered for. Examples:
* Basic
* Broad
* Special excluding theft
* Earthquake As used here, this is for transit coverage.
TRANSIT
Deductible
Enter deductible: The deductible amount that is to apply to this subject of insurance. As used
here, this is for transit coverage.
TRANSIT
Premium
Enter amount: The premium amount for this subject of insurance. As used here, this is for
transit coverage.
PEAK SEASON
Description One
Enter text: The description of the item.
PEAK SEASON
Time Period From One
Enter date: The start date for peak season coverage.
PEAK SEASON
Time Period To One
Enter date: The end date for peak season coverage.
PEAK SEASON
Applies To Schd One
Check the box (if applicable): Indicates the class is scheduled.
PEAK SEASON
Applies To UnSchd One
Check the box (if applicable): Indicates the class is not scheduled.
PEAK SEASON
Limit of Insurance One
Enter limit: The limit amount for peak season coverage.
PEAK SEASON
Premium One
Enter limit: The premium amount for peak season coverage.
PEAK SEASON
Description Two
Enter text: The description of the item.
PEAK SEASON
Time Period From Two
Enter date: The start date for peak season coverage.
PEAK SEASON
Time Period To Two
Enter date: The end date for peak season coverage.
PEAK SEASON
Applies To Schd Two
Check the box (if applicable): Indicates the class is scheduled.
PEAK SEASON
Applies To UnSchd Two
Check the box (if applicable): Indicates the class is not scheduled.
PEAK SEASON
Limit of Insurance Two
Enter limit: The limit amount for peak season coverage.
PEAK SEASON
Premium Two
Enter limit: The premium amount for peak season coverage.
PEAK SEASON
Description Three
Enter text: The description of the item.
PEAK SEASON
Time Period From Three
Enter date: The start date for peak season coverage.
PEAK SEASON
Time Period To Three
Enter date: The end date for peak season coverage.
PEAK SEASON
Applies To Schd Three
Check the box (if applicable): Indicates the class is scheduled.
PEAK SEASON
Applies To UnSchd Three
Check the box (if applicable): Indicates the class is not scheduled.
PEAK SEASON
Limit of Insurance Three
Enter limit: The limit amount for peak season coverage.
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PEAK SEASON
Premium Three
Enter limit: The premium amount for peak season coverage.
PEAK SEASON
Description Four
Enter text: The description of the item.
PEAK SEASON
Time Period From Four
Enter date: The start date for peak season coverage.
PEAK SEASON
Time Period To Four
Enter date: The end date for peak season coverage.
PEAK SEASON
Applies To Schd Four
Check the box (if applicable): Indicates the class is scheduled.
PEAK SEASON
Applies To UnSchd Four
Check the box (if applicable): Indicates the class is not scheduled.
PEAK SEASON
Limit of Insurance Four
Enter limit: The limit amount for peak season coverage.
PEAK SEASON
Premium Four
Enter limit: The premium amount for peak season coverage.
PEAK SEASON
Description Five
Enter text: The description of the item.
PEAK SEASON
Time Period From Five
Enter date: The start date for peak season coverage.
PEAK SEASON
Time Period To Five
Enter date: The end date for peak season coverage.
PEAK SEASON
Applies To Schd Five
Check the box (if applicable): Indicates the class is scheduled.
PEAK SEASON
Applies To UnSchd Five
Check the box (if applicable): Indicates the class is not scheduled.
PEAK SEASON
Limit of Insurance Five
Enter limit: The limit amount for peak season coverage.
PEAK SEASON
Premium Five
Enter limit: The premium amount for peak season coverage.
PEAK SEASON
Description Six
Enter text: The description of the item.
PEAK SEASON
Time Period From Six
Enter date: The start date for peak season coverage.
PEAK SEASON
Time Period To Six
Enter date: The end date for peak season coverage.
PEAK SEASON
Applies To Schd Six
Check the box (if applicable): Indicates the class is scheduled.
PEAK SEASON
Applies To UnSchd Six
Check the box (if applicable): Indicates the class is not scheduled.
PEAK SEASON
Limit of Insurance Six
Enter limit: The limit amount for peak season coverage.
PEAK SEASON
Premium Six
Enter limit: The premium amount for peak season coverage.
PEAK SEASON
Description Seven
Enter text: The description of the item.
PEAK SEASON
Time Period From Seven
Enter date: The start date for peak season coverage.
PEAK SEASON
Time Period To Seven
Enter date: The end date for peak season coverage.
PEAK SEASON
Applies To Schd Seven
Check the box (if applicable): Indicates the class is scheduled.
PEAK SEASON
Applies To UnSchd Seven
Check the box (if applicable): Indicates the class is not scheduled.
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PEAK SEASON
Limit of Insurance Seven
Enter limit: The limit amount for peak season coverage.
PEAK SEASON
Premium Seven
Enter limit: The premium amount for peak season coverage.
PEAK SEASON
Description Eight
Enter text: The description of the item.
PEAK SEASON
Time Period From Eight
Enter date: The start date for peak season coverage.
PEAK SEASON
Time Period To Eight
Enter date: The end date for peak season coverage.
PEAK SEASON
Applies To Schd Eight
Check the box (if applicable): Indicates the class is scheduled.
PEAK SEASON
Applies To UnSchd Eight
Check the box (if applicable): Indicates the class is not scheduled.
PEAK SEASON
Limit of Insurance Eight
Enter limit: The limit amount for peak season coverage.
PEAK SEASON
Premium Eight
Enter limit: The premium amount for peak season coverage.
PEAK SEASON
Description Nine
Enter text: The description of the item.
PEAK SEASON
Time Period From Nine
Enter date: The start date for peak season coverage.
PEAK SEASON
Time Period To Nine
Enter date: The end date for peak season coverage.
PEAK SEASON
Applies To Schd Nine
Check the box (if applicable): Indicates the class is scheduled.
PEAK SEASON
Applies To UnSchd Nine
Check the box (if applicable): Indicates the class is not scheduled.
PEAK SEASON
Limit of Insurance Nine
Enter limit: The limit amount for peak season coverage.
PEAK SEASON
Premium Nine
Enter limit: The premium amount for peak season coverage.
PEAK SEASON
Total Limit of Insurance
Enter limit: The total limit amount for all items listed.
PEAK SEASON
Total Premium
Enter limit: The total premium amount for all items listed.
ADDITIONAL INTEREST
Additional Insured One
Check the box (if applicable): Indicates the additional interest type is an additional insured.
ADDITIONAL INTEREST
Loss Payee One
Check the box (if applicable): Indicates the additional interest type is a loss payee.
ADDITIONAL INTEREST
Mortgagee One
Check the box (if applicable): Indicates the additional interest type is a mortgagee.
