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PERSONAL INFORMATION |
| Name |
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| Email Address |
required to submit form |
| Telephone Number |
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| Preferred Method of Contact |
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| Street Address |
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| City or Town |
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| State |
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| ZIP Code |
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BOAT INFORMATION |
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Type of Boat |
| Manufacturer or Builder |
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| Construction of Boat |
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| Model |
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| Year of Boat |
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| Length: |
feet |
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Engine Information |
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Does the boat have an engine? |
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If the boat has an engine, please provide the following additional information |
| Engine Manufacturer |
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Horsepower |
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Engine Type |
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| Fuel Type: |
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Is boat berthed? |
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If yes, where is it berthed? |
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Trailer Information |
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Do you have a boat trailer |
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If yes, make of trailer |
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Value of Trailer |
$
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Water/Boating Course Completed:
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Limit to 250 characters |
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Boating Experience |
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Previous Boats Owned |
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Current Navigation Limits |
Sacramento & San Joaquin Rivers, Tributaries, NOT West of the Carquinez Bridge
San Francisco Bay, Tributaries, INCLUDING Coastal Waters not more than 30 mile radius of Mile Rock
San Francisco Bay, Tributaries, INCLUDING Coastal Waters not North of Bodega Head or South of Point Sur |
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Last Pulled Survey |
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INSURANCE COVERAGE |
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The following information is required to help us provide an accurate quote: |
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Number of claims in 3 years? |
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Current Insurance Carrier |
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Current Deductibles |
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Current Insurance Coverage |
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Hull Insurance Coverage |
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P&I/Liability Insurance Limit |
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| Additional Comments |
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