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Boat Rental / Boat Club Application
Business Information
Business Name:
Contact Name:
Business Address:
City:
State:
Zip:
Contact Phone
Email Address:
Website Address:
Preferred Agent
Any Is Fine
Nick McGinty
Garrison Rudisill
Kerry Gonzalez
Vance Barker
Owner's Information:
Name:
Date of Birth
Social Security Number:
Business Address:
City:
State:
Zip:
Business Details:
Storage Location of Vessel, including Zip:
What Year was the Business Started
Describe All Way the vessel(s) are used:
Has Insurance Been Cancelled:
Yes
No
Has Insurance Been Non-Renewed or Refused:
Yes
No
Anyone Involved Convicted of a Felony?
Yes
No
If Yes: Why Cancelled
If Yes: Why Cancelled
Prior Business or Marine Claims?
Yes
No
How Many Claims?
1
2
3
4
5+
Has the Business Operated by another Name:
Yes
No
Age of Youngest Employee
Other Prior Names:
List Detail of all claim: (Year, What Happened, Amount Paid)
List Detail of all claim: (Year, What Happened, Amount Paid)
List Detail of all claim: (Year, What Happened, Amount Paid)
List Detail of all claim: (Year, What Happened, Amount Paid)
List Detail of all claim: (Year, What Happened, Amount Paid)
# of Days a Year Used / Operated:
Do you employ Crew to Operate / Maintain vessels?
Yes
No
# of Crew
Any Used as Liveaboard?
Yes
No
Do Individuals Stay Overnight?
Yes
No
Swimming / Snorkeling allowed?
Yes
No
Is Vessel Seaworthy?
Yes
No
Do You Lease Vessels From Others?
Yes
No
Any Other Insurance in Force for the Business?
Yes
No
Any Camp / Youth Group Affiliation?
Yes
No
Any Relationship with a legal Entity requiring additional insured?
Yes
No
Describe Relationship & any Ability to Control your business:
Rental & Boat Club Questionairre
Describe Business Model:
Rentals
Club Membership
Both
Describe how Employees are Trained:
Minimum Age to Execute Rental / Club Agreement:
Do All known operators need to sign:
Yes
No
Minimum Age Allowed to Operate
Description of Screening & Validation of Experience:
Describe the Navigation Restrictions on the Vessels:
Any Usage Allowed Dusk til Dawn:
Yes
No
Do you monitor On-water Activity:
Yes
No
Are Operators always in-sight:
Yes
No
Is On-Water Assistance Provided:
Yes
No
If Yes: Describe Assistance:
Are Prop Guards Installed on All Vessels?
Yes
No
Does applicant or employees used the vessel for personal use?
Yes
NO
Are Vessels Used to tow Skiers, water Toys, Para-Sail?
Yes
No
Describe Equipment: Who Provides it: What is allowed
Rental - Additional Information
Are Renters Allowed to Trailer to other locations?
Yes
No
Please Describe:
Does the insured trailer units to other locations?
Yes
No
Please Describe:
Do you provide an employee as capt or crew to a renter?
Yes
No
Please Describe:
Are PCW's used for guided tours?
Yes
No
Please Describe:
Do Renters Engage in river rafting / racing activites?
Yes
No
Please Describe:
Storage & Navigation Information
Facility Name:
Facility address:
Kept on A mooring Buoy?
Yes
No
Do the Vessels Lay up?
Yes
No
Dates: From - To:
Lay-up Storage:
Afloat
Ashore
Lift
Navigational Area Desired:
If Coastal Navigation - Miles offshore:
1
5
25
50
100
200
250
Number of Vessels:
1
2
3
4
5
6+
We will email you over a spreadsheet for the vessel schedule.
Vessel 1
Year
Length
Manufacturer:
Model:
Hull Material
Fiberglass
Steel
Aluminum
Cold Molded
Wood
Other
Type
Mono
Catamaran
Trimaran
# Engines
1
2
3
4
Fuel
Gas
Diesel
HP Each:
Engine Manufacturer
Engine Type
Outboard
I/O
Inboard
Jet
Trailer?
Yes
NO
Trailer Year
Trailer Make:
Trailer Value:
Type of Coverage:
Property & Liability
Liability Only
Insured Value of Vessel:
Safety Equipment
EPIRB
Life Raft
CO Detector
Smoke Detector
Fixed Fire Suppression
GPS
Depth Finder
VHF
Coverage Limits
Vessel Deductible: (Check one)
$500
$1000
1%
2%
3%
4%
5%
10%
Watercraft Liability: (Check One)
$100,000
$300,000
$500,000
$1,000,000
Excess Liability
$1M
$2M
$3M
$4M
$5M
Medical Payment
$1,000
$5,000
$10,000
$25,000
Pollution:
$25,000
$300,000
$854,400
Personal Effects:
None
$1,000
$2,500
$5,000
$10,000
Additional Coverage's:
*
Watersports Liability
Permitted Rental captain
Permitted Operator for Pleasure Use
Premise Liability