| Basic Yacht
Information |
|
Yacht
Owner's Name |
|
| Yacht Owner's Date of Birth |
|
Occupation
|
Address
|
City
|
State
Zip Code
|
E-mail
Address |
|
Please
Contact me by: |
|
Work Telephone |
|
Home Phone |
|
| Vessel
Details |
|
Description of
Your Yacht |
|
|
|
| Length
|
Model
|
| Maximum Speed
|
Total Horsepower
|
Registration
Doc# |
|
| Type
|
Contruction
|
| Date Purch
|
Purchase Price
|
Your Yacht Engine
Manufacturer/Model |
|
| Year Built
|
Fuel Type
|
Vessel Power Type (Motor) |
Engine(s)
|
| Your Current Insurance Carrier |
|
| Current Insurance Expiration Date |
|
| Personal
Data |
|
| Years Ownership Experience
|
Years Operating Experience
|
Previously Owned Vessels
(Size
& Type) |
|
| Boating Courses Completed |
|
Loss History
(Include Dates, Cause and Amounts) |
|
| Other Operators |
|
| Name
|
D.O.B.
Experience
|
| Occupation
|
Boating Courses
|
| Name
|
D.O.B.
Experience
|
| Occupation
|
Boating Courses
|
| Navigation |
|
| Your Vessel's Navigation Area |
|
| Include the Bahamas in this area? |
Select one
|
| Lay Up From
To
|
Lay Up Type:
Afloat
Ashore |
| Your Vessel's Home Port? |
|
| Exact Mooring Location? |
|
| Navigation & Safety
Equipment |
Please Check
All That Apply |
VHF Radio
Loran/GPS
Compass
Auto Pilot
Depth Finder
Halon/CO2
|
Anti Theft Devices
Radar
Sat Navigation
Fume Detector
Other
|
| Dinghy/Tender |
|
| Dinghy Manufacturer |
|
| Length of Dinghy
|
Purchase Date
Price
|
| Dinghy Outboard Manufacturer |
|
| Dinghy Outboard Price |
|
| Dinghy Outboard HP |
|
| Trailer Model/Manufacturer |
|
| Tralier Year/Price |
|
| Survey |
|
| Current Survey
|
Date of Current Survey
|
| |
Survey Type
|
| Loss Payee
Information |
|
| Mortgagee Name |
|
| Mortgagee Address |
|
| Miscellaneous Comments |
|
| Is this Yacht ever chartered to
others? |
|
| If Answer is Yes, Please Explain |
|
| Is this Yacht used for commercial
purposes?
|
Explain Please
|
| No. of Trips
|
Avg Number of Passengers
|
Do you employ a paid captain
or crew?
|
How Many?
Captains and/or
Crew |
| Has any carrier cancelled or refused
yacht insurance?
|
Explain
|
| Is this Yacht used for racing?
|
|
| Requested
Insurance Coverages |
|
| Yacht Hull and Equipment
|
Select Deductible
|
| *Dinghy Coverage
|
Included up to 16", 35 HP
$5000 / $100 Deductable |
| Trailer Amount
|
|
| Liability(P&I) Amount
|
*Medical Payment $10,000
|
| *Personal Effects$5,000
|
$250 Deductible |
| Uninsured Boater
|
|
| *Vessel Assistance/Towing $1000>>> |
|
| *Hurricane Haul Out
|
$500 Max per Occurance/$1,000 Max
Aggregate |
| *Sails/Canvas Loss
|
Zurich will pay ACV, using 10%
depreciation as a "norm" for each year. |
| Sail Boat Club Racing Permissable?
>> |
|
| *Fishing Equipment
|
$5,000 Limit / $250 Deductible |
| *Electronics Deductable
|
$250 Deductible |
| Additional Comments
/ Questions |
|
* Amounts shown are
for the Luhr's Group Program. Prices and deductibles
may not apply to non-group participants.
For Yachts over 10 years of age, Zurich requires a survey
less than 3 yrs old.
Yachts less than 10 years, no survey required (unless
requested by company).
Thank You for allowing Coleman Marine, Inc. to quote
your policy!
