30. Are you a subcontractor? Yes No
31. Do you subcontract work? Yes No
If yes, do you obtain certificates of insurance? Yes No
If yes, Limit $ ____________
32. Are you named as an insured on other policies? Yes No
33. Do you rent or lease any property? Yes No
If yes, approximate size of property ___________________________________
34. Do you have any docks on your property? Yes No
If yes, how many slips _____________
35. Owner: Date of birth: ________________________ Years in this trade ___________________
Licenses held: ______________________________________________________________________________________
Certifications/education: _____________________________________________________________________________
__________________________________________________________________________________________________
Past employment positions: ___________________________________________________________________________
__________________________________________________________________________________________________
36. Employee: For each employee, list years with this business and certification (attach separate page if necessary)
Name: _________________________________________________ Years: __________________________________
Certifications: ______________________________________________________________________________________
37. Limit of liability requested $: ____________________ Effective date: _________________________________
38. Current Insurance Company: _______________________________________________________________________
NOTICE TO APPLICANTS: THIS APPLICATION MUST BE COMPLETED IN FULL AS THE QUOTE WILL BE BASED SOLELY ON
THE INFORMATION PROVIDED.
Fraud Warning Notice
ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR OTHER PERSON, FILES
AN APPLICATION FOR INSURANCE CONTAINING FALSE INFORMATION, OR CONCEALS FOR THE PURPOSE OF MISLEADING
INFORMATION CONCERNING ANY FACT MATERIAL THERETO, COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A
CRIME BY SIGNING THIS APPLICATION, THE SIGNOR WARRANTS THAT TO THEIR BEST KNOWLEDGE ALL INFORMATION
GIVEN IS TRUE AND ACCURATE. IN COLORADO, THE DISTRICT OF COLUMBIA, LOUISIANA, MAINE, TENNESSEE, AND
WASHINGTON, INSURANCE BENEFITS MAY ALSO BE DENIED.
_____________________________________ ________________________________________ _____________
Name (type or print) Signature Date
NOTICE TO PRODUCERS: THE PRODUCER HEREBY WARRANTS THAT THE INFORMATION CONTAINED IN THIS
APPLICATION IS TRUE AND CORRECT TO THE BEST OF THEIR KNOWLEDGE.
_____________________________________ ________________________________________ _____________
Signature Date Name (type or print)
______________
License #
Marine Artisans Application 011121 Page 3 of 3
RSGprograms.com
RSG National Specialty Programs is a unit of the RSG Underwriting Managers division of RSG Specialty, LLC, a Delaware limited liability company based in Illinois. RSG Specialty, LLC, is a
subsidiary of Ryan Specialty Group, LLC (RSG). RSG National Specialty Programs works directly with brokers, agents and insurance carriers, and as such does not solicit insurance from the
public. Some products may only be available in certain states, and some products may only be available from surplus lines insurers. In California: RSG Specialty Insurance Services, LLC
(License # 0G97516). ©2021 Ryan Specialty Group, LLC
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