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(41 Entries Submitted)
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Check box if you need to correct the address.
How did you obtain the corrected address?
Number and Street:
City, State:
Zip code:
What is the radius of operations?
What type of goods/products do they haul?
Are all loads transported properly secured?
Describe in detail how the loads are secured. (chains, straps, tarps, etc.)
Is hauling done for only one firm/company?
Name of the firm/company:
Did you get photos of some or all the vehicle and/or trailers insured?
What is the total number of insured units including trucks and/or trailers?
Did you verify the attached vehicle list on the order with the insured?
Do they operate passenger cars in the business?
Do they operate single axle truck/tractors in the business?
Do they operate tandem axle truck/tractors in the business?
Do they operate trailer/semi-trailers in the businesses?
Where are the vehicles stored at night?
Who performs maintenance/repairs on the vehicles?
Are maintenance records kept?
Is there a formal safety program?
Do they have an accident investigation program in place?
Do they have a substance abuse program in place?
Did you verify the attached drivers list on the order with the insured?
Were there any additional drivers that need to be added or do you need to add a new list of drivers?
Did you attach a drivers list?
Do they use owner operators:
Do they have any drivers under 18 years of age or over 65 years of age?
Do they obtain MVR's on all new hires and owner operators?
Do they obtain MVR's annually on all drivers and owner operators?
Is there a policy in place to review MVR data?
Has there been any losses in the past 5 years?
Describe the losses.
Additional notes:
Driver Name:
Driver Age:
Driver License #:
Driver Name:
Driver Age:
Driver License #:
Do you have additional employees/drivers?
Additional notes
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Own Staff/Employees
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No
Yes
Yes
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Yes
Yes
No
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Yes
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Dealership
Yes
Yes
Yes
No
No
Yes
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Yes
Yes
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Yes
Yes
No
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Yes
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Yes
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Yes
Yes
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ZXZX
Own Staff/Employees
Yes
Yes
Yes
No
Yes
Yes
Yes
Yes
Yes
No
Yes
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ZXZX
ZXZX
ZXZ
XZX
ZXZX
ZXZX
ZXZX
ZXZX
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4 weeks ago
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Yes
77355
100 Miles
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Yes
test
Yes
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Yes
10000000000
Yes
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No
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Own Staff/Employees
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Yes
Yes
Yes
Yes
Yes
Yes
Yes
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No
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option2
4 weeks ago
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100 Miles
Gym equipment
Yes
yep
Yes
Kelsey Insurance
Yes
1
Yes
Yes
Yes
Yes
Yes
1
Own Staff/Employees
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
addddd
adddd
Alisha Driver
33
2659865
No
option1
option1
4 weeks ago
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Continental USA
Test
Yes
Test
Yes
Test
No
option1
option1
1 month ago
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Yes
Continental USA
Sunil Test
Yes
Sunil Test
No
Sunil Test
Yes
Yes
No
Yes
No
Sunil Test
Own Staff/Employees
Yes
No
Yes
Yes
Yes
No
No
Yes
Yes
No
Yes
Yes
Yes
Sunil Test
Sunil Test
Sunil Test
Sunil Test
Sunil Test
Sunil Test
Sunil Test
Sunil Test
Yes
Sunil Test
option2
option2
7 months ago
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Yes
Found online
5655 Test St.
Houston Texas
77002
Continental USA
Test
Yes
Test
Yes
Test Testingson
No
sasa
sasa
asa
asas
sasas
option1
option1
7 months ago
Edit
Continental USA
What type of goods/products do they haul.
Yes
Describe in detail how the loads are secured. (chains, straps, tarps, etc
CRISP
No
hat is the total number of insured units including
Yes
Yes
Yes
No
No
test
Own Staff/Employees
Yes
Yes
No
No
Yes
No
Yes
No
Yes
Yes
No
No
Yes
Yes Describe the losses.
Additional notes
test
23
23123
test
45
3123
Yes
Yes Additional notes
option1
option1
11 months ago
Edit
Yes
From Google.
Wz-1337
Delhi
110089
Continental USA
Books, stationaries
Yes
300 tones
Yes
Suntec India.
Yes
500 Units
Yes
Yes
No
Yes
Yes
Parking
Own Staff/Employees
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
No
No
Yes
Due to fire.
No not required.
Sunil Singh
44
DL97977dhhhd
Rohit
60
DL982639623
Yes
Not Reduiukd,
3 years ago
Edit
Continental USA
asass
No
asasas
Yes
No
Yes
Yes
Yes
Yes
Yes
Own Staff/Employees
Yes
Yes
Yes
Yes
Yes
Yes
as
SsSsS
3 years ago