Flagship Marine Trade Quote Form

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1 Flagship Marine Trade Quote Form Insurance from A - Z

2 For an indication of premium and terms, simply complete this form and to or fax back on AGENT DETAILS Name Tel No. Fax No CLIENT DETAILS Name Address Post Code Tel No Business Description Fax No Section 1 - Material Damage 1.1 Section 1a - Property At The Premises Excess 250 Cover Option All Risks Fire & Perils Only Subsidence Construction of Buildings Standard Non Standard (Give details on last page) (Sum insured) Buildings: Standard Stock (ex Vessels) Buildings: Non Standard General Rent Chandlery Tenants Improvements Engines Business Equipment Clothing Computers & Assoc Equipment Target Stock Hand Tools Other Lifting Plant Moulds & Mould Tools Machinery & Other Contents (If "other stock" please give full details on last page) 1.2 Section 1b - Property Away from the Premises Excess 250 UK only EU Elsewhere Computers Mobile Phones Tools & Equipment Other Property 1.3 Section 1c - Goods In Transit - Excluding owned Vessels (see Section 2) Excess 250 Own Vehicles (Limit Per vehicle) Number of Vehicles Annual Sendings Limit per Consignment Type of Goods carried 1.4 Section 1d - Exhibitions Excluding owned Vessels (see Section2) Excess 250 Number of Exhibitions attended annually Value of Goods Exhibited ex vessels Value of Stand Exhibition Expenses 1.5 Section 1e - Glass Excess 250 Value of External glass Sanitaryware Value of Internal glass Signs/ Blinds 1.6 Section 1f - Frozen Food Excess 50 Value of Food in Freezers Age of Unit Annual maintenance contract in force? Yes No 1

3 Section 2 - Marine 2.1 Section 2a Vessels Excess 250 (Sum insured) Stock New / Used Vessels / Trailers Max Value any one craft Trailers Dinghies Max Value any one craft Yachts Max Value any one craft Power / Narrowboats Max Value any one craft PWCs Max Value any one craft Commercial Vessels Max Value any one craft Others Max Value any one craft Stock of Engines Loss of hire per charter Vessel Owned / Charter Hire Vessels Please give full details of all Type of Craft Age Construction Use Value Location Third Party Liability 1M 2M 3M Other Exhibitions Included Excluded Transit Included Excluded Uk Only EU Private & Pleasure Use Included Excluded Racing Risks Included Excluded Water-skiiers liability Included Excluded 250, ,000 1M Cruising Range Uk Inland Waters Only Uk Inland and Coastal Waters Uk Inland and Coastal Waters Including Brest to Elbe Limits Other - please give details Loss of Hire of Charter Vessels - Limit per vessel 2.2 Section 2b Builders Risks Excess 500 Max Value any one craft Max Value at any one time Construction turnover No. of Vessels in build per Year Type of Vessels built Private Pleasurecraft Commercial Third Party Liability 1,000,000 2,000,000 Other 2.3 Section 2c Marine Installations Excess 500 Sum Insured Floating Pontoons Fixed Pontoons Fuel Pontoons Travel Hoist Bays Services Others 2

4 Section 3 - Financial Loss 3.1 Business Interruption Indemnity Period (delete as applicable) 12 / 18 / 24 / 36 months Book Debts Gross Profit / Revenue Increased Cost of Working Extensions Available Breach of Canal Denial of Access Public Utilities Customers Suppliers (A maximum of 10,000 cover per extension is available) 3.2 Loss of Money Excess 50 On Premises (during Bus.Hours) Annual Carryings of Cash On Premises (outside Bus.Hours) How often is cash in Transit In Safe Limit Safe Details Make Model How Secured 3.3 Loss of Licence Sum Insured 3.4 Defective Title Excess 10% Used Boat Sales (Turnover) Brokerage Fees Limit Per Vessel 4.1 Employers Liability Section 4 - Liabilities Limit of Indemnity Wageroll Clerical /Administration Waterbourne Activities Skipper & Crew of Vessels Boat Builder/Manufacturer Service & RepaIr Woodworking Sailmakers Welding Shop/Chandlery/Club Other Boat Cleaners 4.2 Public Liability Excess 500 Limit of Indemnity required 2M 3M 5M Other Turnover Brokerage (Fees) Hire Fleet Charges Boat Sales Sale of Food / Drink Chandlery / Sales Other Service / Repair Exports Ex USA/Canada Mooring / Storage ExportsTo USA/Canada Boat Building Etc Heat work away from the Lifting/Hauling Out Premises (Excess 1,000, Max LOI 1,000,000) Non-Marine turnover Percentage of Turnover related to Non-Marine work % Type of Non-Marine work carried out Products Liability Required Yes No CPA Extention (Limit 100,000) Yes No Type of Equipment hired Max value of Plant at any one time Plant Hire Charges 3

5 Section 5 - Personal Accident 5 Personal Accident Name Occupation Units of cover required (max 20) Capitals 2000, Weekly TTD 20, Weekly TPD 8 General Questions Please answer the questions below by ticking the appropriate box. Shaded boxes ticked may require further information/comment. 1. Have you had any claims or convictions or been declared Bankrupt in the last 5 Years or been refused/declined insurance or had special terms imposed? Yes No (If 'Yes' please give full details on a separate sheet) 2. How long have you been trading? 3. Do you use a current BMF Terms of Business or equivalent? Yes No 4. Do you have a written Health & Safety policy? Yes No 5. Have you carried out a risk assessment and is this ongoing? Yes No 6. Do you have a security alarm fitted? Yes No (If 'Yes' please give details) Is your alarm a NSI/ Nacoss Redcare alarm? Yes No Do you have a regular maintenance contract in place? Yes No 7. How are your premises heated? Portable Heating Electric Gas Radiators Other 8. When were the electrics at the premises last tested by a qualified independent electrician? / / 9. Do you have appropriate Fire Extinguishing Appliances in place? Yes No 10. Are the Premises subject to flooding? Yes No (If 'Yes' please give details in the Additional Information box below) 11. Do you have window locks & 5 lever locks fitted? Yes No 12. Is your premises: a) Shared with others? Yes No b) Unduly exposed to the elements? Yes No c) Made up on a landfill site? Yes No Additional information you feel the insurers should be made aware of Sign & Date Please prepare me a quotation for the Flagship Marine Trade policy which may be subject to amendment on receipt of a full completed and signed proposal form. Position (Broker) Signed Date Full Policy Wording is available on application or via our website 4

6 Towergate Underwriting and Towergate Underwriting Marine are trading names of Towergate Underwriting Group Limited THS House, 91/92 High Street, Lymington, Hampshire SO41 9AP Tel: Fax: Registered Office: Towergate House, Eclipse Park, Sittingbourne Road, Maidstone, Kent ME14 3EN Registered in England No Authorised and regulated by the Financial Services Authority 5114/160/QF/03.09

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