Online Quote Portal – Casey insurance

Quote Portal Form

Are You An Insurance Producer Working At or With Casey Insurance?(Required)

Yes

Please enter your work email(Required)

Name(Required)

First Last

Phone(Required)

Email(Required)

Enter Email Confirm Email

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Marital Status(Required)

Date of Birth(Required)

Driver's License Number

Format: Please write your drivers license number first, followed by the state.

Do You Have Any of the Following Mariner's Credentials?(Required)

How many years of boating experience do you have?(Required)

Previous Vessels Owned

Include make, model, age and number of years owned for.

Are You The Owner of the Vessel?(Required)

Yes

Owner of the Vessel:(Required)

Are You the Sole Operator of the Vessel?(Required)

Yes

Please list all other operators.(Required)

Name of the Vessel(Required)

Country of Registration/Flag(Required)

Year Built(Required)

Length of the Vessel(Required)

Vessel Manufacturer(Required)

Vessel Model(Required)

Vessel Class(Required)

Construction Material of Vessel(Required)

Date Purchased(Required)

Price Paid (Include Currency)(Required)

Date of Last Survey

Name of Surveyor

Manufacturer of Engine(Required)

Engine Model(Required)

Engine Year Built(Required)

Engine Horsepower (per engine)(Required)

Engine Serial Number

Number of Engines(Required)

Type of Fuel Used(Required)

Diesel

Gasoline

Electric

Max Designed Speed (Knots)(Required)

Manufacturer of Tender

Tender Model

Does Your Tender Display Parent Vessels Name?

Yes

Tender Engine Manufacturer

Tender Engine Year Built

Tender Engine Model

Tender Motor HP

What Type of Fuel Does Your Tender Use?

Gasoline

Diesel

Electric

Does Your Vessel Have Any of the Following Safety Equipment?(Required)

Number of Handheld Fire Extinguishers on Board(Required)

Location of Automatic Fire Extinguisher

Is there a propane tank on board the vessel?(Required)

Yes

Is the propane tank kept in a self-draining cockpit locker?(Required)

Yes

In what waters will you be cruising your vessel in the next 12 months?(Required)

Name of Primary Mooring Location(Required)

Type of Mooring Used(Required)

What is the current value of your vessel?(Required)

Do you have a tender you'd like to insure?(Required)

Yes

Value of Tender and Outboard(Required)

Would you like to insure a trailer?(Required)

Yes

Trailer Value:(Required)

Are you interested in personal effects coverage?(Required)

Yes

Personal effects coverage in marine insurance protects the personal belongings of crew, passengers, or vessel owners—such as clothing, electronics, and luggage—against loss or damage from marine-related risks like storms, fire, or theft. It typically excludes cash, professional tools, and has limits and conditions defined by the policy.

What is the value of the items you'd like to insure?(Required)

How Much Third-Party Liability Coverage Do You Require?(Required)

Are you interested in uninsured boater coverage?(Required)

Yes

Uninsured boater coverage in marine insurance protects you if you're injured or your boat is damaged in an accident caused by another boater who has no insurance or insufficient coverage.

Please select an amount of uninsured boater coverage(Required)

$100,000

$250,000

$500,000

Are you interested in medical payments coverage?(Required)

Yes

Medical payment coverage in marine insurance provides reimbursement for medical expenses incurred by the crew, passengers, or other individuals injured due to accidents on a vessel, regardless of who is at fault. It typically covers costs such as hospital bills, surgery, and ambulance services.

How much medical payments coverage do you require?(Required)

$5,000

$10,000

$15,000

$25,000

Do you require captain and crew liability coverage?(Required)

Yes

Captain and crew liability coverage in marine insurance protects the vessel owner or operator against legal claims arising from injuries, illnesses, or deaths of the captain or crew while working on the vessel. It typically covers legal defense costs, settlements, and related liabilities.

How Much Captain and Crew Liability Coverage Do You Require?(Required)

Do You Require Passenger Liability Coverage?(Required)

Yes

Passenger liability coverage in marine insurance protects the vessel owner or operator against legal claims from passengers who are injured or suffer losses while onboard. It covers medical expenses, legal defense, and potential settlements or judgments.

