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:
Do you want coverage for owned watercraft?

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)