COMPOSITE INSURANCE PACKAGE FOR
MARINAS, BOATDEALERS AND YACHT CLUBS
Brokerage:
Contact Name: / Phone: / E-mail Address:
GENERAL INFORMATION
Full Legal Name and Operating Name of Applicant / Mailing Address
Street:
City:
Province: / Postal Code:
List in detail all the operations of the applicant (Please provide any brochures or lists of services offered):
Website: / / Member of OMOA: / Yes No
List of Locations (list on separate sheet if more than 4)
Address: / Loc. 1 / Number of Buildings: / Loc. 1
Loc. 2 / Loc. 2
Loc. 3 / Loc. 3
Loc. 4 / Loc. 4
Structure of Company: / Proprietorship Corporation Partnership Joint Venture
Years in Business: / If less than 5 years in business, please list previous experience in managing such a business:
Years Under Current Management:
Policy Effective Date Required: / Target Premium Required:
Previous Insurer
Have you ever had Insurance refused or cancelled? / Yes No / If Yes, please explain:
Policy #: / Expiring Premium:
Mortgagees and Loss Payees (list on separate sheet if more than 3)
1. / Name: / Address: / Interest:
2. / Name: / Address: / Interest:
3. / Name: / Address: / Interest:
List all Losses (claimed or not) in the last 5 years:
Have you or any predecessor firm filed for bankruptcy? / Yes No / If Yes, please explain:
Do you or any employees ever travel to the USA? / Yes No / If Yes, please explain:
Do you manufacture or build boats? / Yes No / If Yes, please explain:
Are you involved in the automotive sales/repairs? / Yes No / If Yes, please explain:
Do you sell ammunition or firearms? / Yes No
Do you rent jet skis or other jet powered watercraft? / Yes No
Do you rent out houseboats? / Yes No
Do you store boats indoor? / Yes No / If Yes, please provide: / -Gross Receipts from indoor storage:
-Max. value of boats stored at any one time:
SECTION 1 – PROPERTY INSURANCE
Location Number
Building Number
CONSTRUCTION
Walls
(Type of Construction)
Roof
(Type of Construction)
Year Updated: / Year Updated: / Year Updated: / Year Updated: / Year Updated:
% Completed: / % Completed: / % Completed: / % Completed: / % Completed:
Floor
(Type of Construction)
Height
(Number of Stories)
Area
(Sq. Ft. / M2)
Age / Year Built
(Date)
Wiring
(Type / Amps)
Year Updated: / Year Updated: / Year Updated: / Year Updated: / Year Updated:
% Completed: / % Completed: / % Completed: / % Completed: / % Completed:
Heating
(Type)
Year Updated: / Year Updated: / Year Updated: / Year Updated: / Year Updated:
% Completed: / % Completed: / % Completed: / % Completed: / % Completed:
Plumbing
(Type)
Year Updated: / Year Updated: / Year Updated: / Year Updated: / Year Updated:
% Completed: / % Completed: / % Completed: / % Completed: / % Completed:
OCCUPANCY
Occupancy of Building
Occupancy of 1st Floor
Occupancy of 2nd Floor
Occupancy of 3rd Floor
BUILDING PROTECTION
Extinguishers / Yes No / Yes No / Yes No / Yes No / Yes No
Burglar Alarm / Yes No / Yes No / Yes No / Yes No / Yes No
Monitored: / Yes No / Monitored: / Yes No / Monitored: / Yes No / Monitored: / Yes No / Monitored: / Yes No
Smoke / Heat Detectors / Yes No / Yes No / Yes No / Yes No / Yes No
Monitored: / Yes No / Monitored: / Yes No / Monitored: / Yes No / Monitored: / Yes No / Monitored: / Yes No
Sprinkler / Yes No / Yes No / Yes No / Yes No / Yes No
Hydrants / Yes No / Yes No / Yes No / Yes No / Yes No
Distance: / Distance: / Distance: / Distance: / Distance:
Distance Fire Department / Distance: / Distance: / Distance: / Distance: / Distance:
Fire Department Description / Full Time Volunteer / Full Time Volunteer / Full Time Volunteer / Full Time Volunteer / Full Time Volunteer
Limit of Insurance
Any Cradles or Travel Lifts on Wharves/Docks? / Yes No / If Yes, please provide: / Age: / Value:
Year of Last Inspection (attach copy of inspection):
Does the marina have any other equipment for moving or lifting vessels? / Yes No / If Yes, what is the largest vessel (in length and weigh) that you will lift or move?