ADDITIONAL INTEREST
Lienholder One
Check the box (if applicable): Indicates the additional interest type is a lien holder.
ADDITIONAL INTEREST
Employee as Lessor One
Check the box (if applicable): Indicates the additional interest type is an employee as lessor.
ADDITIONAL INTEREST
Other Interest One
Check the box (if applicable): Indicates the additional interest is other than those listed.
ADDITIONAL INTEREST
Describe Other Interest One
Enter text: The description of the other type of additional interest.
ADDITIONAL INTEREST
Rank One
Enter number: The ranking of 'this' additional interest when multiple additional interests are
associated with the same item.
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ADDITIONAL INTEREST
Name and Address One
Enter text: The additional interest's full name.
ADDITIONAL INTEREST
Enter text: The additional interest's mailing address line one.
ADDITIONAL INTEREST
Enter text: The additional interest's mailing address line two.
ADDITIONAL INTEREST
Enter text: The additional interest's mailing address city name.
ADDITIONAL INTEREST
Enter code: The additional interest's mailing address state or province code.
ADDITIONAL INTEREST
Enter code: The additional interest's mailing address postal code.
ADDITIONAL INTEREST
Reference # One
Enter identifier: The loan number, account number or other controlling number that the
additional interest may have assigned the insured.
ADDITIONAL INTEREST
Certificate Required One
Check the box (if applicable): Indicates if the additional interest requires a Certificate of
Insurance.
ADDITIONAL INTEREST
Location One
Enter number: The producer assigned number of the location which has an additional interest.
ADDITIONAL INTEREST
Building One
Enter number: The producer assigned number of the building which has an additional interest.
ADDITIONAL INTEREST
Vehicle One
Enter number: The producer assigned number of the vehicle which has an additional interest.
ADDITIONAL INTEREST
Boat One
Enter number: The producer assigned number of the boat which has an additional interest.
ADDITIONAL INTEREST
Scheduled Item Number
One
Enter number: The producer assigned number of the scheduled item which has an additional
interest.
ADDITIONAL INTEREST
Other Item One
Enter text: The description of the item which has an additional interest.
ADDITIONAL INTEREST
Item Description One
Enter text: The description of the item of interest if needed to further clarify. For a vehicle, list
the make, model and VIN number. For a scheduled item, list the description, such as three
carat diamond in six point setting.
ADDITIONAL INTEREST
Additional Insured Two
Check the box (if applicable): Indicates the additional interest type is an additional insured.
ADDITIONAL INTEREST
Loss Payee Two
Check the box (if applicable): Indicates the additional interest type is a loss payee.
ADDITIONAL INTEREST
Mortgagee Two
Check the box (if applicable): Indicates the additional interest type is a mortgagee.
ADDITIONAL INTEREST
Lienholder Two
Check the box (if applicable): Indicates the additional interest type is a lien holder.
ADDITIONAL INTEREST
Employee as Lessor Two
Check the box (if applicable): Indicates the additional interest type is an employee as lessor.
ADDITIONAL INTEREST
Other Interest Two
Check the box (if applicable): Indicates the additional interest is other than those listed.
ADDITIONAL INTEREST
Describe Other Interest Two
Enter text: The description of the other type of additional interest.
ADDITIONAL INTEREST
Rank Two
Enter number: The ranking of 'this' additional interest when multiple additional interests are
associated with the same item.
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ADDITIONAL INTEREST
Name and Address Two
Enter text: The additional interest's full name.
ADDITIONAL INTEREST
Enter text: The additional interest's mailing address line one.
ADDITIONAL INTEREST
Enter text: The additional interest's mailing address line two.
ADDITIONAL INTEREST
Enter text: The additional interest's mailing address city name.
ADDITIONAL INTEREST
Enter code: The additional interest's mailing address state or province code.
ADDITIONAL INTEREST
Enter code: The additional interest's mailing address postal code.
ADDITIONAL INTEREST
Reference # Two
Enter identifier: The loan number, account number or other controlling number that the
additional interest may have assigned the insured.
ADDITIONAL INTEREST
Certificate Required Two
Check the box (if applicable): Indicates if the additional interest requires a Certificate of
Insurance.
ADDITIONAL INTEREST
Location Two
Enter number: The producer assigned number of the location which has an additional interest.
ADDITIONAL INTEREST
Building Two
Enter number: The producer assigned number of the building which has an additional interest.
ADDITIONAL INTEREST
Vehicle Two
Enter number: The producer assigned number of the vehicle which has an additional interest.
ADDITIONAL INTEREST
Boat Two
Enter number: The producer assigned number of the boat which has an additional interest.
ADDITIONAL INTEREST
Scheduled Item Number
Two
Enter number: The producer assigned number of the scheduled item which has an additional
interest.
ADDITIONAL INTEREST
Other Item Two
Enter text: The description of the item which has an additional interest.
ADDITIONAL INTEREST
Item Description Two
Enter text: The description of the item of interest if needed to further clarify. For a vehicle, list
the make, model and VIN number. For a scheduled item, list the description, such as three
carat diamond in six point setting.
ADDITIONAL INTEREST
Additional Insured Three
Check the box (if applicable): Indicates the additional interest type is an additional insured.
ADDITIONAL INTEREST
Loss Payee Three
Check the box (if applicable): Indicates the additional interest type is a loss payee.
ADDITIONAL INTEREST
Mortgagee Three
Check the box (if applicable): Indicates the additional interest type is a mortgagee.
ADDITIONAL INTEREST
Lienholder Three
Check the box (if applicable): Indicates the additional interest type is a lien holder.
ADDITIONAL INTEREST
Employee as Lessor Three
Check the box (if applicable): Indicates the additional interest type is an employee as lessor.
ADDITIONAL INTEREST
Other Interest Three
Check the box (if applicable): Indicates the additional interest is other than those listed.
ADDITIONAL INTEREST
Describe Other Interest
Three
Enter text: The description of the other type of additional interest.
ADDITIONAL INTEREST
Rank Three
Enter number: The ranking of 'this' additional interest when multiple additional interests are
associated with the same item.
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ADDITIONAL INTEREST
Name and Address Three
Enter text: The additional interest's full name.
ADDITIONAL INTEREST
Enter text: The additional interest's mailing address line one.
ADDITIONAL INTEREST
Enter text: The additional interest's mailing address line two.
ADDITIONAL INTEREST
Enter text: The additional interest's mailing address city name.
ADDITIONAL INTEREST
Enter code: The additional interest's mailing address state or province code.
ADDITIONAL INTEREST
Enter code: The additional interest's mailing address postal code.
ADDITIONAL INTEREST
Reference # Three
Enter identifier: The loan number, account number or other controlling number that the
additional interest may have assigned the insured.
