Motor Truck Cargo Insurance Application
|
|
- Silvester Chase
- 7 years ago
- Views:
Transcription
1 Motor Truck Cargo Insurance Application Named Insured: Mailing Address: Policy period or date policy is to be in effect: Business is: Corporation Partnership Sole Owner Established in 19 For whom does trucker haul primarily? Operates in state of: Common Carrier Private Carrier Contract Carrier With what regulatory commissions are cargo filings made? ICC (include # ) States (include # ) te: If not currently required by regulatory authorities, attach latest year-end statement. Name of present insurance company: Is present policy being cancelled or non-renewed Present insuring conditions: All Risks Named Perils Theft Deductible: Radius of operations (%) Local: % Intermediate % Long Haul: % Page 1 of 5
2 Equipment type Drayage Trucks Tractors Semi-Trailers Full trailers Tank Semi-trailers Refrigerated Trailers Number of Pieces of Equipment Company Owned Long Term Lease Trip Lease From Other Is equipment leased, loaned or rented to others? Does applicant interchange equipment with other carriers? Details: Gross receipts for the past two years: Motor Carrier Freight forwarder Owner Operator Freight Broker Shippers Agent Other Warehousing Total Name principal commodities hauled (avoid term General Commodities ) Does applicant offer insurance coverage to shippers, beyond Bill of Lading? Provide details and annual values: PREMIUMS AND LOSSES Period Losses (Paid and Outstanding) Total From To Prem Fire Collision Overturn Theft Other Page 2 of 5
3 CARGO LIMITS REQUESTED Cargo Limits Requested: per vehicle: per disaster Average exposure per vehicle: Maximum exposure Per vehicle: How long, on average, have drivers been with applicant? Check as appropriate. If you have multiple locations, please attach responses for each location. TERMINALS WHERE VEHICLES MAY BE KEPT attach a copy if required for additional locations Address Construction Protection Limit Does applicant offer insurance coverage to owners, beyond warehouse receipt? Provide details and annual values: Any other entities to be listed as Additional Insureds? Name or Entity Provide details Interest/Activity Page 3 of 5
4 BUILDINGS OR REAL PROPERTY TO BE INSURED attach copy if required for additional locations Address Construction Protection Value GENERAL INFORMATION Explain all YES responses 1. Is there a vehicle maintenance program in operation? If yes, who maintains the vehicles? 9. Are vehicles equipped with anti-theft devices? If yes, 2. Does applicant obtain MVR verification before hiring drivers? 3. Does applicant have a driver recruiting method? 4. Does applicant have a driver training method? If, who trains new drivers? 5. Does applicant have a loss prevention program? If yes, who runs the program? describe 10. Are vehicles left unlocked when unattended? 11. Are any vehicles operated for the applicant by others? 12. Do terminals have fire protection? 13. Do terminals have guards or watchmen? If yes, how many when closed? Guard Watchmen 6. Do drivers receive regular physicals? If, how often? 7. Are drug tests performed at the same time? 8. Are two drivers used on highvalue shipments? 14. Do terminals have alarms, fences, lights or dogs? 15. Are vehicles left loaded overnight? 16. Are loaded vehicles brought home by drivers? 17. Does applicant have a written company personnel policy? Alarm Fences Lights Dogs Page 4 of 5
5 INSURED S WARRANTY I UNDERSTAND THAT THE INFORMATION CONTAINED ON THIS APPLICATION IS CORRECT AND ACCURATE. ANY MATERIAL DISCREPANCIES MAY CAUSE ANY SUBSEQUENTLY ISSUED POLICY TO BE AMENDED OR CANCELLED, AT THE DISCREION OF UNDERWRITERS. Insured s Signature: Agent or Broker: Address: Agent or Broker Signature: Date: Date: Page 5 of 5
BASIC INFORMATION. Yes No in the last five years? Is applicant a Limited (incorporated) company? Yes No. Current Insurer: Policy No.