Storage Tanks
Age: / Number: / Construction: / Full Capacity: / Location of Pump:
Last Surveyed: / Fueling: / Ashore On the Dock | By Employees By Boat Owners
SECTION 2 – BOAT DEALERS
Describe types of vessels sold (i.e. power, sail, etc…) and list name of Manufacturers you represent:
Total Limit of Boats under 28ft: / Total Limit of Boats over 28ft: / Maximum Value any one Boat:
Requested P&I Limit: / Requested P&I Deductible:
Is Lot fully secured, gated and locked? / Yes No
SECTION 3 – VESSELS (H&M and P&I)– Owned Boats / Rental Fleet
Owned Vessels (if more than 5, please complete the Schedule of Vessels)
# / Description / Year / Make / Length / Model / HP / Serial Number / Value
1.
2.
3.
4.
5.
Please describe what these work boats are used for:
Do you transport goods or people? / Yes No / If Yes, please explain:
Do you rent boats? / Yes No / If Yes, please explain:
(If you have a rental fleet of Boats, please attach a schedule of boats)
Requested Liability Limit: / Requested Liability Deductible:
SECTION 4 – WHARVES/DOCKS/FLOATS
Wharf/Dock No. 1
Year Built: / Construction: / No. of Slips: / Date of last Inspection: / Insured Value:
Wharf/Dock No. 2
Year Built: / Construction: / No. of Slips: / Date of last Inspection: / Insured Value:
Wharf/Dock No. 3
Year Built: / Construction: / No. of Slips: / Date of last Inspection: / Insured Value:
Do you have any covered slips or own any boathouses attached to the docks? / Yes No / Describe:
Do any of your docks have fuel? / Yes No / Describe:
Are there any commercial vessels moored at the docks? / Yes No / Gross Receipts for Commercial Moorage:
Are Docks removed from the water during winter season? / Yes No / If Yes, please describe winter storage arrangements:
SECTION 5 – LIABILITY INSURANCE
Do you have any US Exposure (i.e. products sold to US Citizens, deliveries to USA, etc)? / Yes No
If Yes, please describe and quantify gross receipts from these sales:
% of Work contracted out: / Nature of Work sub-contracted out:
Are Certificates of Insurance obtained from sub-contractors? Yes No
Provide details of Contracts whereby you indemnify, hold harmless or release another party, attach sample contract if necessary:
Do operations involve storing, treating, disposing or transporting hazardous or waste materials? / Yes No
Are transporters, handlers or disposal companies CEPA Certified and properly insured? / Yes No
Have you, during the past 5 years, had any reportable releases or spills of hazardous substances, hazardous waste or any other pollutants, from locations owned or operated by you, into the environment? / Yes No
(If Yes, please attach a separate sheet describing incident in detail)
Do you use any mobile equipment? / Yes No / If Yes, please describe:
Comments on safety procedures:
MARINA OPERATOR’S LIABILITY
Usual operating season: Open all year Closed in Winter
Average value of any vessel at Marina: / Maximum total value of vessels moored at Marina at any one time:
If storage (ashore or afloat), describe method:
If stored in a building, advise percentage of indoor storage revenue: / Who has access to the storage?
Percentage of boats stored on a trailer? / How often is the storage inventory checked?
Items other than boats at the same location?
Describe other businesses also located at or adjacent to this marina whose customers would have access to the docks (i.e. pubs or cafes, etc…):
Is a Hold Harmless Moorage Agreement in use? / Yes No / If Yes, please attach a copy
Are there any signs posted stating USE AT OWN RISK or similar? / Yes No / If Yes, please describe wording and locations of signs:
SHIPREPAIRER’S LEGAL LIABILITY
Name, experience and certification of key personnel:
For mobile repairs describe areas traveled to and worked in:
Type of Repairs: / Type of Vessels Repaired:
Engine / % / Painting / % / Recreational boats under 60ft in length / %
Fiberglass / % / Welding / % / Recreational boats over 60ft in length / %
Hull / % / Boiler / % / Commercial Vessels / %
How are dangerous materials (i.e. paints, cleaners, etc) stored?
