ACORD Form 82 Watercraft Application Instructions

 

ACORD 82 (2007/06) 1 of 24

Universal wording updates to improve clarity and intent were made to all FIG text for this form on 10/07/2008.
Section Name	Field Name	Field and/or Section Description
TITLE ACORD 82 (2007/06)	Watercraft Application	The title of the form. The ACORD 82 - Watercraft Application is used when insurance is desired for watercraft. The underwriting process for any personal lines policy begins with the submission of a completed application. The following will provide assistance in completing ACORD 82, Watercraft Application. This form can be used either as a stand-alone application or as a supplement to the Homeowners Application (ACORD 80) if physical damage on watercraft is being written under the Homeowners policy. Check with the company to determine whether physical damage can be written on the Homeowners policy. If coverage will be provided under a yacht policy, do not use this form. Use ACORD 210, Yacht Section.
IDENTIFICATION SECTION	Date	Enter date: The month/day/year on which the form is completed. (MM/DD/YYYY)
IDENTIFICATION SECTION	Agency	Enter text: The producer's full name.
IDENTIFICATION SECTION		Enter text: The producer's mailing address line one.
IDENTIFICATION SECTION		Enter text: The producer's mailing address line two.
IDENTIFICATION SECTION		Enter text: The producer's mailing address city name.
IDENTIFICATION SECTION		Enter code: The producer's mailing address state or province code.
IDENTIFICATION SECTION		Enter code: The producer's mailing address postal code.
IDENTIFICATION SECTION	Contact Name	Enter text: The name of the individual at the producer's establishment that is the primary contact.
IDENTIFICATION SECTION	Phone No.	Enter number: The producer's contact person's phone number.
IDENTIFICATION SECTION	Fax No.	Enter number: The fax number of the producer.
IDENTIFICATION SECTION	E-Mail Address	Enter text: The producer's contact person e-mail address.

ACORD 82 (2007/06) 2 of 24

Section Name	Field Name	Field and/or Section Description
IDENTIFICATION SECTION	Code	Enter code: The identification code assigned to the producer (e.g. agency or brokerage firm) by the insurer.
IDENTIFICATION SECTION	Sub Code	Enter code: The identification code assigned by the insurer to the sub-producer (e.g. person) within a producer's office (e.g. agency or brokerage).
IDENTIFICATION SECTION	Agency Customer ID	Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage).
IDENTIFICATION SECTION	Applicant's Name and Address	Enter text: The named insured’s full name as it appears on the policy declarations page.
IDENTIFICATION SECTION		Enter text: The named insured's mailing address line one.
IDENTIFICATION SECTION		Enter text: The named insured's mailing address line two.
IDENTIFICATION SECTION		Enter text: The named insured's mailing address city name.
IDENTIFICATION SECTION		Enter text: The applicant's physical address county name.
IDENTIFICATION SECTION		Enter code: The named insured's mailing address state or province code.
IDENTIFICATION SECTION		Enter code: The named insured's mailing address postal code.
IDENTIFICATION SECTION	Effective Date	Enter date: The effective date of the policy.
IDENTIFICATION SECTION	Expiration Date	Enter date: The date on which the terms and conditions of the policy will expire.
IDENTIFICATION SECTION	Carrier	Enter text: The insurer's full legal company name(s) as found in the file copy of the policy. This is not the insurer's group name or trade name.
IDENTIFICATION SECTION	NAIC Code	Enter code: The identification code assigned to the insurer by the NAIC.
IDENTIFICATION SECTION	Plan	Enter code: The product code of the insurer for the policy.
IDENTIFICATION SECTION	Policy Number	Enter identifier: The identifier assigned by the insurer to the policy, or submission, being referenced. If required for self-insurance, the self-insured license or contract number.
IDENTIFICATION SECTION	Home Phone #	Enter number: The named insured's primary phone number.

ACORD 82 (2007/06) 3 of 24

Section Name	Field Name	Field and/or Section Description
IDENTIFICATION SECTION	Day	Check the box (if applicable): Indicates the home phone number is where the named insured can be reached during the day.
IDENTIFICATION SECTION	Evening	Check the box (if applicable): Indicates the home phone number is where the named insured can be reached during the evening.
IDENTIFICATION SECTION	Business Phone #	Enter number: The named insured's secondary phone number.
IDENTIFICATION SECTION	Day	Check the box (if applicable): Indicates the business phone number is where the named insured can be reached during the day.
IDENTIFICATION SECTION	Evening	Check the box (if applicable): Indicates the business phone number is where the named insured can be reached during the evening.
BOAT HULL	Boat Hull No.	Enter number: The producer assigned number for the watercraft.
BOAT HULL	Power - Inboard	Check the box (if applicable): Indicates the watercraft is propelled by an inboard motor.
BOAT HULL	Outboard	Check the box (if applicable): Indicates the watercraft is propelled by an outboard motor.
BOAT HULL	Inboard/Outdrive	Check the box (if applicable): Indicates the watercraft is propelled by an inboard/out drive motor.
BOAT HULL	Waterjet	Check the box (if applicable): Indicates the watercraft is propelled by a water jet.
BOAT HULL	Sail	Check the box (if applicable): Indicates the watercraft is propelled by a sail.
BOAT HULL	Other	Check the box (if applicable): Indicates the watercraft is propelled by a method other than those listed.
BOAT HULL	Other Description	Enter text: The method of propulsion of the watercraft.
BOAT HULL	Type of Hull - Cabin Cruiser	Check the box (if applicable): Indicates the watercraft type is a cabin cruiser.
BOAT HULL	Open Cockpit	Check the box (if applicable): Indicates the watercraft type is an open cockpit.
BOAT HULL	Sailboat	Check the box (if applicable): Indicates the watercraft type is a sailboat.
BOAT HULL	Pontoon	Check the box (if applicable): Indicates the watercraft type is a pontoon boat.
BOAT HULL	Bass	Check the box (if applicable): Indicates the watercraft type is a bass boat.
BOAT HULL	Personal WC	Check the box (if applicable): Indicates the watercraft type is a personal watercraft.
BOAT HULL	Ski	Check the box (if applicable): Indicates the watercraft type is a ski boat.
BOAT HULL	Other	Check the box (if applicable): Indicates the watercraft type is other than those listed.
BOAT HULL	Other Description	Enter text: The description of the watercraft type.
BOAT HULL	Hull Material - Fiberglass	Check the box (if applicable): Indicates the hull is constructed with fiberglass.
BOAT HULL	Metal	Check the box (if applicable): Indicates the hull is constructed with metal.
BOAT HULL	Wood	Check the box (if applicable): Indicates the hull is constructed with wood.
BOAT HULL	Hull Design - Flat Bottom	Check the box (if applicable): Indicates the hull design is flat bottom.
BOAT HULL	Round Bottom	Check the box (if applicable): Indicates the hull design is round bottom.

