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“Wells & Co insures boats and only boats, and has been doing so for 30 years. A family owned and operated business, we pride ourselves on providing our customers with exceptional customer service and coverage of the highest quality at an affordable price.” — Rob Wells

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Name*
First Last
Name Insured*
Is the Named Insured an:*
- Individual
- Partnership
- DBA
- Corporation
Address*
Street Address Address Line 2 City State ZIP Code
Telephone*
Email*
Vessel Information
Vessel Name
Vessel Type*
Vessel Use
Present Insurer (if any)
Homeport
Policy Expiration Date
MM slash DD slash YYYY
Status
- docked
- moored
Lay-Up Begin Date (if any)
MM slash DD slash YYYY
Lay-Up End Date
MM slash DD slash YYYY
Vessel Properties
Year Built Length Gross Tons Make Model Hull Material Official No.
Trailer Description
Engine Details
Year Make Model Horsepower

Click the “+” sign for additional engines.
6 PACKS ONLY
Is the vessel equipped with the following?
High Water Level Alarms
- Yes
- No
Engine Alarms
- Yes
- No
Anti-Theft Alarms
- Yes
- No
Fixed Fire Extinguishing System
- Yes
- No
EPIRB
- Yes
- No
Fume Detectors
- Yes
- No
6 PACKS ONLY - END
Waters Navigated
Lien Holder
Lien Amount ($)
Name of Surveyor
Date of Last Survey
MM slash DD slash YYYY
Coverages
Hull/Machinery Value ($)
Trailer Value ($)
Deductibles
Protection & Indemnity (P&I)
Number of Passengers
Capacity
Average Capacity
Number of Crew Members
Full-Time Soft Full-Time Hard Part-Time Soft Part-Time Hard
Captain’s Information
Is vessel owner-operated?
- Yes
- No
Is a licensed captain always in control?
- Yes
- No
Captain Details
Name License No. Date of Birth Years of Experience

Click the “+” sign for additional captains.
Does the insured own other vessels?
- Yes
- No
Please list a five-year loss history on any owned vessels.
Email
This field is for validation purposes and should be left unchanged.

Year	Make	Model	Horsepower

Name	License No.	Date of Birth	Years of Experience

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Vessel Information

6 PACKS ONLY

6 PACKS ONLY - END

Coverages

Number of Passengers

Captain’s Information