Sportfishing/Charter Vessel Application

Step 1 of 10

10%

Producer Information

Desired effective date:*

MM slash DD slash YYYY

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone*

Contact Email*

Copy of current condition and validation survey*

Max. file size: 50 MB.

Date of Last Survey*

MM slash DD slash YYYY

Vessels with an Out-of-Water Condition and Valuation Survey of 3 years or older may need to have a new survey performed before coverage can be bound.

Section 2: Business Information

Named insured (including DBA names):*

Tax ID/FEIN #:*

Mooring location zip code:*

Year business was established:*

Location/marina address:*

Street Address City State / Province / Region

Mailing address:*

Street Address City State / Province / Region

Primary Phone:*

Secondary Phone:*

Email*

Website

Section 3: Designee Information

First Designee Name:*

First Last

Date of Birth*

MM slash DD slash YYYY

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

SSN:*

Second Designee Name:

First Last

Date of Birth

MM slash DD slash YYYY

Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

SSN:

Section 4: Business Detail

Usages:*

Charter

Guide

Bareboat

Bed and Breakfast

Commercial fish

Boat school

Other/Owner

Describe your business in detail:*

Describe your operational experience:*

Who is your current insurer?*

Has anyone involved with the business ever been convicted of a felony?*

Yes

Has the business been cancelled, non-renewed, or refused insurance coverage?*

Yes

Additional insured(s):

Please provide name, address, and relationship.

Please list, date, and describe all prior business and marine losses/claims:*

Section 5: Safety

Please explain your safety measures.*

Section 6: Boat Usage

Is the business in compliance with all legal requirements?*

Yes

Is overnight usage of the units allowed?*

Yes

If yes, please describe:*

Is operation permitted from dusk to dawn?*

Yes

If yes, please describe:*

Are all units seaworthy and fit for their intended purpose?*

Yes

If not, please describe:*

Are all units and components unmodified and stock?*

Yes

If not, please describe:*

If a pontoon, are all access gates attached and in good working order? Photos required.*

Yes

Recent photograph of pontoon gates*

Drop files here or

Max. file size: 50 MB.

Photos of pontoons are required, showing the condition of the unit and that all gates are fully paneled.

Is seating available for all guests that is permanently affixed and in good condition?*

Yes

If not, please describe:*

Do you lay up the unit seasonally?

Yes

If yes, please select:*

Ashore

Afloat

On a lift

Layup dates, From:

MM slash DD slash YYYY

To:

MM slash DD slash YYYY

Lienholder(s)/Loss payee(s):*

Please provide name, address, and relationship.

Section 7: Charter usage

Do you employ a crew?*

Yes

If yes, how many crew (including a hired captain) are on board?

Is food or liquor provided to passengers?*

Yes

If yes, please describe how alcohol is provided and if there is a charge.*

Describe any shoreside activities.*

Section 8: Bareboat charter usage

How old must a person be to charter a vessel?

How old must a person be to operate?

Do you require all known participants to sign the contract?

Yes

Describe how you screen and validate the experience of each participant (attach applicable forms).

Section 9: Navigation

Describe the waters where the units are used.*

If coastal:

1 Mile

5 Miles

25 Miles

50 Miles

100 Miles

Section 10: Operator Information

Name*

First Last

Date of Birth*

MM slash DD slash YYYY

Driver's license:*

State

Year USCG licensed:

Does the business owner or a captain operate the vessel more than 75% of the time while under charter?

Yes

Describe and provide the month/year for all motor vehicle violations and accidents in the past three years:

Describe and provide the month/year for all marine losses that have occurred personally, or for any vessel when its operator was in control.

Does the operator take any medication or substance that could impair physical or cognitive ability? If yes, please describe.

Yes

If yes, please describe.

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Please list experience for the three most recent vessels owned or operated.*

Vessel year

Builder

Length

From (mo/yr)

To (mo/yr)

Owned (y/n)

Operated (y/n)

Move Please list experience for the three most recent vessels owned or operated.

