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This is a quote request for renters insurance in the state of South Dakota. Renters insurance covers the personal property of those living in an apartment or renting a house. It also provides liability and medical payments coverage. There is absolutely no obligation to purchase insurance by filling out this form. And, no insurance coverage can be bound by filling out this form. If coverage is later requested, an application for insurance will need to be signed and a down payment of premium made. Any rates given are subject to the companies final review and approval.

Contact Information

Name
Address
City, State ZIP
Phone
E-Mail
FAX

Applicant Information

First Name

Last Name

Birth Date

Social Security #

Residence Information

What type of building do you live in?
List the street address of the house if different from the address above.

Coverage Amounts
click here for description

Personal Property
$

Personal Liability

Medical Payments

Scheduled Personal Property
click here for description

Do you own any jewelry or other collectible items which you
would like specifically scheduled on your insurance policy?

Additional Information

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

Insurance History

List your current insurance company
and the policy expiration date:

Company

Exp. Date

  List all insurance claims you have
  had at this residence in last five years
  including dates, type and amounts:

Comments

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

Copyright © 2000 Strait Insurance Agency, Inc. All rights reserved.

Personal Property - The primary purpose of a renters insurance policy is to place insurance coverage on your household personal belongings. Take a quick inventory of your personal property and estimate how much it would cost to replace everything you own. The minimum amount of coverage on a renters policy is usually $10,000 and most people, especially families, will require much more coverage than that.

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

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

click here to return to Coverage Amounts

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

Recreational Vehicles - Watercraft, snowmobiles and ATVs can usually be added onto a homeowners policy. (Sometimes, however, they must be written on separate policies.) List the amount of coverage, year, make, model, and horsepower or CC's in the comments section.

click here to return to Scheduled Personal Property

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