HURRICANE QUESTIONNAIRE / PLAN

833-922-4897

HurricanePlan@PremiumCaptains.com

PremiumCaptains
361 NW 38th PL
Pompano Beach, FL 33312

Insured's full name

Address

(mobile)

Alternate Emegency Number

(fax)

E Mail

example@example.com

Vessel Name

Port of Registry

Type Model

Year built

Hull identification number

Other identification number (STATE ID numbers)

1. If different from above, who is going to be responsible for the vessel before and after the hurricane? (Vessel address & property owner contact info)

2. What is the name, address and contact details of the marina or residence where the vessel is kept?

3. How frequently, do you or the person named above visit the vessel if not permanently crewed?

4. Who if other than the Insured, has the authority to move and or prepare the vessel for a storm?

Is the vessel in a single slip? if so what is the clearance between the insured vessel and surrounding, docks and piers?

6. Is the insured vessel in a single slip with a neighbouring vessel? If so what is the distance in feet between the widest beam of the insured vessel and the neighbouring vessel?

7. How many lines are going to be used to secure the vessel and what is the diameter and material of those lines?

8. Is the slip covered by a roof or building?

YesNo

9. Does the slip have overhead power lines?

YesNo

10. Which direction is the slip facing?

11. If the Insured Vessel is a sailboat will the vessel be hauled and blocked ashore during hurricane season?

12. If the Insured Vessel is a sailboat does she have a “hurricane pit” and will it be used throughout hurricane season?

13. If the vessel will be ashore are all the stands supporting the vessel chained together?

14. Will all canvas and/or cushions and/or outriggers removed?

15. If the vessel is to be moved to a hurricane hole, what is the travel time by water & if there are any bridges will they open prior to the hurricane?

16. What arrangements have you made for the safety of your vesse in the event that a named storm warning is issued?

17. What are your alternative plans in the event that the above plan becomes unlikely?

Have you ever had to prepare for a storm before If so, we would appreciate any tips or comments you may have

To the best of my knowledge and belief the information provided in connection with this hurricane questionnaire / plan, whether in my own hand or not, is true and I have not withheld any material facts*. I understand that non-disclosure or misrepresentation of a material fact* may entitle underwriters to void the insurance.

*A material fact is one likely to influence acceptance or assessment of this hurricane questionnaire / plan by underwriters; if you are in any doubt as to whether a fact is material or not you must disclose it.

This hurricane questionnaire / plan and the information provided in connection therewith contain statements upon which underwriters will rely in deciding to accept this insurance. Should a contract of insurance be concluded this hurricane questionnaire / plan will form the basis of the insurance.

Full Name:

Signature:

Date:

Date

HURRICANE QUESTIONNAIRE / PLAN

INSURED DETAILS

DETAILS OF YACHT

HURRICANE PLAN INFORMATION REQUIRED

DECLARATION