MARKEL MARINE TRADESMAN INSURANCE APPLICATION

Name *

First

Last

Home Address

Date of Birth

Social Security #

Company name (Named Insured)

Location Address

Mailing Address

Section 3 BUSINESS DETAILS

What is the zip code of the vessel mooring location?

Describe all ways in which the vessel is used.

What year did the applicant purchase or establish this business?

Has any company cancelled, non-renewed or refused to offer insurance (including under any prior names)?

If yes, describe.

Are any of the vessels homemade or have any of the vessels, engines or operating equipment been modified or altered from original, stock condition?

If yes, describe.

Is any vessel currently being held for sale?

Has anyone involved with this business ever been convicted of a felony?

List the date of Loss, write a detailed description of the Loss and Amount Paid

Has the applicant or business operated under any other name?

If yes, describe.

What year was this business incorporated under this name?

Describe the owner's experience with this type of Operation and vessel usage?

Who is your current insurance carrier?

How many days per year is the vessel(s) used commercially?

Does the owner employ a Captain, Crew, or other employees to Operate or Maintain the vessel(s)?

If yes, number of crew.

Is any vessel used as a liveaboard?

Do individuals stay onboard overnight?

Is swimming, snorkeling, SCUBA, or diving allowed from any vessel?

If yes, describe.

Are the vessels seaworthy and fit for their intended use?

If yes, describe.

Do you lease a vessel from or to another party?

If yes, describe.

List and describe any other insurance in force for this business.

Is there any affiliation with a camp or youth group?

If yes, describe.

Do you have a relationship with any legal entity, other than a marina or yacht club that will require legal protection as an Additional Insured?

If yes, describe the relationship and their ability to control any aspect of your business.

Additional Insured Name

First

Last

Additional Insured Address

OPERATOR/CAPTAIN INFORMATION IS REQUIRED FOR: CHARTER, CHARTER – GUIDE, OWNER/OPERATOR, BOAT SCHOOL & COMMERCIAL FISHING RISKS

SECTION 4 PRIMARY OPERATOR/CAPTAIN INFORMATION

Fill out the boxes below

Full Name *

First

Last

Date of Birth

Drivers License #

License State:

Year USCG Licensed:

Describe and provide the month/year for all Motor Vehicle Violations and Accidents in the last 3 years: (If none, write none.)

Describe and provide the month/year for any marine losses that have occurred personally or for any vessel when this operator was in control. (If none, write none.)

Does the operator take any medicine or substance that could impair physical or cognitive ability? If yes, describe. If none, write none.

Outline experience below for the last 3 vessels owned or operated:

Vessel Year, Builder, Length, From (Mo/Yr) To (Mo/Yr), Owned(YES or NO), Operated (YES or NO)

Section 5 CREW COVERAGE INFORMATION

Describe training and safety courses taken:

If the Captain/Skipper is the owner, what percentage of the charters will they act as the Charter Captain?

Has the operator sustained any injuries that required a doctor visit, hospitalization, or professional care in the last 5 years?

If yes, describe.

Does the operator have any known health problems?

If yes, describe.

Does the operator have health care insurance?

Additional Remarks:

Section 10 VESSEL INFORMATION

Please complete an additional sheet for each Operator/Captain.

Vessel Usage:

IN SEASON LOCATION

Facility/Marina Name:

Facility/Marina Address:

Is any vessel kept on a mooring buoy?

LAY-UP/STORAGE LOCATION

Lay-Up Dates:

From:

To:

Lay-Up Type:

Ashore
Afloat
On a Lift

Lay-Up Address:

NAVIGATION

Navigation Area Desired:

VESSEL #1

Year

Length

Manufacturer

Model

Hull Material:

Hull ID# (HIN):

# of Engines:

Total HP:

Hull Type:

Propulsion:

Engine Serial #’s: (if outboard)

Total Value (Vessel w/Engines):

Liability Only Coverage?

Loss Payee Name & Address

Trailer Year:

Manufacturer:

Value:

VESSEL #2

Year

Length

ability? altered of

Manufacturer:

Model:

Hull Material:

Hull ID# (HIN):

# of Engines:

Total HP:

Hull Type:

Propulsion

Engine Serial #’s: (if outboard)

Total Value (Vessel w/Engines):

Liability Only Coverage?

Loss Payee Name & Address:

Trailer Year:

Manufacturer:

Value:

In areas where a wind deductible applies, the hull value needs to be greater than the wind deductible. The windstorm deductible will be the maximum of 2 times the stated deductible or 5% of the unit value, whichever is greater.

PRIMARY COVERAGES

POLLUTION

$25,000
$300,000
$854,000

ADDITIONAL COVERAGES

BAREBOAT CHARTER

Towing
Captained Charter
Premises Liability*
Slip & Mooring*

BOAT CLUB

Watersport Liability
Permitted Operator – Pleasure Use
Premises Liability*
Slip & Mooring*

COMMERCIAL FISH

COMMERCIAL FISH

BOAT SCHOOL

Captained Charter
Premises Liability*
Slip & Mooring*

Additional Remarks:

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