Intact Insurance Company Motor Truck Cargo Application If you are primarily a local or regional carrier, in the business of transporting goods for others, our Motor Truck Cargo Carriers Legal Liability
More informationAlabama Trucking Association Workers Compensation Fund P. O. BOX 241605 Telephone: (334) 834-7911 MONTGOMERY, AL 36124 Facsimile: (334) 834-7931
Alabama Trucking Association Workers Compensation Fund P. O. BOX 241605 Telephone: (334) 834-7911 MONTGOMERY, AL 36124 Facsimile: (334) 834-7931 Motor Carrier Application A Complete ATA Workers Compensation
More informationCOMMERCIAL AUTO APPLICATION
Acceptance Indemnity Insurance Company Acceptance Casualty Insurance Company Occidental Fire & Casualty of North Carolina Wilshire Insurance Company Harco National Insurance Company Transguard Insurance
More informationPersonnel Position Name Years % of Ownership President Operations Manager Safety Director Loss Control Contact Insurance Contact
Truck Transportation Application Agent Information Agency Producer General Information Named Insured Street Address State Phone Affiliated Companies Date Received Effective Date Requested Quote Date DBA
More informationCOMBINED MOTOR TRUCK CARGO AND COMMERCIAL AUTOMOBILE PHYSICAL DAMAGE PROPOSAL FORM
COMBINED MOTOR TRUCK CARGO AND COMMERCIAL AUTOMOBILE PHYSICAL DAMAGE PROPOSAL FORM ALL QUESTIONS MUST BE ANSWERED, ANY QUESTIONS LEFT BLANK WILL BE DEEMED TO HAVE BEEN ANSWERED NO OR NOT APPLICABLE DETAILS
More informationSmall Fleet Truckers (6-19 Revenue Units) Underwriting Checklist
Small Fleet Truckers (6-19 Revenue Units) Underwriting Checklist Fleet: City, State: Insured s Email Address: Expiration Date: Proposed Effective Date: Date Quote Required: Broker: Producer(s): Producer
More informationHazardous Materials Haulers, Auto Liability, Physical Damage and Pollution Liability
Email: info@eiains.com Phone: (800) 977-3335 Mail: PO Box 23605 Portland, OR 97281 Fax: (503) 977-3334 Hazardous Materials Haulers, Auto Liability, Physical Damage and Pollution Liability GENERAL INFORMATION
More informationCanal Truck Insurance Application
Insurance Indemnity Sections 1 through 6 must be completed for a quote indication. Sections 7 through 9 must be completed in order to bind. 1. General Information Applicant Legal Name Company Name (DBA)
More informationMcM 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 informationA-One Commercial Insurance Risk Retention Group, Inc. Auto Liability Application GENERAL INFORMATION
Agency Producer Email Name: DBA (if any): GENERAL INFORMATION Business Entity: Individual Sole Proprietor Corporation Partnership LLC Other: Effective Date: US DOT: SSN or FEIN: Yrs in business: Yrs in
More informationMOTOR TRUCK CARGO APPLICATION BROAD FORM 15. 1. Name of Applicant: doing business as. Name Address City State Zip Code Function
MOTOR TRUCK CARGO APPLICATION BROAD FORM 15 Use space on last page or attach an extra sheet if there is insufficient room for answers. 1. Name of Applicant: doing business as Company: Year established:
More informationCOMMERCIAL AUTO TRUCKING APPLICATION
COMMERCIAL AUTO TRUCKING APPLICATION A. GENERAL INFORMATION Proposed Effective Date: Business Name: (DBA) Applicant s Name: Applicant s Mailing Address: City: : Zip: E-Mail: County: Business Telephone
More informationTruck 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 informationIndividual LLC Partnership Corporation Joint Venture Trust Principal or Majority Owner (please include all principals)
Canal Truck Insurance Application Insurance Indemnity Sections 1 through 6 must be completed for a quote indication. Sections 7 through 9 must be completed in order to bind. 1. General Information Applicant
More informationIndividual LLC Partnership Corporation Joint Venture Trust Principal or Majority Owner (please include all principals)
Insurance Indemnity Sections 1 through 6 must be completed for a quote indication. Sections 7 through 9 must be completed in order to bind. 1. General Information Applicant Legal Name Company Name (DBA)
More informationCOMMERCIAL 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 informationA-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 informationINSURANCE HISTORY & LOSS EXPERIENCE HAS ANY INSURANCE COMPANY CANCELED OR NONRENEWED YOUR POLICY IN THE LAST THREE YEARS? Yes No If Yes, explain.
