Name of Applicant

First Middle Last

Phone

Email

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Type of Business:

Boat Repair

Boat Storage

Boat Marinas or Yards

Years in Business:

Years in business under the same ownership

Is Applicant affiliated with any other business (e.g., resort)?

Yes

No

If yes, provide details:

Business premises are located on which body of water?

Who governs this body of water (e.g., Corp of Engineers, TVA, etc.)?

Is business open all twelve (12) months of the year?

Yes

No

If no, when open?

From To

Deductible requested

$1,000 (minimum)

$2,500

Provide Total Estimated Annual Gross Receipts:

$

Boat Dealers Class Code ( 10101 )

Annual Gross Sales $

Boat Storage and Moorage Class Code ( 10105 )

Annual Gross Sales $

Boat Yards or Marinas—Public Class Code (10107 )

Annual Gross Sales $

Diving-Marina (Hull Repair/Hull Cleaning Class Code (91666)

Payroll $

Restaurants—with no sale of alcoholic beverages—with table service Class Code (16900)

Annual Gross Sales $

Restaurants—with no sale of alcoholic beverages—without table service—with seating Class Code (16901)

Annual Gross Sales $

Boats—canoes or rowboats—for rent not equipped with motors Class Code (10110)

Annual Gross Sales $

Boats-motor or sail rented to others Class Code (10117 )

Annual Gross Sales $

Boat Repair and Servicing Class Code (91235 )

Payroll $

Campgrounds or Recreational Vehicle Parks Class Code (10331)

No. of Spaces: $

Hotels/Motels— with pools and beaches—less than four stories Class Code (45190)

Annual Gross Sales $

Hotels/Motels— without pools and beaches—less than four stories Class Code (45192)

Annual Gross Sales $

Restaurants—with no sale of alcoholic beverages—without seating Class Code (16902)

Annual Gross Sales $

Restaurants—with sale of alcoholic beverages that are less than thirty percent (30%) of the annual receipts of the restaurant—with seating Class Code (16910)

Annual Gross Sales $

Store—food or drink Class Code (18435)

Annual Gross Sales $

Store—no food or drink Class Code (18437)

Annual Gross Sales $

Annual Gross Liquor Receipts

Annual Gross Receipts $

Other (Describe):

$

Type of vessels repaired:

Gross Registered Tonnage (GRT)

Length/Beam

Any conversion or reconstruction of vessels (e.g., for parasailing)?.

Yes

No

If Yes:

Annual reciepts

Describe work performed:

Other—Describe

Value of vessels handled:

Average: $ Maximum: $

Percentage of income from:

Commercial craft: % Pleasure/Personal: %

Are operations subject to the Jones Act or the USL&H Act?

Yes

No

PLEASE ATTACH A COPY OF THE FOLLOWING ITEMS IF APPLICABLE

YOUR BOAT RENTAL AGREEMENT

YOUR SLIP RENTAL AGREEMENT

YOUR FIVE YEAR CURRENTLY VALUED INSURANCE CARRIER LOSS RUNS

Recents Articles

Why Golf Insurance is Essential for Every Golfer: Protecting Your Game and Your Gear

Understanding Homeowners Insurance: Coverage, Necessity, and Choosing the Right Policy

April Insurance Agency

Get A Quote

Helpful Links

For Clients

Boat Marinas Repair Service Quote

Recents Articles

Why Golf Insurance is Essential for Every Golfer: Protecting Your Game and Your Gear

Understanding Homeowners Insurance: Coverage, Necessity, and Choosing the Right Policy

April Insurance Agency

Get A Quote

Helpful Links

For Clients