Vessel year

Builder

From

MM slash DD slash YYYY

Owned

Yes

Operated

Yes

Vessel year

Builder

From

MM slash DD slash YYYY

Owned

Yes

Operated

Yes

Vessel year

Builder

From

MM slash DD slash YYYY

Owned

Yes

Operated

Yes

Describe training and safety courses taken:

Has the operator sustained any injuries that required a doctor visit, hospitalization, or professional care in the past five years?

Yes

If yes, please describe.

Does the operator have any known health problems?

Yes

If yes, please describe.

Does the operator have health insurance?*

Yes

Section 11: Unit Schedule

Unit 1*

Bed and Breakfast

Commercial fish

Boat school

Other/owner

For charter use, number of passengers:*

Sail

Mono hull

Multi hull

Fishing

Bass

Center console

Sportfish

Drift boat

Power

Cruiser

Jet boat

Houseboat

Trawler

PWC

Runabout

Airboat

Yacht

Ski boat

Pontoon (photos required)

Commercial boat

Unit Make:*

Year:*

Model:*

Serial/Hull ID:*

Unit Material:*

Fiberglass

Wood

Steel/metal

Glass over wood

Other

Unit Market Value:*

Number of engines:*

Engine make:*

Year:*

Horsepower:*

Engine Serial:*

Trailer year:*

Trailer make:*

Trailer serial:*

Trailer market value:*

Is unit ever kept on a mooring ball?

Yes

If yes, please explain.*

Recent photograph of vessel*

Drop files here or

Max. file size: 50 MB.

Photos of pontoons are required, showing the condition of the unit and that all gates are fully paneled.

Section 12: Coverage

Named windstorm deductible: In areas where a wind deductible applies, the hull value must be greater than the stated deductible, or 5% of the unit value, whichever is greater.

Owner/Operator & Charter-Guide	Captained charter, Bed & breakfast, Boat school	Bareboat charter & Commercial fish
$500	$750	$1,000

Unit deductible

10%

20%

No hull coverage

Emergency towing

$500

$750

$1,000

$1,500

$2,500

$5,000

No emergency towing coverage

Watercraft liability

$25,000

$50,000

$100,000

$300,000

$500,000

$1,000,000

No watersport liability

Personal effects

$1,000

$2,500

$5,000

$7,500

$10,000

$15,000

$20,000

$25,000

Watersport liability

$25,000

$50,000

$100,000

$300,000

$500,000

$1,000,000

No watersport liability

(available for owner use only)

Uninsured boater

$25,000

$50,000

$100,000

$300,000

$500,000

$1,000,000

No uninsured boater coverage

(not available for commercial fish)

Medical payments

$1,000

$2,500

$5,000

$10,000

$15,000

$20,000

$25,000

No medical payments

Pollution liability

$25,000

$300,000

$997,100

No pollution liability

Premise liability?

Yes

Slip and mooring liability?

Yes

Section 13: Additional usage coverage

Captained charter*

Yes

# crew

Crew liability

$25,000

$50,000

$100,000

$300,000

$500,000

$1,000,000

Fishing equipment

$1,000

$2,000

$3,000

$4,000

$5,000

$7,500

$10,000

Business interruption

$2,500

$5,000

Liveaboard*

Yes

Preferred charter*

Yes

Shoreside liability extension*

Yes

Guest passenger liquor liability*

Yes

Bareboat*

Yes

Captained charter

If yes, No. of passengers?

Boat School*

Yes

Captained charter

If yes, No. of passengers?

Bed and breakfast*

Yes

Liveaboard

Business interruption

$2,500

$5,000

Captained charter*

Yes

If yes, No. of passengers?

Owner/Operator*

Yes

Liveaboard

Cargo*

Yes

Business Interuption

$2,500

$5,000

Crew liability

$25,000

$50,000

$100,000

$300,000

$500,000

$1,000,000

Date*

MM slash DD slash YYYY

Consent

I agree to the privacy policy.

Comments

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

Producer Information

Section 2: Business Information

Section 3: Designee Information

Section 4: Business Detail

Section 5: Safety

Section 6: Boat Usage

Section 7: Charter usage

Section 8: Bareboat charter usage

Section 9: Navigation

Section 10: Operator Information

Move Please list experience for the three most recent vessels owned or operated.

Section 11: Unit Schedule

Section 12: Coverage

Section 13: Additional usage coverage

Forms

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