Marine Commercial Liability
Supplementary Information For Vessel Construction
Applicant's Name:
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.
Deck Barges:
Number of Deck Barges built Annually
Crane Barges:
Number of Crane Barges built Annually
Tank Barges:
Number of Tank Barges built Annually
Hopper Barges:
Number of Hopper Barges built Annually
Towboats:
Number of Towboats built Annually
Crewboats:
Number of Crewboats built Annually
Supply Boats:
Number of Supply built Annually
Fishing Vessels:
Number of Fishing Vessels built Annually
Private/Pleasure (Type):
Number of Private/Pleasure (Type) built Annually
Other:
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
(b) Dimensions
(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:
Fire Protection:
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):
Watchmen:
How many watchmen employed?
How many watchmen on each shift?
Watchclocks?
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
What limits?
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:
What limits?
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.)