ACORD 82 (2007/06) 4 of 24

Section Name	Field Name	Field and/or Section Description
BOAT HULL	Vee Bottom	Check the box (if applicable): Indicates the hull design is vee bottom.
BOAT HULL	Catamaran	Check the box (if applicable): Indicates the hull design is catamaran bottom.
BOAT HULL	Other	Check the box (if applicable): Indicates the hull design is other than those listed.
BOAT HULL	Other Description	Check the box (if applicable): The description of the hull design.
BOAT HULL	Fuel Tank - Fiberglass	Check the box (if applicable): Indicates the fuel tank is fiberglass.
BOAT HULL	Metal	Check the box (if applicable): Indicates the fuel tank is metal.
BOAT HULL	Spar Material - Aluminum	Check the box (if applicable): Indicates the type of spar material used (i.e. masts, riggings, etc.) is aluminum.
BOAT HULL	Wood	Check the box (if applicable): Indicates the type of spar material used (i.e. masts, riggings, etc.) is wood.
BOAT HULL	Carbon Fiber	Check the box (if applicable): Indicates the type of spar material used (i.e. masts, riggings, etc.) is carbon fiber.
BOAT HULL	Other	Check the box (if applicable): Indicates the type of spar material used (i.e. masts, riggings, etc.) is other than those listed.
BOAT HULL	Other Description	Enter text: The description of the spar material used (i.e. masts, riggings, etc.).
BOAT HULL	Year	Enter year: The model year of the watercraft.
BOAT HULL	Manufacturer/Model	Enter text: The manufacturer of the watercraft.
BOAT HULL		Enter text: The manufacturer's model name for the watercraft.
BOAT HULL	Length	Enter number: The length of the watercraft expressed in feet.
BOAT HULL	Max Speed	Enter number: The maximum speed attainable by the watercraft. State if the speed in in miles per hour or knots per hour.
BOAT HULL	Date Purchased	Enter date: The date the watercraft was purchased.
BOAT HULL	Cost New	Enter amount: The cost of the watercraft when it was purchased new, in whole dollar amounts.
BOAT HULL	Present Value	Enter amount: The watercraft's present value, stated or agreed, in whole dollar amounts.
BOAT HULL	Name of Boat	Enter text: The name in which the watercraft is registered.
BOAT HULL	Name of Beneficial Owner	Enter text: The additional interest's full name. As used here, this is the beneficial owner.
BOAT HULL	Registration Number	Enter identifier: The unique identifier for the watercraft assigned by the registering authority.
BOAT HULL	Country of Registration	Enter code: The country code in which the boat is registered.
BOAT HULL	Hull Identification Number	Enter identifier: The 12 character Hull Identification Number of the watercraft. It is typically located on the transom of the watercraft.
BOAT HULL	Waters Navigated	Enter text: The waters where the watercraft is predominantly used (e.g. Atlantic, Great Lakes, Inland Waterways, etc.).

ACORD 82 (2007/06) 5 of 24

Section Name	Field Name	Field and/or Section Description
BOAT HULL	Territory	Enter code: This is typically the navigation territory. However, use company manuals to determine territory.
BOAT HULL	Date of Last Survey	Enter date: The date the last survey was completed.
BOAT HULL	Primary Berth/Storage Location	Enter text: The first address line of the physical location. As used here, this is the primary berth/storage location.
BOAT HULL	Summer	Check the box (if applicable): Indicates the primary storage location is used in the summer.
BOAT HULL	Winter	Check the box (if applicable): Indicates the primary storage location is used in the winter.
BOAT HULL	City	Enter text: The city of the physical location.
BOAT HULL	State	Enter code: The state or province of the physical location.
BOAT HULL	Zip	Enter code: The postal code of the physical location.
BOAT HULL	Country	Enter code: The code that identifies the country.
BOAT HULL	Secondary Berth/Storage Location	Enter text: The first address line of the physical location. As used here, this is the secondary berth/storage location.
BOAT HULL	Summer	Check the box (if applicable): Indicates the secondary storage location is used in the summer.
BOAT HULL	Winter	Check the box (if applicable): Indicates the secondary storage location is used in the winter.
BOAT HULL	City	Enter text: The city of the physical location.
BOAT HULL	State	Enter code: The state or province of the physical location.
BOAT HULL	Zip	Enter code: The postal code of the physical location.
BOAT HULL	Country	Enter code: The code that identifies the country.
BOAT HULL	Lay-Up Period	Enter date: The start of the period during which the unit is not in use.� The date the lay up period starts.
BOAT HULL		Enter date: The end of the period during which the unit is not in use.
BOAT HULL	Dry	Check the box (if applicable): Indicates the unit is stored dry during the lay up period.
BOAT HULL	Afloat	Check the box (if applicable): Indicates the unit is stored afloat during the lay up period.
ENGINE/MOTOR	Year	Enter year: The model year of the engine/motor.
ENGINE/MOTOR	Manufacturer/Model	Enter text: The manufacturer of the engine/motor.
ENGINE/MOTOR		Enter text: The manufacturer's model name for the engine/motor.
ENGINE/MOTOR	Serial Number	Enter identifier: The serial number of the engine/motor.

ACORD 82 (2007/06) 6 of 24

Section Name	Field Name	Field and/or Section Description
ENGINE/MOTOR	Horsepower	Enter number: The horsepower of the engine. There is a method for determining the maximum safe horsepower for a specific boat based on length and width. If the company employs this formula, it may be helpful to make note of the width in remarks.
ENGINE/MOTOR	Fuel - Gasoline	Check the box (if applicable): Indicates the engine/motor runs on gasoline.
ENGINE/MOTOR	Diesel	Check the box (if applicable): Indicates the engine/motor runs on diesel fuel.
ENGINE/MOTOR	Battery	Check the box (if applicable): Indicates the engine/motor is runs on battery power.
ENGINE/MOTOR	Date Purchased	Enter date: The date the engine/motor was purchased.
ENGINE/MOTOR	Cost New	Enter amount: The cost of the engine/motor when it was purchased new, in whole dollar amounts. (For Outboard Motors Only)
ENGINE/MOTOR	Present Value	Enter amount: The engine/motor's present value, stated or agreed, in whole dollar amounts. (For Outboard Motors Only)
ENGINE/MOTOR	Other	Enter text: The description of any other pertinent information to assist in underwriting the policy.
ENGINE/MOTOR	Year	Enter year: The model year of the engine/motor.
ENGINE/MOTOR	Manufacturer/Model	Enter text: The manufacturer of the engine/motor.
ENGINE/MOTOR		Enter text: The manufacturer's model name for the engine/motor.
ENGINE/MOTOR	Serial Number	Enter identifier: The serial number of the engine/motor.
ENGINE/MOTOR	Horsepower	Enter number: The horsepower of the engine. There is a method for determining the maximum safe horsepower for a specific boat based on length and width. If the company employs this formula, it may be helpful to make note of the width in remarks.
ENGINE/MOTOR	Fuel - Gasoline	Check the box (if applicable): Indicates the engine/motor runs on gasoline.
ENGINE/MOTOR	Diesel	Check the box (if applicable): Indicates the engine/motor runs on diesel fuel.
ENGINE/MOTOR	Battery	Check the box (if applicable): Indicates the engine/motor is runs on battery power.
ENGINE/MOTOR	Date Purchased	Enter date: The date the engine/motor was purchased.
ENGINE/MOTOR	Cost New	Enter amount: The cost of the engine/motor when it was purchased new, in whole dollar amounts. (For Outboard Motors Only)
ENGINE/MOTOR	Present Value	Enter amount: The engine/motor's present value, stated or agreed, in whole dollar amounts. (For Outboard Motors Only)
ENGINE/MOTOR	Other	Enter text: The description of any other pertinent information to assist in underwriting the policy.
TRAILER	Year	Enter year: The model year of the trailer.
TRAILER	Manufacturer/Model	Enter text: The manufacturer of the trailer.
TRAILER		Enter text: The manufacturer's model name for the trailer.
TRAILER	Serial Number	Enter identifier: The serial number of the trailer.

