GEORGIA COMMERCIAL AUTO

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "GEORGIA COMMERCIAL AUTO"

Transcription

1 AGENCY GEORGIA COMMERCIAL / SECTION NAMED INSURED(S) (MM/DD/YYYY) POLICY NUMBER EFFECTIVE CARRIER NAIC CODE BUSINESS SECTION 1 9 EA TOWING TRADITIONAL (REDUCED) NEW (AD ON) (IF APPLICABLE) N-OWNED SYMBOLS 6 6 EACH SON (1) ANY () ALL OWNED S () OWNED PRIVATE PASSENGER S COVERAGE IS: () OWNED S THAN PRIVATE PASSENGER (5) ALL OWNED S WHICH REQUIRE -FAULT COVERAGE (6) OWNED S SUBJECT TO COMPULSORY U.M. LAW # DAYS # VEH COVERAGE / UCTIBLE PRIMARY COMP SPEC C OF L COLL () S ON SCHEDULE () S (9) N-OWNED S SECONDARY SONAL INFORMATION ABOUT YOU MAY BE COLLECTED FROM SONS THAN YOU. SUCH INFORMATION AS WELL AS SONAL AND ANY SON WHO KWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR ATHER SON FILES AN APPLICATION FOR INSURANCE THERETO, COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME AND SUBJECTS THE SON TO CRIMINAL AND CIVIL PENALTIES. I UNDERSTAND AND ACKWLEDGE THAT TRADITIONAL (REDUCED) COVERAGE AND, IF APPLICABLE, NEW (AD ON) COVERAGE HAVE BEEN OFFERED AND EXPLAINED TO ME. I HAVE SELECTED THE AND UCTIBLE OPTIONS SHOWN IN THIS APPLICATION. RENEWALS, CONTINUATIONS AND CHANGES UNLESS I TIFY YOU WISE IN WRITING. APPLICANT'S PRODUCER'S ACORD 1 GA (011/0) Page 1 of ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD

2 TRUCKERS SECTION EA SYMBOLS 6 UCTIBLE N-TRUCKERS EACH SON TRUCKERS N-OWNED TOWING TRAILER VALUE SCL F FT FTW TRAILER INTERCHANGE FARTH SYMBOL # TRAILERS ZONE # DAYS # DAYS # VEH LSP RADIUS UCTIBLE COVERAGE IS: PRIMARY SECONDARY (1) ANY () OWNED S ONLY () OWNED COMMERCIAL S ONLY () OWNED S SUBJECT TO -FAULT (5) OWNED S SUBJECT TO A COMPULSORY LAW (6) SPECIFICALLY DESCRIBED S () S ONLY () TRAILERS IN YOUR POSSESSION UNDER A TRAILER INTERCHANGE AGREEMENT (9) YOUR TRAILERS IN THE POSSESSION OF ATHER TRUCKER UNDER A TRAILER INTERCHANGE AGREEMENT (50) N-OWNED S ONLY SONAL INFORMATION ABOUT YOU MAY BE COLLECTED FROM SONS THAN YOU. SUCH INFORMATION AS WELL AS SONAL AND ANY SON WHO KWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR ATHER SON FILES AN APPLICATION FOR INSURANCE THERETO, COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME AND SUBJECTS THE SON TO CRIMINAL AND CIVIL PENALTIES. I UNDERSTAND AND ACKWLEDGE THAT COVERAGE HAS BEEN OFFERED AND EXPLAINED TO ME. I HAVE SELECTED THE AND UCTIBLE OPTIONS SHOWN IN THIS APPLICATION. RENEWALS, CONTINUATIONS AND CHANGES UNLESS I TIFY YOU WISE IN WRITING. APPLICANT'S PRODUCER'S ACORD 1 GA (011/0) Page of 5

3 MOTOR CARRIER SECTION N-TRUCKERS TRUCKERS N-OWNED EACH SON EA TOWING TRAILER VALUE SYMBOLS # DAYS # VEH SCL F TRAILER INTERCHANGE FT FTW LSP UCTIBLE SYMBOL # TRAILERS FARTH # DAYS RADIUS UCTIBLE ZONE COVERAGE IS: PRIMARY SECONDARY (61) ANY (6) OWNED S ONLY () OWNED PRIVATE PASS S ONLY () OWNED COMMERCIAL S ONLY (65) OWNED S SUBJECT TO -FAULT (66) OWNED S SUBJECT TO A COMPUL- SORY LAW (6) SPECIFICALLY DESCRIBED S (6) S ONLY () TRAILERS IN YOUR POSSESSION UNDER A TRAILER INTERCHANGE AGREEMENT (0) YOUR TRAILERS IN THE POSSESSION OF ATHER TRUCKER UNDER A TRAILER INTERCHANGE AGREEMENT (1) N-OWNED S ONLY SONAL INFORMATION ABOUT YOU MAY BE COLLECTED FROM SONS THAN YOU. SUCH INFORMATION AS WELL AS SONAL AND ANY SON WHO KWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR ATHER SON FILES AN APPLICATION FOR INSURANCE THERETO, COMMITS A FRAUDULENT INSURANCE ACT, WHICH IS A CRIME AND SUBJECTS THE SON TO CRIMINAL AND CIVIL PENALTIES. I UNDERSTAND AND ACKWLEDGE THAT COVERAGE HAS BEEN OFFERED AND EXPLAINED TO ME. I HAVE SELECTED THE AND UCTIBLE OPTIONS SHOWN IN THIS APPLICATION. RENEWALS, CONTINUATIONS AND CHANGES UNLESS I TIFY YOU WISE IN WRITING. APPLICANT'S PRODUCER'S ACORD 1 GA (011/0) Page of 5

4 TRADITIONAL AND NEW COVERAGE MANDATORY OFFER AND EXPLANATION Georgia insurance law requires that we offer and explain to you Traditional Uninsured Motorist Coverage and if applicable, New Uninsured Motorist Coverage. Below is a brief description of each coverage option. Only the policy provides a complete description of coverage(s) and limitation(s). You have the right to select a specific coverage or reject all uninsured motorist coverage(s) in writing. Traditional Uninsured Motorist Coverage a/k/a Uninsured Motorist Coverage-Reduced by At-Fault Liability Limits pays for bodily injury and property damage losses to you and your passengers as a result of an accident with a driver who either has no liability protection and is legally responsible for the injuries or damages, or does not have enough protection to pay the full amount that the injured person is legally entitled to recover as damages. New Uninsured Motorist Coverage a/k/a Uninsured Motorist Coverage-Added on At-Fault Liability Limits pays for the same bodily injury and property damage losses as Traditional Uninsured Motorist Coverage, however; it provides additional protection that will pay for your damages in addition to the At-Fault driver's Liability Coverage Limits up to your New Uninsured Motorist Coverage Limits. This new coverage is available on vehicles qualifying as private passenger type vehicles under Georgia law. You have the right to purchase Traditional Uninsured Motorist Coverage or New Uninsured Motorist Coverage, if applicable, with limits up to the liability limits of your policy. Your selection coverage options are listed below: I accept Traditional Uninsured Motorist Coverage I accept New Uninsured Motorist Coverage I reject ALL Uninsured Motorist Coverage I acknowledge that I read and understand my Traditional Uninsured Motorist and/or New Uninsured Motorist Coverage, if applicable, options. Applicant's Signature Date ACORD 1 GA (011/0) Page of 5

