Name

This field is for validation purposes and should be left unchanged.

Business Info

Business Name

Mailing Address

Street Address Address Line 2 City State ZIP Code

Email

Phone

EIN (if applicable)

Business Structure

Owners Information

Number of Owners

First Owners Name

First Last

First Owners Date of Birth

Second Owners Name

First Last

Second Owners Date of Birth

Third Owners Name

First Last

Third Owners Date of Birth

Location Information

Number of locations rented/owned/leased where work is performed

Primary Location Address

Street Address Address Line 2 City State ZIP Code

(Primary Location) Is this building owned or rented/leased?

Security Measures

Fire Alarmed

Guard Dogs

Lighted

No Yard/Everything Locked Indoors

Security Alarmed

Security Guard/Watchman

Yard Fenced, Gated, and Locked

None

Maximum Number of Customer Vessels at this location at any given time?

Maximum Total Value of Customer Vessels at this location at any given time?

Second Location Address

Street Address Address Line 2 City State ZIP Code

(Second Location) Is this building owned or rented/leased?

(Second Location) Maximum Number of Vessels at this location at any given time?

(Second Location) Maximum Value of Vessels at this location at any given time?

Third Location Address

Street Address Address Line 2 City State ZIP Code

(Third Location) Is this building owned or rented/leased?

(Third Location) Maximum Number of Vessels at this location at any given time?

(Third Location) Maximum Value of Vessels at this location at any given time?

Underwriting

Maximum value of individual vessel worked on

Average value of vessel worked on

Number of Employees (excluding owners):

Annual Payroll (excluding owners):

Total Annual Revenue:

Type(s) of Vessels worked on (must equal 100%)

Fiberglass/Composite

Aluminum

Steel

Wood

Ferro Metal

Percentage of work performed by Applicant and others (must equal 100%)

By you and your employees

Sub-contractors

1099’s

Union Longshoremen

Labor Pools, Leased Workers, or Temporary Employees

What year did your business start?

How many years of experience does the owner have in this trade?

Have you had any insurance losses in the past 10 years?

Yes

No

Describe those losses (Date, What Happened, Paid Amount)

Final Info

Are you currently insured?

Yes

No

Name of Current Insurer

Expiration Date of Policy

How did you hear about On The Water Marine Insurance

May we text you regarding your insurance?

Yes

No

This field is hidden when viewing the form

Assigned Agent

This field is hidden when viewing the form

Get a Marine Artisans Quote

Business Info

Owners Information

Work Performed

Location Information

Underwriting

Type(s) of Vessels worked on (must equal 100%)

Percentage of work performed by Applicant and others (must equal 100%)

Marine Liability Coverage Requested

Equipment Coverage Requested

Final Info

Get A Quote

Navigation

On The Water Marine

Follow Us

Request Your Boat Insurance Quote

Tell me about Yourself

Watercraft Information

A SURVEY WILL BE REQUIRED. Liability only policies will need an In Water Survey. To include Hull Coverage, an Out of Water Survey will be required. To find a local survey visit the Society of Accredited Marine Surveyors.

Mooring and Usage

Prior Boating Experience

Final Questions

Contact Information