John Fleming Insurance Agency
Pleasure Craft
Instructions:  Please fill out the information below. Areas with an asterisk (*) need to be filled in.
Contact Information
Name*
Address
City
Postal Code
Email Address*
Telephone:*
Fax:
   
Detailed Quote Information
1. Description
Type
Identification
Construction
Engine
2. Auxiliary
Year Built
Fuel
H.P.
Manufacturer
3. Outboard
Year Built
Fuel
H.P.
Manufacturer
4. Tender
Year Built
Length in Feet
Value
Manufacturer
5. Trailer
Year Built
Serial Number
Value
Manufacturer
6. Boating Experience of Operators
Name
Years Owned
Years Operated
Vessel Size
Courses Successfully Completed (CPS,CYA, etc.)
Will there be any operators under 18 years of age?
7. Electronic Equipment (List of all navigation equipment used specifically in the operation of the vessel)
C.B. Radio Value
Depth Sounder Value
VHF Radio Value
Loran Value
Radar Value
Other Value
     
8. Safety Equipment
Number of Bilge Pumps
Automatic
Manual
Fume Detector
Automatic Fire Extinguishing System
Quantity
Type
Date last tested and tagged
List of other safety features
9. Location
Where is your vessel moored?
Where is vessel laid up?
Afloat year round   Ashore
Primary areas of operation
10. Insurance Valuation (including Hull, Machinery, Attached Equipment)
Present Insurer
Policy #
Estimated Current Replacement (New) Value
Present Market Value
Price Paid When Purchased
Date Purchased
Comments