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Michael W. Smith Agency

Revised:

May 06, 2015

Watercraft / Boat

 763-535-7293

 

 

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Watercraft / Boat

 

Information

 

We have great rates for good drivers.

Let me know about any special concerns you have.

 

To receive a quote, please complete the form below.

Watercraft Quote Request Form

This is a request for a Minnesota Watercraft quote, not a policy application. Submitting this form does not obligate you to purchase any boat insurance products. Please complete this form as accurately as possible. Watercraft insurance rates are subject to change.

General Information

Name
Street
City, State ZIP   
E-mail
Phone
FAX

Current Watercraft Insurance Information

Current Insurance Co.
Expiration Date

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Operator Information (please list all Operators)

Driver #1
Name Birthdate Sex Marital Status Years  Experience
Social Security # Drivers License #  

Number of Accidents (Last 5 Years)

Comment on Accidents (Date, Fault, Amount)

Number of Violations (Last 5 Years)

Comment on Violations (Date, Violation Type)

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Driver #2
Name Birthdate Sex Marital Status Years  Experience
Social Security # Drivers License #
Number of Accidents (Last 5 Years) Comment on Accidents (Date, Fault, Amount)
Number of Violations (Last 5 Years) Comment on Violations (Date, Violation Type)

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Percentage of Watercraft Use

Driver 1. Driver 2.

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Watercraft Information

Hull Information

Year Make Model Length
Type Material Maximum Speed Value
Describe Any Accessories/Special Equipment Including Cost When New

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Motor Information

Year Make Type
Horsepower Fuel Type Value

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Risk Evaluation Information

Waters Navigated Storage  Used for Water-skiing Raced Competitively
Yes No Yes No
Heating Cook Stove Chartered Out Hired Captain or Crew
Yes No Yes No Yes No Yes No

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Watercraft Protection

Fire Extinguishers CO2 Chemical System Fume Detectors Anti-Theft Device
Yes No Yes No Yes No Yes No
Ship to Shore Radio Radio Direction Finder Radar Depth Sounder
Yes No Yes No Yes No Yes No

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Trailer Information

Year Make Model Value

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Coverage's

Liability Coverage. Pays for other people's injuries and damage to their property if you or someone else cause an accident while driving your watercraft. It protects your assets in the event you are held liable for damage to others.

Bodily Injury Liability Comment

Property Damage Liability

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Medical Expense Coverage. If you and your passengers are injured in an watercraft accident, this coverage pays your medical expenses.

Medical Expense Comment

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Uninsured and Underinsured Operators Coverage. Pays bodily injury claims if you or your passengers are injured by a negligent uninsured operator, hit-and-run operator or a negligent operator without adequate insurance.

Uninsured/Underinsured Operators
Comment

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Comprehensive Coverage. Pays for damage to your watercraft caused by theft, fire, windstorm, vandalism and many other non-collision occurrences.

Collision Coverage. If your watercraft collides with another watercraft or object, this coverage pays to repair your watercraft.

  Watercraft Trailer
Comprehensive Deductible
Collision Deductible

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Comments

 

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Number of hits since August 15, 1998

 

 

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Copyright 2001, 2002, 2003, 2004, 2005, 2006, 2007, 2008, 2009 Michael W. Smith Agency