Boat Protection Checklist
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Boat Policy Protection Checklist
Client Name
Insured Property Address
City
State
Zip
Policy Number
Renewal Date of Policy
Email
Home Phone
Work Phone
Cell Phone
Please indicate Yes, No, or Insured meaning you already have the coverage.
Question 1
Have you purchased a motor, trailer, or other accessories for your watercraft that is not currently listed on your policy?
Please Select
Yes
No
Insured
Question 2.
Are any watercraft NOT registered or titled in ONLY you and/or your spouse’s name? If so which watercraft and whose name is on the title?
Please Select
Yes
No
Insured
Watercraft and Name
Question 3.
Has any watercraft been customized or altered?
Please Select
Yes
No
Insured
Question 4.
Where do you use your watercraft?
Please Select
Inland_Waters
Ocean
Great_Lakes
Question 5.
Do you own any SEADOOS?
Please Select
Yes
No
Insured
Question 6.
Do you rent, charter or use your watercraft in any way for hire?
Please Select
Yes
No
Insured
Details
Question 7.
Do you use your watercraft to fish competitively?
Please Select
Yes
No
Insured
Details
Question 8.
Do you participate in any racing events with your watercraft?
Please Select
Yes
No
Insured
Question 9.
Do you have any of the following permanently attached to your boat?
Please Select
Yes
No
Insured
Depth Finder?
Sonar?
Radar?
Ship-to-Shore Radio?
Navigational System?
Burglar Alarm?
Fume Detector?
Built-in Fire Extinguishing System?
Diesel Engine?
Navigation Courses (taken in last 3 years)?
Classes
Question 10.
Your policy includes Emergency Service up to $250 per occurrence for reasonable expenses incurred resulting from emergency service to the boat, outboard motor(s), or boat trailer. Would you like to increase that amount for an additional premium?
Please Select
Yes
No
Insured
Question 11.
Your policy includes Boating Equipment & Accessories with a $500 maximum amount payable for loss to boating equipment and accessories. Would you like to increase that amount for an additional premium?
Please Select
Yes
No
Insured
Question 12.
Your policy includes Personal Effects up to $500 coverage for your clothing, fishing and diving equipment (except water skis and tow ropes), other sporting equipment, portable televisions and radios, cameras while in or upon a boat we insure. Personal effects does not include money, bullion, accounts, bills, checks, travelers checks, passports, credit cards; silverware and goldware; jewelry, watches, furs; valuable papers and records; computer hardware/software; property covered under Boating Equipment and Accessories. Would you like to increase that amount for an additional premium?
Please Select
Yes
No
Insured
Question 13.
Would you like to have your premium spread over 12 months and drafted from your checking account in order to have NO SERVICE FEES?
Please Select
Yes
No
Insured
Question 14.
Would you like a FREE No Obligation Review of your families Life Insurance Needs?
Please Select
Yes
No
Insured
The name of the person that completed this form and the date. By typing your name and date below you are electronically signing this document acknowledging that all the information is true.
Name
Date
Do you have any additional comments?
Message
Thank you for completing this form. It is a very important part of your insurance protection. Your form will be reviewed to ensure we have all the information you indicated. If you have requested additional information we will contact you. If you would like to speak with a member of the O’Connor Insurance Team please check below.
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