ACORD 82 (2007/06) 7 of 24

Section Name	Field Name	Field and/or Section Description
TRAILER	# Axles	Enter number: The number of axels on the trailer.
TRAILER	Capacity	Enter number: The capacity/volume of the watercraft trailer.
TRAILER	Date Purchased	Enter date: The date the trailer was purchased.
TRAILER	Cost	Enter amount: The cost of the boat trailer when it was purchased, in whole dollar amounts.
COVERAGES/LIMITS OF LIABILITY	Hull - Limit	Enter limit: The limit for boat (hull) coverage. This may include collision liability.
COVERAGES/LIMITS OF LIABILITY	Hull - Deductible	Enter deductible: The deductible for boat (hull) coverage.
COVERAGES/LIMITS OF LIABILITY	Hull - Premium	Enter amount: The premium for boat (hull) coverage.
COVERAGES/LIMITS OF LIABILITY	Outboard Motor 1 - Limit	Enter limit: The limit for outboard motor coverage.
COVERAGES/LIMITS OF LIABILITY	Outboard Motor 1 - Deductible	Enter deductible: The deductible for outboard motor coverage.
COVERAGES/LIMITS OF LIABILITY	Outboard Motor 1 - Premium	Enter amount: The premium for outboard motor coverage.
COVERAGES/LIMITS OF LIABILITY	Outboard Motor 2 - Limit	Enter limit: The limit for outboard motor coverage.
COVERAGES/LIMITS OF LIABILITY	Outboard Motor 2 - Deductible	Enter deductible: The deductible for outboard motor coverage.
COVERAGES/LIMITS OF LIABILITY	Outboard Motor 2 - Premium	Enter amount: The premium for outboard motor coverage.
COVERAGES/LIMITS OF LIABILITY	Portable Accessories - Limit	Enter limit: The limit for portable accessories (equipment not permanently attached to the boat) coverage.
COVERAGES/LIMITS OF LIABILITY	Portable Accessories - Deductible	Enter deductible: The deductible for portable accessories (equipment not permanently attached to the boat) coverage.
COVERAGES/LIMITS OF LIABILITY	Portable Accessories - Premium	Enter amount: The premium for portable accessories (equipment not permanently attached to the boat) coverage.
COVERAGES/LIMITS OF LIABILITY	Trailer - Limit	Enter limit: The limit for trailer coverage.
COVERAGES/LIMITS OF LIABILITY	Trailer - Deductible	Enter deductible: The deductible for trailer coverage.
COVERAGES/LIMITS OF LIABILITY	Trailer - Premium	Enter amount: The premium for trailer coverage.

ACORD 82 (2007/06) 8 of 24

Section Name	Field Name	Field and/or Section Description
COVERAGES/LIMITS OF LIABILITY	Personal Effects - Limit	Enter limit: The limit for personal effects coverage.
COVERAGES/LIMITS OF LIABILITY	Personal Effects - Deductible	Enter deductible: The deductible for personal effects coverage.
COVERAGES/LIMITS OF LIABILITY	Personal Effects - Premium	Enter amount: The premium for personal effects coverage.
COVERAGES/LIMITS OF LIABILITY	Towing - Limit	Enter limit: The limit for towing coverage.
COVERAGES/LIMITS OF LIABILITY	Towing - Deductible	Enter deductible: The deductible for towing coverage.
COVERAGES/LIMITS OF LIABILITY	Towing - Premium	Enter amount: The premium for towing coverage.
COVERAGES/LIMITS OF LIABILITY	Hurricane Haul-Out - Limit	Enter limit: The limit for hurricane haul out coverage.
COVERAGES/LIMITS OF LIABILITY	Hurricane Haul-Out - Deductible	Enter deductible: The deductible for hurricane haul out coverage.
COVERAGES/LIMITS OF LIABILITY	Hurricane Haul-Out - Premium	Enter amount: The premium for hurricane haul out coverage.
COVERAGES/LIMITS OF LIABILITY	Blank Space - Limit	Enter text: The description of the coverage or adjustment.
COVERAGES/LIMITS OF LIABILITY	Blank Space - Deductible	Enter limit: The limit for the coverage or adjustment.
COVERAGES/LIMITS OF LIABILITY	Blank Space - Premium	Enter deductible: The deductible for the coverage or adjustment.
COVERAGES/LIMITS OF LIABILITY	Blank Space - Limit	Enter amount: The premium for the coverage or adjustment.
COVERAGES/LIMITS OF LIABILITY	Blank Space - Deductible	Enter text: The description of the coverage or adjustment.
COVERAGES/LIMITS OF LIABILITY	Blank Space - Premium	Enter limit: The limit for the coverage or adjustment.
COVERAGES/LIMITS OF LIABILITY	Blank Space - Limit	Enter deductible: The deductible for the coverage or adjustment.
COVERAGES/LIMITS OF LIABILITY	Blank Space - Deductible	Enter amount: The premium for the coverage or adjustment.
COVERAGES/LIMITS OF LIABILITY	Blank Space - Premium	Enter text: The description of the coverage or adjustment.

ACORD 82 (2007/06) 9 of 24

Section Name	Field Name	Field and/or Section Description
COVERAGES/LIMITS OF
LIABILITY	Blank Space - Limit	Enter limit: The limit for the coverage or adjustment.
COVERAGES/LIMITS OF
LIABILITY	Blank Space - Deductible	Enter deductible: The deductible for the coverage or adjustment.
COVERAGES/LIMITS OF
LIABILITY	Blank Space - Premium	Enter amount: The premium for the coverage or adjustment.
COVERAGES/LIMITS OF		Enter limit: The limit amount for combined single limit liability (may be called protection
LIABILITY	Liability - Limit	and indemnity).
COVERAGES/LIMITS OF
LIABILITY	Liability - Deductible	Enter deductible: The deductible for combined single limit boat (hull) coverage.
COVERAGES/LIMITS OF
LIABILITY	Liability - Premium	Enter amount: The premium for combined single limit boat (hull) coverage.
COVERAGES/LIMITS OF
LIABILITY	Liability - Limit	Enter limit: The bodily injury each person limit for boat (hull) damage.
COVERAGES/LIMITS OF
LIABILITY	Liability - Deductible	Enter deductible: The deductible for bodily injury coverage.
COVERAGES/LIMITS OF
LIABILITY	Liability - Premium	Enter amount: The premium for bodily injury coverage.
COVERAGES/LIMITS OF
LIABILITY	Liability - Limit	Enter limit: The limit for property damage coverage.
COVERAGES/LIMITS OF
LIABILITY	Liability - Deductible	Enter deductible: The deductible for property damage coverage.
COVERAGES/LIMITS OF
LIABILITY	Liability - Premium	Enter amount: The premium for property damage coverage.
COVERAGES/LIMITS OF		Enter limit: The limit for medical payments for bodily injury to occupants of the boat
LIABILITY	Medical Payments - Limit	coverage.
COVERAGES/LIMITS OF
LIABILITY	Medical Payments - Deductible	Enter deductible: The deductible for medical payments coverage.
COVERAGES/LIMITS OF
LIABILITY	Medical Payments - Premium	Enter amount: The premium for medical payments coverage.
COVERAGES/LIMITS OF
LIABILITY	Uninsured Boaters Liability - Limit	Enter limit: The each accident limit for uninsured boaters coverage.
COVERAGES/LIMITS OF	Uninsured Boaters Liability -
LIABILITY	Deductible	Enter deductible: The deductible for uninsured boaters combined single limit coverage.
COVERAGES/LIMITS OF	Uninsured Boaters Liability -
LIABILITY	Premium	Enter amount: The premium for uninsured boaters combined single limit coverage.