5 Example of New Uninsured Motorist Coverage and Traditional Uninsured Motorist Coverage Claim Payment Calculation An underinsured driver fails to stop at a red light, hits your car and causes you to have 15,000 in damages. The at-fault underinsured driver (At-Fault's) has 50,000 of Liability Coverage. Your policy contains 100,000 of Uninsured Motorist Coverage. NEW COVERAGE (IF APPLICABLE) (This coverage is also referred to as Uninsured Motorist-Added on to At-Fault Liability Limits) At-Fault's Liability Coverage Limit 50,000 Your New Uninsured Motorist Coverage Limit 100,000 Total Amount of Your Damages 15,000 Payment Break Out: At-Fault's Liability Coverage = Your New Uninsured Motorist Coverage = Total Payment = Amount Not Covered = 50, , ,000 5,000 The maximum available coverage in this example was 150,000 (At-Fault's Liability Coverage Limit + Your New Uninsured Motorist Coverage Limit). Please notice that 5,000 of the loss was not covered. TRADITIONAL COVERAGE (IF APPLICABLE) (This coverage is comparable to your current coverage. The coverage is also referred to as Uninsured Motorist Coverage-Reduced by At-Fault Liability Limits) At-Fault's Liability Coverage Limit 50,000 Your Traditional Uninsured Motorist Coverage Limit 100,000 Total Amount of Your Damages 15,000 Payment Break Out: At-Fault's Liability Coverage = Your Available Traditional Uninsured Motorist Coverage = Total Payment = Amount Not Covered = 50,000 50, ,000 5,000 (b) The 50,000 amount shown here is determined by subtracting the At-Fault's Liability Coverage Limit from Your Traditional Uninsured Motorist Coverage Limit. The total available Traditional Uninsured Motorist Coverage you have in this example is 50,000. (b) Please notice that 5,000 of the loss was not covered. ACORD 1 GA (011/0) Page 5 of 5

GEORGIA COMMERCIAL AUTO

GEORGIA COMMERCIAL AUTO AGENCY GEORGIA COMMERCIAL / LIMITS SECTION NAMED INSURED(S) (MM/DD/YYYY) POLICY NUMBER EFFECTIVE CARRIER NAIC CODE BUSINESS SECTION SYMBOLS LIMITS 1 9 EA SYMBOLS LIMITS TRADITIONAL (REDUCED) NEW (AD ON)

More information

SOUTH CAROLINA AUTO SUPPLEMENT

SOUTH CAROLINA AUTO SUPPLEMENT AGENCY AGENCY CUSTOMER ID: SOUTH CAROLINA AUTO SUPPLEMENT APPLICANT/NAMED INSURED POLICY NUMBER CARRIER NAIC CODE. OFFER OF ADDITIONAL UNINSURED MOTORIST COVERAGE AND OPTIONAL UNDERINSURED MOTORIST COVERAGE

More information

STRATFORD INSURANCE COMPANY OFFER OF OPTIONAL ADDITIONAL UNINSURED MOTORISTS COVERAGE AND OPTIONAL UNDERINSURED MOTORIST COVERAGE

STRATFORD INSURANCE COMPANY OFFER OF OPTIONAL ADDITIONAL UNINSURED MOTORISTS COVERAGE AND OPTIONAL UNDERINSURED MOTORIST COVERAGE STRATFORD INSURANCE COMPANY OFFER OF OPTIONAL ADDITIONAL UNINSURED MOTORISTS COVERAGE AND OPTIONAL UNDERINSURED MOTORIST COVERAGE Automobile liability insurance coverage pays other motor vehicle drivers

More information

SOUTH CAROLINA OFFER OF ADDITIONAL UNINSURED MOTORISTS COVERAGE AND OPTIONAL UNDERINSURED MOTORISTS COVERAGE

SOUTH CAROLINA OFFER OF ADDITIONAL UNINSURED MOTORISTS COVERAGE AND OPTIONAL UNDERINSURED MOTORISTS COVERAGE IL U 007 01 07 SOUTH CAROLINA OFFER OF ADDITIONAL UNINSURED MOTISTS COVERAGE AND OPTIONAL UNDERINSURED MOTISTS COVERAGE Policy Number: Policy Effective Date: Company: Producer: Applicant/Named Insured:

More information

STATE OF SOUTH CAROLINA DEPARTMENT OF INSURANCE SCDOI FORM NUMBER 2006 [REVISED JANUARY 1, 2007]

STATE OF SOUTH CAROLINA DEPARTMENT OF INSURANCE SCDOI FORM NUMBER 2006 [REVISED JANUARY 1, 2007] STATE OF SOUTH CAROLINA DEPARTMENT OF INSURANCE SCDOI FORM NUMBER 2006 [REVISED JANUARY 1, 2007] OFFER OF ADDITIONAL UNINSURED MOTORIST COVERAGE AND OPTIONAL UNDERINSURED MOTORIST COVERAGE Automobile liability

More information

GEORGIA (To be completed and signed by Named Insured) IMPORTANT NOTICE GEORGIA UNINSURED MOTORISTS COVERAGE PLEASE READ THIS NOTICE CAREFULLY.

GEORGIA (To be completed and signed by Named Insured) IMPORTANT NOTICE GEORGIA UNINSURED MOTORISTS COVERAGE PLEASE READ THIS NOTICE CAREFULLY. SUPPLEMENTARY COMMERCIAL AUTOMOBILE APPLICATION GEORGIA (To be completed and signed by Named Insured) Name Address IMPORTANT NOTICE GEORGIA UNINSURED MOTORISTS COVERAGE PLEASE READ THIS NOTICE CAREFULLY.

