Boats
over 10 years old must have a full out-of-the-water
survey in order to consider for a quote. Please fax
or email the survey for the boat to us after completing
the Quote Request Form.
All
fields should be completed. If a field does not apply
insert "NONE".
About
the Owner
Coverage
Request:
Vessel
Purchase Price:
Deductible: (Lower
rate applies for higher deductible)
Liability:
About
Your Boat and Machinery:
Year
Built:
Length
Overall:
Manufacturer:
Type
or Model:
Hull
Material:
Engine
Make:
Horse
Power:
Type:
Fuel:
Auto
Fire Extinguishing System:
Yes
No
Other
Equipment:
VHF
Compass
Depthfinder
Fume
Detector
GPS
Loran
Radar
Tender
and Outboard to Primary Boat:
If no Tender and Outboard,
check here.
Tender
Year:
Tender
Length:
Tender
Manufacturer:
Cost
of Tender:
Outboard
Year:
Outboard
Manufacturer:
Outboard
Horsepower:
Cost
of Outboard:
Trailer:
If no Trailer, check
here.
Year
of Trailer:
Manufacturer
of Trailer:
Current
Market Value:
About
the Operator(s):
Operator
No. 1
Operator
Name:
Date
of Birth:
Your
Years as an Operator:
Your
Years as an Owner:
Have
you completed a Safe Boating Course such
as offered by the Coast Guard Auxiliary
or US Power Squadron?
Yes
No
Have
there been any boating or marine liability, losses,
claims or accidents in the past five years?
Yes
No
If
yes, provide date details of loss and amount paid:
Date
of Loss:
Amount
Paid:
Operator
No. 2
If no Operator No. 2,
check here.
Operator
Name:
Date
of Birth:
Your
Years as an Operator:
Your
Years as an Owner:
Have
you completed a Safe Boating Course such
as offered by the Coast Guard Auxiliary
or US Power Squadron?
Yes
No
Have
there been any boating or marine liability, losses,
claims or accidents in the past five years?
Yes
No
If
yes, provide date details of loss and amount paid:
Date
of Loss:
Amount
Paid:
Prior
Vessels Owned:
Prior
Vessel Owned No. 1
If no Prior Vessel
Owned No. 1, check here.
Make:
Model:
Length:
Prior
Vessel Owned No. 2
If no Prior Vessel
Owned No. 2, check here.
Make:
Model:
Length:
Use
of the Boat:
Is
boat used for private pleasure use only?
Yes
No
Do
you use a paid captain or crew?
Yes
No
If
yes, how many?
Is
the boat ever chartered, rented or used commercially?
