Wood Boat and Yacht Insurance
Brought to you by:
W.R. HODGENS
MARINE INSURANCE, Inc.
Wood Yacht Insurance Specialists
1425 South Andrews Ave
Suite 250
Fort Lauderdale, FL 33316
(954) 523-6867
(800) 990-WAVE (9283)
(954) 523-6488 Fax
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Insurance Quote Form
Charter Insurance
F.A.Q.
Wood Links
Contact
Wooden Yacht Insurance Quote
Please complete the following in as much detail as possible to assure we can provide you with the most competitive wood yacht insurance rate, or phone us at 1-800-990-WAVE for immediate quote on our wooden boat policy.
*
E-mail address required.
APPLICANT'S PERSONAL INFORMATION
Full Name:
Address:
City:
State/Province:
Zip code/Postal zone:
Country:
Drivers License State and Number:
--- Select ---
AL
AK
AP
AR
AZ
CA
CO
CT
DC
DE
FL
GU
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Telephone:
Fax:
*
E-mail:
Occupation:
Date Of Birth:
Years of boating experience:
Size and builder of previous boats owned:
Are course/member certificates available?
Power Squadron
USCG Auxillary
USCG Captain License
None
Motor vehicle driving record past 5 years:
Are there other operators of this vessel?
Yes
No
VESSEL INFORMATION
NAME OF VESSEL:
YEAR:
MANUFACTURER/BUILDER:
--- Select ---
Albin
Alden
Avanti
Azimut
Baha
Bayliner
Benetti
Benneteau
Bertram
Blackfin
Black Watch
Blue Water
Boston Whaler
Bristol
Broward
Buddy Davis
Burger
Burnside
C+C
Cabo Rico
Caine
Cal
Californian
Cape Dory
Carolina Skiff
Carver
Catalina
Chaparral
Choey Lee
Chris Craft
Christensen
Cobia
Codecasa
Columbia
Contender
Contest
Cooper
Cruisers Inc.
CSY
Davis
DeFever
Donzi
Doral
Dufour
Dusky
East Bay
Eastbay
Egg Harbor
Eliminator
Endeavor
Erickson
Fairline
Feadship
Ferretti
Formula
Fountaine Pajot
Fountain
Four Winns
Freedom
Gemini
Grady White
Grand Banks
Gulfstar
Hallberg-Rassy
Hans Christian
Hatteras
Harris
Henriques
Hinckley
HiStar
Hunter
Hutchins
Hydra-Sport
Infinity
Intrepid
Irwin
Island Gypsy
Island Packet
Islander
J Boat
Jenneau
Jefferson
Jersey
Krogen
Lagoon
Little Harbor
Luhrs
Main Ship
Maiora
Mako
Mares
Marine Trader
Magnum
Maxum
Monk
Monterey
Moody
Morgan
Nauticat
Newport
Nordic
Northstar
Nova
Ocean Alexander
Ocean Yacht
Offshore
Pacemaker
Pacific Seacraft
Pacifica
Palmer Johnson
Passport Yachts
PDQ
Pearson
Penn Yan
Performance Cat
Phoenix
Post
Proline
President Yachts
Prout
Pursuit
Queenship
Rampage
Ranger
Real Ships
Regal
Regulator
Rinker
Robalo
Robinson
S2Yachts
Sabre
Sea Ray
Schock
Silverton
Sonic
Southern Cross
Soverel
Stamas
Stryker
Sunseeker
Swan
Ta Chiao (CT)
Ta Shing
Tanaya
Tartan
Tiara
Tollycraft
Topaz
Trinity
Trojan
Uniflite
Viking
Valiant
Wahoo
Wellcraft
Westbay
Westerly
Westport
Westship
Worldcat
If your builder is not listed above please add your builder here:
MODEL:
TYPE OF VESSEL:
--- Select ---
Cruiser
Houseboat
Motor Yacht
Performance
Runabout
Sail Yacht
Sportfisher
Trawler
Other
LENGTH:
PURCHASE PRICE OF VESSEL:
DATE OF PURCHASE:
FLAG:
US
Foreign
MAXIMUM SPEED:
HULL TYPE:
--- Select ---
Catamaran
Monohull
Other
HULL MATERIAL:
--- Select ---
Fiberglass
Aluminum
Steel
Wood
Other
ENGINES:
NUMBER:
--- Select ---
1
2
3
4
FUEL TYPE:
--- Select ---
Gas
Diesel
HORSEPOWER EACH.........
MANUFACTURER..............
--- Select ---
Caterpillar
Crusader
Cummins
Detroit
Evinrude
GM
Honda
John Deere
Lehman
Mercruiser
Mercury
MTU
Perkins
Volvo
Yamaha
Yanmar
Other
DRIVE TYPE...
--- Select ---
Inboard
Outboard
In/outboard
Other
AUTO FIRE EXTINGUISHERS:
--- Select ---
Yes
No
VESSEL USAGE AND LOCATION
PRIVATE PLEASURE
PART TIME CHARTER
FULL TIME CHARTER
IF CHARTER- MAX. NUMBER PAYING PASSENGERS/GUESTS:
WHERE IS THE VESSEL MOORED?
NAVIGATION LIMITS
Waters navigated next twelve months:
If vessel is south of North Carolina June through November, where navigated and berthed?
Is vessel ever laid-up?
Yes
No
What months is she out of commission?
--- Select ---
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
to
--- Select ---
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
If laid up, is vessel stored:
--- Select ---
Ashore
In Water
Will anyone be living aboard the vessel during the policy period?
Yes
No
PRESENT AND PAST INSURANCE INFORMATION
PRESENT INSURANCE CO.:
EXPIRATION DATE OF POLICY:
CURRENT PREMIUM:
OWNED BOATS SINCE:
Have you had any yacht insurance claims in the past 10 years?
Yes
No
Please enter the year, amount, and a brief outline of the loss/claim.
COVERAGES REQUESTED
Hull and equipment value:$
Tender/Dinghy $
Year
Trailer............ $
Year
Survey Available:
--- Select ---
No
Yes
Survey Date
Survey conducted:
--- Select ---
Afloat
Ashore
LIABILITY COVERAGE (Protection and indemnity)
--- Select ---
$100,000
$300,000
$500,000
$1,000,000
Other
Paid Crew
--- Select ---
Yes
No
Number of Paid Crew:
Comments