More information

MARYLAND PERSONAL AUTO SUPPLEMENT

MARYLAND PERSONAL AUTO SUPPLEMENT MARYLAND PERSONAL AUTO SUPPLEMENT AGENCY NAMED INSURED(S) POLICY NUMBER EFFECTIVE DATE CARRIER NAIC CODE Mandatory Offer of Increased Liability Coverage for Claims of Family Members at an Additional Premium

More information

NORTH CAROLINA PERSONAL AUTO APPLICATION

NORTH CAROLINA PERSONAL AUTO APPLICATION NORTH CAROLINA PERSONAL AUTO APPLICATION (MMDDYYYY) AGENCY APPLICANT'S NAME AND MAILING ADDRESS (Include county & ZIP+4) TELEPHONE NUMBER CONTACT NAME: PHONE (AC, No, Ext): FAX (AC, No): E-MAIL ADDRESS:

More information

OFFICE OF INSURANCE AND SAFETY FIRE COMMISSIONER

OFFICE OF INSURANCE AND SAFETY FIRE COMMISSIONER OFFICE OF COMMISSIONER OF INSURANCE SAFETY FIRE COMMISSIONER INDUSTRIAL LOAN COMMISSIONER COMPTROLLER GENERAL DIRECTIVE 08-P&C-1 SEVENTH FLOOR, WEST TOWER FLOYD BUILDING 2 MARTIN LUTHER KING JR. DRIVE

More information

CANAL INSURANCE COMPANY INDEMNITY COMPANY

CANAL INSURANCE COMPANY INDEMNITY COMPANY CANAL INSURANCE COMPANY INDEMNITY COMPANY GEORGIA SUPPLEMENTAL APPLICATION MUST be completed if Auto Liability Coverage is requested 1. Applicant Name 2. DBA, if any UNINSURED MOTORIST COVERAGE SELECTION/REJECTION

More information

NEW HAMPSHIRE PERSONAL AUTO APPLICATION

NEW HAMPSHIRE PERSONAL AUTO APPLICATION AGENCY NEW HAMPSHIRE PERSONAL AUTO APPLICATION APPLICANT'S NAME AND MAILING ADDRESS (Include county & ZIP+4) TELEPHONE NUMBER (MMDDYYYY) CONTACT NAME: PHONE (AC, No, Ext): FAX (AC, No): E-MAIL ADDRESS:

More information

GEORGIA UNINSURED MOTORISTS COVERAGE SELECTION/REJECTION

GEORGIA UNINSURED MOTORISTS COVERAGE SELECTION/REJECTION GEGIA UNINSURED MOTISTS COVERAGE SELECTION/REJECTION IL U 049 01 09 Policy Number: Policy Effective : Company: Producer: Applicant/Named Insured: Georgia law permits you to make certain decisions regarding

More information

Policy Number (If Not New Business) PENNSYLVANIA NOTICE IMPORTANT NOTICE

Policy Number (If Not New Business) PENNSYLVANIA NOTICE IMPORTANT NOTICE SUPPLEMENTARY AUTOMOBILE APPLICATION - PENNSYLVANIA (To be completed by the Named Insured or Applicant) Name abc Policy Number (If Not New Business) Address PENNSYLVANIA NOTICE IMPORTANT NOTICE Insurance

More information

By Donald L. Brown. Commercial Auto Policy

By Donald L. Brown. Commercial Auto Policy By Donald L. Brown Every company owner should protect business operations with adequate insurance coverage. Yet the automobile liability requirements can be confusing because of seemingly overlapping coverages,

More information

WASHINGTON UNDERINSURED MOTORISTS COVERAGE SELECTION/REJECTION

WASHINGTON UNDERINSURED MOTORISTS COVERAGE SELECTION/REJECTION IL U 008 04 06 WASHINGTON UNDERINSURED MOTORISTS COVERAGE SELECTION/REJECTION Policy Number: Policy Effective : Company: Producer: Applicant/Named Insured: Washington law permits you to make certain decisions

More information

WASHINGTON PERSONAL AUTO APPLICATION

WASHINGTON PERSONAL AUTO APPLICATION AGENCY WASHINGTON PERSONAL AUTO APPLICATION APPLICANT'S NAME AND MAILING ADDRESS (Include county & ZIP+4) TELEPHONE NUMBER (MM/DD/YYYY) CONTACT NAME: PHONE (A/C, No, Ext): FAX (A/C, No): E-MAIL ADDRESS:

More information

July 2000 WEST VIRGINIA INFORMATIONAL LETTER NO. 121

July 2000 WEST VIRGINIA INFORMATIONAL LETTER NO. 121 July 2000 WEST VIRGINIA INFORMATIONAL LETTER NO. 121 W.Va. Code 33-6-31d became effective on April 10, 1993. This statute requires that all insurers "make available" to a named insured under each policy

More information

COMMERCIAL AUTOMOBILE APPLICATION

COMMERCIAL AUTOMOBILE APPLICATION Home Office: One Nationwide Plaza Columbus, Ohio 43215 Administrative Office: 8877 North Gainey Center Drive Scottsdale, Arizona 85258 1-800-423-7675 Fax (480) 483-6752 A STOCK COMPANY COMMERCIAL AUTOMOBILE

More information

South Carolina Department of Insurance 300 Arbor Lake Drive, Suite 1200 Columbia, South Carolina 29223

South Carolina Department of Insurance 300 Arbor Lake Drive, Suite 1200 Columbia, South Carolina 29223 South Carolina Department of Insurance 300 Arbor Lake Drive, Suite 1200 Columbia, South Carolina 29223 Mailing Address: P.O. Box 100105, Columbia, S.C. 29202-3105 Telephone: (803) 737-6223 MARK SANFORD

More information

PUBLIC AUTO INSURANCE APPLICATION- PENNSYLVANIA

PUBLIC AUTO INSURANCE APPLICATION- PENNSYLVANIA A. GENERAL STRATFORD INSURANCE COMPANY WESTERN WORLD INSURANCE COMPANY PUBLIC AUTO INSURANCE APPLICATION- PENNSYLVANIA Applicant's Name: Phone #: Contact Person: Address: Garaging Location(s) if different:

More information

COMMERCIAL AUTOMOBILE/TRUCKERS APPLICATION

COMMERCIAL AUTOMOBILE/TRUCKERS APPLICATION National Casualty Company Home Office: Madison, Wisconsin Adm Office: 8877 Gainey Center Dr. Scottsdale, Arizona 85258 Scottsdale Insurance Company Home Office: One Nationwide Plaza Columbus, Ohio 43215

More information

AUTOMOBILE APPLICATION FOR INSURANCE FOR NON-TRUCKING USE (BOBTAIL)

AUTOMOBILE APPLICATION FOR INSURANCE FOR NON-TRUCKING USE (BOBTAIL) National Casualty Company Home Office: Madison, Wisconsin Scottsdale Insurance Company Home Office: One Nationwide Plaza Columbus, Ohio 43215 Scottsdale Indemnity Company Home Office: One Nationwide Plaza

More information

AUTOMOBILE APPLICATION FOR INSURANCE FOR NON-TRUCKING USE (BOBTAIL)

AUTOMOBILE APPLICATION FOR INSURANCE FOR NON-TRUCKING USE (BOBTAIL) Surplus Call 800-342-5706 Insurance Fax 800-578-7758 www.surplusins.com Email quotes: submit@surplusins.com Brokers Agency Inc. P O Box 749, South Bend IN 46624-0749 AUTOMOBILE APPLICATION FOR INSURANCE

More information

UMBRELLA / EXCESS SECTION

UMBRELLA / EXCESS SECTION AGENCY UMBRELLA / EXCESS SECTION APPLICANT (First Named Insured) DATE (MM/DD/YYYY) POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE EXPIRATION DATE DIRECT BILL PAYMENT PLAN AUDIT FOR COMPANY USE ONLY AGENCY

More information

Coverage Selection Form - Hawaii Important notice about your policy. Please read carefully.

