MarineFirst
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Niche Applications - Marine First 
EXCURSION VESSEL APPLICATION

GENERAL INFORMATION


  First Name of Insured: Last Name:  
  Street Address:
  City: State:    Zip:  

  Owner of Vessel:  

  Description of Operations:

  Sportfishing:   Sightseeing:   Whale Watching:
  Dinner Cruise:   Ferry Service:   Overnight Cruises:
  Other:  

  Effective Date of Coverage:  

  Management Experience/Time in business:  

  Does this placing include all vessels operated by the prospective insured?   Yes   No
  If not, explain:  

  Where and when can vessel(s) be inspected:
  

  Name of contact:     Phone Number:  

  Loss information (Last 5 Years)

DATE NATURE OF LOSS AMT. PAID AMT. OUTSTANDING



ATTACHED COMPANY BROCHURES, SURVEYS, COAST GUARD CERTIFICATE


  I/ we hereby warrant that the information provided above is complete and accurate to the best   of my knowledge and belief, and it is our understanding that underwriters shall rely upon the   information and representation listed above heavily in determining the acceptability and rates   and condition of coverages.

ASSURED:   
  TITLE:   
DATE:   


VESSEL INFORMATION

  Name of Vessel:   Type:
  Location of Landing:   Home Port:  
  Name of Mortgagee:   Address:
  City:   State:      Zip:


  Hull Information:
  Year Built:  Builder:
  Dimensions:  Hull Material:
  Number of Decks:  Gross Registered Tonnage:
  Market Value:     $  Replacement Cost:           $

  Machinery:
  Manufacturer:  Year Built:  Number of Engines:
  Fuel Type:  Horsepower:

  Equipment:
  Fire Extinguishing Apparatus:
  Radio Telephone:
  Radar:
  Depth Sounder:
  Other:  

  Crew/Passenger Information:

NAME
EXPERIENCE
LICENCE OF OPERATORS

  No. of Crew (incl. Capt.):  Max: 		  Hard    Soft     Avg:   Hard    Soft

  No. of Passengers:          Max per Coast Guard Cert.:  
   Average:  

  Dock Liability:
  List all Docking Locations:
  A. 
  B. 
  C. 

  Please provide this information for each location that the assured will be docking at:

  1.  Is insured responsible for any property adjacent to docking locations?   Yes   No        If yes, please explain below for each location
  A. 
  B. 
  C. 

  2.  Does the assured carry any type of General Liability Policy covering properties adjacent
       to vessel docking locations?   Yes   No
       If yes, please describe:
      

  3.  Does the assured sell any products on the land?  Yes  No
       If yes, please describe all products sold:
      

  4.  Is there a parking lot or a street within the 300' of the vessel that this dock liability
       is being requested for?  Yes  No       If yes, please describe:
      

  General Information:

  Navigation limits desired or allowed by license:
      

  Lay-up period, if any:
  Length of Trips:   Number of Days:
  Where is Galley located:     How are stoves heated:  
  Food Served:      Yes No          Type:  Receipts:
  Liquor Served:    Yes No     Receipts:
  Souvenirs Sold:  Yes No        Type of Entertainment:  

  Coverage Desired

  Amount of Hull Insurance:  $
  Deductible (1% or $2,500, whichever is greater):  $
  Breach of Warranty Limit:     
  In Favor Of:  
  Protection &
  Indemnity Limit: 		  Deductible:
  Trip Transit:

  Other: 		USLHW Port Risk Total Loss Only (Separate Application required)
General Liability

   Additional Comments

  (Please list any additional information that you feel the underwriter should be aware of:)
  


ADDITIONAL VESSEL INFORMATION

  Name of Vessel:   Type:
  Location of Landing:   Home Port:  

  Hull Information:
  Year Built: Builder:
  Dimensions: Hull Material:
  Number of Decks: Registered Tonnage: Gross       Net
  Market Value:     $ Replacement Cost:     $

  Machinery:
  Manufacturer:  Year Built:  Number of Engines:
  Fuel Type:  Horsepower:

  Equipment:
  Fire Extinguishing Apparatus:
  Radio Telephone:
  Radar:
  Depth Sounder:
  Other:  

  Crew/Passenger Information:

NAME
EXPERIENCE
LICENCE OF OPERATORS

  No. of Crew (incl. Capt.):  Max: 		  Hard    Soft     Avg:   Hard    Soft

  No. of Passengers:          Max per Coast Guard Cert.:   
   Average:   
  Total Annual Passengers Carried:   
  Is vessel docked at same locations as all other vessels insured?    Yes No       
  If not, please list additional dock location(s).   
  Where is Galley located:     How are stoves heated:  
  Food Served: Yes No         Type:  Receipts:
  Liquor Served: Yes No    Receipts:
  Souvenirs/Gifts Sold:    YesNo     Type of Entertainment:  

  Coverage Desired
  Amount of Hull Insurance:  $
  Deductible (1% or $2,500, whichever is greater):  $
  Breach of Warranty Limit:     
  In Favor Of:  
  Protection &
  Indemnity Limit: 		  Deductible:
  Trip Transit:

  Other: 		USLHW Port Risk Total Loss Only (Separate Application required)
General Liability

  Additional Comments

  (Please list any additional information that you feel the underwriter should be aware of:)
  

BROKER INFORMATION

Agency Name:

Agency Contact:
Phone:
Fax:
E-Mail: