Mendoza Insurance
1108 Sheridan Avenue · Chico, CA · 95926 Ph. 530-895-1086 · Fx. 530-894-6166 License #0625161
Office Hours: Mon - Fri · 9am - 5pm · (Closed Noon to 1pm)
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Get A Boater's Insurance Quote
Your Name DOB
Email Address Marital Status
Street Address SSN
City, State, Zip , Occupation:
Phone Number   
 
Please enter the following operator information for all operators:
Operator 1
Full Name
 
Male
Female
Single
Married
 
Occupation
 
Current Age
 
Total Years Licensed
 
Driver's License #
 
Issuing State
 
Total Years Of Watercraft Experience
 
Owner/Operator Status
 
Relation To Insured
Has this operator been convicted of a moving violation or had an accident (regardless of fault or type of vehicle driven) with the past three years?
Yes No
 
If yes, provide details:
 
Operator 2
Full Name
 
Male
Female
Single
Married
 
Occupation
 
Current Age
 
Total Years Licensed
 
Driver's License #
 
Issuing State
 
Total Years Of Watercraft Experience
 
Owner/Operator Status
 
Relation To Insured
Has this operator been convicted of a moving violation or had an accident (regardless of fault or type of vehicle driven) with the past three years?
Yes No
 
If yes, provide details:
 
Operator 3
Full Name
 
Male
Female
Single
Married
 
Occupation
 
Current Age
 
Total Years Licensed
 
Driver's License #
 
Issuing State
 
Total Years Of Watercraft Experience
 
Owner/Operator Status
 
Relation To Insured
Has this operator been convicted of a moving violation or had an accident (regardless of fault or type of vehicle driven) with the past three years?
Yes No
 
If yes, provide details:
 
 
Please enter the following mooring/storage information:
Marina/Location Name
Location Type
 
Location Address (If different from mailing address)
Address
City, State, ZIP
,
 
Location Security (Check All That Apply)
Fenced Area
Security Guard
Lighted Area
Burgular Alarm
Security Camera
Patrolling Security Guard
Closed Gate Marina/Limited Access
 
Please enter the following vessel information:
Manufacturer

Model
Year

Hull Identification No. (HIN)
Primary Waters Navigated

Homemade Vessel
Yes No
 
Power Type (Check All That Apply)
Inboard
Outboard
Inboard/Outdrive
Outboard Jet Drive
Jet Drive
Sail
No Engine
 
 
Hull Material (Check All That Apply)
Alum
Fiber
Wood
Steel
Fiber Over Wood
Composite
Other
 
 
Protective Devices (Check All That Apply)
Automatic Fire Exstinguishing Equipment
Alarm System (High Water/Fire/Theft)
Central Station Monitoring System
No Strike Lightning System
 
Number Of Main Drive
Engines
Horsepower Of Each
Fuel Type

Used For Racing
Yes No
 
Description Of Outboard Motor(s)
(If more than 2 use the Additional Comments Box below)
Motor 1
Manufacturer
Model
Year
Fuel Type
Horsepower
Serial Number
Value Of Motor
$
Motor 2
Manufacturer
Model
Year
Fuel Type
Horsepower
Serial Number
Value Of Motor
$
 
Transport Trailer
Homemade Trailers Are Prohibited
Make
Model
Model Year
Value $
Serial Number
 
Indicate amount of coverage needed $
Trailer deductible
 
Coverages And Limits
Personal Liability Coverage
 
Uninsured Watercraft Coverage
 
Medical Payments Coverage
 
Deductible Options
Age Of Watercraft
Agreed Amount Coverage Deductible
1%
2%
3%
5%
Subject to a minimum deductible.
 
Personal Property
Indicate amount of coverage needed $
Round to the nearest 100. Maximum: $10,000. Deductible: $100.
 
Replacement Cost Option Yes No
 
Additional Comments Or Questions