ACORD 82 (2007/06) 10 of 24

Section Name	Field Name	Field and/or Section Description
COVERAGES/LIMITS OF
LIABILITY	Uninsured Boaters Liability - Limit	Enter limit: The each person limit for uninsured boaters bodily injury coverage.
COVERAGES/LIMITS OF	Uninsured Boaters Liability -
LIABILITY	Deductible	Enter deductible: The deductible for uninsured boaters bodily injury coverage.
COVERAGES/LIMITS OF	Uninsured Boaters Liability -
LIABILITY	Premium	Enter amount: The premium for uninsured boaters bodily injury coverage.
COVERAGES/LIMITS OF
LIABILITY	Uninsured Boaters Liability - Limit	Enter limit: The limit for uninsured boaters property damage coverage.
COVERAGES/LIMITS OF	Uninsured Boaters Liability -
LIABILITY	Deductible	Enter deductible: The deductible for uninsured boaters property damage coverage.
COVERAGES/LIMITS OF	Uninsured Boaters Liability -
LIABILITY	Premium	Enter amount: The premium for uninsured boaters property damage coverage.
COVERAGES/LIMITS OF	Underinsured Boaters Liability -
LIABILITY	Limit	Enter limit: The each accident limit for underinsured boaters coverage.
COVERAGES/LIMITS OF	Underinsured Boaters Liability -
LIABILITY	Deductible	Enter deductible: The deductible for underinsured boaters combined single limit coverage.
COVERAGES/LIMITS OF	Underinsured Boaters Liability -
LIABILITY	Premium	Enter amount: The premium for underinsured boaters combined single limit coverage.
COVERAGES/LIMITS OF	Underinsured Boaters Liability -
LIABILITY	Limit	Enter limit: The each person limit for underinsured boaters bodily injury coverage.
COVERAGES/LIMITS OF	Underinsured Boaters Liability -
LIABILITY	Deductible	Enter deductible: The deductible for underinsured boaters bodily injury coverage.
COVERAGES/LIMITS OF	Underinsured Boaters Liability -
LIABILITY	Premium	Enter amount: The premium for underinsured boaters bodily injury coverage.
COVERAGES/LIMITS OF	Underinsured Boaters Liability -
LIABILITY	Limit	Enter limit: The limit for underinsured boaters property damage coverage.
COVERAGES/LIMITS OF	Underinsured Boaters Liability -
LIABILITY	Deductible	Enter deductible: The deductible for underinsured boaters property damage coverage.
COVERAGES/LIMITS OF	Underinsured Boaters Liability -
LIABILITY	Premium	Enter amount: The premium for underinsured boaters property damage coverage.
COVERAGES/LIMITS OF
LIABILITY	Total	Enter amount: The total premium amount for the watercraft.
COVERAGES/LIMITS OF	Other Coverages and	Enter text: The description of any other coverages, adjustments and endorsements to
LIABILITY	Endorsements	apply.
COVERAGES/LIMITS OF	Describe all Credits to Apply to
LIABILITY	each Boat	Enter text: The listing of all credit amounts and names for each watercraft.

ACORD 82 (2007/06) 11 of 24

Section Name	Field Name	Field and/or Section Description
COVERAGES/LIMITS OF LIABILITY	Credit	Enter amount: The total credit amount for the watercraft portion of the policy.
IDENTIFICATION SECTION	Agency Customer ID	Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage).
PAYMENT PLAN	ACORD 610 Attached	Check the box (if applicable): Indicates the ACORD 610 Premium Payment Supplement is attached.
PAYMENT PLAN	Account #	Enter identifier: The account number to be used for billing purposes. This is the billing number assigned by the billing entity. If agency bill, the agency assigns; if direct bill, the insurer assigns. If the account already exists, the agent should provide the previously assigned number.
PAYMENT PLAN	Direct Bill	Check the box (if applicable): Indicates if the policy is to be direct billed.
PAYMENT PLAN	Agency Bill	Check the box (if applicable): Indicates if the policy is to be producer/agency billed.
PAYMENT PLAN	Bill Applicant	Check the box (if applicable): Indicates the payor of the policy is the insured.
PAYMENT PLAN	Bill Mortgagee	Check the box (if applicable): Indicates the payor of the policy is the mortgagee.
PAYMENT PLAN	Bill Other	Check the box (if applicable): Indicates the payor of the policy is other than those listed.
PAYMENT PLAN	Bill Other Description	Enter text: The description of the payor of the policy.
PAYMENT PLAN	Full Pay	Check the box (if applicable): Indicates a full payment will be made on the policy.
PAYMENT PLAN	Other	Check the box (if applicable): Indicates the policy will be paid in a frequency other than those listed.
PAYMENT PLAN	Other Description	Enter code: The payment plan for the policy.
PAYMENT PLAN	Agent	Check the box (if applicable): Indicates if the policy paper should be sent to the producer.
PAYMENT PLAN	Applicant	Check the box (if applicable): Indicates if the policy paper should be mailed directly to the named insured.
PAYMENT PLAN	Other	Check the box (if applicable): Indicates if the policy paper should be mailed to other than the agent or applicant.
PAYMENT PLAN	Other Description	Enter text: The description of whom the policy paper should be mailed to.
ADDITIONAL INTEREST	Addl Interest	Check the box (if applicable): Indicates the additional interest type is an additional interest.
ADDITIONAL INTEREST	Loss Payee	Check the box (if applicable): Indicates the additional interest type is a loss payee.
ADDITIONAL INTEREST	Other	Check the box (if applicable): Indicates the additional interest is not any of the types listed on the form.
ADDITIONAL INTEREST	Other Description	Enter text: The description of the type of interest in the item.
ADDITIONAL INTEREST	Name and Address	Enter text: The additional interest's full name.
ADDITIONAL INTEREST		Enter text: The additional interest's mailing address line one.

