Marine Contractors Liability Insurance

Marine Contractors Liability Insurance

PLEASE NOTE: Not to be used for a ship repairer.
Applicant Information
Applicant Name*
Years in Business (if less than 3 years, please attach resume)*
Mailing Address (including City, State, Zip)*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Inspection Contact/ Phone Number*
Total Projected Gross Receipts for Terms ($)*
Proposed Effective/Expiration Date*

MonthDayYear
Date
List of Insured Locations*
Contractor Limits
General Aggregate Limit ($)*
Products - Completed Operations Aggregate ($)*
Personal and Advertising Injury ($)*
Each Occurrence ($)*
Damage To Rented Premisis ($)*
Medical Expense ($)*
Deductible ($)*
Describe Owned Watercraft:
YesNo

Type of Work:

Indicate percentage of work performed in:

Gross Receipts for last year and Projected Gross Receipts for this year:

Describe your Non-Marine work and give percentage of total revenues
Current Insurer
Is the current insurer cancelling, increasing rate, changing coverage, etc? Please explain:
Loss Experience

List all claims (insured or not) during past 5 years on all operations (ATTACH FULL LOSS EXPERIENCE DETAILS)

Do you require subcontractors to (indicate yes or no)