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Trucking
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Non Fleet (Base Requirements)
Legal Name
Mailing Address
Garaging Address
# Years in Business Under this Name
Loss Summary - Three Years
Driver Schedule (Current)
DOB (Each Driver)
DOH (Each Driver)
# Years Commercial Driving Experience
(Each Driver)
Accident / Violation History - Three Years (Each Driver)
Vehicle Schedule (Current)
GVW (Each Vehicle)
Stated Values (Current)
Radius of Operation
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Cities Entered / Areas of Operation
U.S. D.O.T. #(if applicable)
FHWA #(if applicable)
Commodities Hauled
Limits
Deductibles
Company Application
Hazardous Material Detail
D.O.T. Safety Rating Problems Addressed?
Vehicle "Out of Service" Problems Addressed?
Driver "Out of Service" Problems Addressed?
Freight Brokerage Detail
Target Premium
Additional Remarks
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Small Fleet
(Base requirements) +
Hard Copy Loss Runs - Three Years (Currently Valued)
Current MVR (Each Driver)
IFTA Mileage Reports (4 Qtrs)
Power Unit Count History (Three Years)
Receipts History (Three Years)
Mileage History (Three Years)
Driver Monitoring/Selection Info
Vehicle Maintenance Info
Safety Program
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Large Fleet
(Base requirements) +
Hard Copy Loss Runs - Five Years (Currently Valued)
Current MVR (Each Driver)
IFTA Mileage Reports (4 Qtrs)
Power Unit Count History (Five Years)
Receipts History (Five Years)
Mileage History (Five Years)
C.A.B. Rating Problems Addressed?
Driver Monitoring/Selection Info
Vehicle Maintenance Info
Safety Program
Current Financials
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Public Auto
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Non Fleet (Base requirements)
Legal Name
Mailing Address
Garaging Address
# Years in Business Under this Name
Loss Summary - Three Years
Driver Schedule (Current)
DOB (Each Driver)
DOH (Each Driver)
# Years Commercial Driving Experience
(Each Driver)
Accident / Violation History - Three Years (Each Driver)
Vehicle Schedule (Current) |
Seating Capacity (Each Vehicle)
Stated Values (Current)
Radius of Operation
Cities Entered / Areas of Operation
Which Airports Serviced?
Limousine Length(s) (inches)
U.S. D.O.T. #(if applicable)
FHWA #(if applicable)
Limits
Deductibles
Company Application
Target Premium
Additional Remarks |
Small Fleet
(Base requirements) +
Hard Copy Loss Runs - Three Years (Currently Valued)
Current MVR (Each Driver)
Seating Capacity (Each Vehicle)
Which Airports Serviced?
Limousine Length(s) (inches)
Power Unit Count History (Three Years)
Receipts History (Three Years)
Mileage History (Three Years)
Driver Monitoring/Selection Info
Vehicle Maintenance Info
Safety Program |
Large Fleet
(Base requirements) +
Hard Copy Loss Runs - Five Years (Currently Valued)
Current MVR (Each Driver)
Seating Capacity (Each Vehicle)
Which Airports Serviced?
Limousine Length(s) (inches)
Power Unit Count History (Five Years)
Receipts History (Five Years)
Mileage History (Five Years)
Driver Monitoring/Selection Info
Vehicle Maintenance Info
Safety Program
Current Financials |
Business Auto
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Non Fleet (Base requirements)
Legal Name
Mailing Address
Garaging Address
# Years in Business Under this Name
Loss Summary - Three Years
Driver Schedule (Current)
DOB (Each Driver)
DOH (Each Driver)
# Years Commercial Driving Experience
(Each Driver)
Accident / Violation History - Three Years (Each Driver) |
Vehicle Schedule (Current)
GVW (Each Vehicle)
Stated Values (Current)
Radius of Operation
Cities Entered / Areas of Operation
U.S. D.O.T. #(if applicable)
FHWA #(if applicable)
Commodities Hauled
Limits
Deductibles
Additional Remarks |
Small Fleet
(Base requirements) +
Hard Copy Loss Runs - Three Years (Currently Valued)
Current MVR (Each Driver)
Radius of Operation
Power Unit Count History (Three Years)
Receipts History (Three Years)
Mileage History (Three Years)
Driver Monitoring/Selection Info
Vehicle Maintenance Info
Safety Program
Additional Remarks |
Large Fleet
(Base requirements) +
Hard Copy Loss Runs - Five Years (Currently Valued)
Current MVR (Each Driver)
Power Unit Count History (Five Years)
Receipts History (Five Years)
Mileage History (Five Years)
Driver Monitoring/Selection Info
Vehicle Maintenance Info
Safety Program
Current Financials
Additional Remarks |
Property & Casualty
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(Base requirements)
Fully completed application which is to include:
Legal Name Mailing Address
# years of experience
# years in business
# years owned this property
Description of operations
Loss Summary - Three years
Details of all losses
Current & prior Carrier information
Target premium
Limits
Deductibles
Additional Remarks
Any other entities owned |
Property:
(Base requirements) +
Complete description of occupancy of building
Residential properties: any student, elderly or subsidized housing
Perils desired
Age of building
When updates completed
Protection devices: smoke alarms, extinguishers, automatic extinguishing
systems, central station alarms,
sprinkler systems
Co-insurance percentage
Deductible desired |
Inland Marine:
(Base requirements) +
Completed schedule of equipment
Model year of each item
Where stored when not in use
Protections provided at job site
How transported to job sites |
General Liability:
(Base requirements) +
Complete description of operations
Payroll & Gross Receipts
Any use of Subcontractors
Cost of Subcontractors
Additional Insureds - what is their interest
Trucking risks - need commodities hauled
Contractors - any roofing exposures plus details as to type of work being
done
Storage/Warehouse exposures - types of items stored |
Umbrella / Excess General Liability:
(Base requirements) +
Underlying carrier name
Limits of underlying policies
Premiums of underlying policies
5 years hard copy loss runs
Details of all losses in excess of $10,000
Annual Payroll & Gross Receipts information
Completed vehicle schedule including commodities hauled & radius of
operations |
Garage:
(Base requirements) +
Driver schedule (current) including family members
Date of Birth (each driver)
# years experience (each driver/mechanic)
Accident / Violation History - 3 years (each driver)
Radius of operation
How vehicles transported
Job duties of each driver including whether full or part time
Any repair operations on vehicles of others
Any rebuilding of vehicles
Frame straightening exposures
Lot protection - all sides
How plates stored
# and types of plates
Towing exposures - for hire or not for hire |
Workers Compensation:
# full time & part time employees for each code
Experience modifier (if eligible)
States of operation
Fully Completed Census |