Coverage Selection Form - Hawaii Important notice about your policy. Please read carefully. Important notice about your policy. Please read carefully. BODILY INJURY AND PROPERTY DAMAGE LIABILITY LIMITS Bodily Injury (BI) and Property Damage (PD) Liability coverage pays for bodily injury to another

More information

WASHINGTON UNDERINSURED MOTORISTS COVERAGE SELECTION/REJECTION

WASHINGTON UNDERINSURED MOTORISTS COVERAGE SELECTION/REJECTION CA 7051 08 10 WASHINGTON UNDERINSURED MOTISTS COVERAGE SELECTION/REJECTION Policy Number: Policy Effective : Company: HARCO NATIONAL INSURANCE CO. Producer: Applicant/Named Insured: Washington law permits

More information

PHYSICAL DAMAGE Medical Combined Single. Maximum Bodily Injury Property Damage Payments Limit BI & PD

PHYSICAL DAMAGE Medical Combined Single. Maximum Bodily Injury Property Damage Payments Limit BI & PD Drive-Away Application COLUMBIA INSURANCE COMPANY NATIONAL FIRE & MARINE INSURANCE COMPANY NATIONAL INDEMNITY COMPANY NATIONAL INDEMNITY COMPANY OF MID-AMERICA NATIONAL INDEMNITY COMPANY OF THE SOUTH NATIONAL

More information

INTRODUCTION TO MOTOR VEHICLE LIABILITY INSURANCE LAWS. Prepared for the Revenue and Transportation Interim Committee

INTRODUCTION TO MOTOR VEHICLE LIABILITY INSURANCE LAWS. Prepared for the Revenue and Transportation Interim Committee INTRODUCTION TO MOTOR VEHICLE LIABILITY INSURANCE LAWS Prepared for the Revenue and Transportation Interim Committee By Jeff Martin, Legislative Research Analyst Montana Legislative Services September

More information

Personal Umbrella Liability Insurance Application

Personal Umbrella Liability Insurance Application ANY CHANGES MADE TO AN ANSWER ON THIS APPLICATION MUST BE INITIALED BY THE APPLICANT. PLEASE PRINT ALL INFORMATION CLEARLY. Personal Umbrella Liability Insurance Application RLI Insurance Company Name

More information

UMBRELLA / EXCESS SECTION

UMBRELLA / EXCESS SECTION UMBRELLA / EXCESS SECTION DATE (MM/DD/YYYY) IMPORTANT - If CLAIMS MADE is checked in the POLICY INFORMATION section below, this is an application for a claims-made policy. AGENCY CARRIER NAIC CODE POLICY

More information

ARE YOU DRIVING ON THIN ICE : FULL COVERAGE MIGHT NOT BE WHAT YOU THINK IT IS

ARE YOU DRIVING ON THIN ICE : FULL COVERAGE MIGHT NOT BE WHAT YOU THINK IT IS ARE YOU DRIVING ON THIN ICE : FULL COVERAGE MIGHT NOT BE WHAT YOU THINK IT IS By: Jay R. Vaughn, Esq. Schachter, Hendy & Johnson, P.S.C. (859) 578-4444 jvaughn@pschachter.com My practice focuses on personal

More information

Cossio Insurance Agency 864-688-0121 Fax: 864-688-0138 PO Box 188 Simpsonville SC 29681

Cossio Insurance Agency 864-688-0121 Fax: 864-688-0138 PO Box 188 Simpsonville SC 29681 DIRECTIONS: 1. Complete the application (all pages) in full by filling in the blue fields. 2. Please fill in all the fields with the correct information. 3. Email the application to apps@cossioinsurance.com

More information

Roush Insurance Services, Inc.

Roush Insurance Services, Inc. Roush Insurance Services, Inc. PO Box 1060 Noblesville, IN 46061-1060 Phone (800) 752-8402 Fax (317) 776-6891 Email: quote@roushins.com www.roushins.com AUTOMOBILE APPLICATION FOR INSURANCE FOR NON-TRUCKING

More information

COM M ERCIAL AUTO NON-FLEET INSURANCE APPLICATION

COM M ERCIAL AUTO NON-FLEET INSURANCE APPLICATION COM M ERCIAL AUTO NON-FLEET INSURANCE APPLICATION PO Box 2575 Jacksonville, Florida 32203 904-363-0900 800-874-8053 Fax 904-363-8093 GENERAL INFORMATION New Business Renewal Producer Name: Contact Name:

More information

COVERAGE SELECTION FORM - STANDARD POLICY

COVERAGE SELECTION FORM - STANDARD POLICY Policy Number: COVERAGE SELECTION FORM - STANDARD POLICY This Coverage Selection Form is for a STANDARD POLICY, see Buyer s Guide, page 5. A BASIC POLICY with the minimum of required coverages is also

More information

Personal Umbrella Liability Insurance Application

Personal Umbrella Liability Insurance Application ANY CHANGES MADE TO AN ANSWER ON THIS APPLICATION MUST BE INITIALED BY THE APPLICANT. PLEASE PRINT ALL INFORMATION CLEARLY. Personal Umbrella Liability Insurance Application RLI Insurance Company Name

More information

BUSINESS AUTO DECLARATIONS

BUSINESS AUTO DECLARATIONS COMMERCIAL AUTO B CA DS 03 01 12 Issuing Company: Tri-State Insurance Company of Minnesota Policy No.: Previous Policy No.: BUSINESS AUTO DECLARATIONS ITEM ONE NAMED INSURED AND ADDRESS AGENCY NAME AND

More information

motorcycle insurance protecting your dreams

motorcycle insurance protecting your dreams motorcycle insurance protecting your dreams let s ride. The freedom of the open road feels even better the less you have to worry about. But protecting yourself on a cycle involves more than leather and

More information

Coverage for Other People Using Your Car. Today s Lecture State Farm Car Policy. Other People s Use of Your Car - Example

Coverage for Other People Using Your Car. Today s Lecture State Farm Car Policy. Other People s Use of Your Car - Example Today s Lecture State Farm Car Policy Other people using your car Your using other cars Other people using other cars Coverage for Other People Using Your Car Anybody using your car with permission is

More information

GARAGE INSURANCE: The Basics How to make garage risks a part of your agency portfolio.