NORTHLAND INSURANCE COMPANY FLORIDA COMMERCIAL AUTO FLEET INSURANCE APPLICATION Entire application must be completed and signed. Brokering Agent s Register No. Responding Fire Department/ Municipal Tax
More informationCOMMERCIAL 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 informationCOMMERCIAL AUTO INSURANCE
COMMERCIAL AUTO INSURANCE GENERAL INFORMATION Requested effective date: / / Term: / / Name of applicant: Individual Partnership LLC S-Corporation Corporation Other (explain) Mailing address: Principal
More informationdomicile, including but not limited to Personal Injury Protection (PIP) and Personal Property insurance (PPI), must be carried.
Independent Contractor Insurance Requirements Sample provided by Paul Hanson Partners Specialty Insurance Solutions This document should be reviewed with your broker and attorney and modifications for
More informationBlog by Tommy Ruke, The King Pin Leading Expert in Truck Insurance
Blog by Tommy Ruke, The King Pin Leading Expert in Truck Insurance Non-Owned Trailers Additional Discussion The previous blog received a lot of comments. Here is a more in depth discussion: Denny Beecher
More informationTo separate a composite load into individual shipments and route to different destinations.
Term: Definition: 3PL The transportation, warehousing and other logistics related services provided by companies employed to assume tasks that were previously performed in-house by the client. Also referred
More informationCanal Commercial Combination Insurance Application Entire Application Must Be Completed and Signed
CANAL INSURANCE COMPANY CANAL INDEMNITY COMPANY 1. GENERAL INFORMATION Applicant Legal Name Company Name (DBA) (if any) Canal Commercial Combination Insurance Application Entire Application Must Be Completed
More informationYrs. in Trucking Industry Yrs. Under Business Name Mailing Address Federal ID # or SSN U.S. DOT Number
NEW YORK COMMERCIAL AUTO FLEET INSURANCE APPLICATION Entire application must be completed and signed. GENERAL INFORMATION Individual Corporation Partnership LLC Other Name Yrs. in Trucking Industry Yrs.
More informationAuto Repair and Service Insurance Application
Auto Repair and Service Insurance Application INSTRUCTIONS: ALL QUESTIONS MUST BE ANSWERED IN FULL. INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED MVR S MUST BE SUBMITTED ON ALL OWNERS AND EMPLOYEES. Producer
More informationCOMMERCIAL AUTO INSURANCE NON-FLEET
COMMERCIAL AUTO INSURANCE NON-FLEET GENERAL INFORMATION Requested effective date: / / Term: 1 year Name of applicant: Individual Partnership LLC Corporation S-Corporation Other (explain) Mailing address:
More informationCOMMERCIAL AUTO FLEET INSURANCE APPLICATION Entire application must be completed and signed.
COMMERCIAL AUTO FLEET INSURANCE APPLICATION Entire application must be completed and signed. GENERAL INFORMATION Individual Corporation Partnership LLC Other Name Yrs. in Trucking Industry Yrs. Under Business
More informationAuto Service and Repair Insurance Application
Auto Service and Repair Insurance Application Section I General Information Policy Period Desired From to 1. d Insured Type of Entity: Corp Partnership Individual LLC Other 2. For inspection purposes:
More information"Insurance Services Office, Inc. Copyright"
POLICY NUMBER: COMMERCIAL AUTO CA 23 23 11 02 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. "Insurance Services Office, Inc. Copyright" This form has been promulgated by the Virginia State
More informationKANSAS COMMERCIAL AUTO FLEET INSURANCE APPLICATION Entire application must be completed and signed.
