What is your first name?
What is your last name?
What is your preferred phone number?
Please enter your email.
Is there another person, besides the owner, who should be listed as an emergency contact for this vessel?
What is the name of the person we should contact in the event of an emergency with your vessel?
What is the emergency contact's relationship to the owner?
What is the emergency contact's phone number?
What is the emergency contact's email address?
What is the name of the vessel?
Where will the vessel be located from June 1st to November 30th?
Who is the owner of the private residence?
What is the complete address of the residence where the vessel will be located?
What is the name of the marina?
What is the complete address of the marina where the vessel will be located?
Please select the applicable security measures that are in place for this watercraft. (Select all that apply)
Does this vessel have GPS tracking capabilities installed?
What is the GPS tracker manufacturer's name?
What is the GPS tracker model?
Is the GPS tracker a satellite based system?
Do you agree to keep the GPS tracker in working order and the monthly service active?
How frequently do you visit the vessel?
Who attends to the vessel when you do not or are unable to?
What is the back up attendee's relationship to you / the owner?
What is the back up attendee's phone number?
What is the back up attendee's email address?
How often does the back up attendee visit the vessel?
Is the back up attendee paid?
Do you want / require coverage for a crew?
Storm Preparedness Plan
Please give full details of your plan for protecting the vessel in the event of any storm warning, including intended places of refuge, mooring and/or anchoring arrangements and how the vessel will be secured.
Will your Bimini top, canvas, antennas and outriggers be stowed correctly from wind exposure?
Will you be using additional anchors, chafe gear, and multiple mooring lines?
Are you in contact with your neighboring boaters to be sure that unattended boats are properly secured?
Do you have any alternative plans in the event that the primary plan cannot be executed for some reason?
Please provide details of your back up plan.
Will your vessel be kept ashore during a storm (including on a trailer or lift)?
Please provide details on how the vessel will be secured ashore.
Have you ever had to prepare for a hurricane, cyclone, or typhoon before?
Please share any tips or comments you can from your prior experience. We appreciate it!
Severe Storm Statement
- IT IS HEREBY UNDERSTOOD AND AGREED that in the event of a named hurricane, cyclone or typhoon warning, I/we will make every reasonable effort to secure our vessel in a suitable shelter, slip or mooring and take all other reasonable precautions that may be necessary to safeguard the vessel and/or its equipment and accoutrements, including, but not limited to: removing/stowing of Bimini top canvas, loose cushions, roller-furled sails, outriggers and antennas. The undersigned/assured is aware that, in the event of physical damage to the insured vessel, the assured is responsible for payment of the deductible amount shown on the Declarations Page and/or as superseded by the Policy or as otherwise stated by Endorsement to the Policy).
Please print your full name
Please enter today's date.
MM slash DD slash YYYY
Please sign your name in the space below.
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.