ACORD 82 (2007/06) 12 of 24

Section Name	Field Name	Field and/or Section Description
ADDITIONAL INTEREST		Enter text: The additional interest's mailing address line two.
ADDITIONAL INTEREST		Enter text: The additional interest's mailing address city name.
ADDITIONAL INTEREST		Enter code: The additional interest's mailing address state or province code.
ADDITIONAL INTEREST		Enter code: The additional interest's mailing address postal code.
ADDITIONAL INTEREST	Loan Number	Enter identifier: The account number (loan number).
ADDITIONAL INTEREST	Addl Interest	Check the box (if applicable): Indicates the additional interest type is an additional interest.
ADDITIONAL INTEREST	Loss Payee	Check the box (if applicable): Indicates the additional interest type is a loss payee.
ADDITIONAL INTEREST	Other	Check the box (if applicable): Indicates the additional interest is not any of the types listed on the form.
ADDITIONAL INTEREST	Other Description	Enter text: The description of the type of interest in the item.
ADDITIONAL INTEREST	Name and Address	Enter text: The additional interest's full name.
ADDITIONAL INTEREST		Enter text: The additional interest's mailing address line one.
ADDITIONAL INTEREST		Enter text: The additional interest's mailing address line two.
ADDITIONAL INTEREST		Enter text: The additional interest's mailing address city name.
ADDITIONAL INTEREST		Enter code: The additional interest's mailing address state or province code.
ADDITIONAL INTEREST		Enter code: The additional interest's mailing address postal code.
ADDITIONAL INTEREST	Loan Number	Enter identifier: The account number (loan number).
RATING/UNDERWRITING	Hull No.	Enter number: The producer assigned number for the watercraft.
RATING/UNDERWRITING	Bilge Pumps	Enter Y for a “Yes” response. Input N for “No” response. Indicate if the watercraft has a bilge pump. A bilge pump is a manually operated or automatically activated device used for pumping water from the inner part of the ship's hull. Using the same principle as the manual pump, the automatic pump is activated by the rise of water within the hull. Specify the manufacturer and the model (e.g., Dynaflow Pump 304) in the Remarks section.
RATING/UNDERWRITING	Cooking Stove	Enter Y for a “Yes” response. Input N for “No” response. Indicates if there is a cooking stove in the watercraft. Use the Remarks section to indicate the manufacturer, model, fuel type and the number of stoves.
RATING/UNDERWRITING	Fume Detector	Enter Y for a “Yes” response. Input N for “No” response. Indicates if there is a fume detector on the watercraft. A fume detector is a device used for detecting the presence of fuel vapors below deck. Specify the manufacturer and model (e.g., Sniffer 203) in the Remarks section.

ACORD 82 (2007/06) 13 of 24

Section Name	Field Name	Field and/or Section Description
RATING/UNDERWRITING	CO2/ Chemical System	Enter Y for a “Yes” response. Input N for “No” response. Indicates if there is a carbon dioxide (CO2)/chemical system on the watercraft. A CO2 or chemical system is a built-in fire extinguishing device. Use the Remarks section to Indicate if it is manual or automatic and identify the spaces protected. Include the manufacturer and model.
RATING/UNDERWRITING	Fire Extinguishers	Enter Y for a “Yes” response. Input N for “No” response. Indicates if there is a fire extinguisher on the watercraft. Use the Remarks section to indicate the number of fire extinguishers, the type, size, and the date last weighed, if available.
RATING/UNDERWRITING	Depth Sounder	Enter Y for a “Yes” response. Input N for “No” response. Indicates if there is a depth sounder on the watercraft. An electronic device for determining the depth of the water beneath the boat. Use the Remarks section to indicate the manufacturer and model (e.g., Moran 6" - 150/SV-300).
RATING/UNDERWRITING	Radar	Enter Y for a “Yes” response. Input N for “No” response. Indicates if the watercraft has a radar system. A radar system is a device for detecting distant objects and determining their position. Specify the manufacturer and model in the Remarks section.
RATING/UNDERWRITING	Radio Direction Finder	Enter Y for a “Yes” response. Input N for “No” response. Indicates if the watercraft has a radio direction finder used as a navigational aid employing a radio signal. Enter the manufacturer and model (e.g., Loran, GSP) in the Remarks section.
RATING/UNDERWRITING	Ship to Shore Radio	Enter Y for a “Yes” response. Input N for “No” response. Indicates if the watercraft has a ship to shore radio. Use the Remarks section to indicate the type of radio. Examples: * SSB-Single Side Band * VHF-FM-Very High Frequency - Frequency Modulation * CB -Citizens Band * Cellular Phones * Marine Radio
RATING/UNDERWRITING	Anti-Theft Devices	Enter Y for a “Yes” response. Input N for “No” response. Indicates if the watercraft has an anti-theft device. Special locks, burglar alarms or engine cut-out devices may be employed by the applicant. Marina security may be noted as well using the Remarks section.
RATING/UNDERWRITING	Heating	Enter Y for a “Yes” response. Input N for “No” response. Indicates if the watercraft has a heating system.
RATING/UNDERWRITING	Other Description	Enter text: The description of the equipment on the watercraft.

ACORD 82 (2007/06) 14 of 24

Section Name	Field Name	Field and/or Section Description
RATING/UNDERWRITING	Other	Enter Y for a “Yes” response. Input N for “No” response. Indicates there is equipment other than those listed.
PORTABLE ACCESSORIES AND LIFEBOATS / TENDERS	Hull No.	Enter number: The producer assigned number for the watercraft.
PORTABLE ACCESSORIES AND LIFEBOATS / TENDERS	Equipment	Enter text: The description of the equipment (ex. lifeboat, tender, etc.).
PORTABLE ACCESSORIES AND LIFEBOATS / TENDERS	Year	Enter year: The model year of the equipment.
PORTABLE ACCESSORIES AND LIFEBOATS / TENDERS	Manufacturer	Enter text: The name of the manufacturer of the equipment.
PORTABLE ACCESSORIES AND LIFEBOATS / TENDERS	Model	Enter text: The manufacturer's model name for the equipment.
PORTABLE ACCESSORIES AND LIFEBOATS / TENDERS	Serial Number	Enter identifier: The serial number for the equipment.
PORTABLE ACCESSORIES AND LIFEBOATS / TENDERS	Limit	Enter amount: The limit amount required for the equipment.
PORTABLE ACCESSORIES AND LIFEBOATS / TENDERS	Equipment	Enter text: The description of the equipment (ex. lifeboat, tender, etc.).
PORTABLE ACCESSORIES AND LIFEBOATS / TENDERS	Year	Enter year: The model year of the equipment.
PORTABLE ACCESSORIES AND LIFEBOATS / TENDERS	Manufacturer	Enter text: The name of the manufacturer of the equipment.
PORTABLE ACCESSORIES AND LIFEBOATS / TENDERS	Model	Enter text: The manufacturer's model name for the equipment.

