1. Applicant:

2. Address:

    City: State: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KY KS LA MA ME MD MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY Zip:

3. Phone: Fax: E-mail (required):

4. Description of Boats-Motors-Trailers Held for Sale:

6. Total Sales Past 12 months:

7. Any of the following theft preventions in effect:
   Central Alarm Yes No
   Local Alarm Yes No
   Watchman Service Yes No
   Fencing Around Premises Yes No
   Floodlights Yes No

8. Transportation to or from Dealership:

   Navigation under own power:  Yes No ,No. of Trips:    Distance
   Dealers Truck Yes No :   No. of Trips:    Distance:

9. How long has insured been in operation?:

10. Who demonstrates boats and what is his/her experience?:

11. Location of Demonstration:

12. Frequency of Demonstrations:

13. Limits: Deductible:

14. List all claims for past 5 years from operations - include date, cause and amount paid:

Marina Operators Legal Liability, Including Comprehensive General Liability, Ship Repairers Liability and Protection & Indemnity

1. Applicant:

2. Address:

   City: State: Zip:

3. Phone: Fax: Email (required):

4. Marina Location:

5. Limit Required:

6. Mooring & Slip Rental:

   No. of Slips:   No. Rented: No. Covered:

   No. of Docks :  No. of Slips at each Dock:
   Type and No. of Moorings:
   Avg. Value of Boat at Slips & Moorings:
   Maximum Value at Any One Time:

7. Storage Operations (Lay Up and Out of Commission):

   Maximum No. of boats stored at any one time during the past year:   
   Estimated Total Value
   Estimate avg. value of individual boats stored ashore during the past year:   
   Afloat:
   No. of slips rented during the past year for lay up storage afloat:

8. Repairs:

   No. of Boats Repaired in Last Year:
   Maximum value of any Boat Repaired:
   Average Value:

9. Hauling (Describe methods & Equipment):

   Location
   Design
   Power
   Rated Capacity
   Size
   Movable or Stationary

10. No. of Boats Hauled Out Past Year for:

   Repairs
   Storage
   Others

11. Boating Season from     to

12. Average Depth of Water:    Tide Rise:

13. Fire Protection: Public Paid Volunteer

   Distance from Marina
   No. of Public Fire Hydrants
   No. of Fire Extinguishers

14. Is watchman employed? (explain): Yes No

15. Is storage area fenced in?: Yes No

16. Any fueling operations?: Yes No Nature: Gas Diesel Both

17. How long has marina been operated by present management?:

18. Last survey date of marina:

19. Names and experience of key personnel:

20. Gross Receipts Past 12 Months:
   Mooring/Slip Rental
   Storage
   Repairs
   Boat Rentals
   Fueling & Miscellaneous
   Hauling / Launching

21. List all claims for past 5 years from operations- include date, cause and amount paid.

Marina Operators Property Damage

1. Applicant:

2. Address:

City: City: City:

3. Slips and Piers:
a. Total Insured Value   (Replacement Cost)
b. Construction / Anchorage Details
c. Built by:   Year Built:
d. Loss History (5 years)

4. Real & Personal Property:

a.

b. Loss History (5 years)

5. Private Fire Protection:

a. Fire Alarm Yes No
b. Fire Extinguisher Yes No
c. Fire Boat/Pumping Point Yes No
d. Restaurant Ansul System Yes No

Hull & Machinery

1. Assured:

2. Address:

3. Do you rent boats?: Yes No
Explain procedures prior to renting:

4. Schedule of Vessels:
Vessel Number    Type of Vessel (Include yr. , length & H.P.)    Hull No.    Amount of Insurance

5. List all claims for last 5 years - include date, cause and amount