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AREAS COVERED:

SOUTHERN CALIFORNIA

NORTHERN CALIFORNIA

 

IF YOU WOULD LIKE A QUOTE PLEASE PROVIDE THE FOLLOWING ! WORKERS COMPENSATION

NAME OF BUSINESS

OWNERS FULL NAME & PHONE, DATE OF BIRTH  ( FOR QUOTING PURPOSES ONLY)

ADDRESS

CORPORATIONS OR INDIVIDUAL

HOW MANY YEARS IN BUSINESS

 HOW MANY EMPLOYEES

HOW MANY FULL TIME? HOW MANY PART-TIME?

 FEDERAL EMPLOYER ID NUMBER

ANNUAL PAYROLL CURRENT POLICY PREMIUM

ANY CLAIMS LOSES

NATURE OF BUSINESS/DESCRIPTION OF OPERATIONS

 LOSS RUNS

COPY OF DEC PAGE IF POSSIBLE

 

 TRUCKING CLIENTS PLEASE INCLUDE:

USDOT# CA# MC#

BUSINESS NAME

MAILING & GARAGING ADDRESS

DRIVER(S) LICENSE INFORMATION

VEHICLE IDENTIFICATION NUMBER & VEHICLE VALUE

WHAT TYPE OF TRUCK? SEMI,TRACTOR,BOX, CARGO VAN, LIMO

WHAT GOODS ARE HAULED, REEFER, DRYVAN ETC.

CALIFORNIA ONLY ? 48 STATES?

LOSS RUNS

COVERAGE'S YOUR LOOKING FOR  AND ANY SUPPORTING DOCUMENTS

CERTIFICATE HOLDERS, ADDITIONAL INSURED'S

 GENERAL LIABILITY QUOTES

BUSINESS NAME?  OWNER NAME?  LOCATION ADDRESS?  MAILING ADDRESS? ANNUAL ESTIMATED INCOME? NATURE OF BUSINESS? ANNUAL PAYROLL IF ANY?

 

 

 

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