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?
Yes
No
Is
the boat ever used for racing?
Yes
No
Is
the boat used for water-skiing?
Yes
No
Is
the boat ever used for any scuba diving activities?
Yes
No
Is
the boat used as a primary residence?
Yes
No
Do
you transport your boat overland?
Yes
No
If
yes, how many miles?
Navigation
and Location:
Describe
the navigation limits that specifically meets
your needs:
Location
of the boat when in commission including zip code:
Marina
Name, if any:
City:
State:
Zip:
Location
of the boat when laid up and out of commission
including zip code:
Marina
Name, if any:
City:
State:
Zip:
Ashore:
Yes
No
Current
Insurance Information:
Do
you have current Insurance Coverage?
Yes
No
Company:
Renewal
Date:
Any
Insurance Cancelled, Declined or Non-Renewed:
Yes
No
If
so, detail reason:
Does
the boat have any deficiencies or unrepaired damage?
Yes
No
If
so, detail reason:
Is
the boat owned in whole or in part by anyone other
than you (excluding a lienholder)?
Yes
No
If
so, detail reason:
Is
the boat ever stored in a public parking area
such as an apartment house parking lot?
Yes
No
If
so, detail reason:
Was
there a lapse in insurance coverage for more than
30 days just before answering this question?
Yes
No
If
so, detail reason:
Have
you or any regular operator ever been convicted
of or pleaded no contest to a felony?
Yes
No
If
so, detail reason:
Has
any operator:
a.
been
charged with operating a boat or motor vehicle
under the influence of drugs or alcohol
Yes
No
b.
been
charged with reckless or careless driving
Yes
No
c.
had
more than 2 moving violations within the last
36 months
Yes
No
Any
special comments, questions or instructions be sure
to let us know.