ADDITIONAL INTEREST
Certificate Required Three
Check the box (if applicable): Indicates if the additional interest requires a Certificate of
Insurance.
ADDITIONAL INTEREST
Location Three
Enter number: The producer assigned number of the location which has an additional interest.
ADDITIONAL INTEREST
Building Three
Enter number: The producer assigned number of the building which has an additional interest.
ADDITIONAL INTEREST
Vehicle Three
Enter number: The producer assigned number of the vehicle which has an additional interest.
ADDITIONAL INTEREST
Boat Three
Enter number: The producer assigned number of the boat which has an additional interest.
ADDITIONAL INTEREST
Scheduled Item Number
Three
Enter number: The producer assigned number of the scheduled item which has an additional
interest.
ADDITIONAL INTEREST
Other Item Three
Enter text: The description of the item which has an additional interest.
ADDITIONAL INTEREST
Item Description Three
Enter text: The description of the item of interest if needed to further clarify. For a vehicle, list
the make, model and VIN number. For a scheduled item, list the description, such as three
carat diamond in six point setting.
Form Page 2
Section Name
Field Name
Description
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g., agency or
brokerage).
IDENTIFICATION SECTION
Loc #
Enter number: The producer assigned number of the location.
MISCELLANEOUS
Miscellaneous Agricultural
Machinery And Implements
Not Exceeding $ _________
per Item
Enter limit: The maximum amount of coverage per item for this subject of insurance or
premium-bearing option.
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MISCELLANEOUS
Miscellaneous Agricultural
Machinery And Implements
Limit Of Insurance
Enter limit: The maximum amount of coverage provided for this subject of insurance or
premium-bearing option.
MISCELLANEOUS
Miscellaneous Agricultural
Machinery And Implements
Coins %
Enter percentage: The Coinsurance Percentage is the percentage of the total value of the
subject of insurance being insured. If the amount of insurance falls below this percentage, the
insured must share in the amount of the loss. This field should be completed even when writing
agreed amount coverage.
MISCELLANEOUS
Miscellaneous Agricultural
Machinery And Implements
Cause Of Loss (Perils)
Enter code: The causes of loss the subject of insurance is to be covered for. Examples:
* Basic
* Broad
* Special excluding theft
* Earthquake
MISCELLANEOUS
Miscellaneous Agricultural
Machinery And Implements
Deductible
Enter deductible: The deductible amount that is to apply to this subject of insurance.
MISCELLANEOUS
Miscellaneous Agricultural
Machinery And Implements
Premium
Enter amount: The premium amount for this subject of insurance.
MISCELLANEOUS
Miscellaneous Tools,
Equipment And Supplies
Not Exceeding $ _________
Per Item
Enter limit: The maximum amount of coverage per item for this subject of insurance or
premium-bearing option.
MISCELLANEOUS
Miscellaneous Tools,
Equipment And Supplies
Limit Of Insurance
Enter limit: The maximum amount of coverage provided for this subject of insurance or
premium-bearing option.
MISCELLANEOUS
Miscellaneous Tools,
Equipment And Supplies
Coins %
Enter percentage: The Coinsurance Percentage is the percentage of the total value of the
subject of insurance being insured. If the amount of insurance falls below this percentage, the
insured must share in the amount of the loss. This field should be completed even when writing
agreed amount coverage.
MISCELLANEOUS
Miscellaneous Tools,
Equipment And Supplies
Cause Of Loss (Perils)
Enter code: The causes of loss the subject of insurance is to be covered for. Examples:
* Basic
* Broad
* Special excluding theft
* Earthquake
MISCELLANEOUS
Miscellaneous Tools,
Equipment And Supplies
Deductible
Enter deductible: The deductible amount that is to apply to this subject of insurance.
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MISCELLANEOUS
Miscellaneous Tools,
Equipment And Supplies
Premium
Enter amount: The premium amount for this subject of insurance.
MISCELLANEOUS
Total Limit of Insurance
Enter limit: The total limit amount for the location / building.
MISCELLANEOUS
Total Premium
Enter amount: The premium for this property.
SCHEDULED FARM
PERSONAL PROPERTY
# One
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Year One
Enter year: The model year of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Make One
Enter text: The name of the manufacturer of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Model One
Enter text: The manufacturer's model name or number for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Serial # One
Enter identifier: The identification number, serial number, or any other identifying symbol of the
item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils) One
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance One
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible One
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium One
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Two
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Year Two
Enter year: The model year of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Make Two
Enter text: The name of the manufacturer of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Model Two
Enter text: The manufacturer's model name or number for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Serial # Two
Enter identifier: The identification number, serial number, or any other identifying symbol of the
item.
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SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils) Two
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Two
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Two
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Two
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Three
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Year Three
Enter year: The model year of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Make Three
Enter text: The name of the manufacturer of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Model Three
Enter text: The manufacturer's model name or number for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Serial # Three
Enter identifier: The identification number, serial number, or any other identifying symbol of the
item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils) Three
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Three
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Three
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Three
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Four
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Year Four
Enter year: The model year of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Make Four
Enter text: The name of the manufacturer of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Model Four
Enter text: The manufacturer's model name or number for the item.
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SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Serial # Four
Enter identifier: The identification number, serial number, or any other identifying symbol of the
item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils) Four
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Four
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Four
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Four
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Five
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Year Five
Enter year: The model year of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Make Five
Enter text: The name of the manufacturer of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Model Five
Enter text: The manufacturer's model name or number for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Serial # Five
Enter identifier: The identification number, serial number, or any other identifying symbol of the
item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils) Five
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Five
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Five
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Five
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Six
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Year Six
Enter year: The model year of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Make Six
Enter text: The name of the manufacturer of the item.
ACORD 403 (2014/12) rev. 04-29-2014
Page 12 of 88
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Model Six
Enter text: The manufacturer's model name or number for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Serial # Six
Enter identifier: The identification number, serial number, or any other identifying symbol of the
item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils) Six
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Six
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Six
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Six
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Seven
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Year Seven
Enter year: The model year of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Make Seven
Enter text: The name of the manufacturer of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Model Seven
Enter text: The manufacturer's model name or number for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Serial # Seven
Enter identifier: The identification number, serial number, or any other identifying symbol of the
item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils)
Seven
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Seven
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Seven
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Seven
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Eight
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Year Eight
Enter year: The model year of the item.
ACORD 403 (2014/12) rev. 04-29-2014
Page 13 of 88
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Make Eight
Enter text: The name of the manufacturer of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Model Eight
Enter text: The manufacturer's model name or number for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Serial # Eight
Enter identifier: The identification number, serial number, or any other identifying symbol of the
item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils) Eight
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Eight
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Eight
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Eight
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Nine
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Year Nine
Enter year: The model year of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Make Nine
Enter text: The name of the manufacturer of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Model Nine
Enter text: The manufacturer's model name or number for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Serial # Nine
Enter identifier: The identification number, serial number, or any other identifying symbol of the
item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils) Nine
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Nine
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Nine
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Nine
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Ten
Enter identifier: The producer assigned identifier for the item.