ACORD 82 (2007/06) 15 of 24

Section Name	Field Name	Field and/or Section Description
PORTABLE ACCESSORIES AND LIFEBOATS / TENDERS	Serial Number	Enter identifier: The serial number for the equipment.
PORTABLE ACCESSORIES AND LIFEBOATS / TENDERS	Limit	Enter amount: The limit amount required for the equipment.
PORTABLE ACCESSORIES AND LIFEBOATS / TENDERS	Equipment	Enter text: The description of the equipment (ex. lifeboat, tender, etc.).
PORTABLE ACCESSORIES AND LIFEBOATS / TENDERS	Year	Enter year: The model year of the equipment.
PORTABLE ACCESSORIES AND LIFEBOATS / TENDERS	Manufacturer	Enter text: The name of the manufacturer of the equipment.
PORTABLE ACCESSORIES AND LIFEBOATS / TENDERS	Model	Enter text: The manufacturer's model name for the equipment.
PORTABLE ACCESSORIES AND LIFEBOATS / TENDERS	Serial Number	Enter identifier: The serial number for the equipment.
PORTABLE ACCESSORIES AND LIFEBOATS / TENDERS	Limit	Enter amount: The limit amount required for the equipment.
OPERATORS	#	Enter number: The number assigned to the driver by the producer.
OPERATORS	Name	Enter text: The driver's first name (given name).
OPERATORS		Enter text: The driver's middle name or initial (other given name).
OPERATORS		Enter text: The driver's last name (surname).
OPERATORS	Sex	Enter code: The gender of the driver.
OPERATORS	Marital Status	Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
OPERATORS	Date of Birth	Enter date: The birth date of the driver.
OPERATORS	Occupation	Enter text: The occupation of the driver.
OPERATORS	Auto Driver's License Number	Enter identifier: The driver's license number.
OPERATORS	Licensed State	Enter code: The state the driver is licensed in.

ACORD 82 (2007/06) 16 of 24

Section Name	Field Name	Field and/or Section Description
OPERATORS	Social Security	Enter identifier: The tax identifier (social security number) of the driver.
OPERATORS	#	Enter number: The number assigned to the driver by the producer.
OPERATORS	Name	Enter text: The driver's first name (given name).
OPERATORS		Enter text: The driver's middle name or initial (other given name).
OPERATORS		Enter text: The driver's last name (surname).
OPERATORS	Sex	Enter code: The gender of the driver.
OPERATORS	Marital Status	Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
OPERATORS	Date of Birth	Enter date: The birth date of the driver.
OPERATORS	Occupation	Enter text: The occupation of the driver.
OPERATORS	Auto Driver's License Number	Enter identifier: The driver's license number.
OPERATORS	Licensed State	Enter code: The state the driver is licensed in.
OPERATORS	Social Security	Enter identifier: The tax identifier (social security number) of the driver.
OPERATORS	#	Enter number: The number assigned to the driver by the producer.
OPERATORS	Name	Enter text: The driver's first name (given name).
OPERATORS		Enter text: The driver's middle name or initial (other given name).
OPERATORS		Enter text: The driver's last name (surname).
OPERATORS	Sex	Enter code: The gender of the driver.
OPERATORS	Marital Status	Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
OPERATORS	Date of Birth	Enter date: The birth date of the driver.
OPERATORS	Occupation	Enter text: The occupation of the driver.
OPERATORS	Auto Driver's License Number	Enter identifier: The driver's license number.
OPERATORS	Licensed State	Enter code: The state the driver is licensed in.
OPERATORS	Social Security	Enter identifier: The tax identifier (social security number) of the driver.
OPERATORS	#	Enter number: The number assigned to the driver by the producer.
OPERATORS	Name	Enter text: The driver's first name (given name).
OPERATORS		Enter text: The driver's middle name or initial (other given name).
OPERATORS		Enter text: The driver's last name (surname).
OPERATORS	Sex	Enter code: The gender of the driver.
OPERATORS	Marital Status	Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
OPERATORS	Date of Birth	Enter date: The birth date of the driver.

ACORD 82 (2007/06) 17 of 24

Section Name	Field Name	Field and/or Section Description
OPERATORS	Occupation	Enter text: The occupation of the driver.
OPERATORS	Auto Driver's License Number	Enter identifier: The driver's license number.
OPERATORS	Licensed State	Enter code: The state the driver is licensed in.
OPERATORS	Social Security	Enter identifier: The tax identifier (social security number) of the driver.
OPERATORS	#	Enter number: The number assigned to the driver by the producer.
OPERATORS	Name	Enter text: The driver's first name (given name).
OPERATORS		Enter text: The driver's middle name or initial (other given name).
OPERATORS		Enter text: The driver's last name (surname).
OPERATORS	Sex	Enter code: The gender of the driver.
OPERATORS	Marital Status	Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
OPERATORS	Date of Birth	Enter date: The birth date of the driver.
OPERATORS	Occupation	Enter text: The occupation of the driver.
OPERATORS	Auto Driver's License Number	Enter identifier: The driver's license number.
OPERATORS	Licensed State	Enter code: The state the driver is licensed in.
OPERATORS	Social Security	Enter identifier: The tax identifier (social security number) of the driver.
OPERATORS	#	Enter number: The number assigned to the driver by the producer.
OPERATORS	Name	Enter text: The driver's first name (given name).
OPERATORS		Enter text: The driver's middle name or initial (other given name).
OPERATORS		Enter text: The driver's last name (surname).
OPERATORS	Sex	Enter code: The gender of the driver.
OPERATORS	Marital Status	Enter code: The marital status of the driver. Examples are: S - Single; M - Married; D -Divorced; P - Separated; W - Widowed, C - Domestic Partner (unmarried), V - Civil Union, U - Unknown, O - Other
OPERATORS	Date of Birth	Enter date: The birth date of the driver.
OPERATORS	Occupation	Enter text: The occupation of the driver.
OPERATORS	Auto Driver's License Number	Enter identifier: The driver's license number.
OPERATORS	Licensed State	Enter code: The state the driver is licensed in.
OPERATORS	Social Security	Enter identifier: The tax identifier (social security number) of the driver.
OPERATORS EXPERIENCE	#	Enter number: The producer assigned number for the driver.
OPERATORS EXPERIENCE	Prior Boat Make	Enter text: The name of the manufacturer of the prior watercraft.
OPERATORS EXPERIENCE	Model	Enter text: The manufacturer's model name for the prior watercraft.

ACORD 82 (2007/06) 18 of 24

Section Name	Field Name	Field and/or Section Description
OPERATORS EXPERIENCE	Number of Years Owned	Enter number: The number of years the prior watercraft was owned.
OPERATORS EXPERIENCE	Experience	Enter text: Describe any operator completed courses offered by the United States Coast Guard Auxiliary, the Power Squadron or other recognized training.
OPERATORS EXPERIENCE	#	Enter number: The producer assigned number for the driver.
OPERATORS EXPERIENCE	Prior Boat Make	Enter text: The name of the manufacturer of the prior watercraft.
OPERATORS EXPERIENCE	Model	Enter text: The manufacturer's model name for the prior watercraft.
OPERATORS EXPERIENCE	Number of Years Owned	Enter number: The number of years the prior watercraft was owned.
OPERATORS EXPERIENCE	Experience	Enter text: Describe any operator completed courses offered by the United States Coast Guard Auxiliary, the Power Squadron or other recognized training.
OPERATORS EXPERIENCE	#	Enter number: The producer assigned number for the driver.
OPERATORS EXPERIENCE	Prior Boat Make	Enter text: The name of the manufacturer of the prior watercraft.
OPERATORS EXPERIENCE	Model	Enter text: The manufacturer's model name for the prior watercraft.
OPERATORS EXPERIENCE	Number of Years Owned	Enter number: The number of years the prior watercraft was owned.
OPERATORS EXPERIENCE	Experience	Enter text: Describe any operator completed courses offered by the United States Coast Guard Auxiliary, the Power Squadron or other recognized training.
OPERATORS EXPERIENCE	#	Enter number: The producer assigned number for the driver.
OPERATORS EXPERIENCE	Prior Boat Make	Enter text: The name of the manufacturer of the prior watercraft.
OPERATORS EXPERIENCE	Model	Enter text: The manufacturer's model name for the prior watercraft.
OPERATORS EXPERIENCE	Number of Years Owned	Enter number: The number of years the prior watercraft was owned.
OPERATORS EXPERIENCE	Experience	Enter text: Describe any operator completed courses offered by the United States Coast Guard Auxiliary, the Power Squadron or other recognized training.
OPERATORS EXPERIENCE	#	Enter number: The producer assigned number for the driver.

