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Equipment Breakdown & Service Line – LINK to information

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* RCFM-90  Equipment Breakdown Form       

E2Value: 

If you would like our office to do an E2Value, please complete the form below and return to our office.

Applications

(Please note: the applications are legal contracts and you must keep a copy of the signed applications on file)

Claims

Manual 1-1-19

 Payment Options:

PAYMENT BY PHONE

To make a payment by phone, please call us at (605) 698-7122. Please have your bank account and routing number available.  We do not accept credit cards.

PAYMENT BY CHECK

To make a payment by check, please mail the check to us at 418 Veterans Avenue, Sisseton, SD 57262

Newsletters:

Please go to site map tab and click newsletters

Forms

Privacy Notice Privacy act
STD-F Standard Fire
ML-0686 09 02 On all policies that are owner occupied
FL-1 ED 1.0 – Used for rental and seasonal policies – vandalism is an added on peril
Form 1 ED 2.0  Basic form
FO-1 ED 1.0 – Farm basic form
GL-1 ED 1.0  – Gives personal liability for the home
CTL 2.0 – Terrorism Loss
FL-2 ED 1.0 –
FO-2 ED 1.0 Used for rental & seasonal policies
Form 2 ED 2.0 Broad form
GL-2 ED 1.0 Gives them personal liability for farm
GL-2 ED 2.0 –
Form 3 ED 2.0 Special form
FO-3 ED 1.0 – Farm special form
FORM 4 ED 2.0 Renters & condo unit owners form
FO-4 ED 1.0 – Farm renters & condo unit owners form
GL-5 SD 02 02 Cancellation & non renewal, change of policy terms, inspections, examination of books & records
FL-6 ED 1.0 Coverage for rental & seasonal outbuildings
FO-6 ED 1.0  Coverage for outbuildings & farm personal property – ACTUAL CASH VALUE
HP-7 3.0 Mold exclusion
ML-8 07 99 Applies to homes of lesser value/limited perils and vandalism is optional
PDT-8 102017 Terrorism coverage
GL-9 ED 1.0 –
GL-10 ED 1.0 Exclusion of punitive damages
FO-15 ED 1.0 –
ML-15 Ed 1.0 Coverage is provided on an actual cash value basis
RCFM-19 10-2017 Total loss only coverage – outbuildings
FL-20 ED 1.0 Appraisal, abandonment of property, assignment, cancellation & non renewal
FO-20 ED 1.0 –
ML-20 Attached to Form 8 – gives the policy conditions
ML-29 Ed 2.0 Changes to ML forms – concerning farm liability coverage
FL-34 ED 1.0 Provides theft coverage
FL-35 ED 1.0 Provides limited theft coverage
GL-40 ED 1.0 –
FO-41 ED 1.0 
ML-41 Ed 1.0 – 
ML-42 Ed 1.0 Liability for incidental office coverage
ML-46 Ed 1.0 Extending coverage to include coverage for personal injury
FO-52 ED 1.0 –
ML-52 Ed 2.0 –
FO-55 ED 2.0 –
ML-55 Ed. 2.0  – adds replacement to household goods
FO-61 ED 1.0 –
ML-61 Ed 1.0
RCFM-IM-61 Goes on with the IM-100 inland marine coverage
ML-67 Ed 1.0 Other residence
GL-70 ED 1.0 Additional insured
GL-70 ED 2.0 – Additional insured
ML-70 ED 2.0Additional residence – rented to others, liability only
GL-71 ED 1.0 –
GL-71 ED 2.0 –
ML-71 ED 1.0 Business activities
GL-72 ED 1.0 Additional insured & additional residences
GL-73 1.0 Additional residences or farms rented to others
GL-74 ED 1.0 coverage applies to business activities as described on declarations page – there are exclusions