ACORD 403 (2014/12) rev. 04-29-2014
Page 14 of 88
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Year Ten
Enter year: The model year of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Make Ten
Enter text: The name of the manufacturer of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Model Ten
Enter text: The manufacturer's model name or number for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Serial # Ten
Enter identifier: The identification number, serial number, or any other identifying symbol of the
item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils) Ten
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Ten
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Ten
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Ten
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Eleven
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Year Eleven
Enter year: The model year of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Make Eleven
Enter text: The name of the manufacturer of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Model Eleven
Enter text: The manufacturer's model name or number for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Serial # Eleven
Enter identifier: The identification number, serial number, or any other identifying symbol of the
item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils)
Eleven
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Eleven
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Eleven
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Eleven
Enter amount: The premium amount for the coverage.
ACORD 403 (2014/12) rev. 04-29-2014
Page 15 of 88
SCHEDULED FARM
PERSONAL PROPERTY
# Twelve
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Year Twelve
Enter year: The model year of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Make Twelve
Enter text: The name of the manufacturer of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Model Twelve
Enter text: The manufacturer's model name or number for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Serial # Twelve
Enter identifier: The identification number, serial number, or any other identifying symbol of the
item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils)
Twelve
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Twelve
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Twelve
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Twelve
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Thirteen
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Year Thirteen
Enter year: The model year of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Make Thirteen
Enter text: The name of the manufacturer of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Model Thirteen
Enter text: The manufacturer's model name or number for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Serial # Thirteen
Enter identifier: The identification number, serial number, or any other identifying symbol of the
item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils)
Thirteen
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Thirteen
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Thirteen
Enter deductible: The deductible amount for the coverage.
ACORD 403 (2014/12) rev. 04-29-2014
Page 16 of 88
SCHEDULED FARM
PERSONAL PROPERTY
Premium Thirteen
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Fourteen
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Year Fourteen
Enter year: The model year of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Make Fourteen
Enter text: The name of the manufacturer of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Model Fourteen
Enter text: The manufacturer's model name or number for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Serial # Fourteen
Enter identifier: The identification number, serial number, or any other identifying symbol of the
item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils)
Fourteen
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Fourteen
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Fourteen
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Fourteen
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Fifteen
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Year Fifteen
Enter year: The model year of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Make Fifteen
Enter text: The name of the manufacturer of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Model Fifteen
Enter text: The manufacturer's model name or number for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Equipment
Serial # Fifteen
Enter identifier: The identification number, serial number, or any other identifying symbol of the
item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils)
Fifteen
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Fifteen
Enter limit: The limit amount for the coverage.
ACORD 403 (2014/12) rev. 04-29-2014
Page 17 of 88
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Fifteen
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Fifteen
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# One
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Non-
Equipment Livestock info,
feed, hay, etc) One
Enter text: The description of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils) One
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance One
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible One
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium One
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Two
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Non-
Equipment Livestock info,
feed, hay, etc) Two
Enter text: The description of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils) Two
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Two
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Two
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Two
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Three
Enter identifier: The producer assigned identifier for the item.
ACORD 403 (2014/12) rev. 04-29-2014
Page 18 of 88
SCHEDULED FARM
PERSONAL PROPERTY
Description - Non-
Equipment Livestock info,
feed, hay, etc) Three
Enter text: The description of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils) Three
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Three
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Three
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Three
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Four
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Non-
Equipment Livestock info,
feed, hay, etc) Four
Enter text: The description of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils) Four
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Four
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Four
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Four
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Five
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Non-
Equipment Livestock info,
feed, hay, etc) Five
Enter text: The description of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils) Five
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Five
Enter limit: The limit amount for the coverage.
ACORD 403 (2014/12) rev. 04-29-2014
Page 19 of 88
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Five
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Five
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Six
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Non-
Equipment Livestock info,
feed, hay, etc) Six
Enter text: The description of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils) Six
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Six
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Six
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Six
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Seven
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Non-
Equipment Livestock info,
feed, hay, etc) Seven
Enter text: The description of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils)
Seven
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Seven
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Seven
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Seven
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Eight
Enter identifier: The producer assigned identifier for the item.
ACORD 403 (2014/12) rev. 04-29-2014
Page 20 of 88
SCHEDULED FARM
PERSONAL PROPERTY
Description - Non-
Equipment Livestock info,
feed, hay, etc) Eight
Enter text: The description of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils) Eight
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Eight
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Eight
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Eight
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Nine
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Non-
Equipment Livestock info,
feed, hay, etc) Nine
Enter text: The description of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils) Nine
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Nine
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Nine
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Nine
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Ten
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Non-
Equipment Livestock info,
feed, hay, etc) Ten
Enter text: The description of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils) Ten
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Ten
Enter limit: The limit amount for the coverage.
ACORD 403 (2014/12) rev. 04-29-2014
Page 21 of 88
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Ten
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Ten
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Eleven
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Non-
Equipment Livestock info,
feed, hay, etc) Eleven
Enter text: The description of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils)
Eleven
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Eleven
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Eleven
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Eleven
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Twelve
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Non-
Equipment Livestock info,
feed, hay, etc) Twelve
Enter text: The description of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils)
Twelve
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Twelve
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Twelve
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Twelve
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Thirteen
Enter identifier: The producer assigned identifier for the item.
ACORD 403 (2014/12) rev. 04-29-2014
Page 22 of 88
SCHEDULED FARM
PERSONAL PROPERTY
Description - Non-
Equipment Livestock info,
feed, hay, etc) Thirteen
Enter text: The description of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils)
Thirteen
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Thirteen
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Thirteen
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Thirteen
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Fourteen
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Non-
Equipment Livestock info,
feed, hay, etc) Fourteen
Enter text: The description of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils)
Fourteen
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Fourteen
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Fourteen
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Fourteen
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Fifteen
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Non-
Equipment Livestock info,
feed, hay, etc) Fifteen
Enter text: The description of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils)
Fifteen
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Fifteen
Enter limit: The limit amount for the coverage.
ACORD 403 (2014/12) rev. 04-29-2014
Page 23 of 88
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Fifteen
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Fifteen
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Sixteen
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Non-
Equipment Livestock info,
feed, hay, etc) Sixteen
Enter text: The description of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils)
Sixteen
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance Sixteen
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Sixteen
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Sixteen
Enter amount: The premium amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
# Seventeen
Enter identifier: The producer assigned identifier for the item.
