AREAS COVERED:

SOUTHERN CALIFORNIA

NORTHERN CALIFORNIA

 

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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

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 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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