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Maritime Insurance Application ~ Boat / Yacht Dealer & Broker / Marina / Boatyard
This is a General Application - Additional Information may be required
GENERAL INFORMATION
Named Insured
Contact Name
Email Address: (Required to Submit)
*
Phone #:
Mailing Address, City State, Zip:
Applicant is
Partnership
Corporation
LLC
Other
# Years In Business
Effective Date of Coverage
Do you Currently Have Coverage
Yes
No
Ever Declared Bankruptcy?
YES
NO
Has Coverage Ever Been Cancelled?
Yes
No
If Coverage Has been cancelled - Explain Why & by Whom:
# of Locations
1
2
3
4+
Location 1: Address, City, State, Zip
Location 2: Address, City, State, Zip
Location 3: Address, City, State, Zip
Any Claims in the Last 5 Years
NO
YES
How Many Claims?
1
2
3
4
5
6
7
Claim #1 - Date, What Happened, Amount of Claim
Claim #2 - Date, What Happened, Amount of Claim
Claim #3 - Date, What Happened, Amount of Claim
COVERAGE REQUESTED
PLEASE CHECK ALL THAT APPLY
🛈
Boat or Yacht Dealer & Brokerage
Marina / Boatyard / Dry Stack
General & Legal Liability
Protection & Indemnity
Piers & Docks
Commercial Tools & Equipment
Owned Watercraft
Bumbershoot / Umbrella
Property - Buildings
Commercial Auto
Workers Compensation
Boat & Yacht Dealer & Broker Section
Do you Sell New or Brokerage Yachts?
New
Brokerage
Both
Do you Sell Parts & Accessories?
Yes
No
Do you do Service Work?
Yes
No
New Boats / Yachts & Accessories:
Yacht / Boat Lines Sold
Engine & Accessory Lines Sold
Highest Value - Any One Vessel
Maximum Inventory any One Time
Average Total Inventory Per Month
Annual Sales: New Boats & Motors
Annual Sales - Parts & Accessories
Are Vessels Ever Used For:
Rentals
Personal Use - Owner
Personal Use - Employees
Customer Loaners
Est. # Boat Shows Per Year?
1
2
3
4
5
6
7
8
9
10+
Est. # Of Demo's / Year
Demos:Applicants Staff In Charge?
Yes
No
Describe Security (Fence, Lights, Etc.)
Service Work Performed
Annual Sales - Service Work (Labor)
% Of Sales Warranty Related:
Brokerage:
Annual Sales - Brokerage Vessels
Annual Commissions - Brokerage Vessels
# of Sales Staff
1
2
3
4
5
6
7
8
9
10+
Legal Liability Limit: Marina Operators / Yacht Dealer & Broker / Shiprepairers
Limit of Liability:
$300,000
$500,000
$1,000,000
Deductible:
$1,000
$2,500
$5,000
Marinas / Dry Stacks / Boatyards / Rentals
Please Check All of the Operations That Apply:
Dock Rental
Mooring / Anchoring
Fueling
Ship Store Sales
Hauling & Launching
Ship / Vessel Repair
Rack Storage - Ashore
Non-Rack Storage - Ashore
Rental Boats
Rental Properties - Buildings
General:
Do you Get Certificates of Insurance on Customers?
Yes
No
Does Your Contract have a Hold Harmless?
Yes
No
Docking / Slip Rentals
# of Slips Available:
Ave. Value of All Vessels Docked
Max Value of all Vessels Docked
Estimated Sales from Dock Rentals
Mooring & Anchoring
Max # of Vessels Moored
Max Value of any one Vessel
Estimated Sales - Anchoring / Mooring
Fueling
Type of Fuel Sold
Gas
Diesel
Both
LPG
All
Is After Hour Fuel Available?
Yes
No
Type of Fire Protection
Estimated Sales from Fueling:
Ship Store Sales
Annual Sales From Ship Store Sales:
Do you Sell Consumables (Food / Drinks):
Yes
No
Types of Consumables Sold:
Food
Drinks - Non-Alcohol
Alcohol
What % of Sales are Food & Drinks (Non Alcohol):
Alcohol:
Type Sold
Beer & Wine
Liquor
Onsite or Offsite License
On-Site (drinking establishments)
Off-site (Package Stores)
Hours of Operation
Any Violations?
Annual Beer / Wine Sales:
Sales on Liquor
Hauling & Launching
Est. Number of Vessels Handled per Year
Max Value any One Vessel
Estimated Sales from Hauling & Launching
Ship Repairers
Ave. Vessel Value:
Maximum Vessel Value:
% Work on Pleasure Vessels:
% Work on Commercial Vessels:
% Engine Repair
% Welding
% Refinishing
% Spray Painting
% Work on Commercial Vessels:
% Electrical
% Fiberglass
% Woodworking
% General Repair
% Painting
Estimated Sales from Vessel Repair:
Rack Storage:
Are Racks Inside / Outisde
Outside - Open Rack
Inside Racks
Both
Ave. Value of Any One Vessel
Max Value of Any One Vessel:
How Many Units High:
# of Units - Open Racks
# of Units - Inside Racks
Age of the Building:
Building Construction:
Brick
Frame
Steel
Concrete Block
Other
Is it Sprinkled:
Yes
No
Central Station Alarm:
Yes
No
Is the Building Wind Rated?
Yes
No
What is it Rated For?
Annual Sales / Revenue - Open Racks:
Annual Sales / Revenue - Inside Racks
Non-Rack Storage Ashore
Ave. Value Any One Vessel:
Max Value Any One Vessel:
# of Vessels Stored
Annual Revenue - Non Rack Storage:
How are Vessels Stored
Stands
Trailers
Cradles
Other
If Other - Describe:
Do You Winterize Vessels
Yes
No
Rental Boats
# Of Vessels
1
2
3
4+
Do your Rental Agreements have a Hold Harmless?
Yes
No
Annual Sales: Rental Boats
Vessel 1: (List Year, Make, Engine Make, HP, Value)
Vessel 2: (List Year, Make, Engine Make, HP, Value)
Vessel 3: (List Year, Make, Engine Make, HP, Value)
You will be emailed for additional Vessel Information - Thanks!
Rental Buildings / Offices
# of Tenants:
Total Square Feet of Space:
Total Rental Income (Buildings / Suites):
Protection & Indemnity
Limit of Liability:
$1,000,000
$500,000
$300,000
Deductible Requested:
$1,000
$2,500
$5,000
Crew Coverage:
Yes
No
# of Crew:
1
2
3
4
5
6
7
8
9
10
Sailing Instruction:
Yes
No
Waterski Liability:
Yes
No
Regatta Liability:
Yes
No
Towers Liability (Commercial Towing):
Yes
No
Sudden & Accidental (S&A) Pollution:
Yes
No
S&A Limit of Liability:
$1,000,000
$500,000
$300,000
Docks & Piers
Brief Description of Property to Be Insured Including Age of Docks:
Describe the Maintenance Program:
Describe Firefighting Capabilities at Pier:
# Of Slips
Electricity on Docks
If Pylons - How far About high tide:
Sep. Fuel Dock?
Are Docks Rated For Wind - If So, What Speed
For Anchored / Cabled Docks - Are the Connections inspected annually?
Types of Docks
Fixed
Floating
Both
Construction of Docks
Wood
Concrete
Steel
Aluminium
Valuation:
Actual Cash Value
Replacement Cost
Total Value of All Docks:
Deductible Requested:
Wind / Water (Storm) Deductible:
Loss of Business Income Limit:
Commercial Tools & Equipment
Total Value of Tools (Misc. Shop Tools):
Equipment List
Travel Lift
Fork Trucks
Tractors
Other
# Of Lifts
1
2
# Of Trucks
1
2
3
Travel Lift #1: (Year, Make, & Value):
Travel Lift #2: (Year, Make, & Value):
Fork Truck #1: (Year, Make, & Value):
Fork Truck #2: (Year, Make, & Value):
Fork Truck#3: (Year, Make, & Value):
List of Any other Items including Make, Year, & Value:
Owned Warcraft
Vessel 1: Year, Make, Length, Engine Make, HP
Vessel 1: Value
Vessel 2: Year, Make, Length, Engine Make, HP
Vessel 2: Value
Do you have Additional Vessels you need to add?
Yes
No
Bumbershoot / Umbrella
Underlying Coverages:
General Liability
Legal Liability (Marina, Yacht Broker, Repair)
Workers Comp
Commercial Auto
Limit of Liability (Excess)
$1MM
$2MM
$3MM
$4MM
$5MM
$6MM
$7MM
$8MM
$9MM
$10MM
Workers Comp
Business Classes:
Clerical
Marina Employees
Service Employees
Sales
Clerical Payroll
Marina Payroll
Service Payroll
Sales Payroll
Have you have Coverage for the last 3 Years?
Yes
No
Has coverage ever been Cancelled
Yes
No
Property - Builldings
Total Value of All Property
Business Interruption Limit
Total Number of Buildings
Commercial Auto
Please List your State as we will need to complete State Specific Applications
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