SCHEDULED FARM
PERSONAL PROPERTY
Description - Non-
Equipment Livestock info,
feed, hay, etc) Seventeen
Enter text: The description of the item.
SCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss (Perils)
Seventeen
Enter code: The causes of loss (perils) that are to be covered.
SCHEDULED FARM
PERSONAL PROPERTY
Limit of Insurance
Seventeen
Enter limit: The limit amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Deductible Seventeen
Enter deductible: The deductible amount for the coverage.
SCHEDULED FARM
PERSONAL PROPERTY
Premium Seventeen
Enter amount: The premium amount for the coverage.
Form Page 3
Section Name
Field Name
Description
ACORD 403 (2014/12) rev. 04-29-2014
Page 24 of 88
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g., agency or
brokerage).
IDENTIFICATION SECTION
Loc #
Enter number: The producer assigned number of the location.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Barley Unit Price
Enter amount: The price per unit for barley.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for barley.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for barley.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for barley.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Corn Unit Price
Enter amount: The price per unit for corn.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for corn.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for corn.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for corn.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Fodder Unit Price
Enter amount: The price per unit for fodder.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for fodder.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for fodder.
ACORD 403 (2014/12) rev. 04-29-2014
Page 25 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for fodder.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Fruit Unit Price
Enter amount: The price per unit for fruit.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for fruit.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for fruit.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for fruit.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ground Feed Unit Price
Enter amount: The price per unit for ground feed.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for ground feed.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for ground feed.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for ground feed.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Hay Unit Price
Enter amount: The price per unit for hay.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for hay.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for hay.
ACORD 403 (2014/12) rev. 04-29-2014
Page 26 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for hay.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Mfg Stk Feed Unit Price
Enter amount: The price per unit for manufacturing stock feed.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for manufacturing stock feed.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for manufacturing stock feed.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for manufacturing stock
feed.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Nuts Unit Price
Enter amount: The price per unit for nuts.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for nuts.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for nuts.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for nuts.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Oats Unit Price
Enter amount: The price per unit for oats.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for oats.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for oats.
ACORD 403 (2014/12) rev. 04-29-2014
Page 27 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for oats.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Silage Unit Price
Enter amount: The price per unit for silage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for silage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for silage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for silage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Soybeans Unit Price
Enter amount: The price per unit for soybeans.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for soybeans.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for soybeans.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for soybeans.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Straw Unit Price
Enter amount: The price per unit for straw.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for straw.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for straw.
ACORD 403 (2014/12) rev. 04-29-2014
Page 28 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for straw.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Wheat Unit Price
Enter amount: The price per unit for wheat.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for wheat.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for wheat.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for wheat.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Agricultural Produce
One
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Unit Price
Enter amount: The price per unit.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Agricultural Produce
Two
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Unit Price
Enter amount: The price per unit.
ACORD 403 (2014/12) rev. 04-29-2014
Page 29 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Agricultural Produce
Three
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Unit Price
Enter amount: The price per unit.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Agricultural Produce
Four
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Unit Price
Enter amount: The price per unit.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
ACORD 403 (2014/12) rev. 04-29-2014
Page 30 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Agricultural Produce
Five
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Unit Price
Enter amount: The price per unit.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Agricultural Produce
Six
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Unit Price
Enter amount: The price per unit.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Agricultural Produce
Seven
Enter code: The code that further defines the class (group) of the inland marine items being
described.
ACORD 403 (2014/12) rev. 04-29-2014
Page 31 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Unit Price
Enter amount: The price per unit.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Agricultural Produce
Eight
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Unit Price
Enter amount: The price per unit.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Total Value:
Enter limit: The total limit amount for all items listed.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Chickens Unit Price
Enter amount: The price per unit for chickens.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for chickens.
ACORD 403 (2014/12) rev. 04-29-2014
Page 32 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for chickens.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for chickens.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Turkeys Unit Price
Enter amount: The price per unit for turkeys.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for turkeys.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for turkeys.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for turkeys.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Poultry One
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Unit Price
Enter amount: The price per unit.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Poultry Two
Enter code: The code that further defines the class (group) of the inland marine items being
described.
ACORD 403 (2014/12) rev. 04-29-2014
Page 33 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Unit Price
Enter amount: The price per unit.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Poultry Three
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Unit Price
Enter amount: The price per unit.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Poultry Four
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Unit Price
Enter amount: The price per unit.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
ACORD 403 (2014/12) rev. 04-29-2014
Page 34 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Total Value:
Enter limit: The total limit amount for all items listed.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Dairy Cows Unit Price
Enter amount: The price per unit for dairy cows.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for dairy cows.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for dairy cows.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for dairy cows.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Dairy Heifers Unit Price
Enter amount: The price per unit for dairy heifers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for dairy heifers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for dairy heifers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for dairy heifers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Dairy Calves Unit Price
Enter amount: The price per unit for dairy calves.
ACORD 403 (2014/12) rev. 04-29-2014
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AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for dairy calves.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for dairy calves.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for dairy calves.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Beef Cows Unit Price
Enter amount: The price per unit for beef cows.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for beef cows.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for beef cows.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for beef cows.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Beef Calves Unit Price
Enter amount: The price per unit for beef calves.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for beef calves.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for beef calves.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for beef calves.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Feeder Cattle Unit Price
Enter amount: The price per unit for feeder cattle.
ACORD 403 (2014/12) rev. 04-29-2014
Page 36 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for feeder cattle.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for feeder cattle.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for feeder cattle.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Bulls Unit Price
Enter amount: The price per unit for bulls.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for bulls.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for bulls.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for bulls.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Sows & Gilts Unit Price
Enter amount: The price per unit for sows and gilts.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for sows and gilts.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for sows and gilts.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for sows and gilts.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Boars Unit Price
Enter amount: The price per unit for boars.
ACORD 403 (2014/12) rev. 04-29-2014
Page 37 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for boars.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for boars.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for boars.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Feeder Pigs Unit Price
Enter amount: The price per unit for feeder pigs.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for feeder pigs.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for feeder pigs.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for feeder pigs.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ewes Unit Price
Enter amount: The price per unit for ewes.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for ewes.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for ewes.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for ewes.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Rams Unit Price
Enter amount: The price per unit for rams.
ACORD 403 (2014/12) rev. 04-29-2014
Page 38 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for rams.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for rams.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for rams.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Lambs Unit Price
Enter amount: The price per unit for lambs.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for lambs.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for lambs.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for lambs.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Horses Unit Price
Enter amount: The price per unit for horses.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for horses.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for horses.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for horses.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ponies Unit Price
Enter amount: The price per unit for ponies.