KANSAS COMMERCIAL AUTO FLEET INSURANCE APPLICATION Entire application must be completed and signed. GENERAL INFORMATION Individual Corporation Partnership LLC Other Name Yrs. in Trucking Industry Yrs.
More information576 Valley Rd, #234 Wayne, NJ 07470 Tel: (973) 333-4922 Fax: (973) 595-7720. Attention: Date:
Attention: 576 Valley Rd, #234 Tel: (973) 333-4922 Fax: (973) 595-7720 From: Date: Cheryl Biron I would like to take this time to thank you for your interest in becoming a qualified carrier for One Horn
More information5Star Submission Checklist & Questionnaire Trucking Program
5Star Submission Checklist & Questionnaire Trucking Program Agency Helpline ~ 877-247-9772 No coverage is effective until approved by the General Agent Choose the office to work with: Send submissions
More informationMotor Carrier Filings For Non-Trucking Cases
Insurance Indemnity Sections 1 through 6 must be completed for a quote indication. Sections 7 through 9 must be completed in order to bind. 1. General Information Applicant Legal Name Company Name (DBA)
More informationAutomobile Service Operations Application
Automobile Service Operations Application NATIONAL INDEMNITY COMPANY OF THE SOUTH NATIONAL LIABILITY & FIRE INSURANCE COMPANY Administrative Office Omaha, Nebraska Desired Policy Term From: To: 1. Named
More informationContingent 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 informationAutomobile Service Operations Application
Automobile Service Operations Application COLUMBIA INSURANCE COMPANY NATIONAL FIRE & MARINE INSURANCE COMPANY NATIONAL INDEMNITY COMPANY NATIONAL INDEMNITY COMPANY OF MID-AMERICA NATIONAL INDEMNITY COMPANY
More informationTRANSPORTATION AGREEMENT
TRANSPORTATION AGREEMENT THIS AGREEMENT ( Agreement ) is dated as of, 200 between including its subsidiaries (collectively, Shipper ), and Dick Harris and Son Trucking Co., Inc. (Carrier). Carrier agrees
More informationCOMMERCIAL 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 informationMOTOR CARRIER APPLICATION FOR TRUCKERS INSURANCE FOR NON-TRUCKING LIABILITY AND VEHICLE PHYSICAL DAMAGE COVERAGE
MOTOR CARRIER APPLICATION FOR TRUCKERS INSURANCE FOR NON-TRUCKING LIABILITY AND VEHICLE PHYSICAL DAMAGE COVERAGE Applicant: _ City, State: Proposed Effective Date: Proposed Expiration Date: Date Quote
More informationCOMMERCIAL 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 informationCTP 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 informationMOTOR CARRIER QUESTIONNAIRE FOR TRUCKERS INSURANCE FOR NON-TRUCKING LIABILITY AND VEHICLE PHYSICAL DAMAGE COVERAGE
MOTOR CARRIER QUESTIONNAIRE FOR TRUCKERS INSURANCE FOR NON-TRUCKING LIABILITY AND VEHICLE PHYSICAL DAMAGE COVERAGE Applicant: _ City, State: Proposed Effective Date: Proposed Expiration Date: Date Quote
More informationAmerican Fast Freight
Shipping Terms American Fast Freight Ad Valorem Tax A charge levied on persons or organizations based on the value of transaction. It is normally a given percentage of the price of the retail or manufacturing
More informationInsurance for Small to Medium Fleets
Insurance for Small to Medium Fleets At Daimler Truck Financial, every customer is important. We ve been doing business that way since day one, which is why we have been a leader in the industry for close
More informationUsing Independent Contractors: A Guide to IRS and Insurance Guidelines
Using Independent Contractors: A Guide to IRS and Insurance Guidelines Table of Contents About this guide.................................. 1 Defining an independent contractor and their............ 2
More information*NOTE: Applications take a minimum of 15 days to process once all of the above information is received.