ACORD 82 (2007/06) 19 of 24

Section Name	Field Name	Field and/or Section Description
OPERATORS EXPERIENCE	Prior Boat Make	Enter text: The name of the manufacturer of the prior watercraft.
OPERATORS EXPERIENCE	Model	Enter text: The manufacturer's model name for the prior watercraft.
OPERATORS EXPERIENCE	Number of Years Owned	Enter number: The number of years the prior watercraft was owned.
OPERATORS EXPERIENCE	Experience	Enter text: Describe any operator completed courses offered by the United States Coast Guard Auxiliary, the Power Squadron or other recognized training.
OPERATORS EXPERIENCE	#	Enter number: The producer assigned number for the driver.
OPERATORS EXPERIENCE	Prior Boat Make	Enter text: The name of the manufacturer of the prior watercraft.
OPERATORS EXPERIENCE	Model	Enter text: The manufacturer's model name for the prior watercraft.
OPERATORS EXPERIENCE	Number of Years Owned	Enter number: The number of years the prior watercraft was owned.
OPERATORS EXPERIENCE	Experience	Enter text: Describe any operator completed courses offered by the United States Coast Guard Auxiliary, the Power Squadron or other recognized training.
REMARKS	Remarks	Enter text: The remarks associated with the watercraft line of business.
IDENTIFICATION SECTION	Agency Customer ID	Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage).
HULL INFORMATION	Hull No.	Enter number: The producer assigned number for the watercraft.
HULL INFORMATION	1. Is the boat chartered to others? -Yes	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is the boat chartered to others?". If yes, describe the type of arrangements, destination, length of time and frequency. Indicate if it is a bare boat charter where no crew or supervision is furnished, a voyage charter, a time charter, etc. Include the purpose of the charter (sight-seeing, fishing) and whether alcohol is served.
HULL INFORMATION	1. Is the boat chartered to others? -Remarks	Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
HULL INFORMATION	2. Is the boat used commercially or for business purposes? - Yes	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is the boat used commercially or for business purposes?". If yes, describe the commercial or business use of the vessel. Indicate if the vessel is used for demonstrations, promotions, fishing, sight-seeing trips, etc.

ACORD 82 (2007/06) 20 of 24

Section Name	Field Name	Field and/or Section Description
HULL INFORMATION	2. Is the boat used commercially or for business purposes? - Remarks	Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
HULL INFORMATION	3. Is the boat used for racing? -Yes	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is the boat used for racing?". If yes, indicate the frequency of such races during the year, the extent of the race, the waters navigated, etc.
HULL INFORMATION	3. Is the boat used for racing? -Remarks	Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
HULL INFORMATION	4. Is the boat used for waterskiing? - Yes	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is the boat used for waterskiing?". If yes, indicate how frequently the vessel is used for waterskiing.
HULL INFORMATION	4. Is the boat used for waterskiing? - Remarks	Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
HULL INFORMATION	5. Does the applicant employ a paid crew? - Yes	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Does the applicant employ a paid crew?".
HULL INFORMATION	5. Does the applicant employ a paid crew? - Remarks	Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
HULL INFORMATION	6. Any sleeping facilities? - Yes	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any sleeping facilities?".
HULL INFORMATION	6. Any sleeping facilities? -Remarks	Enter number: The number of beds on the watercraft.
HULL INFORMATION	7. Any existing damage to the boat? - Yes	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any existing damage to the boat?".
HULL INFORMATION	7. Any existing damage to the boat? - Remarks	Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
HULL INFORMATION	8. Is the boat used as a primary residence? - Yes	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Is the boat used as a primary residence?".
HULL INFORMATION	8. Is the boat used as a primary residence? - Remarks	Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
HULL INFORMATION	9. Are there any additional owners not listed as the named insured? -Yes	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Are there any additional owners not listed as the named insured?".
HULL INFORMATION	9. Are there any additional owners not listed as the named insured? -Remarks	Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.

ACORD 82 (2007/06) 21 of 24

Section Name	Field Name	Field and/or Section Description
GENERAL INFORMATION	1. Has the applicant lived at current address for less than three (3) years? - Yes	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Has the applicant lived at current address for less than the specified number of years?". If yes, provide the previous address.
GENERAL INFORMATION	1. Has the applicant lived at current address for less than three (3) years? - Remarks	Enter text: The first address line of the previous residence address.
GENERAL INFORMATION		Enter text: The second address line of the previous residence.
GENERAL INFORMATION		Enter text: The city of the previous residence.
GENERAL INFORMATION		Enter code: The state or province code of the previous residence.
GENERAL INFORMATION		Enter text: The postal code of the previous residence.
GENERAL INFORMATION	2. Any operator have physical/mental impairment? - Yes	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any driver have physical/mental impairment? (Not applicable in Wisconsin)". Answer "Yes" only if the impairment impedes the use of the watercraft. Indicate the impairment and any applicable medical treatment being used.
GENERAL INFORMATION	2. Any operator have physical/mental impairment? -Remarks	Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION	3. Any drivers license suspended/revoked during the last three (3) years? - Yes	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any drivers license been suspended/revoked during the last mandated number of years?". If yes, indicate if the drivers license of any operator was suspended or revoked and explain the circumstances.
GENERAL INFORMATION	3. Any drivers license suspended/revoked during the last three (3) years? - Remarks	Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION	4. Has any operator had an accident/conviction during the last three (3) years? - Yes	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any operator had an accident/conviction during the last specified number of years?". If yes, describe accidents/convictions for both driving and boating records.
GENERAL INFORMATION	4. Has any operator had an accident/conviction during the last three (3) years? - Remarks	Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION	5. Any other insurance with this company? - Yes	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any other insurance with this company?". If a submission was mailed to another department recently, note it in the remarks section along with any policy numbers available.