ACORD 403 (2014/12) rev. 04-29-2014
Page 39 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for ponies.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for ponies.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for ponies.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Mules Unit Price
Enter amount: The price per unit for mules.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for mules.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for mules.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for mules.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Livestock One
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Unit Price
Enter amount: The price per unit.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
ACORD 403 (2014/12) rev. 04-29-2014
Page 40 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Livestock Two
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Unit Price
Enter amount: The price per unit.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Livestock Three
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Unit Price
Enter amount: The price per unit.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Livestock Four
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Unit Price
Enter amount: The price per unit.
ACORD 403 (2014/12) rev. 04-29-2014
Page 41 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Total Value:
Enter limit: The total limit amount for all items listed.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Tractors
Enter number: The number of units for tractors.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for tractors.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for tractors.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for tractors.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Discs
Enter number: The number of units for discs.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for discs.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for discs.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for discs.
ACORD 403 (2014/12) rev. 04-29-2014
Page 42 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Harrows
Enter number: The number of units for harrows.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for harrows.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for harrows.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for harrows.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Plows
Enter number: The number of units for plows.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for plows.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for plows.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for plows.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Tillage One
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered.
ACORD 403 (2014/12) rev. 04-29-2014
Page 43 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Tillage Two
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Tillage Three
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Tillage Four
Enter code: The code that further defines the class (group) of the inland marine items being
described.
ACORD 403 (2014/12) rev. 04-29-2014
Page 44 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Cultipackers
Enter number: The number of units for cultipackers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for cultipackers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for cultipackers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for cultipackers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Cultivators
Enter number: The number of units for cultivators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for cultivators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for cultivators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for cultivators.
ACORD 403 (2014/12) rev. 04-29-2014
Page 45 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Drills
Enter number: The number of units for drills.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for drills.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for drills.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for drills.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Planters
Enter number: The number of units for planters.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for planters.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for planters.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for planters.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Rotary Hoes
Enter number: The number of units for rotary hoes.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for rotary hoes.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for rotary hoes.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for rotary hoes.
ACORD 403 (2014/12) rev. 04-29-2014
Page 46 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Seeders
Enter number: The number of units for seeders.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for seeders.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for seeders.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for seeders.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Spreaders
Enter number: The number of units for spreaders.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for spreaders.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for spreaders.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for spreaders.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Sprayers
Enter number: The number of units for sprayers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for sprayers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for sprayers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for sprayers.
ACORD 403 (2014/12) rev. 04-29-2014
Page 47 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Cultivating One
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Cultivating Two
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Cultivating Three
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
ACORD 403 (2014/12) rev. 04-29-2014
Page 48 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Cultivating Four
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Augers
Enter number: The number of units for augers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for augers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for augers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for augers.
ACORD 403 (2014/12) rev. 04-29-2014
Page 49 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Blowers
Enter number: The number of units for blowers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for blowers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for blowers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for blowers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Choppers
Enter number: The number of units for choppers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for choppers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for choppers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for choppers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Combines
Enter number: The number of units for combines.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for combines.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for combines.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for combines.
ACORD 403 (2014/12) rev. 04-29-2014
Page 50 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Corn Pickers
Enter number: The number of units for corn pickers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for corn pickers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for corn pickers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for corn pickers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Cotton Pickers
Enter number: The number of units for cotton pickers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for cotton pickers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for cotton pickers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for cotton pickers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Driers
Enter number: The number of units for driers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for driers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for driers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for driers.
ACORD 403 (2014/12) rev. 04-29-2014
Page 51 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Elevators
(portable)
Enter number: The number of units for portable elevators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for portable elevators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for portable elevators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for portable elevators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Forage Harvesters
Enter number: The number of units for forage harvesters.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for forage harvesters.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for forage harvesters.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for forage harvesters.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Grain Cleaners
Enter number: The number of units for grain cleaners.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for grain cleaners.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for grain cleaners.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for grain cleaners.
ACORD 403 (2014/12) rev. 04-29-2014
Page 52 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Grain Heads
Enter number: The number of units for grain heads.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for grain heads.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for grain heads.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for grain heads.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Grape Harvesters
Enter number: The number of units for grape harvesters.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for grape harvesters.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for grape harvesters.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for grape harvesters.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Hay Balers
Enter number: The number of units for hay balers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for hay balers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for hay balers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for hay balers.
ACORD 403 (2014/12) rev. 04-29-2014
Page 53 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Mowers
Enter number: The number of units for mowers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for mowers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for mowers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for mowers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Nutshakers
Enter number: The number of units for nutshakers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for nutshakers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for nutshakers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for nutshakers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Rakes
Enter number: The number of units for rakes.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for rakes.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for rakes.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for rakes.
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AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Rice Harvesters
Enter number: The number of units for rice harvesters.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for rice harvesters.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for rice harvesters.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for rice harvesters.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Silo Blowers
Enter number: The number of units for silo blowers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for silo blowers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for silo blowers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for silo blowers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Silo Unloaders
Enter number: The number of units for silo unloaders.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for silo unloaders.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for silo unloaders.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for silo unloaders.
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AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Tomato
Harvesters
Enter number: The number of units for tomato harvesters.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for tomato harvesters.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for tomato harvesters.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for tomato harvesters.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Wagons
Enter number: The number of units for wagons.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for wagons.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered for wagons.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for wagons.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Harvesting One
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered.
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AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Harvesting Two
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Harvesting Three
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Harvesting Four
Enter code: The code that further defines the class (group) of the inland marine items being
described.
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AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Harvesting Five
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Harvesting Six
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
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AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause Of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Total Value:
Enter limit: The total limit amount for all items listed.
Form Page 4
Section Name
Field Name
Description
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g., agency or
brokerage).
IDENTIFICATION SECTION
Loc #
Enter number: The producer assigned number of the location.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Fertilizer
Enter number: The number of units for fertilizers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for fertilizers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for fertilizers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for fertilizers.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Herbicides
Enter number: The number of units for herbicides.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for herbicides.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for herbicides.
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AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for herbicides.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Insecticides
Enter number: The number of units for insecticides.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for insecticides.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for insecticides.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for insecticides.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Pesticides
Enter number: The number of units for pesticides.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for pesticides.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for pesticides.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for pesticides.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Air Compressors
Enter number: The number of units for air compressors.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for air compressors.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for air compressors.
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AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for air compressors.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Bins
Enter number: The number of units for bins.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for bins.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for bins.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for bins.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Boxes & Box
Shook
Enter number: The number of units for boxes and box shook.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for boxes and box shook.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for boxes and box shook.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for boxes and box shook.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Electric Motors
Enter number: The number of units for electric motors.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for electric motors.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for electric motors.
