Bogert Insurance Agency, Inc.
Full Service Insurance Agency - All Lines
"Serving ALL of Florida"
877-316-7800 (FAX)

Our agency is licensed to quote and write insurance policies only in Florida. To find agents offering these coverage in all of the other states, please click the logo.


Boat Insurance Quote
Complete and submit this form to our agency

 Personal Information
  Name (required)  
 E-Mail Address (required)  
 Home Phone  
 Work Phone  

 First Name Birthdate Has Operator completed Coast Guard Auxiliary or Power Squadron course?

 Boat Information (ALL INFO REQUIRED)
 Boat Currently Insured?  
Policy Expires Month/Year
 Boat Type
Where is vessel stored
 Waters Navigated  

 Used for Racing?


  Hull Type  
Estimated Market Value  
Year Built
 Max Speed (in MPH)  
 Personal Effects? (Amount)  
Misc Boating Equip? (Amount)  

 #1 Engine
 Make  Year
 Fuel Type
 Est. Value (O/B Only)
 Horse Power


#2 Engine

 Make  Year
 Fuel Type  
 Est. Value (O/B Only)
 Horse Power

 If Yes

 Liability Coverage
 Medical Payments  
 Water Ski Medical Needed  

 Explain all yes answers below
Has any listed operator been involved in a boating accident within the past 5 years?  
Has your boat and / or equipment suffered damage from any cause within the past 5 years ?  
Has any listed operator been involved in an auto accident or received a moving traffic citation in the past 3 years?  

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© Gordon K. Harden, Jr. 1996-99
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Page Created 11-12-99
Latest Revision