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The Community Boating & Sailing School Program – Application
Home
Forms & Applications
The Community Boating & Sailing School Program – Application
Sailing School
Step
1
of
13
7%
GENERAL INFORMATION
Legal Name of Company/Organization
Name
*
First
Last
Mailing Address
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Phone
Fax
Email
Website
PHYSICAL LOCATIONS
Location A
Location B
Location C
Current Insurance Carrier
Expiration Date
Month
Day
Year
Current Premium
Has any carrier cancelled or refused you insurance?
Yes
No
Why were you cancelled or refused?
What category best describes your program?
Private Nonprofit
Commercial (for profit)
Municipal/County/State
College/University
Brochures or Literature?
Please send brochures or literature describing your program and copies of all release forms
Accepted file types: doc, docx, pdf, jpg, Max. file size: 50 MB.
I. INSTRUCTOR INFORMATION
What is the maximum number of instructors on duty?
Please enter a number greater than or equal to
0
.
Are Life Jackets worn at all times for all persons?
It is a condition of this insurance that a Certified Sailing Instructor be on duty.
Yes
No
II. VESSEL LIABILITY
Number of Vessels < 16'
Please enter a number greater than or equal to
0
.
Number of Vessels 16’ to 25'
Please enter a number greater than or equal to
0
.
Number of Vessels > 25’
Please enter a number greater than or equal to
0
.
III. RACING LIABILITY
Please indicate if your program offers any of the following:
Racing Instruction
Club Racing - member vs. member
You host or sponsor races which include non-member participants
You permit members to use your boats in outside races
Race instruction as part of the regular curriculum is automatically covered if included in (II) above.
Racing activities in addition to instruction require the Racing Liability endorsement and Option 6 should be selected in the Vessel Information section.
IV. BOAT SCHEDULE
Please provide a complete schedule of vessels. Include respective values if Hull Insurance is desired.
A recent survey is required on vessels $50,000 or greater in value.
Total Number of Vessels
Please enter a number greater than or equal to
0
.
DEDUCTIBLES:
Hull & Machinery: 1% of hull value, but not less than $500, except while Racing, Rented or Chartered is 2% of Hull value, but not less than $1,000
Liability
Bodily Injury: $250 per occurrence Property Damage: $1,000 per occurrence
Boat 1
Year Built
Builder
Registration No.
LOA
HP/Fuel
Value
Please enter a number greater than or equal to
0
.
Boat 2
Year Built
Builder
Registration No.
LOA
HP/Fuel
Value
Please enter a number greater than or equal to
0
.
Boat 3
Year Built
Builder
LOA
Registration No.
HP/Fuel
Value
Please enter a number greater than or equal to
0
.
Boat 4
Year Built
Builder
LOA
Registration No.
HP/Fuel
Value
Please enter a number greater than or equal to
0
.
Boat 5
Year Built
Builder
LOA
Registration No.
HP/Fuel
Value
Please enter a number greater than or equal to
0
.
Boat 6
Year Built
Builder
LOA
Registration No.
HP/Fuel
Value
Please enter a number greater than or equal to
0
.
Boat 7
Year Built
Builder
LOA
Registration No.
HP/Fuel
Value
Please enter a number greater than or equal to
0
.
Boat 8
Year Built
Builder
LOA
Registration No.
HP/Fuel
Value
Please enter a number greater than or equal to
0
.
Boat 9
Year Built
Builder
LOA
Registration No.
HP/Fuel
Value
Please enter a number greater than or equal to
0
.
Boat 10
Year Built
Builder
LOA
Registration No.
HP/Fuel
Value
Please enter a number greater than or equal to
0
.
More than 10 Vessels
For each additional vessel, please provide year built, builder, registration no., loa, HP/fuel and value.
V. RENTAL & CHARTERING
Gross Receipts from Boat Rental and Chartering
Please include Membership Dues if they entitle members to open use of boats.
Please enter a number greater than or equal to
0
.
Are members/Instructors entitled to open ended use of boats?
Yes
No
Any overnight Rental/Chartering?
