Richmond-Quote

Boat
Insurance
Quote

We would like to provide you with a free, no obligation Watercraft insurance quote. Please provide as much information possible for the most accurate quote. This information will be kept confidential and will be used for quote purposes only.

Personal Information

Owners Name
Mailing Address
City, State Zip
Day Phone
Best Time to Call
Email Address

Current Auto Insurance Information

Company Name (not agency)
Policy Expiration Date
Premium Amount
Term

Operator #1
(always list insured as Operator 1)

Name
Occupation
Marital Status
Date of Birth
Drivers License #, and State
Social Security #
Years Boating Experience
Years a Boat Owner
Do you Live Aboard This Boat?
Boating Courses Completed
Loss History (dates, Causes, Amounts Paid). If No Losses, Enter None
List All Prior Owned Boats (Size & Type)
Rental Experience

Operator #2

Name
Occupation
Date of Birth
Drivers License #, and State
Social Security #
Years Boating Experience
Years a Boat Owner
Boating Courses Completed
Loss History (dates, Causes, Amounts Paid). If No Losses, Enter None
List All Prior Owned Boats (Size & Type)
Rental Experience

Operator #3

Name
Occupation
Date of Birth
Drivers License #, and State
Social Security #
Years Boating Experience
Years a Boat Owner
Boating Courses Completed
Loss History (dates, Causes, Amounts Paid). If No Losses, Enter None
List All Prior Owned Boats (Size & Type)
Rental Experience

Vessel/Navigation Information

Year
Manufacturer/Model
Length
Date Purchased
Hull Identification #

Purchase Price
Max Speed
Tenders or Dinghies (include value)
Waters Navigated

Stored on Trailer
Will be trailered over 100 Miles?
Marina Name
Marina Address
# of Engines
Total Horsepower
Year Engine Built
Engine Manufacturer
Engine Serial Numbers	Eng. 1 Eng. 2
Type
Power Type
Fuel Tanks
Fuel
Construction
Mooring Location
Laid UP:	From: to
Lay Location

Mortgagee/ Loss Payee Information

Name of Lender
Address of Lender (Include City, State, & Zip)
Current Amount Financed

Boat/Watercraft Usage

Is the Boat ever Chartered to Others?
Is the Boat Used for Entertaining of Business Clients?
Is the Boat used for any other Commercial Purpose?
Do you Employ a Paid Captain or Paid Crew?
Has any Carrier Ever Cancelled or Refused Boat Insurance?
Is the Boat used for Racing

Equipment
(Please Select ALL equipment of your Watercraft)

VHF Radio	Diesel Generator
GPS	Gas Generator
Radar	Sonar
CO2/Halo	Other
Fume Detector
Fire Extinguisher
Anti-theft devices

Coverage's

Type	Sums Insured	Type	Sums Insured
Hull- Physical Damage		Liability
Tender		Medical Payments
Trailer		Towing
Personal Effects		Uninsured Boater

Additional Comments

Please give any additional comments you feel
appropriate for this quotation.

Please Note: Boats 10 years of age and older usually require a marine survey not over
2 years old in order to obtain insurance. If you have a current survey, please list
the date that the survey was completed in the box below.

The completion of this application does not bind the applicant or Davis & Associates to effect insurance: it is submitted for the purposes of rating, quoting and determining acceptability only.

Davis & Associates - Richmond Kentucky