GARAGE INSURANCE: The Basics How to make garage risks a part of your agency portfolio. GARAGE INSURANCE: The Basics How to make garage risks a part of your agency portfolio. By Jim Krotki, CPCU An often overlooked source of commercial insurance prospects is garage business. Some agents are

More information

NEW YORK MOTOR VEHICLE NO-FAULT INSURANCE LAW COVER LETTER POLICYHOLDER POLICY NUMBER DATE OF ACCIDENT CLAIM NUMBER

NEW YORK MOTOR VEHICLE NO-FAULT INSURANCE LAW COVER LETTER POLICYHOLDER POLICY NUMBER DATE OF ACCIDENT CLAIM NUMBER NEW YORK MOTOR VEHICLE -FAULT INSURANCE LAW COVER LETTER NAME, ADDRESS AND PHONE NUMBER OF INSURER, SELF-INSURER OR REPRESENTATIVE* NAME, ADDRESS AND PHONE NUMBER OF CLAIM REPRESENTATIVE* POLICYHOLDER

More information

Quick Preview PROPERTY DAMAGE

Quick Preview PROPERTY DAMAGE Quick Preview PROPERTY DAMAGE You are you first priority, take care of you first Understand rental insurance, towing and storage costs Figure out what kind of insurance coverage you have Choose a reputable

More information

PERSONAL UMBRELLA APPLICATION

PERSONAL UMBRELLA APPLICATION AGENCY PERSONAL UMBRELLA APPLICATION CARRIER DATE (MM/DD/YYYY) NAIC CODE APPLICANT'S NAME AND MAILING ADDRESS (include county & ZIP+4) CONTACT NAME: PHONE (A/C, No, Ext): FAX (A/C, No): E-MAIL ADDRESS:

More information

PERSONAL UMBRELLA APPLICATION

PERSONAL UMBRELLA APPLICATION AGENCY PERSONAL UMBRELLA APPLICATION CARRIER DATE (MM/DD/YYYY) NAIC CODE APPLICANT'S NAME AND MAILING ADDRESS (include county & ZIP+4) CONTACT NAME: PHONE (A/C, No, Ext): FAX (A/C, No): E-MAIL ADDRESS:

More information

Contingent Liability Application (Bobtail & Deadhead)

Contingent Liability Application (Bobtail & Deadhead) Contingent Liability Application (Bobtail & Deadhead) COLUMBIA INSURANCE COMPANY NATIONAL FIRE & MARINE INSURANCE COMPANY NATIONAL INDEMNITY COMPANY NATIONAL INDEMNITY COMPANY OF MID-AMERICA NATIONAL INDEMNITY

More information

Automobile Insurance Guide

Automobile Insurance Guide Automobile Insurance Guide Page 1 Simply stated, automobile insurance is a contract between you and your insurance company that protects you against financial loss if you are in an accident. Auto policies

More information

21st Century Pinnacle Insurance Company STANDARD POLICY COVERAGE SELECTION FORM

21st Century Pinnacle Insurance Company STANDARD POLICY COVERAGE SELECTION FORM 21st Century Pinnacle Insurance Company STANDARD POLICY COVERAGE SELECTION FORM Name: Quote/Policy number: This Coverage Selection Form is for a STANDARD POLICY, see Buyer's Guide, page 3. A BASIC POLICY

More information

Your Guide to Auto Insurance Premiums

Your Guide to Auto Insurance Premiums INSURANCE FACTS for Pennsylvania Consumers Your Guide to Auto Insurance Premiums 1-877-881-6388 Toll-free Automated Consumer Line www.insurance.state.pa.us Pennsylvnaia Insurance Department Website Required

More information

A CONSUMER'S GUIDE TO MOTORCYCLE INSURANCE. from YOUR North Carolina Department of Insurance CONSUMER'SGUIDE

A CONSUMER'S GUIDE TO MOTORCYCLE INSURANCE. from YOUR North Carolina Department of Insurance CONSUMER'SGUIDE A CONSUMER'S GUIDE TO MOTORCYCLE INSURANCE from YOUR North Carolina Department of Insurance CONSUMER'SGUIDE A MESSAGE FROM YOUR INSURANCE COMMISSIONER Greetings, The North Carolina Department of Insurance

More information

ST. PAUL PROTECTIVE INSURANCE COMPANY Hartford, CT NEW JERSEY AUTOMOBILE INSURANCE STANDARD POLICY COVERAGE SELECTION FORM

ST. PAUL PROTECTIVE INSURANCE COMPANY Hartford, CT NEW JERSEY AUTOMOBILE INSURANCE STANDARD POLICY COVERAGE SELECTION FORM ST. PAUL PROTECTIVE INSURANCE COMPANY Hartford, CT NEW JERSEY AUTOMOBILE INSURANCE STANDARD POLICY COVERAGE SELECTION FORM Name: Policy #: This Coverage Selection Form is for a STANDARD POLICY. See Buyer

More information

COMMERCIAL AUTOMOBILE/TRUCKERS APPLICATION

COMMERCIAL AUTOMOBILE/TRUCKERS APPLICATION National Casualty Company Home Office: Madison, Wisconsin Adm Office: 8877 Gainey Center Drive Scottsdale, Arizona 85258 Scottsdale Insurance Company Home Office: One Nationwide Plaza Columbus, Ohio 43215

More information

COMMERCIAL AUTO APPLICATION

COMMERCIAL AUTO APPLICATION COMMERCIAL AUTO APPLICATION Dependent upon state authority, you are applying for insurance coverage provided by and underwritten by one of the following insurance companies of ARGO GROUP US: ARGONAUT-MIDWEST

More information

NEW YORK MOTOR VEHICLE NO-FAULT INSURANCE LAW APPLICATION FOR MOTOR VEHICLE NO-FAULT BENEFITS POLICYHOLDER POLICY NUMBER DATE OF ACCIDENT CLAIM NUMBER

NEW YORK MOTOR VEHICLE NO-FAULT INSURANCE LAW APPLICATION FOR MOTOR VEHICLE NO-FAULT BENEFITS POLICYHOLDER POLICY NUMBER DATE OF ACCIDENT CLAIM NUMBER NEW YORK MOTOR VEHICLE -FAULT INSURANCE LAW APPLICATION FOR MOTOR VEHICLE -FAULT BENEFITS NAME AND ADDRESS OF INSURER * NAME, ADDRESS, AND PHONE NUMBER OF INSURER S CLAIMS REPRESENTATIVE* POLICYHOLDER

More information

MOTOR CARRIER APPLICATION

MOTOR CARRIER APPLICATION MOTOR CARRIER APPLICATION Name of Applicant: D/B/A: Mailing Address: Garaging Address: (if different than mailing) Phone Number: DOT No.: Loss Control contact name and telephone number: Agent Name: Producer:

More information

NEW JERSEY AUTO STANDARD POLICY COVERAGE SELECTION FORM

NEW JERSEY AUTO STANDARD POLICY COVERAGE SELECTION FORM IL U 051 11 10 NEW JERSEY AUTO STANDARD POLICY COVERAGE SELECTION FORM Policy Number: Policy Effective Date: Company: Producer: Applicant/Named Insured: This Coverage Selection Form is for a STANDARD POLICY,

More information

114CSR63 WEST VIRGINIA LEGISLATIVE RULE INSURANCE COMMISSIONER SERIES 63 STANDARD MOTOR VEHICLE POLICY PROVISIONS

114CSR63 WEST VIRGINIA LEGISLATIVE RULE INSURANCE COMMISSIONER SERIES 63 STANDARD MOTOR VEHICLE POLICY PROVISIONS 114CSR63 WEST VIRGINIA LEGISLATIVE RULE INSURANCE COMMISSIONER SERIES 63 STANDARD MOTOR VEHICLE POLICY PROVISIONS Section. '114-63-1. General. '114-63-2. Definitions. '114-63-3. Liability Insurance Provisions.

