NCBoatInsurance.com: North Carolina Boat Insurance

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Please enter your details in the registration wizard below. This is a quick 4 page process that should take less than 5 minutes! If your boat is less than 25 feet, please click here. If you have a personal watercraft, please click here.

Applicant Details

Requested Effective Date	:
First Name*	:
Middle Name	:
Last Name *	:
Address *	:
City *	:
Zip Code	:
Home Phone *	:
Work Phone *	:
Email Address *	:
Where to call?	:	Work Home

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Vessel Information

Yacht Dealers Coverage

Limits Desired

On any one Vessel	:
While in transit by Land	:
While on exhibit at	:
While on premises at	:
In any one occurence	:
Average Total Inventory	:
Maximum Inventory	:

Average Value on any one Vessel Inside	:
Average Value on any one Vessel Outside	:
Average Value on any one Vessel Waterbornee	:
Maximum Value on any one Vessel Inside	:
Maximum Value on any one Vessel Outside	:
Maximum Value on any one Vessel Waterborne	:
Average Number of vessels in inventory	:
Maximum Number of vessels in inventory	:
Estimated Number of vessels in transit per year	:
Estimated Number of Boat Shows/Exhibitions per year	:
Estimated Number of Demonstrations per year	:
Are applicants personnel in charge	:	YesNo
If not then how are demonstrations performed	:

Are any boats taken out from inventory for Rental	:	YesNo
If yes, estimate of annual receipts (USD)	:
Are any boats taken out from inventory for Personal Use	:	YesNo
If yes, number of times per year	:
Are any boats taken out from inventory for Laoners	:	YesNo
List all major manufacturers and major hull model sold	:
Percent of Inventory represented by Foreign made products	:
Percent of Inventory that are High Performance(more than 60mph)	:
Any products other than boat or boat Accessories	:	YesNo
If yes, percentage of sale	:
Describe non-boat products	:
What percent of inventory is built by a non US-manufacturer	:
Do all foreign manufacturers carry US product liability	:	Yes No
Yacht Dealers endorsment to be included?	:	Yes No
Deductible Requested($1,000):Optional Deductible(USD)	:
Loss Payee	:

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Marina Operators Legal Liability Coverage

Limit of Liability	:
Deductible	:
Docking

Number of Slips available	:
Number of Docks available	:
Average Value of Vessels Docked (USD)	:
Maximum Value of Vessels Docked (USD)	:
Estimated Gross Receipts for proposed policy period	:


Fueling

Fuel	:
Fire protection(Describe Safegaurds)	:
Who supervises Fuelling	:
Is after-hours self pump service offered?	:	Yes No
Estimated Gross Receipts for proposed policy period	:


Hauling and Launching

Approximate number of vessel handled per year	:
Maximum value of any one vessel	:
Three prior years receipt	:
Estimated Gross Receipt for proposed policy period	:


Mooring and Anchoring

Maximum number of vessels moored	:
Maximum value of any one vessel	:
Three prior years receipt	:
Estimated Gross Receipt for proposed policy period	:


Ship Repairers

Average Value of Vessel Handled(USD)	:
Maximum value of Vessel Handled(USD)	:
What percentage of repair receipts are of commercial/non-pleasure craft?	:
If primarily a yacht facility,provide breakdown of repair operations:
Painting	:
Refinishing	:
Fibreglassing	:
Engine Repair	:
Spray Painting	:
General Repair	:
Welding	:
Electrical	:
Wood Working	:
Three prior years receipt	:
Estimated Gross Receipt for proposed policy period	:


Storage Ashore

Average Value of Vessel Handled(USD)	:
Maximum value of Vessel Handled(USD)	:
Value of vessel and method of storage

	Average	Maximum	Number

Outside in Open Racks
Non Racked
Inside in Racks

Three prior years receipt	:
Estimated Gross Receipt for proposed policy period	:


Other

Give details of other activities/services	:
Three prior years receipt	:
Estimated Gross Receipt for proposed policy period	:


Rental Boats

Number of vessels	:
Does your rental agreement contain a Hold Harmless Agreement	:	Yes No
Three prior years receipt	:
Estimated Gross Receipt for proposed policy period	:


Ship Store Sales

What percentage of sales are consumables?	:
Three prior years receipt	:
Estimated Gross Receipt for proposed policy period	:


Storage Ashore

If any part of operations include storage in land,in buildings,in racks or in any other way,please complete the following details
How many levels are racks(2,3 or 4 high)	:
Are vessels ever left on trailors	:	Yes No
If yes then explian safegaurds to gaurd against thefts	:
What is construction of storage building?	:
Winter Storage
Batteries Removed?	:	Yes No
If yes,done by	:	Insured Vessel Owner Both
Fuel topped off or emptied	:	Yes No
If yes,done by	:	Insured Vessel Owner Both
Whar is the age of the building	:
Is building Spinklered	:	Yes No
If yes describe system	:
What protection system are currently being used?	:
Are all vessel owners required to maintain liability insurance	:	Yes No
If yes,minimum limit required($)	:
Are certificate of insurance obtained from all vessel owners kept on file?	:	Yes No
Is a signed contract with Hold Harmless wording utilized by the insured for storage	:	Yes No


