McAlpin Agency, Inc. Watercraft Boat Insurance Quote Request Form for Minnesota MN Allied Progressive Encompass Auto Owners

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
Agent Request

Current Watercraft Insurance Information

Current Insurance Co.
Expiration Date

Operator Information (please list all Operators)

Driver #1
Name	Birthdate	Sex	Marital Status	Years Experience

Social Security #		Driver 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)

Driver #2
Name	Birthdate	Sex	Marital Status	Years Experience

Social Security #		Driver 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)

Percentage of Watercraft Use

Driver 1.	Driver 2.

Watercraft Information

Hull Information

Year	Make	Model	Length

Type	Material	Maximum Speed	Value

Describe Any Accessories/Special Equipment Including Cost When New

Motor Information

Year	Make	Type

Horsepower	Fuel Type	Value

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

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

Trailer Information

Year	Make	Model	Value

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

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

Uninsured and Underinsured Operator 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 Operator		Comment

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

Lay-up Period

Comment

Comments

Last modified: February 12, 2008