RECOVERY SPECIALIST INSURANCE GROUP Application for Membership and Insurance (MUST BE COMPLETED IN ITS ENTIRETY WITH ALL QUESTIONS ANSWERED) Date of Application: / / Repossession Policy: Desired Effective
More informationKAIGLER & COMPANY 7028 Church St East Brentwood TN 37027 Phone 615 376 0798 Fax 615 376 0799 Toll Free 1 888 468 2683
KAIGLER & COMPANY 7028 Church St East Brentwood TN 37027 Phone 615 376 0798 Fax 615 376 0799 Toll Free 1 888 468 2683 COMMERCIAL AUTO TRUCKING Physical Damage Cargo Primary Umbrella Upper Layer Excess
More informationLOGISTICS FREIGHT FORWARDERS SUPPLEMENTAL APPLICATION
LOGISTICS FREIGHT FORWARDERS SUPPLEMENTAL APPLICATION INSTRUCTIONS FOR COMPLETING APPLICATION: 1. Please answer all the questions. This information is required to make an underwriting and pricing evaluation.
More informationCAROLINA 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 informationNew Carrier Setup Form
New Carrier Setup Form Carrier Name: Business Address Street: City: State: Zip: Contact Name: Phone Number: Cell Phone Number: Toll Free Phone Number: Fax Number: Email Address: Payee Address (if different)
More informationFTP INC 131 WHITE OAK LANE OLD BRIDGE,NJ 08857 732 679 3700 FAX 732 679 6928
FTP INC 131 WHITE OAK LANE OLD BRIDGE,NJ 08857 732 679 3700 FAX 732 679 6928 Auto Service Risks Application Applicant s Name Agency Name Agent Mailing Address Address Web site Address E-mail Phone PROPOSED
More informationWCLA Insurance Agency, Inc Commercial Insurance Questionnaire General Information
WCLA Insurance Agency, Inc Commercial Insurance Questionnaire General Information Business Name Mailing Address Physical Address (if different) Telephone Number(s)-(and the best time to call) First Named
More informationFrequently Asked Questions (FAQs)
Frequently Asked Questions (FAQs) 1. What is the difference between an owner-operator and a leased on owner-operator? An owner-operator that operates under their own authority is a true entrepreneur in
More informationCOMMERCIAL AUTO FLEET INSURANCE APPLICATION
PO Box 2575 Jacksonville, Florida 32203 904-363-0900 800-874-8053 Fax 904-363-8093 COMMERCIAL AUTO FLEET INSURANCE APPLICATION GENERAL INFORMATION Producer Name: Contact Name: Date Coverage Desired: From:
More informationCOMMERCIAL AUTO FLEET INSURANCE APPLICATION
PO Box 2575 Jacksonville, Florida 32203 904-363-0900 800-874-8053 Fax 904-363-8093 COMMERCIAL AUTO FLEET INSURANCE APPLICATION GENERAL INFORMATION Date Coverage Desired: From: To: Name: Individual Partnership
More informationAPPLICATION FOR INSURANCE COVERAGE
APPLICATION FOR INSURANCE COVERAGE Policy Eff. Date: Date Needed: Current Carrier: Name of Applicant: Indiv. Corp. Part. Mailing Address: New Renewal City: ST.: Zip: - Bus Telephone: Person to Contact:
More informationNON-FRANCHISED CAR DEALERS / USED CAR SALES DISCOVERY QUESTIONNAIRE THIS IS FOR QUOTATION PURPOSES ONLY THIS IS NOT A BINDER
ANY PERSON WHO KNOWINGLY AND WITH INTENT TO DEFRAUD ANY INSURANCE COMPANY OR OTHER PERSON, FILES AN APPLICATION FOR INSURANCE CONTAINING ANY FALSE INFORMATION, OR CONCEALS FOR THE PURPOSE OF MISLEADING,
More informationHDA Insurance Brokerage 10727 White Oak Avenue, Suite 115 Granada Hills, CA 91344-4646 877-931-3368 Fax 818-831-1268
HDA Insurance Brokerage 10727 White Oak Avenue, Suite 115 Granada Hills, CA 91344-4646 877-931-3368 Fax 818-831-1268 COMMERCIAL AUTO General Information Proposed Effective Date: Applicant s Name: Applicant
