Marine Commercial Liability
Supplementary Information For Vessel Construction
Mailing Address Line 1:
Mailing Address Line 2:
If accepted by the Company, coverage is desired beginning
Location of yard(s):
Type of vessels built and Materials used.
Number of Deck Barges built Annually
Number of Crane Barges built Annually
Number of Tank Barges built Annually
Number of Hopper Barges built Annually
Number of Towboats built Annually
Number of Crewboats built Annually
Number of Supply built Annually
Number of Fishing Vessels built Annually
Number of Private/Pleasure (Type) built Annually
Number of Other built Annually
Describe method of launch:
Describe extent of trials (hours of trial operation, number of crew, usual number of others aboard):
Describe delivery trips (distance, number of crew, others aboard, tower or land conveyance):
Maximum contract values at any one yard location
IF APPLICATION IS FOR COVERAGE ON ONE SPECIFIC VESSEL, complete this item:
(a) Type of vessel
(c) Hull Materials
(d) Completed Contract Price
(e) Period of Construction: From to
(f) See item 1 above construction site (check)
Describe extent of trials:
Delivery description and location:
Public fire department
Distance to nearest fire department
Public fire hydrants: How many?
Public fire hydrants: How far distant?
Public fire mains: Size? Pressure?
Private fire protection (describe):
Building fire protection (describe):
How many watchmen employed?
How many watchmen on each shift?
Is yard fenced?
Is guard at gate when operating?
Describe applicant's experience as builder:
Applicant's gross receipts for past 5 years derived from vessel construction
Percentage of repair work sub-contracted
If so, provide details and copies of contracts:
Current insurance carrier:
Current premiums (i.e. Minimum & Deposit and adjustment rate):
Limit of liability and deductible requested:
If so, provide details:
If so, provide details:
Contact and phone number to arrange an inspection:
LOSS EXPERIENCE (past 5 years) including any insured losses. Show all losses gross (before application of deductible, if any):
If yes, with whom
Current line of credit $
REMARKS (Please use this space to comment upon facts not brought out in answering application items above - i.e. Emergency procedure, Loss Control, OSHA compliance, plans for expansion or upgrading of facilities, etc.)