Rent A Florida Condo Or Home

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At J.D. Smith Insurance, the customer is #1.....and we work for you......not the Insurance Company!.....Peace Of Mind Insurance

Due to licensing restrictions, this quotation request is only for residents of the Province of Ontario in Canada.

J. D. Smith Insurance Ontario P.W.C. Boat Package

  • $5000,000 Third Party Liability
  • $1,000,000 TPL Available
  • Broad Form Coverage
  • Trailer and Road Coverage

PWC Premiums from $300

Owners Name:   Rent a Florida Condo or Home Direct From the Owner
Address:  
   
NOTE: QUOTES ARE ONLY FOR ONTARIO RESIDENTS
Occupation:  

Telephone (Bus):

 
Telephone (Home):  
Email Address :  
Lienholder (Name, Address
& Postal Code):
 
VESSEL: All applications for vessels over 15 years of age must be accompanied by a current Marine Survey
Year Mfg:   Discount Tickets for Orlando Attractions
Manufacturer:  
Model:  
Length:  
Current Market (resale) Value:  
Name of Vessel:  
Serial No.:  
License/Registration No.:  
Purchase Date:  
Purchase Price:  
Type of Boat:  
Type of Hull:  
CONSTRUCTION:
Material:
Production:
Custom paint OR
Metalic Flake Finish?
Yes   No
If "yes", Please Describe:
EQUIPMENT: From the following list check the appropriate equipment which is installed in the vessel, or portable in nature, but used specifically in the operation of the vessel and included in Hull Insurance.
Manufacturer
HP/Length
Year
Serial #
Value
Trailer used solely for transport:
Tender used solely for transportation between the insured vessel and shore:
Outboard Motor used with tender, or as Auxillary:
ELECTRONICS:
Radar: Other Electronics (describe)
Depth Finder:
V.H.F.:
G.P.S.:
APPLIANCES:
Fuel
If Propane/Butane, Natural Gas is Used,
Where is Tank Located?
 
Continuous Burning
Pilot Light?
Stove:
 
Yes   No
Heater:
 
Yes   No
Refrigeration:
 
Yes   No
Barbeque:
 
Yes   No
Water Heater:
 
Yes   No
SAFETY EQUIPMENT :
Built-in Fire
Extinguishing System:
Areas Protected:
Gas Fume Detector:
Smoke Detector:
Engine Blower:
Automatic Bilge Pump:
Auxiliary Generator: (Type of fuel used)
Is Boat Equipped According to Transport Canada’s Office of Boating Safety Standards? Yes   No
BERTHING & NAVIGATION:
Vessel Berth Location:
Name of Marina/Yacht Club:
Type of Berth:
Winter Berth:
Water Navigated:
BOAT USE :
Pleasure Use Only:
Water Skiing/Tubing/Knee Boarding:
Live Aboard?
Racing: Yes   No
If Racing, Describe:
COMMERCIAL USE :
Is Boat Used Commercially or Chartered? Yes   No
If Yes, Describe:
If you charter your yacht please answer the following:
How long have you been employed in commercial operations? yr(s)
What are the estimated annual gross receipts?
What is the passenger capacity of your vessel?
Does Applicant employ a Paid Crew or Captain? Yes   No
QUALIFICATIONS & EXPERIENCE OF ALL OPERATORS:
Years Experience
Size of Vessel
Boat Operators - Including Applicant
Age
Owner
Operator
Owner
Operator
Drivers License No.
1.
2.
3.
COURSES: Are operators graduates of an approved power/sailing course? Yes   No
Describe:
LOSSES: Has any operator or owner had any losses with this or any othe boat in the past 5 years?
Yes   No
If "Yes", explain in the "Remarks" section below. List all other insurance losses in excess of $5,000 within the past 5 years.
VIOLATIONS: Have you or any operator of the said vessel:
(further explain in "Remarks" section below)
  1. had a suspension of your driver's license, because of impairment, dangerous driving or criminal negligence within the pas 6 years? Yes   No
  2. been convicted of an infraction relating to the sailing of a Marine Vessel? Yes   No
  3. been convicted in a court of law for Insurance Fraud? Yes   No
Remarks/Losses/Violations:
Name & Policy Number of Previous Insurer:
Expiry Date:
Was Previous Policy:  
Cancelled by Insuring Co.?
 
Renewal Refused?
 
Yes   No
 
Yes   No
Details:
 
 
Amounts of Insurance Required
Deductible
A. Hull and Equipment
B. Tender and Outboard Motor
C. Boat Trailer
D. Personal Effets
E. Bodily Injury/Property Damage Liability
 

 
For a Quick Quote, call J. D. Smith Insurance
1-800-917-SAVE (7283) or 905-764-7868
   
 
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