WINDSTORM EXCLUSION DISCLAIMER
NAMED INSURED:
QUOTE/POLICY NUMBER:
INSURED VESSEL(S):
As a result of your application for insurance or your request for a policy change, we have provided a quotation which
includes a WINDSTORM EXCLUSION for the insured vessel(s) listed above.
So you can more fully appreciate the benefits and scope of coverage offered in our quote to you, please read the
following additional details and explanations of the policy that will be issued to you:
No coverage exists under this Policy for any demand, claim or “suit” asserting loss, damage, cost, or expense,
arising out of, related to or otherwise resulting directly or indirectly out of, contributed to by or resulting from a
Tropical Depression, Tropical Storm or Hurricane.
This exclusion applies regardless of any other cause or event that contributes concurrently or in any sequence to
the loss, damage, cost or expense, arising out of, related to or otherwise resulting directly or indirectly out of,
contributed to by or resulting from a Tropical Depression, Tropical Storm or Hurricane.
Tropical Depressions, Tropical Storms or Hurricanes are defined as those so designated by the National
Weather Service and/or the National Hurricane Center.
To Request Policy Issuance/Policy Change – If you accept our quotation and wish to request that a Policy/Policy
Change be issued, please sign and date below to acknowledge you understand that the quotation offered by ACE
Recreational Marine includes a WINDSTORM EXCLUSION for the insured vessel(s) listed above, or any subsequent
insured vessel(s) displayed on the Declarations Page or applicable Scheduled Vessel Endorsement for which the
WINDSTORM EXCLUSION is shown. You also acknowledge the WINDSTORM EXCLUSION shall remain in effect for
the term of the Policy and for each renewal, reinstatement, substitute, modified, replacement or amended policy, unless
discontinued by us.
Named Insured/Owner Signature:
______________________________________
Date: __ / __ / ____
(mm/dd/yyyy)
_______________________________________________________________________________
Please return this form to your agent.
Please read your Policy. This information is not intended to amend, alter or modify the actual terms or conditions
in any Policy of insurance or its declarations. Coverage is governed solely by the terms and conditions of the Policy itself.
MA-41055 (01/14)