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Application for Marina Operators
Application for Marina Operators
Please complete the questionnaire as fully as possible.
Step
1
of
11
9%
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
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini (Swaziland)
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Réunion
Saint Barthélemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen Islands
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Åland Islands
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
Edit
Delete
There are no
Locations.
Add Location
Maximum number of locations reached.
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
Select files
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
Boat Dealer's Insurance
Requested Limits
Limit any one vessel
*
Limit any one location
*
Limit any one accident or occurrence
*
Deductible each occurrence each location
*
Please enter a number greater than or equal to
1000
.
Type of boats sold and manufacturer
*
Are any High Performance Boats sold?
*
Yes
No
Are any personal watercraft or Jet Ski's sold?
*
Yes
No
Are any snowmobiles sold?
*
Yes
No
Transit Exposures
Are any boats delivered from mfr. at Insured's risk?
*
Yes
No
How are they delivered?
*
Max. value any one boat
*
Max. value any one delivery
*
Are any boats delivered by water to the insured?
*
Yes
No
From where?
*
Total values of boats delivered by insured during the past year
*
Values of boats delivered by public carrier
*
Values of boats delivered by applicant's vehicle
*
Average distance the boats are transported
Maximum distance the boats are transported
Number of boats delivered to purchaser by water
*
Average distance
*
Average value
*
Boat Shows
# of boat shows annually
*
# of boat shows each show
*
In water or on land?
*
In water
On land
Both
Maximum dollar limit any one show
*
Average/maximum distance to show
*
Transported by:
*
Common carrier
Own vehicles
Both
Demonstrations
Maximum value any one boat
*
Maximum MPH any one boat
*
Is boat under command of competent employee
*
Yes
No
Are demonstrators equipped with full complement of U.S. Coast Guard required safety equipment?
*
Yes
No
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
Edit
Delete
There are no
Buildings.
Add Building
Maximum number of buildings reached.
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
Select files
Max. file size: 50 MB.
Mortgagees/Loss Payees
Name
Address
Interest
Coverage(s) applicable
Location
General Information
Any medical facilities provided or doctor employed/contracted?
*
Yes
No
Explain
*
Any exposure to radioactive/nuclear material?
*
Yes
No
Explain
*
Do operations involve storing, treating, discharging, applying, disposing, or transporting of hazardous material?
*
Yes
No
Explain
*
Any operations sold, acquired, or discontinued in last 5 years?
*
Yes
No
Explain
*
Any parking facilities owned/operators?
*
Yes
No
Explain
*
Number of parking spaces?
*
Yes
No
Is a fee charged for parking?
*
Yes
No
Explain
*
Recreation facilities provided?
*
Yes
No
Explain
*
Is there a swimming pool on the premises?
*
Yes
No
Explain
*
Sporting or social events sponsored?
*
Yes
No
Explain
*
Any structural alterations contemplated?
*
Yes
No
Explain
*
Any demolition exposure contemplated?
*
Yes
No
Explain
*
Does harbormaster or any other person(s) live on premises?
*
Yes
No
Explain
*
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?
*
Yes
No
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
Comments
This field is for validation purposes and should be left unchanged.
Δ
Forms
Application for Marine Insurance
Owner’s / Skipper’s Questionnaire
Sportfishing/Charter Vessel Application
Yacht Proposal Application
Yacht Additional Information Questionnaire
Application for Marine Artisans / Marina Operators
Application for Marina Operators
Maritime Employers’ Liability Application
Roto-Wing Aviation Application
Fixed Wing Aviation Application
Oil Pollution Application
Fishing Nets Application
Electronics Application
Cargo Insurance Application
Aquaculture Application
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Enter the details for each location.
Location Nickname
*
Address
*
Street Address
Address Line 2
City
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Interest of the Named Insured/s in the described premises
*
Owner
Tenant
General Lease
Type of Risk
*
Yacht Club
Marina
Protection at Location
U/L certified central station alarm
*
Yes
No
Are night-watchmen employed on premises?
*
Yes
No
Describe nature & extent of watchman
*
Alarm with outside gong or siren
*
Yes
No
Are premises completely fenced and floodlit at night?
*
Yes
No
Is storage area fenced in?
*
Yes
No
N/A
Describe fencing
*
Does the facility own any automobiles?
*
Yes
No
Is hired and non-owned auto liability required?
*
Yes
No
Automatic/emergency fuel shutoff valve?
*
Yes
No
N/A
Fire Protection
Paid or Volunteer?
*
Paid
Volunteer
Both
Distance from location
*
Public Fire Hydrants - # and Distance
*
Public Fire Mains - Size and Pressure
*
How many sprinkler heads per pod?
