Commercial Vessel/Charterboat/Fisheries Insurance quotation request

Basic information

Insured Name
Address line 1 
Address line 2  
City, State/Province 
Zip/ Postal 
Country 
email
Telephone-Work* 
Telephone-Home*    
Telephone-Other*  
Facsimile/Telecopier*

* We need at least one contact telephone number in case we need to clarify an answer.

Personal information for principal operator

Date of birth MMDDYYYY*  
Gender
Your marital status
Your occupation
How many years have you operated boats?*  If less than 1 show 1
How many years have you owned boats?*   If less than 1 show 1.
Training you have had in your lifetime.*  
Can you prove it? (Do you have a copy? Even if expired)    
Read carefully  

Select any of the following that apply. Checking the box means the answer is true.
Moving traffic violations last 5 years
Felony (criminal) convictions ever  
OUI/DUI/DWI convictions ever
Losses last 5 years  
Insurer cancellations or non-renewals last five years
If you checked any of the above boxes as true, please explain in detail

Vessel information

All information below is required

Primary vessel use 
Is this a live-aboard vessel? 
Do you have a survey (no matter how old)?
Date of survey 
Select boat type
Vessel manufactured by
Model name or number
Length 
Beam
Year built
Hull material
Fuel tank material  

Machinery data - If no engine state "None" in Engine manufactured by and in Model
Engine manufactured by 
Model 
Number of engines
Total HP, KW or CC's  
Drive type 
Fuel type
Top speed in mph
Please select the equipment you have installed
Anti-theft devices  Depth finder HF/SSB radio Stainless propeller
Automatic CO2/Halon Engine alarm Life raft VCR
Autopilot EPIRB LORAN VHF
Bilge Blower Fire extinguisher Personal computer Other-provide details
CB Radio Fume detector Propane/CNG shutoff system
Compass GPS RADAR
Where will you mainly use your boat in the next 12 months?
If offshore how many miles? 
Where will you keep your boat when she is not in use? If applicable, show marina name and include city/town, county (if known) and state/province.
In the next 12 months
Will your boat be laid-up?        If No Tab to next section
If Yes show approximate dates
If Yes where will she be laid-up? 

Estimated number of charters next twelve months
Maximum number of passengers
Average number of passengers
Overnight trips?
Liquor served?
Coverages requested (if coverage not required enter "0")
Please indicate limits required in USD (US dollars)
Boat coverage amount (USD)

Currency converter
Personal Effects amount (USD)

Currency converter
Tender/Dinghy amount (USD) Please provide details in Remarks

Currency converter
Trailer coverage amount (USD) Please provide details in Remarks

Currency converter
Liability amount
(Limits shown are in USD)
Crew coverage required
Number of crew covered

This is a big form isn't it? Well if you made it this far and you do not have a dinghy or trailer you are done except for any remarks may care to make. If you do have a dinghy, in Remarks tell us the year, make, model and length and the year, make, horsepower of the dinghy motor. If you have a trailer, in Remarks tell us the year, make, model, and number of axles.

You're done. Thanks

Remarks: Please add your comments here to elaborate on information provided to tell us more about your situation or coverage options you require.

Important note: Please review entire submission carefully before submitting this form as false information may void your insurance. Submitting this form does not bind you to purchase the insurance or any Insurer to accept the risk, however it is agreed that the information submitted shall be the basis of the quotation and contract should coverage be bound and/or a policy issued. No coverage is bound or in force until confirmed in writing by our office. The information collected from you is used to underwrite coverage and services. This information will be provided to others.  I have read the Important Information and understand and agree with the contents thereof.