More informationCOMMERCIAL 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 informationBROKER S INFORMATION HANDBOOK for PREMIER MOVING & STORAGE PROGRAMS
BROKER S INFORMATION HANDBOOK for PREMIER MOVING & STORAGE PROGRAMS TABLE OF CONTENTS INFORMATION COVERED PAGE NO. Welcome to TRANSGUARD Two General Information Three Submitting Applications Four Processing
More informationAPPLICATION FOR EXPLOSIVES INSURANCE
Please return completed application to: TEXAS AGA, INC. Attn: Explosives Department 4205 Beltway, Addison, Texas 75001 972-980-9484 Fax # 972-980-9481 Toll Free # 800-875-9484 APPLICATION FOR EXPLOSIVES
More informationJames Villanueva / Street Address: City/State/Zip: Street Address: City/State/Zip: Name: Email: Phone Number: Fax Number:
/ For Office Use Only Producer Email Telephone q James Villanueva jamesv@piag.org 404-838-8554 q Lamar Coates lamar@piag.org 678-816-1170 Date Submitted Date Requested PIAG INSURANCE SERVICES James Villanueva
More informationTRUCKING NAVIGATION GUIDE. David A. Miller, CPCU
TRUCKING NAVIGATION GUIDE David A. Miller, CPCU W. A. Schickedanz Agency, Inc. / Interstate Risk Placement, Inc. has produced this document to help producers understand requirements that Commercial Auto
More informationIntercargo Insurance Company Master Application for Transportation Industry Liability Insurance Coverage(s)
Intercargo Insurance Company Master Application for Transportation Industry Liability Insurance Coverage(s) Applicant Name: { NEW { RENEWAL of Policy # PLEASE CHECK ADDENDUM (S) ATTACHED: { Coverage A:
More informationBOAT. TRANSPORTERS NMMA Transportation Task Force FOR. Recommended BEST PRACTICES. nmma.org GOVERNMENT RELATIONS
GOVERNMENT RELATIONS Recommended BEST PRACTICES FOR BOAT TRANSPORTERS NMMA Transportation Task Force nmma.org 200 E. Randolph Drive, Suite 5100, Chicago, Illinois 60601 6528, USA Phone 312.946.6200 Fax
More informationPACIFIC SPECIALTY INSURANCE COMPANY STATE OF CALIFORNIA. Non-Franchised Auto Dealers Program Underwriting and Rate Guide
PACIFIC SPECIALTY INSURANCE COMPANY STATE OF CALIFORNIA Non-Franchised Auto Dealers Program Underwriting and Rate Guide General Information 1. A fully completed and signed application is required on all
More informationTowing 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 informationHow To Get Insurance Coverage
RLP- Renter's Liability Protection SLI - Supplemental Liability Insurance APPLICANT'S SECTION: 1. Business name (s) of applicant (list full entity name, dba's, etc., and state of incorporation, if applicable)
More informationBOAT DEALER/ MARINA OPERATOR This is not a Binder
BOAT DEALER/ MARINA OPERATOR This is not a Binder Great American Insurance Company of New York Great American Insurance Company NAME OF APPLICANT PRODUCER NAME AND ADDRESS ADDRESS - NUMBER AND STREET CITY
More informationCommercial Automobile Insurance Manual
(RULE 112) AMBULANCE SERVICES 1. Ambulance (Class Code 79130) Multiply the fleet or non-fleet Trucks, Tractors and Trailers base premium by 3.00. by the following rating factors:.87 1.23 2. Ambulance Type
More informationII MEDIUM FLEET TRUCKING
., II MEDIUM FLEET OVERVIEW ;nsurance Company AGENDA Highlights: Protective Medium Fleet Program - Mission I Target Customer - Platform Description Coverages Loss Prevention Claims Administration - Underwriting
More information20 IRS Factors and Insurance Guidelines You Need to Know
Guide to Using Independent Contractors: 20 IRS Factors and Insurance Guidelines You Need to Know A1-19812-A (07/11) 11-1062 2011 Paul Hanson Partners. All rights reserved. Table of Contents About This