ACORD 82 (2007/06) 22 of 24

Section Name	Field Name	Field and/or Section Description
GENERAL INFORMATION	5. Any other insurance with this company? - Remarks	Enter code: The line of business of the other policy.
GENERAL INFORMATION		Enter identifier: The other policy number exactly as it appears on the policy, including prefix and suffix symbols.
GENERAL INFORMATION		Enter code: The line of business of the other policy.
GENERAL INFORMATION		Enter identifier: The other policy number exactly as it appears on the policy, including prefix and suffix symbols.
GENERAL INFORMATION		Enter code: The line of business of the other policy.
GENERAL INFORMATION		Enter identifier: The other policy number exactly as it appears on the policy, including prefix and suffix symbols.
GENERAL INFORMATION		Enter code: The line of business of the other policy.
GENERAL INFORMATION		Enter identifier: The other policy number exactly as it appears on the policy, including prefix and suffix symbols.
GENERAL INFORMATION	6. Any losses occur during the last three (3) years? - Yes	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Did any loss occur during the last specified number of years?". If yes, describe in detail including data on the operator, the type of loss, the amount of the loss, the date and the disposition.
GENERAL INFORMATION	6. Any losses occur during the last three (3) years? - Remarks	Enter number: The producer assigned number for the driver involved in the loss, if applicable.
GENERAL INFORMATION		Enter date: The date when the accident or incident occurred that resulted in the filing of a claim.
GENERAL INFORMATION		Enter code: The basic coverage provided, under which the loss incurred.
GENERAL INFORMATION		Enter amount: The amount that has been paid on this claim to date.
GENERAL INFORMATION		Enter code: Indicates the status of the claim (e.g. open, closed, etc.).
GENERAL INFORMATION		Enter number: The producer assigned number for the driver involved in the loss, if applicable.
GENERAL INFORMATION		Enter date: The date when the accident or incident occurred that resulted in the filing of a claim.
GENERAL INFORMATION		Enter code: The basic coverage provided, under which the loss incurred.
GENERAL INFORMATION		Enter amount: The amount that has been paid on this claim to date.
GENERAL INFORMATION		Enter code: Indicates the status of the claim (e.g. open, closed, etc.).
GENERAL INFORMATION		Enter number: The producer assigned number for the driver involved in the loss, if applicable.
GENERAL INFORMATION		Enter date: The date when the accident or incident occurred that resulted in the filing of a claim.
GENERAL INFORMATION		Enter code: The basic coverage provided, under which the loss incurred.

ACORD 82 (2007/06) 23 of 24

Section Name	Field Name	Field and/or Section Description
GENERAL INFORMATION		Enter amount: The amount that has been paid on this claim to date.
GENERAL INFORMATION		Enter code: Indicates the status of the claim (e.g. open, closed, etc.).
GENERAL INFORMATION		Enter number: The producer assigned number for the driver involved in the loss, if applicable.
GENERAL INFORMATION		Enter date: The date when the accident or incident occurred that resulted in the filing of a claim.
GENERAL INFORMATION		Enter code: The basic coverage provided, under which the loss incurred.
GENERAL INFORMATION		Enter amount: The amount that has been paid on this claim to date.
GENERAL INFORMATION		Enter code: Indicates the status of the claim (e.g. open, closed, etc.).
GENERAL INFORMATION	7. Any coverage declined, cancelled, or non-renewed during the last five (5) years? - Yes	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "Any coverage declined, cancelled or non-renewed during the specified number of years? (Not applicable in Missouri)".
GENERAL INFORMATION	7. Any coverage declined, cancelled, or non-renewed during the last five (5) years? - Remarks	Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
GENERAL INFORMATION	8. During the last five years (ten in Rhode Island), has any applicant been indicted for or convicted of any degree of the crime of fraud, bribery, arson or other arson-related crime in connection with this or any other property ? - Yes	Enter Y for a “Yes” response. Input N for “No” response. Indicates the response to the question, "During the last five (5) years [ten (10) years in Rhode Island], has any applicant been indicted for or convicted of any degree of the crime of fraud, bribery, arson or any other arson related crime in connection with this or any other property? (In RI, failure to disclose the existence of an arson conviction is a misdemeanor punishable by a sentence of up to one (1) year of imprisonment.)". If yes, provide details of the indictment or conviction.
GENERAL INFORMATION	8. During the last five years (ten in Rhode Island), has any applicant been indicted for or convicted of any degree of the crime of fraud, bribery, arson or other arson-related crime in connection with this or any other property ? -Remarks	Enter text: An explanation of a response to a general information or underwriting question. Normally, "Yes" responses require an explanation.
REMARKS	Remarks	Enter text: The remarks associated with the watercraft line of business.
IDENTIFICATION SECTION	Agency Customer ID	Enter identifier: The customer's identification number assigned by the producer (e.g. agency or brokerage).

ACORD 82 (2007/06) 24 of 24

Section Name	Field Name	Field and/or Section Description
ATTACHMENTS	State Supplement(s)	Check the box (if applicable): Indicates a state supplement is attached.
ATTACHMENTS	Photograph	Check the box (if applicable): Indicates a photograph is attached.
ATTACHMENTS	Survey	Check the box (if applicable): Indicates a survey is attached.
ATTACHMENTS	Coast Guard Certificate	Check the box (if applicable): Indicates a coast guard certificate is attached.
ATTACHMENTS	Inspection	Check the box (if applicable): Indicates an inspection is attached.
ATTACHMENTS	Other	Check the box (if applicable): Indicates there is an attachment other than those listed.
ATTACHMENTS	Other Description	Enter text: The description of the attachment.
ATTACHMENTS	Other	Check the box (if applicable): Indicates there is an attachment other than those listed.
ATTACHMENTS	Other Description	Enter text: The description of the attachment.
ATTACHMENTS	Other	Check the box (if applicable): Indicates there is an attachment other than those listed.
ATTACHMENTS	Other Description	Enter text: The description of the attachment.
REMARKS	Remarks	Enter text: The remarks associated with the watercraft line of business.
REMARKS	Remarks	Enter text: The remarks associated with the watercraft line of business.
BINDER/SIGNATURE	Effective Date	Enter date: The effective date of the binder.
BINDER/SIGNATURE	Time	Enter time: The time of the binder effective date that the binder becomes effective.
BINDER/SIGNATURE	Expiration Date	Enter date: The expiration date of the binder.
BINDER/SIGNATURE	12:01/ Noon	Check the box (if applicable): Indicates the binder expires at 12:01 AM on the expiration date.
BINDER/SIGNATURE	Noon	Check the box (if applicable): Indicates the binder expires at 12:00 noon on the expiration date.
BINDER/SIGNATURE	Coverage Is Not Bound	Check the box (if applicable): Indicates the coverage has not been bound.
BINDER/SIGNATURE	Notice of Information Practices	Check the box (if applicable): Indicates that a copy of the Notice of Information Practices has been given to the applicant.
BINDER/SIGNATURE	Applicant's Signature	Sign here: Accommodates the signature of the applicant or named insured.
BINDER/SIGNATURE	Date	Enter date: The date the form was signed by the named insured.
BINDER/SIGNATURE	Producer's Signature	Sign here: Accommodates the signature of the authorized representative (e.g. producer, agent, broker, etc.). by all companies to issue Certificates.
BINDER/SIGNATURE	National Producer Number	Enter identifier: The National Producer Number (NPN) as defined in the National Insurance Producer Registry (NIPR).
Edition	Date	The edition identifier of the form including the form number and edition (the date is typically formatted YYYY/MM).