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Brokers Marine Trades Quote Request
Please complete this form if you would like to obtain a quote for Marine Trades Public and Products Liability. This form is not a proposal form and is not binding in any way.
Brokerage
*
Contact name
*
Email
*
Phone
*
Insured name
*
Insured business address
*
Street Address
City
State
Postcode
Business or Occupation
*
Date insurance required
*
Day
Month
Year
The Business
Gross income from business in the last 12 months
Estimated gross income for the next 12 months
Are subcontractors engaged?
YES
NO
Amount of gross income paid to subcontractors
Number of qualified tradesmen employed in the business
What percentage of income is derived from non-marine work?
What services are provided?
Vessel repairs
YES
NO
If YES, what percentage of income is derived from this service?
Fit outs and refurbs
YES
NO
If YES, what percentage of income is derived from this service?
Painting and anti-fouling
YES
NO
If YES, what percentage of income is derived from this service?
Rigging
YES
NO
If YES, what percentage of income is derived from this service?
Detailing/cleaning
YES
NO
If YES, what percentage of income is derived from this service?
Water blasting
YES
NO
If YES, what percentage of income is derived from this service?
New builds
YES
NO
If YES, what percentage of income is derived from this service?
Hauling and/or lifting, operator of lifting/carrying equipment
YES
NO
If YES, what percentage of income is derived from this service?
Slipping (slipway/dry dock)
YES
NO
If YES, what percentage of income is derived from this service?
Launching and sea trials
YES
NO
If YES, what percentage of income is derived from this service?
Fuelling
YES
NO
If YES, what percentage of income is derived from this service?
Premises Occupier (Tenant / Owner)
YES
NO
If YES, what percentage of income is derived from this service?
Car park operator
YES
NO
If YES, what percentage of income is derived from this service?
Other
YES
NO
If YES, please provide details of service. What percentage of income is derived from this service?
Is cover required for any of the following services?
Hot work
YES
NO
Storage
YES
NO
Provision of utilities
YES
NO
Chandlery provider
YES
NO
Landlord
YES
NO
Boat brokerage
YES
NO
Is work done on commercial vessels?
YES
NO
If YES, what percentage of work is on commercial vessels?
What products are sold?
Are standard business terms and conditions used?
YES
NO
Are there any other contractual agreements in place?
YES
NO
Insurance
Limit of Liability - Public Liability
Limit of Liability - Products Liability
Current Insurer
When does your current policy expire?
Full details of losses or claims over the last 5 years
Loss 1
Description
Date of Loss
Amount Paid
Insurer
Loss 2
Description
Date of Loss
Amount Paid
Insurer
Loss 3
Description
Date of Loss
Amount Paid
Insurer
Loss 4
Description
Date of Loss
Amount Paid
Insurer
Has an insurer at any time:
Declined the insured's proposal for insurance?
YES
NO
If YES, please provide details
Cancelled or refused to renew the insured's policy?
YES
NO
If YES, please provide details
Imposed special conditions/rates as a result of the insured's policy history?
YES
NO
If YES, please provide details
Thank you for taking the time to complete this form. You will be contacted by a broker before the close of business today.
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Products
Blue Water Cruising
Builders’ Risks
Cargo & Transit
Commercial Vessels
Commercial Divers
Dive Insurance
Dive Operators & Dive Schools
Dive Professionals
Marina Operators’ Liabilities
Marine Trades Liability
Private Pleasurecraft
Protection & Indemnity
Personal Leisure Travel Insurance
About
About Us
Steadfast
Form Library
News
Legal disclosures
Contact