More information

CTP 5037 (11/11) Page 2 of 6

CTP 5037 (11/11) Page 2 of 6 COMMERCIAL AUTO APPLICATION New Business Renewal Expiring Policy # PO Box 2575 Jacksonville, Florida 32203 904-363-0900 800-874-8053 Fax 904-363-8093 1. GENERAL Applicant s Name: Mailing Address: Garaging

More information

PERSONAL UMBRELLA APPLICATION

PERSONAL UMBRELLA APPLICATION AGENCY PERSONAL UMBRELLA APPLICATION APPLICANT'S NAME AND MAILING ADDRESS (include county & ZIP+4) DATE (MM/DD/YYYY) CONTACT NAME: PHONE (A/C, No, Ext): FAX (A/C, No): E-MAIL ADDRESS: CODE: SUBCODE: DATE

More information

INSURANCE CODE TITLE 10. PROPERTY AND CASUALTY INSURANCE SUBTITLE C. AUTOMOBILE INSURANCE CHAPTER 1952

INSURANCE CODE TITLE 10. PROPERTY AND CASUALTY INSURANCE SUBTITLE C. AUTOMOBILE INSURANCE CHAPTER 1952 INSURANCE CODE TITLE 10. PROPERTY AND CASUALTY INSURANCE SUBTITLE C. AUTOMOBILE INSURANCE CHAPTER 1952. POLICY PROVISIONS AND FORMS FOR AUTOMOBILE INSURANCE (SELECTED SECTIONS) SUBCHAPTER C. UNINSURED

More information

QUESTIONS AND ANSWERS ABOUT ILLINOIS AUTOMOBILE INSURANCE AND ACCIDENTS

QUESTIONS AND ANSWERS ABOUT ILLINOIS AUTOMOBILE INSURANCE AND ACCIDENTS QUESTIONS AND ANSWERS ABOUT ILLINOIS AUTOMOBILE INSURANCE AND ACCIDENTS What types of coverages are available? Generally, automobile insurance policies provide Bodily Injury and Property Damage Liability

More information

A-One Commercial Insurance Risk Retention Group, Inc. Auto Liability Application GENERAL INFORMATION BILLING OPTIONS. Coverage and Limits Information

A-One Commercial Insurance Risk Retention Group, Inc. Auto Liability Application GENERAL INFORMATION BILLING OPTIONS. Coverage and Limits Information Agency Producer Email GENERAL INFORMATION Name: DBA (if any): Business Entity: Individual Corporation Partnership LLC Other: Effective Date: US DOT: SSN or FEIN: Yrs in business: Yrs in Trucking Industry:

More information

Truck Application DESCRIPTION OF OPERATIONS. LIABILITY COVERAGE Complete for desired coverages by indicating limits of insurance.

Truck Application DESCRIPTION OF OPERATIONS. LIABILITY COVERAGE Complete for desired coverages by indicating limits of insurance. Truck Application 1. Name (and "dba") Individual/Proprietorship Partnership Corporation Other Policy Term From: To Business Phone Number 2. Mailing Address City State Zip 3. Premises Address City State

More information

UMBRELLA / EXCESS SECTION

UMBRELLA / EXCESS SECTION AGENCY UMBRELLA / EXCESS SECTION DATE (MM/DD/YYYY) IMPORTANT - If CLAIMS MADE is checked in the POLICY INFORMATION section below, this is an application for a claims-made policy. Read all provisions of

More information

ZacharLawFirm.com (602) 494-4800 Page 1

ZacharLawFirm.com (602) 494-4800 Page 1 There are countless drivers across the state of Arizona that are uninsured or underinsured. In fact, it is estimated that one (1) out of every five (5) drivers on the road is driving without insurance.

More information

The Michigan Auto Insurance Report

The Michigan Auto Insurance Report The Michigan Auto Insurance Report The Inside Secrets To Buying Auto Insurance" By: Daniel L. Buckfire Michigan s No-Fault Insurance Lawyer Call Toll Free: (800) 606-1717 www.buckfirelaw.com www.freeautoinsurancereport.com

More information

2) If using the Manual Entry Fields you must enter the original cost of the vehicle in the OCN (Original Cost New) field.

2) If using the Manual Entry Fields you must enter the original cost of the vehicle in the OCN (Original Cost New) field. PAGE - VEHICLES 7 8 9 0 ) Select the Year, Make and Model of your vehicle. If not listed, enter the Make, Model and Body type (i.e. car, truck, SUV, etc.) into the Manual Entry Fields. ) If using the Manual

More information

UMBRELLA / EXCESS SECTION

UMBRELLA / EXCESS SECTION UMBRELLA / EXCESS SECTION DATE (MM/DD/YYYY) IMPTANT - If CLAIMS MADE is checked in the POLICY INFMATION section below, this is an application for a claims-made policy. AGENCY CARRIER NAIC CODE POLICY NUMBER

More information

WRONGFUL DISCLAIMERS OF UM and UIM COVERAGE UNDER BUSINESS AUTO POLICIES

WRONGFUL DISCLAIMERS OF UM and UIM COVERAGE UNDER BUSINESS AUTO POLICIES WRONGFUL DISCLAIMERS OF UM and UIM COVERAGE UNDER BUSINESS AUTO POLICIES BY: James C. Haggerty HAGGERTY, GOLDBERG, SCHLEIFER & KUPERSMITH, P.C. 1835 Market Street, Suite 2700 Philadelphia, PA 19103 (267)

More information

Automobile Insurance in Pennsylvania a supplement to the Automobile Insurance Guide

Automobile Insurance in Pennsylvania a supplement to the Automobile Insurance Guide and answers about Automobile Insurance in Pennsylvania a supplement to the Automobile Insurance Guide My automobile policy was canceled because I did not pay my premium on time. Is this legal? Yes. If

More information

Please fully complete and print the Application, obtain the insured's signature and forward it to your Program Administrator for processing.

