1202 Grant Ave, Ste E
Novato, CA 94945
(415) 895-1926 Phone
(415) 895-1928 Fax
CA Lic# 0738595
AZ Lic# 1036273
Boat Quote
Depending on your type of policy, some quotes may require further correspondence from us. No coverage is bound using this form, until confirmed by us. This quote form is for Boats only, if you have a personal watercraft or any questions, give us a call or send us an email.
Please complete all fields.

Know Your Boats (PDF) - A useful sheet describing various types of boats.

Contact Information:
*Contact person name: *Your email address:
*Contact phone number:

Confirm Email:
General Information:
Mailing Address:
 Mooring/Storage address (If different than mailing):
Current or prior policy information:
Policy expiration date: Insurance company name:
Policy limits for BI (split): Policy limits for PD:
Or you may have Policy limits for BI & PD Combined as a Single Limit - CSL:
Policy limits for Medical: List any claims in last 3 years:
Vessel description:
Year:
 Make:
 Model:
 Serial #:
 Length:
 Value:
Horsepower:
 Max Speed-MPH:
 Hull Material:
 Hull Design:
 Propulsion:
 Fuel:
Registered Owner:
 Hull Coverage:
 Waters Navigated:
 Vessel used for:
Electronic Aids:
 Auto Bilge Pump		  VHF
 GPS		  Radar
 Auto pilot		  Loran
 Halon		  Depth Sounder
 Fume dectector
Power Description:
Engine #1: Year:
 Make:
 Model:
 Horsepower:
 Value:
Engine #2: Year:
 Make:
 Model:
 Horsepower:
 Value:
Trailer Description:
Year:
 Make:
 Model:
 Serial #:
 # of axels:
 Value:
Driver #1:
Driver Name:
 Date of birth:
 Gender:
 Marital:
 Drivers Lic#:
 State:
 Licensed Since:
Any tickets or accidents? If so, please List date & type:
Years experience as owner or operator:
Safety Courses Completed:
Driver #2:
Driver Name:
 Date of birth:
 Gender:
 Marital:
 Drivers Lic#:
 State:
 Licensed Since:
Any tickets or accidents? If so, please List date & type:
Years experience as owner or operator:
Safety Courses Completed:
Additional Comments:
Comments:
    
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