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AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for electric motors.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Farm Lubricants
Enter number: The number of units for farm lubricants.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for farm lubricants.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for farm lubricants.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for farm lubricants.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Fencing & Posts
Enter number: The number of units for fencing and posts.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for fencing and posts.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for fencing and posts.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for fencing and posts.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Gas/Diesel Fuel
Enter number: The number of units for gas or diesel fuel.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for gas or diesel fuel.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for gas or diesel fuel.
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AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for gas or diesel fuel.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Hand Tools
Enter number: The number of units for hand tools.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for hand tools.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for hand tools.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for hand tools.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Materials & Supp
Enter number: The number of units for materials and supplies.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for materials and supplies.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for materials and supplies.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for materials and
supplies.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Milking
Equipment
Enter number: The number of units for milking equipment.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for milking equipment.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for milking equipment.
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AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for milking equipment.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Office Equipment
Enter number: The number of units for office equipment.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for office equipment.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for office equipment.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for office equipment.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Paints
Enter number: The number of units for paints.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for paints.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for paints.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for paints.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Picking
Equipment
Enter number: The number of units for picking equipment.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for picking equipment.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for picking equipment.
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AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for picking equipment.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Poultry
Equipment
Enter number: The number of units for poultry equipment.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for poultry equipment.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for poultry equipment.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for poultry equipment.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Power Tools
Enter number: The number of units for power tools.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for power tools.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for power tools.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for power tools.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Saddles & Tack
Enter number: The number of units for saddles and tack.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for saddles and tack.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for saddles and tack.
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AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for saddles and tack.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Spare Parts
Enter number: The number of units for spare parts.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for spare parts.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for spare parts.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for spare parts.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Tires
Enter number: The number of units for tires.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for tires.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for tires.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for tires.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Vet Supplies
Enter number: The number of units for veterinary supplies.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for veterinary supplies.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for veterinary supplies.
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AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for veterinary supplies.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Welders &
Torches
Enter number: The number of units for welders and torches.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for welders and torches.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for welders and torches.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for welders and torches.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other One
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Two
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
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AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Three
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Four
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
ACORD 403 (2014/12) rev. 04-29-2014
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AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Five
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Six
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Seven
Enter code: The code that further defines the class (group) of the inland marine items being
described.
ACORD 403 (2014/12) rev. 04-29-2014
Page 69 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Eight
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Nine
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
ACORD 403 (2014/12) rev. 04-29-2014
Page 70 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Total Value:
Enter limit: The total limit amount for all items listed.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Cntr Pivot Irr
Enter number: The number of units for center pivot irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for center pivot irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for center pivot irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for center pivot irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Drip
Enter number: The number of units for drip irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for drip irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for drip irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for drip irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Handset
Enter number: The number of units for handset irrigators.
ACORD 403 (2014/12) rev. 04-29-2014
Page 71 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for handset irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for handset irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for handset irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Ltrl Move Irr
Enter number: The number of units for lateral move irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for lateral move irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for lateral move irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for lateral move
irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Pumps
Enter number: The number of units for pump irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for pump irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for pump irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for pump irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Solid Set
Enter number: The number of units for solid set irrigators.
ACORD 403 (2014/12) rev. 04-29-2014
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AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for solid set irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for solid set irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for solid set irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units Wheel-Line
Enter number: The number of units for wheel line irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class for wheel line irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered for wheel line irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage for wheel line irrigators.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Irrigation Equipment
One
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
ACORD 403 (2014/12) rev. 04-29-2014
Page 73 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Irrigation Equipment
Two
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Irrigation Equipment
Three
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Irrigation Equipment
Four
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
ACORD 403 (2014/12) rev. 04-29-2014
Page 74 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Other Irrigation Equipment
Five
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Total Value:
Enter limit: The total limit amount for all items listed.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Additional Items One
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
ACORD 403 (2014/12) rev. 04-29-2014
Page 75 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Additional Items Two
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Additional Items Three
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
ACORD 403 (2014/12) rev. 04-29-2014
Page 76 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Additional Items Four
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Additional Items Five
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Additional Items Six
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
ACORD 403 (2014/12) rev. 04-29-2014
Page 77 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Additional Items Seven
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Additional Items Eight
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
ACORD 403 (2014/12) rev. 04-29-2014
Page 78 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Additional Items Nine
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Additional Items Ten
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Additional Items Eleven
Enter code: The code that further defines the class (group) of the inland marine items being
described.
ACORD 403 (2014/12) rev. 04-29-2014
Page 79 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Additional Items Twelve
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Additional Items Thirteen
Enter code: The code that further defines the class (group) of the inland marine items being
described.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
# of Units
Enter number: The number of units.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Value
Enter amount: The value of the class / sub-class.
ACORD 403 (2014/12) rev. 04-29-2014
Page 80 of 88
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Cause of Loss
Enter code: The cause of loss (peril) being covered.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Ded
Enter deductible: The deductible amount associated with the coverage.
AGRICULTURE
UNSCHEDULED FARM
PERSONAL PROPERTY
Total Value:
Enter limit: The total limit amount for all items listed.
SUMMARY SCHEDULED
FARM PERSONAL
PROPERTY
Limit of Insurance
Enter limit: The total limit amount for all scheduled farm personal property.
SUMMARY SCHEDULED
FARM PERSONAL
PROPERTY
Premium
Enter amount: The total premium amount for all scheduled farm personal property.
SUMMARY UNSCHEDULED
FARM PERSONAL
PROPERTY
Total All Categories
Enter amount: The total value amount for all unscheduled farm personal property.
SUMMARY UNSCHEDULED
FARM PERSONAL
PROPERTY
Limit of Insurance
Enter limit: The total limit amount for all unscheduled farm personal property.
SUMMARY UNSCHEDULED
FARM PERSONAL
PROPERTY
Premium
Enter amount: The total premium amount for all unscheduled farm personal property.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Class One
Enter code: The code defining the class (group) of the inland marine items being described. As
used here, this identifies an item that is excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Sub-Class One
Enter code: The code that further defines the class (group) of the inland marine items being
described. As used here, this identifies an item that is excluded from blanket coverage.
ACORD 403 (2014/12) rev. 04-29-2014
Page 81 of 88
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Items One
Enter text: The description of the item. As used here, this identifies an item that is excluded from
blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Value One
Enter amount: The value of the class / sub-class. As used here, this identifies an item that is
excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Class Two
Enter code: The code defining the class (group) of the inland marine items being described. As
used here, this identifies an item that is excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Sub-Class Two
Enter code: The code that further defines the class (group) of the inland marine items being
described. As used here, this identifies an item that is excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Items Two
Enter text: The description of the item. As used here, this identifies an item that is excluded from
blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Value Two
Enter amount: The value of the class / sub-class. As used here, this identifies an item that is
excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Class Three
Enter code: The code defining the class (group) of the inland marine items being described. As
used here, this identifies an item that is excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Sub-Class Three
Enter code: The code that further defines the class (group) of the inland marine items being
described. As used here, this identifies an item that is excluded from blanket coverage.
