Transportation/Trucking Insurance Quote

Trucking Insurance Quote

Transportation/Trucking Insurance Quote

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QUOTE SHEET—COMMERCIAL AUTO

Risk Name *

USDOT# *

Email *

Phone Number *

Organization Type: *

Individual/Sole Proprietorship Partnership Corporation

Company Website: *

Business Information

Business type (e.g., plumber, landscaper, gravel hauler) *

Year current business was established *

Does insured have a GL or BOP policy? *

USDOT Number and date issued? *

Is customer required to maintain hours of service records using an electronic logging device (ELD)? *

Name of ELD Vendor *

Insured name *

First

Last

EIN *

SS# *

Date of birth *

Home address *

Line 1

Line 2

City

State

Zip Code

Country

Prior insurance carrier *

BI limits *

Inception/effective date *

Cancel/expiration date *

Has customer ever been insured by Progressive? *

# Additional insureds listed *

# Waivers of Subrogation required *

Vehicle Information

Primary Vehicle

Year *

Make *

Model *

Vehicle type *

Vehicle Identification Number (VIN) *

Passenger capacity or # of axles (for tow trucks, vans, buses ONLY *

Gross Vehicle Weight (if no VIN) *

Trailer hitch? *

Use of vehicle/goods hauled/# sites per day *

Any personal use? *

Garaging zip code *

Total stated amount (includes permanently attached equipment) *

Radius of operation *

Vehicle #2 (if necessary)

Year (V2) *

Make (V2) *

Model (V2) *

Vehicle type (V2) *

Vehicle Identification Number (VIN) (V2) *

Passenger capacity or # of axles (for tow trucks, vans, buses ONLY) (V2) *

Gross Vehicle Weight (if no VIN) (V2) *

Trailer hitch? (V2) *

Use of vehicle/goods hauled/# sites per day (V2) *

Any personal use? (V2) *

Garaging zip code (V2) *

Total stated amount (includes permanently attached equipment) (V2) *

Radius of operation (V2) *

Vehicle #3 (if necessary)

Year (V3) *

Make (V3) *

Model (V3) *

Vehicle type (V3) *

Vehicle Identification Number (VIN) (V3) *

Passenger capacity or # of axles (for tow trucks, vans, buses ONLY) (V3) *

Gross Vehicle Weight (if no VIN) (V3) *

Trailer hitch? (V3) *

Use of vehicle/goods hauled/# sites per day (V3) *

Any personal use? (V3) *

Garaging zip code (V3) *

Total stated amount (includes permanently attached equipment) (V3) *

Radius of operation (V3) *

Vehicle #4 (if necessary)

Year (V4) *

Make (V4) *

Model (V4) *

Vehicle type (V4) *

Vehicle Identification Number (VIN) (V4) *

Passenger capacity or # of axles (for tow trucks, vans, buses ONLY) (V4) *

Gross Vehicle Weight (if no VIN) (V4) *

Trailer hitch? (V4) *

Use of vehicle/goods hauled/# sites per day (V4) *

Any personal use? (V4) *

Garaging zip code (V4) *

Total stated amount (includes permanently attached equipment) (V4) *

Radius of operation (V4) *

Driver Information

Driver Name *

Driver’s license number *

Age *

Marital status *

Date CDL issued *

Accidents in past 35 months *

Violations in past 35 months (list violation and date) *

Filings required? (list type) *

Driver 2 Name (if necessary) *

Driver’s license number (D2) *

Age (D2) *

Marital status (D2) *

Date CDL issued (D2) *

Accidents in past 35 months (D2) *

Violations in past 35 months (list violation and date) (D2) *

Filings required? (list type) (D2) *

Driver 3 Name (if necessary) *

Driver’s license number (D3) *

Age (D3) *

Marital status (D3) *

Date CDL issued (D3) *

Accidents in past 35 months (D3) *

Violations in past 35 months (list violation and date) (D3) *

Filings required? (list type) (D3) *

Driver 4 Name (if necessary) *

Driver’s license number (D4) *

Age (D4) *

Marital status (D4) *

Date CDL issued (D4) *

Accidents in past 35 months (D4) *

Violations in past 35 months (list violation and date) (D4) *

Filings required? (list type) (D4) *

Coverages—Limits/Deductibles

Primary Vehicle

BI/PD *

UM/UIM *

PIP *

Medical Payments *

Comprehensive or F&T w/CAC *

Collision *

Motor Truck Cargo *

Motor Truck Cargo Refrigeration Breakdown *

Non-Trucking/Contingent Liability *

Any Auto *

Non-Owned (include # of employees) *

Hired Auto (include annual cost) *

On-Hook Towing *

Garagekeepers Legal Liability *

Trailer Interchange (include # of trailers) *

Drive Other Car—Broadform *

Rental Reimbursement *

Roadside Assistance *

Vehicle #2 (if necessary)

BI/PD (V2) *

UM/UIM (V2) *

PIP (V2) *

Medical Payments (V2) *

Comprehensive or F&T w/CAC (V2) *

Collision (V2) *

Motor Truck Cargo (V2) *

Motor Truck Cargo Refrigeration Breakdown (V2) *

Non-Trucking/Contingent Liability (V2) *

Any Auto (V2) *

Non-Owned (include # of employees) (V2) *

Hired Auto (include annual cost) (V2) *

On-Hook Towing (V2) *

Garagekeepers Legal Liability (V2) *

Trailer Interchange (include # of trailers) (V2) *

Drive Other Car—Broadform (V2) *

Rental Reimbursement (V2) *

Roadside Assistance (V2) *

Vehicle #3 (if necessary)

BI/PD (V3) *

UM/UIM (V3) *

PIP (V3) *

Medical Payments (V3) *

Comprehensive or F&T w/CAC (V3) *

Collision (V3) *

Motor Truck Cargo (V3) *

Motor Truck Cargo Refrigeration Breakdown (V3) *

Non-Trucking/Contingent Liability (V3) *

Any Auto (V3) *

Non-Owned (include # of employees) (V3) *

Hired Auto (include annual cost) (V3) *

On-Hook Towing (V3) *

Garagekeepers Legal Liability (V3) *

Trailer Interchange (include # of trailers) (V3) *

Drive Other Car—Broadform (V3) *

Rental Reimbursement (V3) *

Roadside Assistance (V3) *

Vehicle #4 (if necessary)

BI/PD (V4) *

UM/UIM (V4) *

PIP (V4) *

Medical Payments (V4) *

Comprehensive or F&T w/CAC (V4) *

Collision (V4) *

Motor Truck Cargo (V4) *

Motor Truck Cargo Refrigeration Breakdown (V4) *

Non-Trucking/Contingent Liability (V4) *

Any Auto (V4) *

Non-Owned (include # of employees) (V4) *

Hired Auto (include annual cost) (V4) *

On-Hook Towing (V4) *

Garagekeepers Legal Liability (V4) *

Trailer Interchange (include # of trailers) (V4) *

Drive Other Car—Broadform (V4) *

Rental Reimbursement (V4) *

Roadside Assistance (V4) *

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Trucking Insurance Quote