Please fully complete and print the Application, obtain the insured's signature and forward it to your Program Administrator for processing. ANY CHANGES MADE TO AN ANSWER ON THIS APPLICATION MUST BE INITIALED BY THE APPLICANT. PLEASE PRINT ALL INFORMATION CLEARLY. Personal Umbrella Liability Insurance Application RLI Insurance Company Name

More information

SOME MASSACHUSETTS PERSONAL AUTO POLICY ISSUES

SOME MASSACHUSETTS PERSONAL AUTO POLICY ISSUES SOME MASSACHUSETTS PERSONAL AUTO POLICY ISSUES Some Mass Personal Auto Issues Michael C. D Orlando, CIC, LIA, CPIA Insurance Training & Consulting Services 11 Lake Shore Drive Amesbury, MA 01913 mcdorlando@aol.com

More information

COMMERCIAL AUTO FLEET INSURANCE APPLICATION

COMMERCIAL AUTO FLEET INSURANCE APPLICATION COMMERCIAL AUTO FLEET INSURANCE APPLICATION PO Box 2575 Jacksonville, Florida 32203 904-363-0900 800-874-8053 Fax 904-363-8093 GENERAL INFORMATION New Business Renewal Producer Name: Contact Name: Date

More information

State of Rhode Island and Providence Plantations DEPARTMENT OF BUSINESS REGULATION Division of Insurance 1511 Pontiac Avenue Cranston, RI 02920

State of Rhode Island and Providence Plantations DEPARTMENT OF BUSINESS REGULATION Division of Insurance 1511 Pontiac Avenue Cranston, RI 02920 State of Rhode Island and Providence Plantations DEPARTMENT OF BUSINESS REGULATION Division of Insurance 1511 Pontiac Avenue Cranston, RI 02920 INSURANCE REGULATION 10 UNINSURED AND UNDERINSURED MOTORIST

More information

Towing V₃antage Towing and Recovery Application

Towing V₃antage Towing and Recovery Application Towing V₃antage Towing and Recovery Application Email to: towing.brokerservices@v3ins.com GENERAL INFORMATION Proposed Policy Period: To Insured Name: DBA (if any): Location 1 Address: City: State: Zip:

More information

State of Rhode Island and Providence Plantations DEPARTMENT OF BUSINESS REGULATION Division of Insurance 1511 Pontiac Avenue Cranston, RI 02920

State of Rhode Island and Providence Plantations DEPARTMENT OF BUSINESS REGULATION Division of Insurance 1511 Pontiac Avenue Cranston, RI 02920 State of Rhode Island and Providence Plantations DEPARTMENT OF BUSINESS REGULATION Division of Insurance 1511 Pontiac Avenue Cranston, RI 02920 INSURANCE REGULATION 10 UNINSURED AND UNDERINSURED MOTORIST

More information

McM CORPORATION COMPANIES

McM CORPORATION COMPANIES McM CORPORATION COMPANIES Commonwealth Underwriters Ltd Occidental Fire & Casualty Co. of North Carolina P O Box 5441 Wilshire Insurance Co. Richmond, VA 23220 FAX 804-359-4568 www.commund.com APPLICATION

More information

ACORD Forms Notification Service February 2008 Bulletin

ACORD Forms Notification Service February 2008 Bulletin ACORD Forms Notification Service February 2008 Bulletin ACORD P&C and Life Form Changes and Additions The following pages include both a List of recently Revised and New ACORD forms and an Explanation

More information

Economic Education for Consumers Chapter 14 Study Guide Automobile and Home Insurance: Sharing the Risk

Economic Education for Consumers Chapter 14 Study Guide Automobile and Home Insurance: Sharing the Risk Economic Education for Consumers Chapter 14 Study Guide Automobile and Home Insurance: Sharing the Risk Section 14-1 Insurance Basics Define Risk Management. Define Shared Risk. How do insurance companies

More information

LMCIT Auto Coverage Guide

LMCIT Auto Coverage Guide INFORMATION MEMO LMCIT Auto Coverage Guide Understand auto liability, auto physical damage, no-fault, and uninsured/underinsured coverage offered by the League of Minnesota Cities Insurance Trust (LMCIT),

More information

CAROLINA CASUALTY INSURANCE COMPANY P.O. BOX 2575 JACKSONVILLE, FLORIDA 32203 (904) 363-0900 (800) 874-8053 FAX (904) 363-8093

CAROLINA CASUALTY INSURANCE COMPANY P.O. BOX 2575 JACKSONVILLE, FLORIDA 32203 (904) 363-0900 (800) 874-8053 FAX (904) 363-8093 CAROLINA CASUALTY INSURANCE COMPANY P.O. BOX 2575 JACKSONVILLE, FLORIDA 32203 (904) 363-0900 (800) 874-8053 FAX (904) 363-8093 MISCELLANEOUS PUBLIC AUTO PROGRAM APPLICATION A. GENERAL INFORMATION PROPOSED

More information

SENATE, No. 131 STATE OF NEW JERSEY. 213th LEGISLATURE PRE-FILED FOR INTRODUCTION IN THE 2008 SESSION

SENATE, No. 131 STATE OF NEW JERSEY. 213th LEGISLATURE PRE-FILED FOR INTRODUCTION IN THE 2008 SESSION SENATE, No. STATE OF NEW JERSEY th LEGISLATURE PRE-FILED FOR INTRODUCTION IN THE 00 SESSION Sponsored by: Senator NICHOLAS P. SCUTARI District (Middlesex, Somerset and Union) SYNOPSIS Provides for stacking

More information

CHILDREN TRANSPORTATION PROVIDERS APPLICATION AND SURVEY FOR AUTOMOBILE LIABILITY AND PHYSICAL DAMAGE INSURANCE

CHILDREN TRANSPORTATION PROVIDERS APPLICATION AND SURVEY FOR AUTOMOBILE LIABILITY AND PHYSICAL DAMAGE INSURANCE 370 West Park Avenue, P. O. Box 9004, Long Beach, NY 11561-9004 Tel: (516) 431-4441 Fax:(516) 889-9872 CHILDREN TRANSPORTATION PROVIDERS APPLICATION AND SURVEY FOR AUTOMOBILE LIABILITY AND PHYSICAL DAMAGE

More information

HOME MEDICAL EQUIPMENT DEALER O&P INSURANCE SURVEY. (please include all organizations that are to be included as insureds)

HOME MEDICAL EQUIPMENT DEALER O&P INSURANCE SURVEY. (please include all organizations that are to be included as insureds) HOME MEDICAL EQUIPMENT DEALER O&P INSURANCE SURVEY P.O. Box 5670 Cortland, NY 13045 Phone: (800) 822-3747 Fax: (607) 756-5051 General Information Date of survey: Legal Name of Organization: Mailing Address:

