Insurance Boat Dealers Application

INSURANCE BOAT DEALERS APPLICATION

APPLICANT / INSURED INFORMATION

BUSINESS DETAILS & OPERATIONS

Year business established: | Years under current ownership:

Entity type: Sole Proprietor Partnership Corporation LLC Other:

Primary operations (check all that apply):

Approximate percentage of gross receipts by activity (enter percentage):

LOCATIONS & PREMISES

Number of additional locations:

INVENTORY / FLEET

Storage types: Dry Stack Land Storage Wet Slips / Marina Number of slips:

EMPLOYEES & PAYROLL

Use of subcontractors: Yes No If yes, describe operations and minimum certificates required:

COVERAGE REQUESTED

Select coverages and indicate limits/deductibles where applicable.

POLICY PERIOD & PREMIUM

Requested effective date: Policy expiration date:

Estimated annual premium:

LOSS HISTORY & PRIOR INSURANCE

RISK MANAGEMENT & SAFETY

Do you maintain a written safety program and training for employees? Yes No

Are waivers, releases or assumption of risk forms used for sea trials, demonstrations or test drives? Yes No

EXCLUSIONS / ACTIVITIES NOT REQUESTED

The following activities are not requested unless explicitly endorsed: intentional damage, pollution cleanup, war, nuclear hazard, professional medical services, aircraft operations. Applicant must disclose use of explosives, blasting, pressure hull testing, or commercial passenger-carrying charters. Failure to disclose such operations may void coverage.

BENEFICIARY / LOSS PAYEE INFORMATION

If a beneficiary or loss payee is required for inland marine or inventory coverage, provide details below.

DECLARATION & AUTHORIZATION

The undersigned applicant declares that the statements made in this application and any attachments are true and complete. Applicant understands that this application is a material part of any policy issued and that any material misrepresentation, omission or incorrect statement may be grounds for denial of coverage or rescission of the policy. Coverage will not be bound until authorized by the insurer in writing.

Applicant authorizes the insurer to obtain loss history, prior policy information and any other underwriting information necessary to evaluate this application. Applicant understands premiums may be subject to audit and that any policy issued will contain provisions for examination of records and adjustment of premium.

Applicant warrants that reasonable controls and maintenance programs are in place to prevent loss, including but not limited to secure storage, fire protection where applicable, and qualified personnel for repairs and testing. Applicant agrees to promptly notify insurer of any material change in operations or location.

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