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Anglers Advantage
Insurance Program
P.O. Box 795
Shawnee Mission, KS. 66201
Fax: 1-800-777-BOAT (2628)
Anglers Advantage Sportfish/Sportfish
Pro
Quote Form
Applicant Information
Name:
*
Age:
*
State
,
Zip
:
Phone
Email:
*
Operator's Experience
Most recently owned boats
Make
Model
HP
Years Owned
Previously owned boats 2
Make
Model
HP
Years Owned
Previously owned boats 3
Make
Model
HP
Years Owned
Total years boating experience
*
Safety course(s)
*
Total years charter experience
*
Captain's License
*
Yes
No
Other License
Watercraft Information
Year of Vessel
*
Make
*
Model
*
Type
*
Length
*
Year of Engine(s)
*
Make
*
Model
*
Type
*
Engine Fuel Type
Gas
Diesel
Year of Trailer
*
Make
*
Value
*
$
Year of Dinghy
*
Make
*
Model
*
Value
*
$
Year of Motor(s)
*
Make
*
Horsepower
*
Value
*
$
MAXIMUM
SPEED
Power type
IB
I/O
O/B
Sail
Auxiliary
Jet
Purchase price
$
Date
Theft Deterrent Devices?
Boat
Trailer
Prop
Purchase Date
*
Total Purchase Price
*
Intended Use
Navigational Territory
Inland waters
Great Lakes
North Atlantic Coastal
Mid-Atlantic Coastal (
Not
North of Sandyhook, NJ or South of Cape Henry, VA limited to 25 miles offshore)
Washington/Oregon Coastal
California Coastal
Other* (details)
* If Other, please explain
Lay-up dates
to
Mooring State
Mooring Zip
Vessel will be used for
Private Pleasure
Occasional
Commercial Fishing
Minors will operate
* Six-Pack Charter
Business Entertainment
Vessel currently for sale
Bareboat Charter
For Profit/Non-Profit Organization Use
Racing
Sightseeing
Liveaboard/Residence
* If Charter, # of Charters per year
1. Do you use your watercraft for either and/or both?
Sportfishing
Sightseeing
2. Do you
ever
provide and/or serve any alcoholic beverages on board your watercraft to fare-paying passengers?
No
No, but I do allow them to bring their own alcoholic beverages on board
Yes
3. Do you
ever
use your watercraft for skin, scuba, or deep-sea diving?
Yes
No
4. * Do you have any
paid
crew members or a
paid
captain?
Yes
No
* If so, how many
paid
crew (including
paid
captain)?
# of crew members (including
paid
captain)
Additional Optional Coverages/Endorsements Desired
Six-Pack Charter
(# of Charters per year)
Crew Coverage
Without
Captain
Crew Coverage
With
Captain
Terrorism (TRIA) Coverage
Tournament Fee Reimbursement
Sportfish
Plus
Liveaboard Coverage
Sale of Catch (Does the Applicant/Insured sell all or any portion of their catch, or distribute the catch among the crew?
If so, this endorsement is required
!)
"Limited/
Occasional
" Commercial Use: Does the Applicant/Insured engage in any sort of "limited" or
occasional
commercial use? (If so, please indicate approximate number of days below)
0-30 days/year
31-60 days/year
61-90 days/year
91-120 days/year
Over 120 days/year!
Coverage Desired
Hull Value
$
Outboard #1 Value
$
Outboard #2 Value
$
Outboard #3 Value
$
Trailer Value
$
Dinghy w/Outboard Value
$
Personal Effects Value
$
Fishing Rods, Reels, Equipment Value
$
Deductible Desired
1%
2% (
Minimum
on
"Pro"
)
3%
4%
5%
Emergency Service/Towing Desired ($500 included) or:
$750
$1,000
$1,500
$2,000
$2,500
$5,000
$7,500
$10,000
Protection & Indemnity (P&I) Limit Desired:
$50,000
$100,000
$300,000
$500,000
$1,000,000
$1,500,000
$2,000,000
$2,500,000
$3,000,000
Has any operator sustained any auto/boating accidents/losses or boating/driving violations/tickets or DUIs in the last 3 years?
Yes
No
If "YES", please explain