ACORD 403 (2014/12) rev. 04-29-2014
Page 82 of 88
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Items Three
Enter text: The description of the item. As used here, this identifies an item that is excluded from
blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Value Three
Enter amount: The value of the class / sub-class. As used here, this identifies an item that is
excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Class Four
Enter code: The code defining the class (group) of the inland marine items being described. As
used here, this identifies an item that is excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Sub-Class Four
Enter code: The code that further defines the class (group) of the inland marine items being
described. As used here, this identifies an item that is excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Items Four
Enter text: The description of the item. As used here, this identifies an item that is excluded from
blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Value Four
Enter amount: The value of the class / sub-class. As used here, this identifies an item that is
excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Class Five
Enter code: The code defining the class (group) of the inland marine items being described. As
used here, this identifies an item that is excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Sub-Class Five
Enter code: The code that further defines the class (group) of the inland marine items being
described. As used here, this identifies an item that is excluded from blanket coverage.
ACORD 403 (2014/12) rev. 04-29-2014
Page 83 of 88
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Items Five
Enter text: The description of the item. As used here, this identifies an item that is excluded from
blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Value Five
Enter amount: The value of the class / sub-class. As used here, this identifies an item that is
excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Class Six
Enter code: The code defining the class (group) of the inland marine items being described. As
used here, this identifies an item that is excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Sub-Class Six
Enter code: The code that further defines the class (group) of the inland marine items being
described. As used here, this identifies an item that is excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Items Six
Enter text: The description of the item. As used here, this identifies an item that is excluded from
blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Value Six
Enter amount: The value of the class / sub-class. As used here, this identifies an item that is
excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Class Seven
Enter code: The code defining the class (group) of the inland marine items being described. As
used here, this identifies an item that is excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Sub-Class Seven
Enter code: The code that further defines the class (group) of the inland marine items being
described. As used here, this identifies an item that is excluded from blanket coverage.
ACORD 403 (2014/12) rev. 04-29-2014
Page 84 of 88
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Items Seven
Enter text: The description of the item. As used here, this identifies an item that is excluded from
blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Value Seven
Enter amount: The value of the class / sub-class. As used here, this identifies an item that is
excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Class Eight
Enter code: The code defining the class (group) of the inland marine items being described. As
used here, this identifies an item that is excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Sub-Class Eight
Enter code: The code that further defines the class (group) of the inland marine items being
described. As used here, this identifies an item that is excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Items Eight
Enter text: The description of the item. As used here, this identifies an item that is excluded from
blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Value Eight
Enter amount: The value of the class / sub-class. As used here, this identifies an item that is
excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Class Nine
Enter code: The code defining the class (group) of the inland marine items being described. As
used here, this identifies an item that is excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Sub-Class Nine
Enter code: The code that further defines the class (group) of the inland marine items being
described. As used here, this identifies an item that is excluded from blanket coverage.
ACORD 403 (2014/12) rev. 04-29-2014
Page 85 of 88
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Items Nine
Enter text: The description of the item. As used here, this identifies an item that is excluded from
blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Value Nine
Enter amount: The value of the class / sub-class. As used here, this identifies an item that is
excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Class Ten
Enter code: The code defining the class (group) of the inland marine items being described. As
used here, this identifies an item that is excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Sub-Class Ten
Enter code: The code that further defines the class (group) of the inland marine items being
described. As used here, this identifies an item that is excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Items Ten
Enter text: The description of the item. As used here, this identifies an item that is excluded from
blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Value Ten
Enter amount: The value of the class / sub-class. As used here, this identifies an item that is
excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Class Eleven
Enter code: The code defining the class (group) of the inland marine items being described. As
used here, this identifies an item that is excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Sub-Class Eleven
Enter code: The code that further defines the class (group) of the inland marine items being
described. As used here, this identifies an item that is excluded from blanket coverage.
ACORD 403 (2014/12) rev. 04-29-2014
Page 86 of 88
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Items Eleven
Enter text: The description of the item. As used here, this identifies an item that is excluded from
blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Value Eleven
Enter amount: The value of the class / sub-class. As used here, this identifies an item that is
excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Class Twelve
Enter code: The code defining the class (group) of the inland marine items being described. As
used here, this identifies an item that is excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Sub-Class Twelve
Enter code: The code that further defines the class (group) of the inland marine items being
described. As used here, this identifies an item that is excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Items Twelve
Enter text: The description of the item. As used here, this identifies an item that is excluded from
blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Value Twelve
Enter amount: The value of the class / sub-class. As used here, this identifies an item that is
excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Class Thirteen
Enter code: The code defining the class (group) of the inland marine items being described. As
used here, this identifies an item that is excluded from blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Property Sub-Class Thirteen
Enter code: The code that further defines the class (group) of the inland marine items being
described. As used here, this identifies an item that is excluded from blanket coverage.
ACORD 403 (2014/12) rev. 04-29-2014
Page 87 of 88
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Items Thirteen
Enter text: The description of the item. As used here, this identifies an item that is excluded from
blanket coverage.
IF EXCLUSION OF
PROPERTY FROM
BLANKET COVERAGE IS
DESIRED, PLEASE LIST
THE SPECIFIC ITEMS
Value Thirteen
Enter amount: The value of the class / sub-class. As used here, this identifies an item that is
excluded from blanket coverage.
Form Page 5
Section Name
Field Name
Description
IDENTIFICATION SECTION
Agency Customer ID
Enter identifier: The customer's identification number assigned by the producer (e.g., agency or
brokerage).
IDENTIFICATION SECTION
Loc #
Enter number: The producer assigned number of the location.
SIGNATURE
Producer's Signature
Sign here: Accommodates the signature of the authorized representative (e.g., producer, agent,
broker, etc.) of the company(ies) listed on the document. This is required in most states.
SIGNATURE
Producer's Name (Please
Print)
Enter text: The name of the authorized representative of the producer, agency and/or broker
that signed the form.
SIGNATURE
State Producer License No
(Required in FL)
Enter identifier: The State License Number of the producer.
SIGNATURE
Applicant's Signature
Sign here: Accommodates the signature of the applicant or named insured.
SIGNATURE
Date
Enter date: The date the form was signed by the named insured. (MM/DD/YYYY)
SIGNATURE
National Producer Number
Enter identifier: The National Producer Number (NPN) as defined in the National Insurance
Producer Registry (NIPR). Note: The NPN is not the same as the producer state license
number.
ACORD 403 (2014/12) rev. 04-29-2014
Page 88 of 88