Town of Fairfield, CT
 
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Instructions

Please submit this form using any of the contact methods provided below.

Instructions
The Fairfield Code Sec. 24-11M and Fairfield Harbor Management Commission Rules and Procedures Sec. 3(b) require the Harbor Master to keep a detailed record of all vessels tied up to any dock in the Southport Harbor Management Area. By completing and submitting this Docked Vessel Information Report for your docked vessel in a timely manner you are doing your part to ensure the Harbor Master’s required records for vessels in Southport Harbor are complete and up-to-date.

If you are unable to complete this Docked Vessel Information Report on the Online Mooring system, please contact the Harbor Master at 203-919-7989 or HarborMaster@fairfieldct.org to complete your Docked Vessel Information Report by mail.
Provider Name
Town of Fairfield
Provider Mailing Address
Attn: Southport Harbor Master, Bryan LeClerc
c/o Department of Public Works, 725 Old Post Road
Fairfield, CT 06824
Provider Phone
203-919-7989
Provider FAX
Provider Email
HarborMaster@fairfieldct.org

Application

Reference Number
BVQEYYHC
Application Status
Unknown
Application Type
Docked Vessel Permit
Application Sticker Number

Applicant

Mobile Phone
First Name
Middle Name
Last Name
Contact Information
Home Street
Home City
Home State
Home Zip
Home Phone
Work Phone
Email Address

Vessel

Reg or Doc #
Vessel Name
Vessel Type
Please circle one of the following:

Power

Sail

Vessel
Size
Length
  feet     inches
Beam
  feet     inches
Draft
  feet     inches
Characteristics
Vessel Make
Vessel Model
Vessel Color
Insurance
Insurer Name
Insurer Policy Number
Other
Vessel Photo(s)
(Maximum file size=10MB)

Mooring

Mooring Number
Inspection
Seasonal Status
Location
Mooring Fee Area
Application Latitude/Longitude
  

Attachments

Attach a paper copy of each attachment listed below:
Boat Registration *
Expiration Date
 
Proof of Insurance *
Expiration Date
 
CT Safe Boating Certificate *

Acceptance

Terms and Conditions
I understand that, pursuant to the Harbor Management Commission’s rules and procedures, the owner of any vessel docked within the Southport Harbor Management Area shall be responsible for causing such vessel to be tied and secured with proper care and equipment and in such manner as may be required to prevent the docked vessel from breaking loose and causing damage to any other vessel, persons or property. The Harbor Master may order any vessel that may have broken loose from its dock, or any vessel that, in the judgment of the Harbor Master, is at risk of breaking loose, to be properly reattached or otherwise secured to avoid damage to any other vessel, persons, or property.

I understand that each person docking a vessel in the Southport Harbor Management Area shall be responsible for any damage to his or her own vessel or to any other vessel or property that may be caused by failure to secure his or her own vessel with proper care and equipment in such a manner to prevent the vessel from breaking loose and causing damage to any other vessel, persons or property.

I understand I am responsible for promptly notifying the Harbor Master of any changes to the information I have provided in this Docked Vessel Information Report by entering the updated information in the Online Mooring system and, as warranted, contacting the Harbor Master.

I further agree to maintain liability insurance on the vessel identified in my Docked Vessel Information Report.

I have read and agree to abide by the Rules and Procedures for Mooring Anchoring and Docking Vessel in the Southport Harbor Management Area.

I have read and understand the Online Mooring User Terms and Conditions
Signature
Date
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