How Much Passenger Liability Coverage Do You Require(Required)

$100,000

$250,000

$500,000

$1,000,000

Do You Want a Fully Comprehensive Policy?(Required)

Yes

A fully comprehensive marine insurance policy provides the broadest level of coverage, protecting against both damage to your own vessel (from accidents, theft, fire, vandalism, etc.) and liability for damage or injury caused to others. It typically includes hull coverage, third-party liability, and any other specifically requested types of insurance shown on this application.

Is Your Vessel Used for Any Commercial Purposes?(Required)

Yes

What commercial activities are conducted on your vessel?(Required)

Bareboat Charter

Captained Charter

Commercial Fishing

Other

What is the Maximum Number of Passengers Your Vessel Is Legally Able to Carry?(Required)

Will there be any in-water activities during charters?(Required)

Yes

Covers passengers only while swimming/snorkeling with a buoyancy aid.

Do You Require Salvage and Wreck Removal Coverage?(Required)

Yes

Salvage and wreck removal coverage in marine insurance pays for the costs of recovering a damaged or sunken vessel and removing it if it's a hazard to navigation or the environment. Salvage covers efforts to save the vessel and its cargo, while wreck removal involves legally required cleanup after a total loss.

Do You Require Agreed Value Coverage?(Required)

Yes

Agreed value coverage in marine insurance pays the full insured amount (agreed upon at policy start) in case of a total loss, with no depreciation deducted.

Will You Be Living On Your Vessel for Longer Than 30 Days At a Time?(Required)

Yes

Will You Be Cruising Your Vessel Anytime From Sunset to Sunrise?(Required)

Yes

Will You Ever Be Cruising Your Vessel Solo?(Required)

Yes

Do You Require Hurricane Coverage?(Required)

Yes

Hurricane coverage for boats in Florida provides insurance for damage or loss caused by named storms, typically including protection for hull damage, salvage costs, wreck removal, and personal property aboard. Common warranties include a requirement to haul out or move the boat to a hurricane-safe location when a named storm is approaching, maintenance of the vessel in seaworthy condition, and compliance with manufacturer-recommended storm preparation measures. Failure to meet these conditions may void coverage.

Will the vessel ever be left unattended away from the primary mooring location for more than 8 hours?(Required)

Yes

Have you ever had insurance on any vessel declined or special terms imposed?(Required)

Yes

Please elaborate(Required)

Have you had any accidents or losses in respect of any vessel?(Required)

Yes

Please provide detailed loss information:(Required)

Have you ever been charged with or convicted of a felony or DUI?(Required)

Yes

Please provide details of the offense(Required)

Is this vessel the subject of any mortgage or financial agreement?(Required)

Yes

Please provide details of your lender(Required)

Are you the sole owner of this vessel?(Required)

Yes

Other Owners:(Required)

Do You Have Any Disabilities or Illnesses that may affect your ability to operate your vessel?(Required)

Yes

Please specify(Required)

I hereby declare that all information provided in this proposal form is true and accurate to the best of my knowledge at the time of submission. I understand that I am obligated to inform the Insurer of any material changes that occur during the policy period, and that failure to do so may result in the invalidation of this insurance contract. I further declare that if any part of this form was completed by another individual, they acted as my agent for this purpose. Submission of this proposal does not bind the Proposer to complete the insurance, and the Insurer reserves the right to accept or decline any proposal at its sole discretion. The Proposer should retain a copy of all information supplied to the Insurer in relation to this application, and a copy of the completed proposal will be provided upon request within three months of submission. This insurance contract may be placed with an Insurer located and registered outside your country of residence and/or outside the agreed geographical area of operation or use. As such, the Insurer may not be authorised or regulated under local law, and you may not be entitled to the benefit of local policyholder protection schemes or data protection legislation. By submitting this form electronically, you acknowledge that this declaration constitutes your legal agreement to the terms herein and is valid as an original signature under applicable electronic transaction laws.(Required)

I Understand and Agree To Continue

Name

This field is for validation purposes and should be left unchanged.

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