Protection & Indemnity Coverage

Limit of Liability(Medical payment of $2,000 included)
Yacht Dealers	:
Marina Operators	:
Owned Watercraft	:
Crew	:	Include Exclude
Number of Crew	:
Sailing Instruction	:	Include Exclude
Maximum number of instruction at any one time	:
Maximum number of students at any one time	:
Water Ski Liability($300,000 limit available)	:	Include Exclude
Regatta Liability	:	Include Exclude
Towers Liability:Do you offer Commercial towing Assistance for Hire	:	Yes No
Sudden and Accidental Pollution Liability	:	Include Exclude
Deductible Requested ($)	:
Average Experience of employees

	Number of	Years with Applicant	Experience

Captains?Yes No
Engineers
Deckhands

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Piers,Wharves and Dock Coverage

Type of construction	:
Percentage of dock covered over with roof,if any	:
Number of Docks	:
Electricity on Docks	:	Yes No
Seperate Fuel Dock	:	Yes No
Year(s) of Construction	:
Were the docks built to a specific wind resistant rating	:	Yes No
If yes, what speed	:
If docks are set with pylons , how many feet above the high tide mark are they?	:
For anchored docks, are all cables,winches and anchor connectios inspected are repaired annually	:	Yes No
Describe the maintainence program	:
Describe firefighting capabilities at pier	:
Local fireboat available	:	Yes No
Is any property removed from water during winter	:	Yes No
Has any company refused or cancelled any similar coverage applied for or on force during the past 3 years	:	Yes No
If yes, then give details	:
Deductible All Perils	:
Deductible Wind, Hail and Wind Driven Water	:
Total Value of Docks	:

Description	Construction	Length	Year	Value
Dock A
Dock B
Dock C
Dock D
Dock E
Dock f

Valuation	:	Actual Cash Value Replacement Cost
Business income limit of insurance desired	:
Include Equipment Breakdown Coverage	:	Yes No

Commercial Tool and Equipment Coverage

Coverage
Equiment Insured (USD)	:
Tools: $10,000 Unscheduled - $5,000.Employees tools - $5,000 Owned Tools - $1,000	:
Maximum value of any one item	:
Deductible per occurence	:
Optional Coverage
Is replacement cost desired	:	Yes No
Is Coverage desired on employees toold	:	Yes No
Number of Employees	:
Amount of Insurance desired on any one employee	:
Maximum value on any one item	:
Total Number of Employees Tools	:
Is Coverage desired for Rental Reinbursement	:	Yes No
What limit of liability is desired	:
Storage and Repair Location
Where is Equipment Stored	:
Are tools kept in locked compartments when premises are closed	:	Yes No
Maintainence
Is there a regular equipment maintainence program in affet at present	:	Yes No
If yes, please describe	:

Schedule of Equipment in excess of $1,000 per item

Trade Name of Machine	Year Built	MFG's Serial or Model #'s	Type of Fuel	Cost New	Limit Insurance
				$	$
				$	$
				$	$
				$	$
				$	$
				$	$

Owned Watercraft Coverage

Rental/WorkBoat/Personal/Water Skiing Boat Coverage

Trade Name	Use of Boat	Year Built	Length	Total HP	Value	Type of Fuel	Material of Hull
					$
					$
					$
					$
					$

Navigation area of above vessel(s)	:
If HouseBoats are scheduled, do any contain rear exhaust for engines or generators	:	Yes No
Are all vessels equipped with c/o detectors	:	Yes No
Deductible Requested($5,000 minimum applies)	:

Yacht Club Supplimental Questionnare

Number of Members	:
Do any special zoning laws applies to the property in the event of loss	:	Yes No
If yes, please specify	:
Value of trophies and/or fine arts(Any one item >$2,500 must be schedules)	:
Are trophies ever off the premises	:	Yes No
Coverage Desired	:	Yes No
Deductible Requested	:
Special Services	:	Swimming Pool Bathing Beach Restaurant Snack Bar Tennis Courts
Annual Income Breakdown

Annual Dues Per Member		Pool Fees
Total Annual Dues		Tennis Fees
Dockage Receipts		Boat Instruction Fees
Mooring Charges		Fuel Sales
Winter Storage Charges		Slip Rental Fee(per ft)
Repair Receipts		Total Annual Slip Fees
Maximum Value of Any One Vessel Docked		Average Value of Vessels Docked

Number of Slips	:
Number of Moorings	:
Is a full- time dockmaster employed for the season?	:	Yes No
Does the club own or lease vehicles	:	Yes No
Number of Employees	:
Does the club own or lease boats	:	Yes No
Does the club provide sailing instructions?	:	Yes No
Annual Revenue	:
Number of Students	:
Ages	:
Length of Program	:
Name of person Incharge	:
Address of Incharge	:
Certification	:	USSA ARC Other
Experience with Sailing Instructor	:
Instructor certified in CPR	:	Yes No
First Aid	:	Yes No

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