Home Back

Boat/Watercraft

 

Home
Back

 

 

 

 


 


Kozhuharov Insurance Agency
Toll Free: (877) 205-0051
Fax: (269) 441-5163
E-mail: deyan@kozhuharovagency.com

Boat/Watercraft Insurance Quote Request

Effective Date:
Your Name:
Your Mailing Address: Street

City & State                                                     Zip
  
E-mail Address:
Daytime Phone #:
Choose One: Please call me with quote premium.
Please send quote via e-mail.
Description of Property:
 
Motor type:
 		Number of Engines:
 		Boat Type:
 		Other Boat Type
Fuel:
 		Maximum Speed:
 		Hull Material:
 		Other Hull Material:
Insured Watercraft:
 
Boat:
 Year    Manufacturer                 Model
Serial Number                                 Length    Total HP
Outboard Motor:
 Year    Manufacturer                 Model
Serial Number                                 Total HP
Trailer:
 Year    Manufacturer                 Serial Number
 
Coverages:                                                     Limits:
 
Boat (Including Auxiliary Equipment, please break down o/b information)
Outboard Motor 1.
(ACV Coverage)
Outboard Motor 2.
(ACV Coverage)
Boat Trailer
 
Personal Property
($500 Automatic)
Commercial Towing
($400 Automatic)
Boat Liability
(ACV Coverage)
Medical Payments
($1000 Automatic with Liability)
Uninsured Boater
 
Optional Coverages
 		 Agreed Value Endorsement
 Actual Cash Value
 Fishing Equipment - Limit:  
Safety Equipment:
Check all that apply:
 
GPS
 Automatic CO2 (Halon)
 Ship to Shore Radio (VHF)
 Depth Sounder
 Electronic Burglar Alarm 		Radar
 Plotter
 EPIRB
 Vapor Detector Alarm
Operator Information:
 
Date of Birth:
 		Years of Boating Experience:
Waters to be Navigated:
 
Inland waters of the following states:
 		Coastal waters of the following states:
Is the boat chartered or used for other than private pleasure purposes?    Yes    No
Previous Loss Information
 Please describe any losses or claims filed on your Homeowners Insurance in the last 3 years:

Date of loss:                                Type of loss:                                         Amount of claim:
Additional Comments
Please use the box below to enter any additional information you wish to include:

We cannot bind coverage from an e-mail or voicemail request. Coverage is bound after you receive a written e-mail or telephone confirmation from an agency staff member.

If you have not received a response from us within one business day, please contact us again.

Thank you.



 

 

[ Home ] [ Back ]

Send mail to deyan@kozhuharovagency.com with questions or comments about this web site.
Copyright © 2008 Kozhuharov Insurance Agency
Last modified: 08/11/11