GL-75 ED 1.0 Coverage applies to custom farming activities of an insured
ML-75 ED 1.0 Applies to bodily injury or property damage, arising out of use of watercraft
GL-76 ED 1.0 Coverage for farm employees
GL-77 ED 1.0 Liability is extended to cover property damage to premises used, rented or operated by you as a farm
GL-80 ED 1.0 –
GL-90 ED 1.0 –
RCFM-90 – Equipment Breakdown
RCFM-95Service Line
RCFM-95A – Farm Service Line
RCFM-98 10-2017 – Excludes asbestos
FO-99 10-2017 –
RCFM-99 10-2017 Vacant property, broad form livestock, milk contamination, lake ice exclusion, rec vehicle exclusion, mobilehome modified loss, hay stack limitation, modified replacement cost – shingles ACV
RCFM-HO-99A 10-2017 –
CL-100 ED 2.0 –
GL-108 ED 1.0 –
Ml-111 ED 1.0 Cancellation & non renewal, appraisal condition & suite against us
ML-147 ED 1.0 –
SMIC-150 10-2017 Covering custom work within 20 miles from home/gross receipts do not exceed $1000
ML-164 ED 2.0 Applies liability and med pay to others
SMIC-166 10-2017 Bodily injury and property damage for recreational vehicles – cannot be used for highway use
FO-170 ED 1.0 –
ML-170 ED 2.0 Covers computers – perils excluded
IM-175 Ed 1.0 –
FO-181 ED 1.0 –
ML-181 ED 1.0 –
SMIC-200 10-2017 ACV provides limited perils for construction on dwelling
ML-209 ED 1.0 Applies liability coverage to waterbeds owned by insured
FO-0217 11 08 –
ML-223 ED 2.0 Excludes Lead & excludes mold
CL-300 ED 1.0 Refers to works and phrases shown in quotations or bold
RCFM-IM 300 10-2017 Outboard motor coverage
FO-309 ED 1.0 –
ML-313 10-2017 Provides Liability & med pay coverage while custom farming
ML-317 Extends coverage for liability to property used, rented of operated as farm
ML-323-A 10-2017 Extends to cover loss to farm personal property due to weight of ice, sleet snow $500 deductible
ML-323-B 10-2017 Extends to cover loss to building due to weight of ice, sleet, snow $500 deductible
RCFM-324 10-2017 Death of livestock caused by freezing or smothering in blizzard-within 5 miles of homestead
ML-327 7-84Liability coverage for incidental business pursuits
FO-352 ED 1.0 –
FO-360 ED 1.0 
ML-0405 07 99 –
ML-435 ED 1.0 
FO-0420 02 05 
ML-483 ED 2.0 –
Ml-502 ED 1.0 Revising the definition of owning home and insured premises
RCFM-508 10-2017 Provides coverage for backup of sewers $500 deductible
GL-600 ED 1.0 Premises only for rental and seasonal
GL-610 ED 1.0 Premises only for farms
GL-610 ED 2.0
HP-614 3.0 Extends to provide a limited amount of coverage for spray drift $10,000 limit
FO-0675 10 06 –
RCFM-777 10-2017 Stated deductibles
RCB-805 10-2017 Additional coverage for birds $500 deductible
GL-0810 03 05 –
GL-872 ED 3.0 –
RCFM-997 10-2017 –  exclusions for punitive damage, lead liability, milk contamination, & adds custom work, hay stack limit
FL-998 10-2017 Amends limitations & exclusions
FL-999 10-2017 Amends limitations & exclusions
FO-1310 05 15 –
FO-5356 12 16 –  
HO-6041 01 06 –
RC-D COVERAGE FOR BIRDS –
RC-D 20-2017 Additional coverage for dogs $500 deductible
RCFM-A 10-2017 Haystack limitation – limits to $20,000 per stack
 
 

Roberts Mutual Staff

Julierobertsjulie@venturecomm.net Tammyrobertstammy@venturecomm.net Suerobertssue@venturecomm.net