Marina Operations Legal Liability Insurance

Marina Operations Underwriting Request Form
Applicant's Information

Your Name Business Name

Address City State ZIP

Website address Email address Business Phone Number

Cell Phone Number

How would you prefer to be contacted? E-Mail Business Phone Cell Phone

How long in business?

Operate as DBA Corp. Individual

Current Insurer Number of Employees

Limit of Coverage Desired - 300K 500K One Million

Value of Vessels in Control Value per Vessel

Max number of Vessels in Control Current Payroll Gross Receipts

Is any work performed on water? Seasonal or all year business - Seasonal All Year

Description of Operations

Additional Insured Required?
California License# 0207713 • 550 E. Hospitality Lane, Suite 100 • San Bernardino, CA 92408
909-379-6700 or Toll-Free 800-655-2814 • © Sawyer Cook Insurance, 2007. All Rights Reserved.