You may request a quote for coverage of your vessel in several ways:

  • By calling (toll-free) 877-331-0572 (Hours 9 am to 5 pm PST)
  • By Filling out and submitting the form below.
QUOTE REQUEST

Thank you for your interest in our insurance services. Please make sure you click the "Submit" button after filling out this form and be sure to fill in all required fields (noted in red). We will respond promptly.

PERSONAL INFORMATION
Name:
Company:
E-mail:
Address:
City:
State or Province:
Zip Code:
Phone:   Cell Phone:
Fax Phone:
Occupation:
DOB:
VESSEL INFORMATION
Experience (Years):
Prior Vessels Owned:
Prior Losses: NO     YES  
If yes, details:
Builder:
Length:
Type: Power:   Sail:     Year:

Engine Manufacturer:

Engine HP:
Inboard:   I/O:   O/B:   Diesel:   Gas:

Automatic Fire System: NO   YES
Fume Alarm: NO   YES
Location of Vessel
Area of Vessel Use:
REQUESTED COVERAGES
Hull & Machinery: $
Hull Deductible: 1%   2%
Tender & Outboard: $
Liability: $300,000   $500,000   $1 MIL
Paid Crew: NO   YES   If yes, how many?
Current Insurance Carrier:
Additional Comments:

  
Phone: 877-331-0572 (toll-free) or 619- 222-2560     FAX: 619-222-6716
Copyright © 2000, Douglas K. Smith Marine Insurance Services, Inc.
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