Quote Portal FormAre You An Insurance Producer Working At or With Casey Insurance?(Required) Yes NoPlease 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)MarriedSingleDivorcedDate of Birth(Required) MM slash DD slash YYYY Driver's License NumberFormat: Please write your drivers license number first, followed by the state.Do You Have Any of the Following Mariner's Credentials?(Required)None100 Ton MasterASA Course(s) Completion6-pack licenseSailing EndorsementHow many years of boating experience do you have?(Required)Previous Vessels OwnedInclude make, model, age and number of years owned for.Are You The Owner of the Vessel?(Required) Yes NoOwner of the Vessel:(Required)Are You the Sole Operator of the Vessel?(Required) Yes NoPlease 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)SailMotorCatamaranOtherConstruction Material of Vessel(Required)FiberglassAluminum/SteelFerro-CementAluminum/SteelOtherDate Purchased(Required) MM slash DD slash YYYY Price Paid (Include Currency)(Required)Date of Last Survey MM slash DD slash YYYY Name of SurveyorManufacturer of Engine(Required)Engine Model(Required)Engine Year Built(Required)How many engines does your vessel have?(Required)Engine Horsepower (per engine)(Required)Engine Serial NumberType of Fuel Used(Required) Diesel Gasoline ElectricMax Designed Speed (Knots)(Required)Manufacturer of TenderTender ModelDoes Your Tender Display Parent Vessels Name? Yes NoTender Engine ManufacturerTender Engine Year BuiltTender Engine ModelTender Motor HPWhat Type of Fuel Does Your Tender Use? Gasoline Diesel ElectricDoes Your Vessel Have Any of the Following Safety Equipment?(Required) Automatic Fire Extinguisher Smoke Detector Radar GPS Depth Finder Auto Pilot Engine Alarm VHF Radio Theft Alarm Tracking Device Surveillance System Locked/Fenced Enclosure Secured Building Yacht Controller CO Detector None of the aboveNumber of Handheld Fire Extinguishers on Board(Required)Location of Automatic Fire ExtinguisherEngine RoomTank SpaceGalleyOtherIs there a propane tank on board the vessel?(Required) Yes NoIs the propane tank kept in a self-draining cockpit locker?(Required) Yes NoIn 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)Dock SlipDry DockOn the HardWhat is the current value of your vessel?(Required)Do you have a tender you'd like to insure?(Required) Yes NoValue of Tender and Outboard(Required)Would you like to insure a trailer?(Required) Yes NoTrailer Value:(Required)Are you interested in personal effects coverage?(Required) Yes NoPersonal 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)$100,000$300,000$500,000$750,000$1,000,000More than $1,000,000Are you interested in uninsured boater coverage?(Required) Yes NoUninsured 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 $500,000Are you interested in medical payments coverage?(Required) Yes NoMedical 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 $25,000Do you require captain and crew liability coverage?(Required) Yes NoCaptain 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) $100,000 $300,000 $500,000 $750,000 $1,000,000Do You Require Passenger Liability Coverage?(Required) Yes NoPassenger 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 $1,000,000Do You Want a Fully Comprehensive Policy?(Required) Yes NoA 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 NoWhat commercial activities are conducted on your vessel?(Required) Bareboat Charter Captained Charter Commercial Fishing OtherWhat 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 NoCovers passengers only while swimming/snorkeling with a buoyancy aid.Do You Require Salvage and Wreck Removal Coverage?(Required) Yes NoSalvage 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 NoAgreed 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 NoWill You Be Cruising Your Vessel Anytime From Sunset to Sunrise?(Required) Yes NoWill You Ever Be Cruising Your Vessel Solo?(Required) Yes NoDo You Require Hurricane Coverage?(Required) Yes NoHurricane 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 NoHave you ever had insurance on any vessel declined or special terms imposed?(Required) Yes NoPlease elaborate(Required)Have you had any accidents or losses in respect of any vessel?(Required) Yes NoPlease provide detailed loss information:(Required)Have you ever been charged with or convicted of a felony or DUI?(Required) Yes NoPlease provide details of the offense(Required)Is this vessel the subject of any mortgage or financial agreement?(Required) Yes NoPlease provide details of your lender(Required)Are you the sole owner of this vessel?(Required) Yes NoOther Owners:(Required)Do You Have Any Disabilities or Illnesses that may affect your ability to operate your vessel?(Required) Yes NoPlease 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 ContinueNameThis field is for validation purposes and should be left unchanged.