Marine Artisan Application

Please fill out the form below and hit the submit at the bottom of the page.

To download a printable version of the application, click here

Applicant Information
Coverages
Loss Information
Policy Limits and Deductibles Requested

Bumbershoot Required Underlying Limits: General Liability: $1,000,000/2,000,000 MOLL: $1,000,000 Commercial Auto: $1,000,000 Protection & Indemnity: $1,000,000 Employers Liability $500/500/500,000
If Bumbershoot is excess of Automobile and Employers Liability please provide underlying schedule.

Mobile Equipment
$
Unscheduled Tools & Equipment
$
$
$
Workboats
$ (minimum $500)
5. Lay-Up

ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR OTHER PERSON FILES AN APPLICATION FOR INSURANCE CONTAINING ANY FALSE INFORMATION, OR CONCEALS FOR THE PURPOSE OF MISLEADING, ANY INFORMATION CONCERNING ANY FACT MATERIAL THERETO, COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME.