RENEWAL QUESTIONNAIRE

Please Note: This is a 3 step process.
STEP 1: complete the application.
STEP 2: Complete the "Terrorism Form".
STEP 3: Upload your Hull and Equipment Schedule.
Hull and Engine ID #s are required now and the vessel schedule must be in Excel format.
Coverage will not be provided if questions are left blank.

Name of Organization
Address (if changed)
Effective Date

Number of Members/Students in the Program

Jones Act: Average Number of coaches on the water

Is the head Coach Certified? YES NO

Boat Rental: If you rent boats to the public what are the annual $ receipts:

Boat Storage: If you store boats for non-members what are the annual receipts:

Borrowed Boats: If you borrow boats, what is the total $ value:

Printed Name

Your Signature
Company Title
Email address
Telephone Number
Date

Signatory should be a Senior Officer.



Step 1 of 3