More information

Business Auto Insurance

Business Auto Insurance Business Auto Insurance Overview of Chapter 5, CPCU 4 I. Covered Autos II. III. IV. Liability Physical Damage Conditions V. Additional Coverages and Endorsements I. Covered Autos - common definition -

More information

Ontario Application for Automobile Insurance

Ontario Application for Automobile Insurance Ontario Application for Automobile Insurance Driver's Form (O.A.F. 2) Notice to Applicant This is your Application for Automobile Insurance. Check it carefully and notify your Broker/Agent of any errors

More information

New Jersey Car Insurance Checklist

New Jersey Car Insurance Checklist New Jersey Car Insurance Checklist What You Need To Check To Be Sure You Are Protected! Why You Should Opt For: Motor Vehicle Medical Coverage (PIP) No Limitation on Lawsuit Liability Coverage AND Uninsured

More information

Massachusetts Private Passenger Automobile Statistical Plan Part VI - Coding Section

Massachusetts Private Passenger Automobile Statistical Plan Part VI - Coding Section STATISTICAL CLASS CODE ASSIGNMENT Statistical Class assignments should be based on the characteristics of the individual used to rate the vehicle. For single vehicle policies, the statistical class must

More information

NEW JERSEY AUTO SUPPLEMENT

NEW JERSEY AUTO SUPPLEMENT AGENCY AGENCY CUSTOMER ID: NEW JERSEY AUTO SUPPLEMENT NAMED INSURED(S) POLICY NUMBER EFFECTIVE DATE CARRIER NAIC CODE NEW JERSEY AUTO INSURANCE BUYER'S GUIDE New Jersey Department of Banking and Insurance

More information

MISSISSIPPI GARAGE DEALER / NON - DEALER APPLICATION

MISSISSIPPI GARAGE DEALER / NON - DEALER APPLICATION MISSISSIPPI GARAGE DEALER / NON - DEALER APPLICATION CANAL INSURANCE COMPANY CANAL INDEMNITY COMPANY Quotation No. New Policy No. Renewal /Rewrite No. Bound by SGA? Yes No Policy Period From AM/PM on /

More information

ARIZONA AUTO INSURANCE APPLICATION. Nevada General Insurance Company UNDERWRITTEN BY NEVADA GENERAL INSURANCE COMPANY Transmittal Date/Time:

ARIZONA AUTO INSURANCE APPLICATION. Nevada General Insurance Company UNDERWRITTEN BY NEVADA GENERAL INSURANCE COMPANY Transmittal Date/Time: ARIZONA AUTO INSURANCE APPLICATION Nevada General Insurance Company Transmittal Date/Time: Policy Number: Program: Valu APPLICATION INFORMATION Named Insured and Mailing Address PRODUCER Producer Code

More information

ACORD 61 PA (2014/02) - PENNSYLVANIA AUTO SUPPLEMENT

ACORD 61 PA (2014/02) - PENNSYLVANIA AUTO SUPPLEMENT ACORD 61 PA (2014/02) - PENNSYLVANIA AUTO SUPPLEMENT ACORD 61 PA, Pennsylvania Auto Supplement - Important Notice, complies with Pennsylvania law and regulations which require that every applicant for

More information

Guide to Knowing Your Auto

Guide to Knowing Your Auto Guide to Knowing Your Auto & Homeowners Insurance Options Presented by: 1 When it comes to insurance, you can never know too much. What type of insurance is available and how much coverage you need? And

More information

What is a definition of insurance?

What is a definition of insurance? What is a definition of insurance? A system of protection against loss in which a number of individuals agree to pay certain sums for a guarantee that they will be compensated for a specific loss. Every

More information

Buyer Beware. Things To Know About Buying Car Insurance In Washington State. By Christopher M. Davis, Attorney at Law

Buyer Beware. Things To Know About Buying Car Insurance In Washington State. By Christopher M. Davis, Attorney at Law Buyer Beware Things To Know About Buying Car Insurance In Washington State By Christopher M. Davis, Attorney at Law Davis Law Group, P.S. 2101 Fourth Avenue Suite 630 Seattle, WA 98121 206-727-4000 Davis

More information

Personal and Business Auto Table of Contents p. 1 of 5 Unit 1 - Introducing Auto Insurance pp. 7-41

Personal and Business Auto Table of Contents p. 1 of 5 Unit 1 - Introducing Auto Insurance pp. 7-41 Personal and Business Auto Table of Contents p. 1 of 5 Unit 1 - Introducing Auto Insurance pp. 7-41 Problems associated with auto accidents and insurance The large number of auto incidents High Cost of

More information

15 HB 190/AP A BILL TO BE ENTITLED AN ACT BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:

15 HB 190/AP A BILL TO BE ENTITLED AN ACT BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA: House Bill 190 (AS PASSED HOUSE AND SENATE) By: Representatives Golick of the 40 th, Smith of the 134 th, Maxwell of the 17 th, and Powell of the 32 nd A BILL TO BE ENTITLED AN ACT 1 2 3 4 5 6 To amend

More information

---, ------:~ ~ "-----' 2 3 SEP 2015 COMMONWEALTH OF THE NORTHERN MARIANA ISLANDS. Ralph DLG. Torres Lieutenant Governor. Eloy S.

---, ------:~ ~ -----' 2 3 SEP 2015 COMMONWEALTH OF THE NORTHERN MARIANA ISLANDS. Ralph DLG. Torres Lieutenant Governor. Eloy S. COMMONWEALTH OF THE NORTHERN MARIANA ISLANDS Eloy S. Inos Governor Ralph DLG. Torres Lieutenant Governor Honorable Victor B. Hocog Senate President, The Senate Nineteenth Northern Marianas Commonwealth

More information

CHAPTER 18 GENERAL INSURANCE

CHAPTER 18 GENERAL INSURANCE WISCONSIN LEGISLATOR BRIEFING BOOK 2015-16 CHAPTER 18 GENERAL INSURANCE Insurance protects against unexpected losses of income or property. The state regulates general insurance matters through the Office

More information

Wayne Howell, PLLC A GUIDE TO ARIZONA AUTOMOBILE INSURANCE COVERAGE

Wayne Howell, PLLC A GUIDE TO ARIZONA AUTOMOBILE INSURANCE COVERAGE Wayne Howell, PLLC If A GUIDE TO ARIZONA AUTOMOBILE INSURANCE COVERAGE you think you have "Full Coverage", you may be at risk without knowing it. "Full Coverage" means different things to different people;

More information

1. What s the difference between Limited Tort and Full Tort Auto Insurance Policies?

1. What s the difference between Limited Tort and Full Tort Auto Insurance Policies? Auto 1. What s the difference between Limited Tort and Full Tort Auto Insurance Policies? Limited Tort and Full Tort refer to different types of coverage under a auto insurance policy and what compensation

More information