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Watercraft Hurricane Preparedness Plan Risk Evaluation
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What is your first name?
What is your first name?
What is your last name?
What is your last name?
What is your preferred phone number?
What is your preferred phone number?
Email
Please enter your email.
Berthing Marina/Facility Name
What is the name of the marina/facility where your vessel is berthed from June 1st to November 30th?
Primary Berthing Location June 1 to November 30
What is the address of the marina/facility where you vessel is berthed from June 1st to November 30th?
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Hurricane Plan
Please provide detailed information about your hurricane protection plan for your vessel.
Hurricane Plan Options
Please indicate which of the following options you have planned and will execute for your vessel in the event of a Hurricane or Named Storm.
Haul Out and Inside Storage
Haul Out and Outside Storage
Moving of Vessel to a Safe Harbor of Inland Waters
Vessel Kept North of the Mason-Dixon Line from June 1st to November 30th
Other
Haul Out Plan
Storage Location Same As Primary Berthing Location?
Is the storage facility / location the same as your primary berthing location from June 1st to November 30th for this vessel?
Yes
No
Storage Facility Name
What is the name of the storage facility where your vessel will be stored when it is hauled out?
Storage Facility Address
What is the address of the storage facility?
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Haul Out Contract?
Do you have a haul out contract specifying that your vessel will automatically be hauled and stored inside / outside in the event of a hurricane or named storm?
Yes
No
Storage First come / First serve?
Is space designated on a first come, first serve basis?
Yes
No
Distance from Primary Berthing Location
How many miles is the storage location from the primary berthing location?
Responsible Party for Moving Vessel
What is the name of the person responsible for moving your vessel to this storage location?
Responsible Person Phone Number
What is the responsible person's phone number?
Responsible Person's Qualifications
Please provide a brief description of the responsible person's qualifications?
Haul Out Obstacles
Are there any obstacles that might prevent this person from moving the vessel to the facility / location? (Examples: Captain or Mate with obligations to other owners' vessels or responsible person is away from the area during hurricane season?
Yes
No
Responsible Back up Person
Who is the back up person you have contracted with to move your vessel?
Vessel Move Decision Maker
What is the name of the person who ultimately makes the decision to move the boat?
Vessel Move Trigger
Please select the event(s) that will trigger execution of the boat being moved to the storage facility. (Select all that apply)
Tropical Storm Warning
Hurricane Warning
Other
Other Vessel Move Trigger
Enter the other event(s) that will trigger execution of the boat being moved to the storage facility.
Hauling Method
Please select the method that will be used to haul your vessel.
Trailer
Driven
Risk Mitigation Steps
What additional steps will you take to mitigate a loss to your vessel?
Remove Electronics
Canvas
Remove Portable Equipment
Other
Other Risk Mitigation Steps
What are the other risk mitigation steps you will take to mitigate a loss?
Facility Construction Material
What is the construction material of the facility?
Masonry
Frame
Steel
Facility Hurricane Resistant?
Is the facility built to withstand Hurricane force winds?
Yes
No
Facility Wind Strength
What wind strength is the facility built to withstand? (mph)
Openings Protected?
Are all openings protected?
Yes
No
Opening Protection Type
Please select the opening protection type for this facility.
Class A Hurricane Shutters
Class A Hurricane Impact Glass
Vessel Method of Storage
Please select how the vessels are stored at this facility.
Stacked
Slip
Moving of Vessel to a Safe Harbor or Inland Waters
Safe Harbor Description
Where do you plan on moving your vessel in the event of a named storm or Hurricane?
Safe Harbor Address
What is the address of the location you plan to move your vessel to in the event of a named storm or Hurricane?
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Distance to Safe Harbor
How far is this location from your primary berthing location? (In miles)
Safe Harbor Plan Impediments?
Are there any bridges or other impediments that might prevent the execution of this plan?
Yes
No
Safe Harbor Plan Impediments Details
Please provide a brief description of the impediments to this plan.
Responsible Person for Move to Safe Harbor
What is the name of the person responsible for moving your vessel to the location listed above?
Responsible Person for Move to Safe Harbor Phone Number
What is the phone number for this person?
Responsible Person for Move to Safe Harbor Qualifications
Please provide this person's qualifications.
Safe Harbor Plan Responsible Person Obstacles
Are there any obstacles that might prevent this person from moving the vessel to the location listed above? (Examples: Captain or Mate with obligations to other owners' vessels or responsible person is away from the area during hurricane season?
Yes
No
Safe Harbor Plan Back up Person
What is the name of the back up person you have contracted with to move your vessel?
Safe Harbor Plan Execution Timeline
What is the approximate timeline to execute this plan? (Example: It will take 24 hours to execute)
Safe Harbor Plan Trigger Indicator
What is the indicator that will trigger execution of this plan?
Tropical Storm Warning
Hurricane Warning
Safe Harbor Plan Risk Mitigation Steps
What additional steps will you take to mitigate a loss to your vessel?
Remove Electronics
Canvas
Remove Portable Equipment
Other
Safe Harbor Plan Other Risk Mitigation Steps
What are the other risk mitigation steps you will take to mitigate a loss to your vessel?
Vessel Moored North of the Mason-Dixon Line
Moored North of MDL Facility / Location Name
What is the name of the facility / location that is north or the Mason-Dixon Line where your vessel will be moored from June 1st to November 30th?
Moored North of MDL Facility / Location Address
What is the address of the facility / location where your vessel will be moored from June 1st to November 30th?
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Other Hurricane Plan
Other Hurricane Plan Details
Please describe your Hurricane Preparedness Plan in detail in the space below.
Renovations to Vessel?
Do you plan on having any work done on your vessel between June 1st and November 30th that could prevent the execution of your Hurricane Preparedness Plan?
Yes
No
Shipyard / Facility Name for Renovations
What is the name of the shipyard / facility where you will have work done to your vessel?
Shipyard / Facility Address for Renovations
What is the address of the shipyard / facility where you will be have work done to your vessel?
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Renovations Estimated Time Frame
What is the estimated time frame it will take to complete the work? (In days)
Nature of Renovations
Please provide full details of the nature of the work being done to your vessel.
Documents and Comments
Upload Relevant Documents
Please upload any documents relevant to your Hurricane Preparedness Plan.
Max. file size: 128 MB.
Insured Full Name
Please print your full name
Today's Date
Please enter today's date.
MM slash DD slash YYYY
Hurricane Preparedness Plan Signature
Please sign your name in the space below.
Consent
*
Disclaimer: This online questionnaire is a tool used to gather information. It is not an application for insurance. No insurance coverage will be bound or put into effect by submitting this form.
Consumer disclosure: By checking the box below you authorize the Agency who supplied this form to you to contact you via phone, email, and text messaging; to save and share with business partners the information you provided; to obtain consumer reports that may include credit-based reports (where legally allowed), public records, claims history, and driving records so that they can give you accurate insurance quotes.
I agree
Christine Marcialis
4076961333
https://www.pontellinsurance.com/
christine@pontellinsurance.com
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