Clay County Mutual Insurance Company

208 W. Fairfield
P.O. Box 122
Clay Center,
Nebraska 68933
402.762.3860

Home Quote

Please note: This is not an offer for insurance. This quote is for comparison shopping.

Name First Last
Please provide your name.
Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country
Please provide your address.
Phone - (###) - ### ####
Email
How would you like to be contacted?
Responding Fire Department
Property Section
Current dwelling coverage $ . Dollars Cents
Contents Amount $ . Dollars Cents
Replacement Cost
Year of Construction
Type of Construction
If mobile home, please list model & manufacturer
Please use the following box to list any items you may have insured specifically and the amount

(ie: jewelry-$500, computer equipment-$5000)
Liability Section
Number of Acres
Liability Coverage

Increased Property Damage is $500
Medical Payments
Any livestock on premise?

Medical Payment to Employees will match the Medical Payments shown above
Please list any liability endorsements on your current policy.