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Hull Builders Risk Application
General Information
Business Name:
Contact Name
Is Applicant:
Builder
Vessel Owner
Phone Number:
Email Address:
Address:
City:
State:
Zip:
Type of Vessel Being Built:
Length:
Hull Material
Steel
Aluminum
Wood
Fiberglass
Cold Molded
Other
If Other Describe:
Vessel New or Used:
New
Used
Is this For a Single Vessel?
Yes
No
Additional Coverage's:
Launching
Sea Trials
Delivery Coverage
Any Loss Payee?
Yes
No
If Used: What Work is being Done:
Limit Desired Any 1 vessel:
Limit Desired While in Transit:
Occurrence - all Vessels Combined:
Limit any 1 Location:
Completed Value of Vessel Including Materials:
Duration of Project:
Effective Date To Begin Coverage:
Loss Payee:
Address:
City:
State:
Zip:
Builders Information:
Builders Name
Address Where Being Built
Number of Years Builder Has been in Business:
Approximate # of Vessels Built:
Type of Building where Constructed:
Framed
Masonry
Steel
Outside
Other
If Other, Describe:
Describe Fire Protection at Premise:
Distance to Fire Dept
Distance to Fire Hydrant
Security (Check all that apply):
Lights
Fence
Watchman
Alarms
Cameras
Other
Describe Other
Does Builder Use Subs
Yes
No
If using Subs; is a waiver of subrogation secured:
Yes
No
Type of Work Subcontracted?
Any Losses / Claims
Yes
No
Description of Losses / Claims (Year, Event, Amount, Open or Closed)
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