Yacht Club 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

Agent info
Applicant info
Quick summary of services provided
Docking
$
Mooring & Anchoring
$
Fueling
gallons
Hauling and Launching (for non-members, typically associated with regattas)
Rental Boats
$
Moll Coverage Limits
Boat Storage Ashore
$
Protection & Indemnity (Watercraft Liability)
Piers, Wharves & Docks Coverage

Attach a diagram, indicating distances between where there is more than one pier, and include a photo (preferably aerial) of site. Show on diagram proximity of surrounding shorelines. Also provide a listing of docks indicating ages, slip sizes, construction type, value of each and whether covered or not. Be sure to note the location of the fuel dock if applicable.

MPH
ft

If Wt of Ice & snow is desired, it can only be bound after receipt and acceptance by underwriting of inspection by accredited dock inspection firm. Minimum deductible $25,000.

$
Commercial Tools & Equipment Coverage
Coverage
$
$ (recommend receipts or photos kept on file)
$
Security & Maintenance
Owned Watercraft
*Indicate whether Work, Rental, Safety or Committee Boat
Restaurant & Liquor Coverage
$ (include daily & regatta sales)
$ (include OTC, served and special event)

Coverage is also available for Buildings, Business Contents, Business Automobile, Comprehensive General Liability, Work Comp, Boiler & Machinery, Crime, Business Interruption.

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, INFORMATION CONCERNING ANY FACT MATERIAL THERETO, COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME.