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Marine Insurance Quote Request

  • Your name *
  • Owner of vessel *
  • Street address *
  • City *
  • State *
  • Zip code *
  • Your e-mail address *
  • Best daytime contact phone number *
  • Fax


  • Vessel description
  • Year built
  • Length
  • Manufacturer
  • Model
  • Vessel’s name
  • Type of vessel
  • Hull material


  • Engines

    Engines Type
  • Number of engines
  • Year
  • Manufacturer
  • Horsepower (each)
  • Fuel: Diesel, Gas


  • Equipment
  • Auto Fire System
    Depth Finder
    Security System
    Fume Detector
    Generator
    Compass
    GPS
    VHF Radio
    Single Side Ban Radio
    Radar
    Chart Plotter
    Weather Fax
    Other


  • Value of vessel:
  • Purchase price
  • Purchase date
  • Current market value
  • Liability coverage desired


  • Tender

    Tender
  • Year
  • Manufacturer:
  • Model:
  • Length:
  • Engine type:
  • Horsepower:
  • Purchase date:
  • Price paid:
  • Current value:

  • Location of vessel

  • Owner’s home
  • Name of facility
  • Address
  • Live-aboard:

    Dock location is:


  • Vessel Use:


  • Navigation area:
  • US East Coast
    US West Coast
    Great Lakes
    Chesapeake Bay
    Bahamas
    Florida Gulf Coast
    Gulf of Mexico
    Inland / Lakes Only

  • Operator Information


  • If Owner Operated
  • Owner’s driver’s License number/state
  • Years of boating experience
  • Prior boats owned
  • Boating courses completed
  • Membership:


  • If Crew / Captain Operated

  • Number of crew
  • Full time
  • Part time


  • Claims
  • Describe any prior marine losses, including date of loss, description of loss, amount of loss


  • Requested effective date
  • Current Insurance Company
  • Date coverage expires


  • Have you ever had coverage cancelled?  


  • Additional information the underwriter should know

  • Please Note: Insurance coverage cannot be bound, cancelled, or changed by using this form. This form is to be used only for informal communication with our agency.