More information7 TOW TRUCK PROGRAM SUPPLEMENTAL APPLICATION
LICATION Named Insured: Owner s Name: Web site Address: Address: Type of business Individual Corporation LLC Other Federal Tax ID: I. ELIGIBILITY 1. Are at least 50% of the operations derived towing? Yes
More informationSLM BROKERS 11441 GEHR RD WAYNESBORO PA 17268 PHONE: 717-762-2772 FAX: 717-762-0953
SLM BROKERS 11441 GEHR RD WAYNESBORO PA 17268 PHONE: 717-762-2772 FAX: 717-762-0953 In order to get you set up with our company we will need the following documents: Copy of your operating authority Copy
More informationTo process this application, the following documents must be provided and attached:
COMMERCIAL FLEET UNDERWRITING CHECKLIST This application cannot be processed unless signed by The Broker and an Authorized Officer of the Applicant Organization To process this application, the following
More informationPLEASE ASK ABOUT OUR QUICKPAY OPTIONS. WE ALSO HAVE A FACTORING DIVISION READY TO HELP WITH ANY AND ALL FINANCING NEEDS.
PLEASE ASK ABOUT OUR QUICKPAY OPTIONS. WE ALSO HAVE A FACTORING DIVISION READY TO HELP WITH ANY AND ALL FINANCING NEEDS. 6871 W Soldier Creek Ave, Rathdrum ID 83858 Phone: 888-253-0430 X. 1 Fax: 208-439-3152
More informationTRUCK FLEET APPLICATION 10+ Power Units
GENERAL INFORMATION TRUCK FLEET APPLICATION 10+ Power Units Entire application must be completed and signed. Individual Corporation Partnership LLC Other Name Yrs. Applicant has been Operating Under Business
More informationMISSISSIPPI 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 informationALARM COMPANIES, FIRE PROTECTION, FIRE EXTINGUISHING SYSTEM INSTALLATION, SERVICE, & REPAIR
Salt Lake City Area Office 8722 S. Harrison St. Sandy, UT 84070 P.O. Box 4439 Sandy, UT 84091 800-257-5590 Fax 877-452-6910 Chicago Office 303 W. Madison Street Suite 2075 Chicago, IL 60606 800-456-4576
More informationAPPLICANT INFORMATION
IAT Specialty Acceptance Indemnity Insurance Company PO Box 3328 Acceptance Casualty Insurance Company Omaha, NE 68103 Occidental Fire & Casualty Insurance Company 1-888-389-0598 Wilshire Insurance Company
More informationCOM 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 informationCustoms-Trade Partnership against Terrorism Supply Chain Security Profile
Customs-Trade Partnership against Terrorism Supply Chain Security Profile Service Provider Assessment (Warehouse) Please answer the following questions about your company s cargo security processes and
More informationTo process this application, the following documents must be provided and attached:
COMMERCIAL FLEET UNDERWRITING CHECKLIST This application cannot be processed unless signed by The Broker and an Authorized Officer of the Applicant Organization To process this application, the following
More informationYear Month Day TO Year Month Day
Ontario Application for Automobile Insurance - Garage Form (O.A.P. 4) Policy No. Assigned New Policy Renewal Replacing Policy No. Language Insurance Company Broker Ensurco Preferred Insurance Group English
More informationInternational Insurance - Part 3. Auto, Employee Benefits & Cargo Coverage
International Insurance - Part 3 Auto, Employee Benefits & Cargo Coverage INTERNATIONAL INSURANCE Auto, Employee Benefits & Cargo Insurance Part 3 Robin Federici, CPCU, AAI, ARM, AINS, AIS, CPIW PO BOX
More informationCustoms-Trade Partnership against Terrorism Supply Chain Security Profile
