Commercial Marine
Insurance Quote
Business Name:    
Premises Address:
City:   Florida     Zip Code:
Contact Name:
Phone #:    Ext #:
Fax:    Years in Business:
Email Address: (Required) 
Description of Operations or SIC code:

Commercial Marine Insurance Coverage Desired:

(check as many boxes as desired)
Terminal Operators Legal Liability
Ship Repairer's Legal Liability
Wharf Owners Liability (Wharfinger)
Stevedoer's Legal Liability
Maritime Employers Liability
USL&H Worker's Compensation
CGL/Marine Liability

Florida Employee & Business Information:

# of full-time employees:  
# of part-time employees:
# of locations:
Estimated Annual Payroll: $

Select all that apply to your Florida
commercial marine business:

Work on vessels, docks, or bridges over water
Operate or lease watercraft
Work above 15 feet
Require out of state travel
Use Subcontractors
Pre-employment physicals
Offer safety incentive programs
Store, treat, dispose, or transport hazardous waste

Claims in the last 3 years:
Description of claims:

Current Insurance Company: 
Policy Expiration Date:          (mm/dd/yyyy)
Current Yearly Insurance Premium: $

Additional Information or Comments

Click on the "Submit Quote Information" button below to send
your Florida Commercial Marine insurance quote request.

Information received from this Florida commercial marine insurance quote form sent to "YOUR AGENCY NAME" will be for our use only and will not be sold, given to or distributed to any other parties. A quote will be based on the Florida commercial marine insurance information provided and does not guarantee acceptance of the risk by us. The precise coverage afforded is subject to meeting underwriting guidelines, and the terms, conditions and exclusions of the policy as issued. By submitting this request you acknowledge that this is neither an offer to insure nor a guarantee of insurance. Completion of this form does not entitle you to Florida Commercial Marine insurance. We are licensed in Florida and will not provide quotes for other states.

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