Move Boat Application:

• Name of Company / Organization
• Entity Type                                 
• Street Address                            
• City                                            
• State                                  Zip
• Contact Person                          
• Phone                                        
• Fax                                          
• Email                                         
  
  
  

Is coverage required outside of the U.S. and Canada?	Yes	No
Does the following apply to any vessels used in the production?	Yes	No
Vessel used within 50 miles of attachment?	Yes	No
Vessel used out of water?	Yes	No
Other vessels to be towed?	Yes	No
Is there water-skiing?	Yes	No
Are there any stunts?	Yes	No
Any prior production losses of any kind?	Yes	No

• Type of Production
  
  
  
• Title of Production
  
  
  
• Budget (Gross Production Costs)
  
  
  
• Brief Description / Synopsis of Shoot
  
  
  
• Cities and States of Shooting Locations
  
  
  
• Coverage Dates of the Production
  
  
  

• Vessel #1 Details
• Name Registration #
• Year Length Market Value
• Type Builder
  
  
  
• Vessel Use
• Dates of Use
                 

  Use	# Vessel Crew	# Production Crew	# Days
  Operating
  Dockside

• Place of Attachment
• Locations Used
• Navigation Area to be Used
  
  
  
• Vessel Owner
• Name of Company / Organization
• Street Address
• City, State, Zip
• Contact Person
• Phone Fax
  
  
• Owner Named as: Additional Insured Loss Payee
  
  
  

• Vessel #2 Details
• Name Registration #
• Year Length Market Value
• Type Builder
  
  
  
• Vessel Use
• Dates of Use
  
                 

  Use	# Vessel Crew	# Production Crew	# Days
  Operating
  Dockside

  
  

• Place of Attachment
• Locations Used
• Navigation Area to be Used
  
  
  
• Vessel Owner
• Name of Company / Organization
• Street Address
• City, State, Zip
• Contact Person
• Phone Fax
  
  
• Owner Named as: Additional Insured Loss Payee
  
  
  

• Vessel #3 Details
• Name Registration #
• Year Length Market Value
• Type Builder
  
  
  
• Vessel Use
• Dates of Use
  
  
                 

  Use	# Vessel Crew	# Production Crew	# Days
  Operating
  Dockside

  
  

• Place of Attachment
• Locations Used
• Navigation Area to be Used
  
  
  
• Vessel Owner
• Name of Company / Organization
• Street Address
• City, State, Zip
• Contact Person
• Phone Fax
  
  
• Owner Named as: Additional Insured Loss Payee
  
  
  

• Vessel #4 Details
• Name Registration #
• Year Length Market Value
• Type Builder
  
  
  
• Vessel Use
• Dates of Use
  
  
                 

  Use	# Vessel Crew	# Production Crew	# Days
  Operating
  Dockside

  
  

• Place of Attachment
• Locations Used
• Navigation Area to be Used
  
  
  
• Vessel Owner
• Name of Company / Organization
• Street Address
• City, State, Zip
• Contact Person
• Phone Fax
  
  
• Owner Named as: Additional Insured Loss Payee
  
  
  ** If you have more than 4 vessels please contact our office 800-728-0988

Hull and Machinery	Yes	No
Protection and Indemnity	$1,000,000	$10,000,000
Wharfinger's Liability	$1,000,000	$10,000,000
Towers Liability	$1,000,000	$10,000,000
Charter's Liability	$1,000,000	$10,000,000