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Home Obama care Sign In Contact Us info@g1g.net 408-286-1111 ext 106 408-997-7890 CA Lic# 0697055   Sign In   User Name11     Password   New User Forgot password? News CEO Zain Jeewanjee Interview on WomenNow TV   Movie Boat Please answer all questions to prevent a delay in processing your quote request. If you have any questions call us at 800.257.7718 for help or fax at 408.997.7890 Contact Information Company Name: Business Entity: -----Entity Type----- Corporation Individual Joint Venture LLC (Limited Liability Company) LLP (Limited Liability Partnership) Non-Profit Partnership Trust Other Proprietorship Communities Company Address:       (street)         (City) ---Select a state--- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming (zip)       Contact Person: Telephone: Fax: Cell Phone: Email Address: Qualification Questions Is coverage required outside of the US and Canada?: Yes No Does the following apply to any vessels used in the production? Yes No Vessel used within 50 miles of attachment? Yes No Vessel used out of water? Yes No Other vessels to be towed? Yes No Is there water-skiing? Yes No Are there any stunts? Yes No Any prior productions with any losses of any kind? Yes No Production Details Type of Production: Title of Production: Budget (Gross Production Cost): $ Brief Description/Synopsis of Shoot: Cities and States of Shooting Locations: Coverage Start Date:   Coverage End Date:   Coverage Options Number of Vessels: > 1 2 3 4 5 Vessel Detail:   Name: Registration #: Year: Length: Market Value: Type: Builder: Vessel Use Date of Use: Use (Operating) # Vessel Crew: # Production Crew: # Days: Use (Dockside) # Vessel Crew: # Production Crew: # Days: Place of Attachment: Locations used: Navigation Area to be Used: Vessel Owner Name of Company/Organization: Contact Person: Phone: Fax: Owner named as: Additional Insured Loss Payee Coverage Options Hull & Machinery: Yes No Protection & Indemnity: $1,000,000 10,000,000 Wharfinger's Liability: $1,000,000 10,000,000 Tower's Liability: $1,000,000 10,000,000 Charterer's Liability: $1,000,000 10,000,000

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