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2. Only licensed steamship agents may apply for berthing space.

   All vessels, including yachts, require an agent.

4. Form cannot be submitted until all spaces are filled. Items must be filled in order for form to submit.
   Where an item is not applicable to your vessel, type "NA".
6. Vessel Name*
7. Call Sign*
9. Official Vessel Number*
10. Vessel Flag*
12. Berth Requested*
13. Length*
15. ETA*
    ETA

    ETA
16. Gross Tons*
18. ETD*
    ETD

    ETD
19. Beam*
21. Agent*
22. Draft*
24. Stevedore*
25. Vessel Phone*
27. ISPS Certificate #*
28. Cargo*

    1. Inbound

    1. Outbound
30. Current Vessel MARSEC Level*

    1. 1
    2. 2

    1. 3
    2. 4
31. Description of Cargo*
33. Additional berth area 1*

    When docked, will the vessel be putting any equipment outside of the vessel on the waterside, such as: Counterweight, pontoon, etc.? 

34. Additional berth area 2*

    If so, please indicate what equipment will be waterside and how long it is anticipated to be in place. 

36. Hazardous Materials on Board*
37. Tonnage*
39. For cargo units exceeding 50 tons, did you receive Port plan approval?*

    1. Yes
    2. No
41. If you answered yes to the question above, please tell us who approved your plan?
43. Cranes Ordered*
44. Select One*

    1. RO/RO
    2. LO/LO

    1. BARGE/TUG
46. For the Above Listed Vessel*

    1. 72-hour notice of arrival

    1. 36-hour notice of arrival

    1. 24-hour notice of arrival
48. Agent Email Address*
49. Agent Contact 24/7 Phone Number*
51. Stevedore Contact Phone Number*
52. Hot Work Permit Requested*

    1. Yes

    1. No
54. Water Service Requested*

    1. Yes

    1. No
55. Line Handlers Requested*

    1. Yes

    1. No
57. Last Port*
58. Next Port*
60. Cleanup of Berth*

    Due to continued challenges with material clean up after bulk/breakbulk deliveries, responsible vessel agents must agree to these terms prior to approving a ship berth request.

    In conjunction with representing the vessel, the vessel agent is submitting this berth application with the clear understanding that complete and thorough cleanup of the dock area must be conducted prior to vessel departure. This cleanup shall include ensuring any materials and that have entered the dockside trench drains are completely removed.

     If the agent fails to ensure a proper cleanup of the area, the agency will be charged for the cleanup.  If the trench drains need to be cleaned, the agency will be charged for a pump truck to clean the drainage system.   The cost of this could be up to $10,000, depending upon how much material has entered the drains.

    
    

Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit Submit and Print

* indicates a required field