Ocean Marine Insurance Agency Inc.

FISHING VESSEL QUOTE

General Information
Date of Request
Saw ad in:
Contact Name
Email

Registered Owner of Vessel
Address
City
State
County
Business Phone
Cell Phone
Fax
Referral
Vessel Information
Name of Vessel
Home Port/ State:
Type of Fishing
Maximum miles offshore:
LOA
GRT
DOC#
In Board Engine? Yes  No
Make/Model of Engine:
Diesel Yes  No
Year Vessel Built:
Built at what yard?:
Please select hull material Glass  Glass Over Wood  Wood  Steel  Other
Current Insurance Company / Policy Information
Insurance Company Name
Present Insurane agent
Date Insurance Expired/Needed:
Has insurance ever been canceled or declined?: Yes  No
If yes, why:
Claim History
Claims for owner for any vessels owned or operated wthin last 5 years
Please describe any claims in the last 5 years
Policy Information
Purchase Price:
Hull currently Insured for:
Requested Hull Insurance Amount:
Do you want Crew Covreage? Yes  No
If yes, how many crew on board?
Crew P&I amount desired: $250,000
$500,000
$1,000,000
Other
If no crew coverage desired. Do you want vessel P&I? Yes  No
Amount of vessel P&I desired. $250,000
$500,000
$1,000,000
Other
Builders Risk:
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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