Classic Boat Coverage Quote Request

If you'd like a proposal for Classic Coverage, please complete this form and press the "Submit" button at the end for a no-obligation quote. If you prefer, you can call us at 1-860-572-5908, or call our office toll free at 1-800-959-3047. You can even download our application form, print it out and fax it to us at 1-860-572-5919 or send it by mail. We'll be happy to help you.

Agency Information

Agency Name:    Email Address:   
Contact Person:      Agency Phone:       
Agency Address  

About The Insured

First Name: Middle Initial:    Last Name:

Date of Birth:    Email Address:

Address, City, State, Zip:
Phone:    This is a:   home number work number  cell phone  
Please list the names and ages of any other regular operators of the vessel:

Name:  Age:      
Name:  Age:    

Has the insured had any marine insurance claims in the last 5 years?  Yes No

If yes, please list dates and amount of claim & briefly describe the reason for the claim:

Insured's years of boating experience:      Years of boat ownership:

Please describe their boating experience.  List any previous boats owned: (type, length, number of years owned)

Has the insured taken any Safe Boating courses? (ex. Power Squadron or USCG Auxiliary) Yes No
Does the insured  have a Captain's License? Yes No    Level
Is the insured a member ACBS or other owner's club? Yes No                                                        Name of Owner's Club:

About the Insured's Boat

Builder/Manufacturer's Name:   

Model:   Designer:

Length:       Year:      Vessel's Name: 

Boat Type:   Hull Material:

If other hull material, please describe any special construction:  


Motor Type:   Motor Manufacturer:   Motor Year:

Number of Engines:  Horsepower of Each:   Fuel:  Gas Diesel  Steam  Electric

Max Speed of Vessel:   Purchase Date:   Purchase Price:
Use of boat:
Private pleasure use only   Live aboard (primary residence)   Chartered (Six pack only, max. 20 per year)

Present location of Boat:   City:   State:    ZIP:

 

Home port of vessel

City: State:   ZIP:  

 

Vessel is kept:  in a slip at a marina

If other,  please describe where and how the boat is used..

Waters navigated:         
Annual lay up:   From (dates):    To:    If no lay-up, check here

Lay up location: City: State:   ZIP:  

Lay Up:    Ashore     In water with a bubbler    In water without a bubbler  

 Paid Captain? Yes No                         Paid Crew Yes No   If yes, Number 
Has a Marina asked to be listed as additional insured?  Yes No 
Is there a loan on the boat?  Yes No 
 

About Coverage

Amounts of Insurance Requested:

Hull & Machinery $           Marine Liability $

 

Deductible:  


Does the insured wish to insure a dinghy/tender?  Yes No  (Some dinghies may already be covered in our policy).

If yes, Tender Make/Manufacturer/Design    
Tender Length: 
   Tender Year:  Tender Value:  
Tender Motor Make/Manufacturer:   Tender Motor Year:   
Tender Motor Horsepower
 


Does the insured wish to insure a trailer?  Yes No  

If yes, Trailer Make/Manufacturer/Design    
Trailer Length: 
    Trailer Year:   Trailer Value:  $  
 

Current or previous insurer :   Policy expiration date:   
Other comments: (Please add as much detail as you wish)

How Did You Hear About Us?:

 

 

 

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