CARE, CUSTODY & CONTROL QUESTIONNAIRE (Horse Liability Questionnaire Must Also Be Complete) INSURED'S NAME POLICY NUMBER Business: Stable Owner Boarding Breeding Farm Trainer Other How long in business? Do you If leasing premises, who is responsible for building and repair? own or lease stable? # of Lighting Fire Smoke/Fire 24 Hr Describe Secondary If over 25 yrs. Stalls Sprinklered Rods? Ext.? Alarms Security Security Egress? When Stable Last updated 1 2 3 4 Breed of Horses: Use of Horses: 1. Minimum number of non-owned horses in your care 2. Maximum number of non-owned horses in your care 3. Minimum value of non-owned horses in your care 4. Maximum values of non-owned horses in your care 5. Average number of non-owned horses in your care 6. Average value of non-owned horses in your care 7. Fire protection class 8. What type of fencing is used in run, pastures and paddocks? 9. Is wire utilized in the construction of pasture fences, paddocks or any area that horses will have access? if yes, please explain the type and the extent of use (make specific reference to any use of barbed wire). 10. Are shelters provided in runs of pastures? Yes No If yes, describe 11. Where are non-owned horses kept at night (stable, pasture, etc.)? 12. Is smoking allowed within structures? Yes No Strickly Enforced? Yes No 13. Are stallions housed, pastured and exercised in separate pastures, paddocks and runs, away from mares Yes No
CARE, CUSTODY & CONTROL QUESTIONNAIRE (Horse Liability Questionnaire Must Also Be Complete) INSURED'S NAME POLICY NUMBER Business: Stable Owner Boarding Breeding Farm Trainer Other How long in business? Do you own or lease stable? If leasing premises, who is responsible for building and repair? Stable # of Stalls Sprinklered Lighting Rods? Fire Ext.? Smoke/Fire Alarms 24 Hr Security Describe Security Secondary Egress? If over 25 yrs. When Last updated 1 2 3 4 Breed of Horses: Use of Horses: 1. Minimum number of non-owned horses in your care 2. Maximum number of non-owned horses in your care 3. Minimum value of non-owned horses in your care 4. Maximum values of non-owned horses in your care 5. Average number of non-owned horses in your care 6. Average value of non-owned horses in your care 7. Fire protection class 8. What type of fencing is used in run, pastures and paddocks? 9. Is wire utilized in the construction of pasture fences, paddocks or any area that horses will have access? if yes, please explain the type and the extent of use (make specific reference to any use of barbed wire). 10. Are shelters provided in runs of pastures? Yes No If yes, describe 11. Where are non-owned horses kept at night (stable, pasture, etc.)? 12. Is smoking allowed within structures? Yes No Strickly Enforced? Yes No 13. Are stallions housed, pastured and exercised in separate pastures, paddocks and runs, away from mares Yes No
Care-Custody-or-Control-Supplement-CP-4650.docx