Are work areas vented to the outside? Yes No
Maximum number of vessels in yard at any one time: / Maximum value of vessels in yard at any one time:
Are work orders used? / Yes No / Do customers sign work orders? / Yes No
Describe in full details other business located in the same yard, compound or facility as your business:
Any NON-MARINE repairs (ATVs, Trailers, etc.)? / Yes No / If Yes, please describe in full detail:
GROSS RECEIPTS DECLARATION
Nature of Work / Annual Revenue (Last 12 months) / Estimated Annual Revenue (Next 12 months)
Moorage Receipts / $ / $
Berthing / Storage Receipts / $ / $
Boat Sales Receipts / $ / $
Boat Rentals / $ / $
Fuel Receipts / $ / $
Chandlery / Boating Supplies Receipts / $ / $
Repair Receipts / $ / $
Hauling / Lifting / $ / $
Sales to USA / $ / $
Propane Sales / $ / $
Restaurant Receipts / $ / $
Liquor Receipts / $ / $
Other (describe): / $ / $
Other (describe): / $ / $
TOTAL SALES: / $ / $
LIMITS OF INSURANCE / LIMITS OF LIABILITY
COVERAGE / CO-INS% / LIMIT OF INSURANCE/LIABILITY / DEDUCTIBLE
Building / 80% / $ / $
Equipment / 80% / $ / $
Property of Every Description (excluding Property as covered under SECTION 2) / - / $ / $
Contents / 80% / $ / $
Furniture, Fixtures, Equipment / $ / $
Stock (Parts and Retail) / $ / $
Other Stock – RV’s, ATV’s, Ski Doos, etc / $ / $
Shop Tools – Hand Tools / $ / $
Wines, Spirits, Cigarettes / $ / $
Fuel / $ / $
Fueling Equipment / $ / $
Other Equipment / $ / $
Travel Hoists / $ / $
Goods in Transit / $ / $
Rent or Rental Value / 100% / $ / $
Business Interruption / Profits / - / $ / $
Rents / 100% / $ / $
Gross Earnings / 80% / $ / $
Gross Earnings / 50% / $ / $
Extra Expense / - / $ / $
Valuable Papers and Records (All Risks) / - / $ / $
Accounts Receivable Insurance / - / $ / $
Computer Insurance / 80% / $ / $
Sign Floater / 80% / $ / $
Glass Rider ( Sq. Ft.) / - / $ / $
Comprehensive Dishonesty, Disappearance and Destruction – Form A / - / $ / $
Boiler & Machinery / - / $ / $
Section 2 – Boat Dealer Stock – Direct Damage / - / Under 28ft in length$ max any one vessel / $
- / $ max any one location / $
- / 28ft and over in length $ max any one vessel / $
- / $ max any one location / $
Section 2 – Beat Dealer – Protection & Indemnity / - / $ / $
Section 3 – Owned Vessels – Hull & Machinery / - / $ max any one vessel / $
Section 3 – Owned Vessels – Protection & Indemnity / - / $ / $
Section 3 – Boats Rented to Others – Hull & Machinery / - / $ max any one vessel / $
Section 3 – Boats Rented to Others – Protection & Indemnity / - / $ / $
Section 4 –Wharves and Floats / - / $ / $
Section 5 – Liability – Commercial General Liability / - / $ / $
Bodily Injury and Property Damage / - / $ / $
Products & Completed Operations / - / $ / $
Personal Injury Liability / - / $ / $
Section 6 – Crime ($ 5,000 / $ 10,000 or $ 25,000 Limits) / - / $ / $
Tenants Legal Liability / - / $ / $
Standard Non-Owned Automobile ($ 2,000,000 Maximum Limit) / - / $ / $
Marina Operators Legal Liability / - / $ / $
Ship Repairer’s Legal Liability / - / $ / $
Yacht Club Extension – Regatta Liability Endorsement ($1,000,000 Max. Limit) / - / $ / $
Limited Pollution Liability ($ 1,000,000 Maximum Limit) / - / $ / $
Checklist of Required Attachments
Photos of all buildings and docks
Copies of the standard moorage and storage agreement used
If consignment sales are done, copy of the standard consignment agreement used
If boats are rented out, copy of the standard boat rental agreement
Where an Applicant for this contract gives false particulars to the prejudice of the Insurer or knowingly misrepresents or fails to disclose any fact in any part of this application required to be stated herein; or (b) the Insured contravenes a term of the contract or commits a fraud; or (c) the Insured willfully makes a false statement in respect of a claim, a claim will become invalid and the Insured’s right of recovery is forfeited. The Applicants have reviewed all parts and attachments of this application and acknowledge that all information is true and correct and understand that this application for Insurance is based on the truth and completeness of this information.
I have provided personal information in this document and otherwise and I may in the future provide further personal information. Some or this personal information may include, but is not limited to my credit information and claims history. I authorize my broker or insurance company to collect, use and disclose any of this personal information, subject to the law and my broker’s or insurance company’s policy regarding personal information, for the purpose of communicating with me, assessing my application for insurance and underwriting my policies, evaluating claims, detecting and preventing fraud, and analyzing business results. I confirm that all individuals whose personal information is contained in this document have authorized that I agree to the above on their behalf.
SIGNATURE OF APPLICANT: / BROKER SIGNATURE:
POSITION HELD: / BROKERAGE:
DATE: / BROKER EMAIL:
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