Boat/Watercraft
Insurance
Quote
 

We would like to provide you with a free, no-obligation boat/watercraft insurance quote. Please complete ALL information so that we may provide you with a quote. This information will be kept confidential and will be used for quote purposes only.

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Disclaimer
I understand that this does not constitute an actual "live" online quote, but is rather a submission of information to Head Insurance Group so that they may put together an insurance proposal (quote) for the above titled risk. There is no obligation on my part to purchase this insurance, and I understand that this online submission does not constitute a statement or contract for insurance.

 I have read and agree with the above disclaimer.
  (Box must be checked before request can be sent)

Personal Information
Name:
Address:
City:   State:   Zip:
Day Phone:   Night Phone:
Best Time To Call:   AM   PM
Email Address:

 
Current Boat/Watercraft Insurance Information
Company Name (not agency):
Policy Expiration Date:   Premium Amount: $
Term: 6 Months 1 Year Other:

 
Coverages
(input only for those desired)
Type
Sums Insured
Type
Sums Insured
Hull- Physical Damage $ Tender / Dinghy $
Liability Coverage $ Crew Liability $
Owner / Operator M&C $ Medical Payments $
Commercial Passenger Liability $ Uninsured Boater $
Trailer $ Personal Property $
Non-Emergency Towing $ Other $

 
Vessel Information
Vessel Name:
Manufacturer/Model:
 
Year
 
Length
Date
Purchased
Purchase
Price
$
Present
Value
$
Max
Speed
mph
 
Registration #
Hull Identification #:
Waters to be navigated:
Tenders or Dinghies:
Storage Address (Street, City, Co., St.):

LAID UP:
From: to
On Shore
Afloat

Stored on Trailer:
Y   N

Will be trailered over 100 miles:
Y   N

 
Equipment
(please select ALL equipment on your Boat/Watercraft)
Bilge Pumps CO2/Halon System Aux Generator, Diesel
EPIRB Fume Detector Aux Generator, Gas
Sonar Fire Extinguishers
Other (list below)
Depth Sounder Cooking Stove
LORAN/ Direction Finder Engine Alarm
GPS Anti-theft Devices
Radar Life Raft
SATNAV/ OMEGA Ship to Shore Radio

 
Miscellaneous
(please check ALL that apply)
Primary Power
Type of Hull
Hull Material
Fuel Tank
Sail Sailboat Wood Metal
Outboard Performance Metal Fiberglass
Inboard Runabout Fiberglass
Inboard/ Outdrive
Other

 
Engine/Outboard Motor Information
(please complete for each engine)
Eng
H.P.
Gas
Diesel
Year
Date
Purchased
Purchase
Price
Present Value
1
$
$
2
$
$
3
$
$
Manufacturer/Model Serial Number
1
2
3

 
Trailer Information
Year
Date Purchased
Purchase Price
$
Present Value
$
Manufacturer/Model:
Serial #:

 
Operators
(always list insured as Operator #1)
 # 
Name
DOB
Auto DL #
State
Social Security #
USCG/Power Squadron
Certificate
1
2
n/a
3
n/a
#
Auto Violations/Suspensions in last 5 years:
Years of Boat Ownership:
1
2
3

 
Boat/Watercraft Usage
 # 
Explain all YES responses in REMARKS Yes/No
 # 
Explain all YES responses in REMARKS Yes/No
1
Is the boat chartered to others with captain? Y
N
6
Is the boat used commercially or for business purposes? Y
N
2
Is the boat chartered to others without
captain?
Y
N
7
Does the applicant employ a paid crew? If so how many? Y
N
3
Is the boat used for racing? Y
N
8
Was any operator involved in a marine loss in the last 10 years (insured or not)? Y
N
4
Is the boat used for water skiing or diving? Y
N
9
Was any coverage declined, cancelled or non-renewed during the last 5 years? Y
N
5
If the boat is used for fare paying passenger charters, what is the average number of passengers
per trip?     Number of trips per year?
REMARKS


Additional Comments
Please give any additional comments you feel appropriate for this quotation. If you have
additional information where there was not enough fields above, such as additional operators, coverages, etc..., please enter them here.


Before Submitting Your Information...
I understand that all of the above information MUST BE COMPLETED in order to obtain an Insurance Quote. Head Insurance Group will be unable to provide me an insurance quote if any fields above are left blank or are partially filled in. PLEASE re-check your information before submitting!

 I have read and agree with the above disclaimer.
  (Box must be checked before request can be sent)

Please click on the "Submit Quote" button to send your quote request.
One of our representatives will respond to your submission as soon as possible.

   


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Cedar Park
201 S. Lakeline Blvd. Ste. # 304
Cedar Park, TX 78613
Phone:
Toll Free:
Fax:
Email:
  512-336-2929
  866-377-2929
  512-336-2930
  info@headinsurancegroup.com

Important Note: This website provides only a simplified description of coverages and is not a statement of contract. Coverage may not apply in all states. For complete details of coverages, conditions, limits and losses not covered, be sure to read the policy, including all endorsements.

 
 
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