Renewal Questionnaire
Please indicate changes/updates to the following:
NEW APPLICATION(S) REQUIRED EVERY THREE YEARS
Applicants Name / Named Insured
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Location Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please describe any changes in operations below:
No changes in operations from last year
Pleas check this box if there are no changes.
New Info Needed for Dock Owners
Do you have a documented procedure for testing dock electrical systems to prevent accidental discharge of electricity into the water surrounding your docks?
Yes
No
If so, please describe:
Do you correct any deficiencies?
Yes
No
Do you document your findings?
Yes
No
Marine General Liability
Any changes in limits (If so, please describe)
Any change in operations?
Any changes in location(s)?
Annual Gross Receipts - Moorage/Storage
Annual Gross Receipts - Repair
Annual Gross Receipts - Hauling/Launching
Annual Gross Receipts - Marine Construction
Annual Gross Receipts - Other
Annual Gross Receipts - Other - Describe
Annual Gross Receipts - Lessor’s Risk
Annual Gross Receipts - Fuel Sales
Annual Sales - Store/Boat Sales
Annual Sales - Brokerage Commission
Annual Sales - Restaurant
Annual Sales - Liquor
Number of Swimming Pools
Hull and Machinery/Protection and Indemnity
Vessels:
Any changes in vessel schedule? Please indicate below or attach updated schedule.
File Upload
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Total Schedule Value
Navigation Warranty
Boat Dealer
Please describe any changes to the boat dealer limits below:
Any one watercraft while at a scheduled location ($)?
Any one watercraft accepted as a trade-in while at locations other than those scheduled for not exceeding 15 days ($)?
Any one watercraft during land and water transit within 75 milesof a scheduled location ($)?
Any one watercraft while on exhibit at watercraft shows ($)?
Any one accident or occurrence with respect to accessories and supplies in inventory at the scheduled locations ($)?
Any one accident or occurrence for all coverage provided by this policy, except as provided in the protection and indemnity clause ($)?
Any one accident or occurrence, including legal and investigative expenses, with respect to claims covered by the protection and indemnity clause ($)?
Projected Average Monthly Inventory
Projected MAX Monthly Inventory
Any change in operations?
Any changes in location(s)?
Piers & Wharves
Please describe any changes to dock schedule below (or attach copy of new schedule):
File Upload
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Contractor's Equipment
Please describe any changes to schedule (or attach renewal schedule):
File Upload
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Excess Liability
Any changes in the underlying policies, auto schedule (or attach renewal application):
File Upload
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Real and Personal Property
Please describe any changes to the Property Schedule and add SQUARE FOOTAGE of each building:
File Upload
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Additional Changes
Any additional changes/comments/coverage, please attach herto:
File Upload
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Agent Signature
Insured Signature
Date
-
Month
-
Day
Year
Date
Contractor’s Equipment - Changes to schedule (or attach renewal schedule)
Excess Liability - Changes in underlying policies/auto schedule (or attach renewal application)
Real and Personal Property - Changes to Property Schedule and square footage of each building
Additional changes/comments/coverage
Agent Signature
*
Insured Signature
*
Date
*
-
Month
-
Day
Year
Date
Submit Renewal Questionnaire
Submit Renewal Questionnaire
Should be Empty: