Please enable JavaScript in your browser to complete this form. - Step 1 of 2What type of service does your business provide? Boat Repair/MaintenanceDetailing/Cleaning/WaxUnderwater Bottom CleanerDescription of Engine Work mark all that apply *Basic maintenance, oil changes, spark plugs etc.Major engine rebuilds% Boiler repair% Detailing / Wax work % Electrical work% Engine work % Hauling or Launching % Marine Carpentry % Fiberglass work% Rigging work% Sail/Canvas repairs% Shrink wraping% Towing or marine salvage% Winterization of watercraft% Upholstery work % Welding% Vessel painting / bottom painting% Electronics% Refrigeration% Sandblasting % Other Description of Other Service DescriptionWhat marine and non-marine services and products provided? Be detailed. *Do you do anything other than boat service and repair? *NoYesDescribe work other than boat service and repair.Do you work on commercial vessels? *NoYes% of work done on commercial vessels Do you provide storage (other than while being serviced/repaired)? *NoYesStorage annual revenueWork on boat/yachts over 100 feet? *NoYesWhat it the average value of vessel you work on? *What is the highest value of vessel you work on? *Do you do any boat rentals?NoYesDo you engage in any diving operations with regard to work performed? *NoYesIf yes, please explain type and extentDo you work on jet skis? *NoYesDo you sea or lake trial jets skis repaired?NoYes% percent of the work is Jet Skis?Do you manufacture any part? *NoYesPlease provide details of parts manufacturedEstimated annual gross sales of manufacturere parts Not installedOnly list gross sales if parts are sold to other not installed Do you do any inflatable patch/repairs?NoYesAny boat hauling? *NoYesDo you haul any boats other than boats you are repairing? *NoYesPropellers pulled or Replace? *NoYesDo you do any Sail boat rigging? NoYes% of sail boat riggingDo you own any work boats?NoYesWill you like tools and equipment coverage? *NoYesTotal value of equipment under $1,000All equipment valued at more than a thousand dollars must be declared separately Do you have a physical location (Shop) *YesNoAddressAddress Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDo you provide mobile services? *YesNoWhat percentage is mobile 100%80%60%50%Less than 25%Active Owners *Full Time EmployeesPart Time EmployeesAnnual Payroll Not counting owners Annual Sales *Limits of Liability Desired<$100,000$100,000$300,000$500,000$1,000,000$2,000,000>$2,000,000Do you use subcontractors? *NoYesEstimated annual Insured sub-contractors costEstimated annual Uninsured sub-contractors Have you been in business less than 3 years *YesNoIf you been in business less than 3 years, provide a simple resume or work history.Do you currently have insurance? *NoYesExpirationInsurance Company NameHave you had any claims? *NoYesProvide details of claim and amount paid by insurance companyIf you had losses we will require hard copy of losses from insurance company.NextCompany Name *Sole proprietor, corporation or LLC name Form business *CorporationLimited Liability CompanySole ProprietorFederal Employer Number FEIN *Website / URLContact Name *Mailing Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeEmail *Phone *Mobile Phone *Txt Msg ConsentYesNoBy select YES and entering your telephone number, you expressly authorize Dopazo & Associates, Inc. (“Dopazo”) to call or text you with offers and reminders at the number you provided, including through the use of the possible use of automated technology and recorded messages. You certify that the number you provided is your own number. If you change your number, you will notify Dopazo as soon as possible. You are not obligated to provide this authorization and it is not a condition to receive a quote or purchase or renew your insurance. You may revoke this authorization at any time by remove@dopazo.com. You understand and agree that standard text messaging rates will apply to any text messages sent to you by Dopazo and that Dopazo will not be responsible for any charges for text messaging.Acknowledgement *I AgreeI acknowledge and understand that insurance coverage cannot be bound or changed via submission of any online form/application provided on this site or otherwise. No binder, insurance policy, change, addition, and/or deletion to insurance coverage goes into effect unless and until confirmed in writing directly by a licensed agent.Submit