Customs-Trade Partnership against Terrorism Supply Chain Security Profile Service Provider Assessment (Trucker) Please answer the following questions about your company s cargo security processes and participation
More informationPHYSICAL 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 informationCarrier Packet Requirements
Carrier Packet Requirements National Transportation Services, LLC looks forward to working with you. Enclosed you will find our carrier requirements, items 1to 9 below reflect the documentation you are
More informationThe Great American Trucking Story
Trucking Division The Great American Trucking Story In recent years, a number of top motor carriers leaders in the trucking industry have chosen to offer Great American s insurance products to the independent
More informationQuotation Request and Proposal
Quotation Request and Proposal Richard Bowen 0800 287 287 Managing Broker MultiSure Ltd 86 Normandale Road, Lower Hutt 5010 Ph: (04) 589 3319 Fax: (04) 587 0258 Email: richard@multisure.co.nz Philip Toohill
More informationGarage and Garagekeepers Supplemental Application TEXAS
Garage and Garagekeepers Supplemental Application TEXAS McNeil & Company, Inc. P.O. Box 5670 Cortland, New York 13045 Phone (800) 822-3747 Fax: (607) 758-9028 General Information Date of survey: Insurance
More informationWarning! Warning! A plain vanilla Business Auto Policy (BAP) does not serve as a substitute for a
The Business Auto Policy, AKA The Commercial Auto Program Warning! Warning! A plain vanilla Business Auto Policy (BAP) does not serve as a substitute for a Personal Auto Policy (PAP). Unless you're in
More informationWORKERS COMPENSATION SUPPLEMENTAL APPLICATION
HOW TO USE USE THIS THIS FORM: FORM: Download and and save save this this form form to your to your hard hard drive drive before before entering yourinformationi n the spaces in the spaces provided. provided.
More informationFederal Motor Carrier Safety Administration, DOT Pt. 376 SUBPART I RESOLVING DISPUTES WITH MY MOVER WHAT MAY I DO TO RESOLVE DISPUTES WITH MY MOVER?
cprice-sewell on PROD1PC63 with CFR Federal Motor Carrier Safety Administration, DOT Pt. 376 WHAT ACTIONS MAY MY MOVER TAKE TO COL- LECT FROM ME THE CHARGES IN ITS FREIGHT BILL? Your mover must present
More informationCOLORADO BUSINESS AUTO PROGRAM
AMERICAN SERVICE INSURANCE COMPANY COMMERCIAL BUSINESS UNIT COLORADO BUSINESS AUTO PROGRAM TRAINING GUIDE WEBSITE: www.atlas-fin.com For your convenience, here is our contact information: Phone: 847.472.6700
More informationI. Pease list the owner(s) of the business applying for insurance and identify how many years experience the owner(s) has in this type of business:
1. General Information Proposed Effective Date: A. Applicant s Name: B. Applicant s Mailing Address: E-Mail: County: Business Telephone Number: Fax: C. Physical Location of Business (if different): Population
More informationThank you for your interest in Enterprise Carrier Services. We are excited
Enterprise Carrier Services 1300 S. French Ave. Box 6-A Sanford, Florida 32771 Dear Sir or Madam: Thank you for your interest in Enterprise Carrier Services. We are excited about the opportunity to help
More informationLarge Fleet Trucking Program Guidelines (20+ power units)
Large Fleet Trucking Program Guidelines (20+ power units) These guidelines will assist you in qualifying, submitting and binding Large Fleet Trucking business with RLI Transportation. These guidelines
More information