Ocean Marine Insurance Agency Inc.

6 Pack and Passenger Vessels

General Information
Date of request *
Saw ad in: *
Contact Name *
Email

Registered Owner of Vessel
Address
City
State
Zip
County
Business Phone
Cell Phone
Fax
Referral
Operation Information
Type of Activity 6 Pack
Head Boat
Whale Watch
Sightseeing
Other
How many hours is each excursion?
Describe Operation
Is Vessel Owner Operated? Yes  No
Total Crew including captain:
Do you tow skiers? Yes  No
Is vessel used for racing? Yes  No
Number of charters per year:
Average # of passengers/trip:
Date of Last USCG inspection passed:
How many years has applicant been in this business?
Do passengers swim, snorkel or scuba dive? Yes  No
Do you serve or sell food? Yes  No
Maximum passengers licensed for:
Ports
1st Port
State
Own or rent dock? Own Dock  Rent Dock
Month beginning
Month ending
Maximum miles from shore
2nd Port
State
Own or rent dock: Own Dock  Rent Dock
Month beginning:
Month ending:
Maximum miles from shore
Month laid up beginning
Month laid up to:
In or Out of water: In Water  Out Of Water
Location when laid up:
Vessel Information
Name of Vessel
LOA
GRT:
DOC#:
Hull ID
Make Engine 1
Model Engine 1
Serial Number Engine 1
Hours Engine 1
Gas or Diesel: Gas  Diesel
Make of Engine 2
Model Engine 2
Serial Number Engine 2
Hours Engine 2
Gas or Diesel Gas  Diesel
Year Vessel Built:
Vessel Manufacturer
Model:
Please select hull material Glass
Glass over Wood
Wood
Steel
Other
Date Purchased
Purchase Price:
Capacity of life rafts:
List electronics:
Dingy
Year
Length
Manufacturer
Serial #:
Engine Year
Engine Manufacturer
HP
Current Insurance Company
Company Name
Present Insurance agent
Date Insurance Expired/Needed:
Has insurance ever been canceled or declined?: Yes  No
If yes, why:
Claims History
Claims for owner for any vessels owned or operated wthin last 5 years
Please describe any claims in the last 5 years
Insurance Information
Hull currently Insured for (Including engine and electronics):
Total Liability limit requested:
P&I for captain and crew requested? Yes  No
Medical Payments: Yes  No
Gangway ticket extension Yes  No
Uninsured boaters: Yes  No
Towing Yes  No
Tender Value:
Personal effects and fishing gear limit:
Oil Pollution liability Yes  No
Additional Comments
Surveys
Enter Last Survey Date
All recommendations been complied with: Yes  No
Mortgagee
Bank Name
Vessel Mortgage Balance:
* = Required Field

Warwick | fairhaven | point judith

 


UXO 3Rs

MarineLink

CLICK HERE to go to Ocean Marine Charter Advantage website

Warwick Office:
33 College Hill Rd. Bldg 10
Warwick, RI. 02886

Fairhaven Office:
7 Water St.
Fairhaven, MA. 02719

Point Judith Office:
270 Great Island Rd.
Narragansett, RI. 02882

Call (800) 767-6687

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