Application for Marina Operators

Proposed Effective Date*
MM slash DD slash YYYY
Proposed Expiration Date*
MM slash DD slash YYYY
New Policy*
- Yes
- No
Current Carrier*
Expiring Premium*
Expiring Policy Date*
MM slash DD slash YYYY
Is the insured a subsidiary of any other entity or does the insured have have any subsidiaries?*
- Yes
- No
Please describe*
Any policy or coverage declined, cancelled, or non-renewed during the prior three years?*
- Yes
- No
Please describe*
Name of Insured(s)*
Email Address*
Phone*
Mailing Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Number of Years in Business*
List and describe any business owned, operated, or managed by the insured, including any lessors risk*
Coverages Requested*
For 1 or more locations
- Marina Operators
- General Liability
- Protection & Indemnity
- Boat Dealer's
- Property Insurance
- Piers, Wharves, & Docks
- Equipment & Tools
- Owned Watercraft

Locations
Please enter the details for each location for which you're seeking coverage.

Locations

Enter all the details relevant for each location

Location Nickname	Type of Risk	Coverages Requested	Actions

There are no Locations.

Marina Operators Liability
Limits Requested
Any One Vessel*
Any One Accident or Occurrence*
Deductible Requested*
minimum $1000
Please enter a number greater than or equal to 1000.

General Liability
Limits Requested*
A. General Aggregate
B. Products-Completed Ops Aggregate
C. Personal & Advertising Injury
D. Each Occurrence
E. Fire Damage (Any One Fire)
F. Medical Expense (Any One Person)
- Option 1
  A. $2m
  B. $1m
  C. $1m
  D. $1m
  E. $100,000
  F. $5,000
- Option 2
  A. $1m
  B. $500,000
  C. $500,000
  D. $500,000
  E. $100,000
  F. $5,000
- Option 3
  A. $1m
  B. $300,000
  C. $300,000
  D. $300,000
  E. $100,000
  F. $5,000
Products Sold*
Boats & Ship Stores Annual Sales No. of Units Intended Use
Does applicant install, service, or demonstrate products?*
- Yes
- No
Please explain*
Foreign products sold, distributed, used as components?*
- Yes
- No
Please explain*
Research and development conducted or new products planned?*
- Yes
- No
Please explain*
Guarantees, warranties, hold harmless agreements?*
- Yes
- No
Please explain*
Products recalled, discontinued, changed?*
- Yes
- No
Please explain*
Products of others sold or repackaged under applicant's label?*
- Yes
- No
Please explain*
Products under label of others?*
- Yes
- No
Please explain*
Vendors coverage required?*
- Yes
- No
Please explain*
Does any named insured sell to other named insured?*
- Yes
- No
Please explain*
Products manufactured?*
- Yes
- No
Please explain*
Please attach literature, brochures, labels, warnings, etc.
Drop files here or

Max. file size: 50 MB.
Additional interests/certificate recipients?
Name Address Interest Certificate

Protection and Indemnity
Sections applicable
Marina Operators*
- Yes
- No
Boat Dealers*
- Yes
- No
Work Boats*
- Yes
- No
How many?*
Rental Boats*
- Yes
- No
How many?*
Other owned boats (excluding boats for sale)*
- Yes
- No
How many?*
For work boats, rental boats and other owned boats, indicate the following for each:
Make Year Built Length Horsepower
Limit Requested*
For owned watercraft, are crew covered?*
- Yes
- No
- N/A
Number of crew covered*
Please fully describe work boat / rental boat / other owned boat operation if you are requesting P&I coverage for these vessels

Property Insurance

Buildings

For each location you've added earlier, add the property details for each building

Location this building is at	Building #	Total Buildings at Location	Actions

There are no Buildings.

Equipment / Tools
Equipment Coverage*
- ACV 80%
- Repl Cost 90%
List Equipment*
Description Value D/A Serial Number Location

Owned Watercraft
Owned Watercraft Coverage*
- ACV 80%
- Repl Cost 90%
Fully describe any operation for which you are requesting coverage for owned watercraft*
List Owned Watercraft*
Description Value D/A Serial Number Location
Are you requesting coverage for boats that are rented?*
- Yes
- No
Upload rental agreement(s) and description of rental qualification standards*
Drop files here or

Max. file size: 50 MB.
Mortgagees/Loss Payees
Name Address Interest Coverage(s) applicable Location

Underwriting Information
How long in operation under present management?*
Name(s) and Past Experience(s) of key personnel*
Number of employees*
Annual Payroll*
Is formal safety program in force?*
Person to contact for survey*
Annual Gross Receipts for Operation
Dock Rental*
Storage (normal)*
Storage (racked)*
Repairs / Servicing*
Fueling*
Hauling / Launching*
Rental Boats*
Rental (leased property)*
All other receipts*
Source of other receipts*
Total Receipts*
New / Used Boat Sales*
Boat Brokerage Comm.*
Ship Store Sales*
Ship Store Sales - Alcoholic Beverages*
Restaurant Sales*
Restaurant Sales - Alcoholic Beverages*
Hotel / Campground*
Other Sales*
Source of other sales*
Total Sales*
Claims and Losses Over the Last 5 Years
List all losses and give full details*
Fraud Warning
Any person who knowingly, and with the intent to defraud any insurance company or other person, files an application for insurance or a statement of claim containing any materially false information or conceals for the purpose of misleading information concerning any fact material, thereto commits a fraudulent insurance act, which is a crime and subjects such a person to criminal and civil penalties.
Applicant's Signature*
Producer's Signature*
Date*
MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.

Step 1 of 11

Locations

Marina Operators Liability

Limits Requested

General Liability

Protection and Indemnity

Sections applicable

Boat Dealer's Insurance

Requested Limits

Transit Exposures

Boat Shows

Demonstrations

Property Insurance

Equipment / Tools

Owned Watercraft

General Information

Underwriting Information

Annual Gross Receipts for Operation

Claims and Losses Over the Last 5 Years

Fraud Warning

Forms

Our Products

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Charter & Sportfishing Vessels

Yacht Insurance

Marine Artisans / Marina Operators

Aviation Insurance

Oil Pollution

Nets & Gear

Cargo

Aquaculture

Misc. Coverages

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Boats & Ship Stores	Annual Sales	No. of Units	Intended Use

Name	Address	Interest	Certificate

Make	Year Built	Length	Horsepower

Description	Value	D/A	Serial Number	Location