Ocean Marine Insurance Agency Inc.

Artisans Quote

Type of Coverage
Type of Coverage *
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
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
Company Name
Present Insurance agent
Date Insurance Expired/Needed:
Has insurance ever been canceled or declined?: Yes  No
If yes, why:
Claims for owner for any vessels owned or operated wthin last 5 years
Please describe any claims in the last 5 years
Insurance Information
Have you and/or affiliated companies been involved in bankruptcy proceedings? Yes  No
Has insurance been denied cancelled or non-renewed on Applicant and/or affiliated companies in the last 5 years? Yes  No
Years in current operation?
Please advise and explain prior experience in trade/operation.
Is any non-marine work performed? Yes  No
Is any work performed on commercial vessels? Yes  No
Do you engage in any diving operations with regard to work performed? Yes  No
If yes please explain
Besides the owner/operator, how many are employed by this business?
Does Applicant own any watercraft used in the course of business. Yes  No
If yes please explain use of watercraft.
Does Applicant own any heavy equipment, or any individual tools, or any one piece of equipment in excess of $2,500 for use in the business? Yes  No
If yes please list
Transport by Vehicle individual vessels worth not more than
Maximum values of marine equipment and vessel(s) at applicant's premises in their care, custody, and control any one time does not exceed
What is the value of the most expensive vessel the Applicant will perform work on?
Other than cabinetry (and other items made by a carpenter), does the Applicant manufacture any products? Yes  No
If yes. Please list products.
What are the total number of paid and outstanding insurance losses for the last three years?
What is the total value of claims in 16?
What are the anticipated annual gross receipts for upcoming year?
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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