Yes
No
**Please
download, sign and return the Boat Rental Endorsement
**
Boat Rental Endorsement PDF
Waiver & Release of Liability Form
INSURANCE UNDER THIS SECTION REQUIRES THAT YOU HAVE EACH CUSTOMER SIGN A WAIVER AND RELEASE OF LIABILITY FORM, PLEASE UPLOAD A COPY OF YOUR FORM.
Accepted file types: pdf, docx, doc, jpg, Max. file size: 50 MB.
Are you Interested in Auto Liability for Hired & Non-Owned Vehicles?
Yes
No
VII. EXCESS LIABILITY INSURANCE
If you believe your school needs more than $1,000,000 limit per occurrence for the Liability coverages you selected above, we can provide additional limits in increments of $1,000,000.
Excess Liability Insurance?
Available in $1,000,000 Increments
Yes
No
Total Excess Liability
Please enter a number greater than or equal to
2000000
.
NAVIGATING LIMITS
The basic policy provides a Navigation Warranty/Limit of 100-miles from your homeport not to exceed 50 miles offshore. If you require coverage beyond the 100-mile limit, please provide specific description including navigating territory, nature of voyages (advanced cruising class, charter, etc.), frequency, and how participants’ competency is determined.
Request for Navigating Limits beyond the standard 100-mile limit
UNDERWRITING SECTION
Number of Instructors
Maximum on Duty at any one time
Please enter a number greater than or equal to
0
.
Are your Instructors currently certified?
Yes
No
Who certified your instructors?
Number of Vessels < 16'
Please enter a number greater than or equal to
0
.
Number of Vessels 16' to 25'
Please enter a number greater than or equal to
0
.
Number of Vessels > 25'
Please enter a number greater than or equal to
0
.
Racing Liability?
Yes
No
Total Hull Values
Please enter a number greater than or equal to
0
.
Annual Gross Receipts
Please enter a number greater than or equal to
0
.
Do you have a Severe Storm Plan?
Yes
No
Please Attach Severe Storm Plan
Accepted file types: doc, docx, pdf, jpg, Max. file size: 50 MB.
Boat Rental & Chartering Receipts
Please enter a number greater than or equal to
0
.
Are Members/Instructors entitled to open-ended use of boats?
Yes
No
Any overnight Rental/Chartering?
Yes
No
Attach Specific Information
Accepted file types: doc, docx, pdf, jpg, Max. file size: 50 MB.
Maximum number of Capt/Crew on board
Please enter a number greater than or equal to
0
.
Marina's Operators Legal Liability Receipts
Please enter a number greater than or equal to
0
.
Hired & Non-Owned Auto Liability?
Yes
No
Number of employees
Please enter a number greater than or equal to
0
.
Number of volunteers
Please enter a number greater than or equal to
0
.
Annual Expenditure for Hired Auto?
Please enter a number greater than or equal to
0
.
Extended Navigation?
Yes
No
Attach Specific Information for Extended Navigation
Accepted file types: doc, docx, pdf, jpg, Max. file size: 50 MB.
Maximum number of students on water at one time
Please enter a number greater than or equal to
0
.
Are Life Jackets worn at all times for all persons during instruction & training?
Yes
No
Do you charter/borrow boats from a 3rd party that are not currently listed on your hull schedule?
Yes
No
Total Excess Liability Requested
Available in $1,000,000 Increments
Please remit this signed Application, Boat Rental Endorsement and copy of your Waiver and Release of Liability Form. You will be billed directly by Travelers. The invoice will include an installment payment option for your convenience.
LOSS INFORMATION
Please attach recently valued Five (5) Year Loss Runs available through your current agent
Attached Loss Runs
Accepted file types: doc, docx, pdf, jpg, Max. file size: 50 MB.
OPERATIONS INFORMATION
Please describe any Operations other than Sailing School:
APPLICANT’S STATEMENT
I have read the above and I declare that to the best of my knowledge and belief, all of the foregoing statements are true; and that these statements are offered as an inducement to the Company to issue the Policy for which I am applying. (Kansas: This does not constitute a warranty). The completion and signing of this application does not bind the Applicant or this Company to effect Insurance on this risk. This application is submitted for purposes of rating and quotation only, if acceptable by this company, it is agreed the information furnished here shall be the basis of the contract shall a Policy be issued.
Full Name
Acts as your signature.
Date
Month
Day
Year
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