Commercial Vessels Quote Form

 

Name: Age: Occupation:
Address:
City: State: Zip:
Work phone: Home phone:
Present Insurer: Fax:
Email Address:
Type of work Performed (Check all that apply)
Canvas Repair Canvas Installation Carpentry Cleaning/Detailing
Electronics Repair/Installation  Fiberglass Gas Freeing Painting Rigging Welding
Engines Describe in detail >>>
Other >>>
Type of Craft:
Where is work Performed?
Does your work include diving? Yes No    Percentage of overall work? %
Describe underwater activities:
Are propellers pulled and replaced? Yes No 
Maximum value any one vessel: $
Maximum value at any one time: $
Do you tow any watercraft? Yes No 
Do you haul/launch? Yes No 
Do you operate any water craft as part of your work? Yes No  If yes describe:
Do you have the watercraft or any of its equipment in or on any property you own, rent or lease? Yes No  If yes describe:
Do you have docks or slips at your place of business? Yes No  If yes how many:
Do any of your customers visit your place of business? Yes No  If yes explain: 
Are you a sub-contractor? Yes No  If yes explain: 
Do you sub-contract? Yes No  If yes explain: 
How many years have you performed this work?
Gross receipts including parts and labor: $
How many people do you employ?
Do you perform any other work or service or provide or sell any other parts, equipment or material in your business? Yes No  If yes explain: 
What are the receipts or sales for this other operation? $
Describe all losses, whether insured or not, for the last five (5) years:
Current Insurance Company?
Has your insurance ever been cancelled? Yes No  If yes explain: 
Limit of Liability? $
P&I Insurance? Yes No
Date policy to be effective?
Additional comments:

  

 

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Revised: 04/27/04. Site Design by Murray Productions.