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 ProductionInsurance.com
  A Service of Supple-Merrill & Driscoll, Inc.

 

  

 

 Movie Boat Insurance Application Instructions

  1. Please complete and submit this online application for a free, no-obligation quote.

  2. Please be sure to provide all required information in order to receive a quotation. 

 

  Program Information

This is a secure application.  Strong cryptography is implemented via the Secure Sockets Layer protocol.  Our Privacy Policy.

  PDF Application (Fillable)

 

( indicates required information)

Applicant Information

Name of Company / Organization:
Entity:

Full Name of Contact:
Number:
Fax:
Street Address:
City, State: ,
Zip/Postal Code:

Email:

We will never rent, sell, or share your email address.

Website:
Applicant Type:

Underwriting Questions

Will the production include any Stunts, Water-skiing or over-the-side activities?

Yes  No

Insurance History

Any insurance declined or cancelled in the past 3 years? Yes  No
Any loss in the past 3 years? Yes  No
Any prior insurance coverage? Yes  No

Production Details

Title:
Production Type:
Total Budget:
Production Dates: to
Country:
State:
Shooting Location:

Synopsis:

Input a brief description of the shoot.

Key Production Contact

First Name:
Last Name:

Role:

At least 1 producer or executive producer must be scheduled on the production.

Drivers License:

 

State & Number

Country of Residence:

Vessel Details
Details - Boat #1
Vessel Name:
Year Built:
Manufacturer/Builder:
Boat Type:
Length:

In Feet

Registration Number:
Market Value:
Owner - Boat #1
Name:
Street:
City:
Country:
State/Province:
Zip/Postal Code:
Details - Boat #2
Vessel Name:
Year Built:
Manufacturer/Builder:
Boat Type:
Length:

In Feet

Registration Number:
Market Value:
Owner - Boat #2
Name:
Street:
City:
Country:
State/Province:
Zip/Postal Code:
Details - Boat #3
Vessel Name:
Year Built:
Manufacturer/Builder:
Boat Type:
Length:

In Feet

Registration Number:
Market Value:
Owner - Boat #3
Name:
Street:
City:
Country:
State/Province:
Zip/Postal Code:
Vessel Use
 
Total Days Number of Vessel Crew Number of Film Crew

Operating Use:

Operating use is when the vessel is not stationed at the dock.

Dockside Use:

 

Dockside use is when the vessel is not being operated and is stationed entirely at the dock.

Is applicant operating the vessel?

Yes  No

This determines if Protection & Indemnity or Charterer's Legal is required.

Describe how this vessel will be used in the production:

Will the vessel be used out of water?

Yes  No

Place of Attachment:
Will the vessel be used within 50 miles of attachment?

Yes  No

Navigation Area to be Used:
 

The navigation area is the territory through which the vessel travels.

Vessel Specific Coverages

Hull & Machinery:

Coverage Term

Coverage Term:

to

Up to 1 year

Hull & Marine Liabilities
Pollution:
Wharfinger's Liability:
Excess Liability:
Terrorism: Included

Inland Marine

Equipment & Property Coverage

Unscheduled Owned Equipment:
Rented Equipment, Props, Sets & Wardrobes:
Negative Film/Faulty Stock:
Terrorism: Included

Notes

 

 

 
Terms and Conditions

Please carefully review the Terms and Conditions below:

  • Please read all exclusions indicated on quotation.

  • The quotation received is not binding on the Insurer in any way.

  • By clicking 'Submit Application' you are not agreeing to purchase coverage.  Via email, you will receive a free, no-obligation insurance quotation.

  • Any person who knowingly and with intent to defraud any insurance company or another person files an application for insurance containing any materially false information, or conceals for the purpose of misleading information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects the person to criminal and (NY: substantial) civil penalties. (Not applicable in CO, HI, NE, OH, OK, OR, VT). In DC, LA, ME, TN and VA, insurance benefits may also be denied.
  • Please note that once coverage is bound, the policy cannot be cancelled.

  • The insurance quotation will be based solely on the coverages and limits selected on this application.

  • Please ask your Supple-Merrill & Driscoll, Inc. representative to explain coverage details, exclusions, limits or other provisions of any insurance policy.

Type your name below, to indicate that you have read

and accepted the Terms and Conditions above:

 

 

 

  

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ProductionInsurance.com is the entertainment division of Supple-Merrill & Driscoll, Inc.  California License 0517777.

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