Form Application for Vessel Construction

Marine Commercial Liability
Supplementary Information For Vessel Construction

Applicant's Name:

Mailing Address Line 1:

Mailing Address Line 2:

If accepted by the Company, coverage is desired beginning

Location of yard(s):

  • Location (a):
  • Location (b):
  • Location (c):
  • Location (d):

Type of vessels built and Materials used.

Deck Barges:

Number of Deck Barges built Annually

Crane Barges:

Number of Crane Barges built Annually

Tank Barges:

Number of Tank Barges built Annually

Hopper Barges:

Number of Hopper Barges built Annually

Towboats:

Number of Towboats built Annually

Crewboats:

Number of Crewboats built Annually

Supply Boats:

Number of Supply built Annually

Fishing Vessels:

Number of Fishing Vessels built Annually

Private/Pleasure (Type):

Number of Private/Pleasure (Type) built Annually

Other:

Number of Other built Annually

Describe method of launch:

Describe extent of trials (hours of trial operation, number of crew, usual number of others aboard):

Describe delivery trips (distance, number of crew, others aboard, tower or land conveyance):

Usual Construction Period (months) Average Contract Value Maximum Contract Value
Deck Barges
Crane Barges
Tank Barges
Hopper Barges
Towboats
Crewboats
Supply Boats
Fishing Vessels
Private/Pleasure
Other

Maximum contract values at any one yard location



IF APPLICATION IS FOR COVERAGE ON ONE SPECIFIC VESSEL, complete this item:

(a) Type of vessel

(b) Dimensions

(c) Hull Materials

(d) Completed Contract Price

(e) Period of Construction: From to

(f) See item 1 above construction site (check)

Describe extent of trials:

Delivery description and location:



Fire Protection:

Public fire department

Distance to nearest fire department

Public fire hydrants: How many?

Public fire hydrants: How far distant?

Public fire mains: Size? Pressure?

Private fire protection (describe):

Building fire protection (describe):



Watchmen:

How many watchmen employed?

How many watchmen on each shift?

Watchclocks?

Is yard fenced?

Is guard at gate when operating?

Describe applicant's experience as builder:



Applicant's gross receipts for past 5 years derived from vessel construction

Amount Year

Percentage of repair work sub-contracted

What limits?

If so, provide details and copies of contracts:

Current insurance carrier:

Current premiums (i.e. Minimum & Deposit and adjustment rate):

Limit of liability and deductible requested:

If so, provide details:

If so, provide details:

What limits?

Contact and phone number to arrange an inspection:



LOSS EXPERIENCE (past 5 years) including any insured losses. Show all losses gross (before application of deductible, if any):

Date of Loss Description Amount (Gross)

If yes, with whom

Current line of credit $



REMARKS (Please use this space to comment upon facts not brought out in answering application items above - i.e. Emergency procedure, Loss Control, OSHA compliance, plans for expansion or upgrading of facilities, etc.)