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

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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
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There are no Locations.

Maximum number of locations reached.

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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.

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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

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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

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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
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There are no Buildings.

Maximum number of buildings reached.

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

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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

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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
Email
This field is for validation purposes and should be left unchanged.

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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.
Email
This field is for validation purposes and should be left unchanged.

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

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

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Protection at Location

Fire Protection

Coverage

Marina Operators Liability

Storage

Repairs and servicing carried out

Type of work:

Boat Dealer's Insurance

Piers, Wharves, & Docks

Subject of Insurance