Hayden Yacht Insurance
LICENSE #0635700
For your complimentary commercial vessel quote, please fill in the following form:
OPERATOR
 
Name of Operation:
Name of Principal:
Address:
City:
State:   Zip:
Day Phone (w/ area code):
Eve. Phone (w/ area code):
Fax (w/ area code):
Email Address:
Contract / Position:
Experience in Vessel Operation: Years
 
CURRENT POLICY INFORMATION
 
Current Insurer:
Policy Expires:   Premium:
 
VESSEL DESCRIPTION
 
Vessel Name:
Vessel Manufacturer:
Power    Sail
Year Built:   Length:   Beam:   Draft:
Hull Material:
Certified Number of Passengers:   Average Number:
Number of Charters per Year:
Number of Engines:   Year Mfg.:   HP per Engine:   Total HP:
Engine Manufacturer:
Engine Model:   Fuel:
County Registered:   USCG No.:
 
OPERATION DETAILS
 
Check all that apply: Operation
Fish
Dive
Gaming
Sightseeing
Dinner
Other   
Average Length of Voyage:      (other)
Passenger Vessel
Barboat Charter
Skippered Charter
6 Pack Operation
Navigation:
Home Port:
No. of Operating Crew:   No. of Service Crew:   Total No. of Crew:
 
COVERAGE REQUESTED
 
Amount of Crew Liability:
Hull & Machinery:   Liability:
Equipment:   Liability:
Tender & Motor:   Liability:
Personal Effects:
Food & Drink: Yes    No
Loss Payee: Yes    No
 
LOSS CLAIM HISTORY
 
Date of Loss    Nature of Claim                                      Claim Amount    Amount Paid    Open/Close
How were you referred to  
Hayden Yacht Insurance?  
    If other, please specify:
 
QUESTIONS / COMMENTS
 
 
   
 
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