*
Please give a full description of other fire protections
*
Coverage
Coverages Requested
*
For this location
Marina Operators
Boat Dealer's Insurance
Piers, Wharves, & Docks
Marina Operators Liability
Slips Available for Rent - Covered
*
Slips Available for Rent - Uncovered
*
Percentage of available slips normally rented at any one time
*
Please enter a number less than or equal to
100
.
Maximum number of slips in use at any one time
*
Any slips under a common roof?
*
Yes
No
N/A
Percentage of available pods rented at any one time?
*
Please enter a number less than or equal to
100
.
Maximum number of pods in use at any one time?
*
Buoys Available for Rent
*
Number of Docks
*
Describe any methods and equipment used for hauling, launching, or heavy lift equipment (indicate lifting capacity)
*
Average number of boats launched / hauled per day
*
Maximum number of boats launched / hauled per day
*
Storage
Average number of boats stored ashore at any one time - normal
*
Average number of boats stored ashore at any one time - racked
*
Average value of any one boat stored ashore
*
Average Value of Yachts
*
Maximum Value of Yachts
*
Maximum value of any one boat stored ashore
*
Maximum number of yachts stored at any time in past year
*
Number stored in summer
*
Number stored in winter
*
Are yachts stored afloat between 12/1 and 4/1?
*
Yes
No
Are yachts stored inside a building?
*
Yes
No
Are they on racks?
*
Yes
No
Is there a sprinkler system?
*
Yes
No
How many pods in racked storage?
*
Type of building construction
*
Fire rate
*
Are yachts stored outside on racks?
*
Yes
No
How many?
*
Please upload a copy of your storage agreement
*
Max. file size: 10 MB.
Repairs and servicing carried out
Type of vessels
*
Type of work:
Servicing
*
Mechanical
*
Electrical
*
Rigging
*
Painting
*
Welding/burning
*
Other
*
Describe
*
Inside building
*
Outside in the yard or at the slip
*
Fueling: Gas
*
Fueling: Diesel
*
Does the insured and/or their employees do all of the fueling?
*
Yes
No
Other operations
Highest value of any one yacht repaired last year
Describe any commercial ship repair work you do
Please provide receipts (if applicable)
Drop files here or
Select files
Max. file size: 50 MB.
Receipts (non-commercial) for past 12 months
Boat Dealer's Insurance
Prior inventory should be 6 months prior to last inventory
Last Inventory Date
*
MM slash DD slash YYYY
Prior Inventory Date
*
MM slash DD slash YYYY
Inventory - BUILDING
Last Inventory
*
Prior Inventory
*
Avg. Monthly Inventory
*
Inventory - OPEN AREA
Last Inventory
*
Prior Inventory
*
Avg. Monthly Inventory
*
Inventory - IN WATER
Last Inventory
*
Prior Inventory
*
Avg. Monthly Inventory
*
Piers, Wharves, & Docks
Number of floating docks
*
Number of fixed piers
*
Insured value for docks
*
Insured value for piers
*
Attach a diagram of the docks/piers (if available)
Max. file size: 50 MB.
Describe the floating docks and piers
Indicate type of construction
Indicate type of flotation devices
Indicate type of mooring devices
Age of docks
Age of piers
Are the slips
Open
Covered
Number of open slips
*
Number of covered slips
*
Describe the maintenance program
*
Describe firefighting capabilities
*
Deductible Requested
*
$1,000 minimum
Please enter a number greater than or equal to
1000
.
Phone
This field is for validation purposes and should be left unchanged.
Δ
Location this building is at
*
Building #
*
Total Buildings at Location
*
Subject of Insurance
For each, choose limit:
ACV (ACV 80%)
or
Repl Cost (RC 90%)
Building
Limit
ACV 80%
RC 90%
Contents
Limit
ACV 80%
RC 90%
Other
Limit
ACV 80%
RC 90%
Deductible
*
Please enter a number greater than or equal to
500
.
Year Built
*
How is this building used by the insured?
*
Construction Type
Protection Class
RCP Code
Total Area (sq. ft.)
Other Occupancies
Building Improvements
Wiring Year
Heating Year
Roofing Year
Plumbing Year
Number of Stories
Burglar Alarm
*
Yes
No
Describe
*
Sprinkler Alarm
*
Yes
No
Describe
*
Basement
*
Yes
No
Describe
*
Business Income and Extra Expense Coverage - Actual Loss Sustained
Requested Limit
*
Coinsurance 80%
Email
This field is for validation purposes and should be left unchanged.
Δ