What is covered?
Commercial Auto Insurance can provide coverage for your fleet of vehicles and drivers (for you and qualified employees) against injury, loss or damage to vehicles or cargo, plus damage to other property. Our Brokerage generally offers convenient, unified billing, and a range of optional coverage's to meet your company's needs and vehicle characteristics.

Who needs it?
We have markets and insurance solutions for a wide range of vehicle types: From pickup trucks to tow trucks, passenger autos to tractor trailers. Some of our programs are designed specifically for small and large fleets, limousines, taxi cabs and charter and sightseeing buses. We also offer garage insurance for businesses that sell, service and repair vehicles, and coverage for motor carriers and truckers.

Commercial Auto Questionnaire

Applicant’s Information

First Name: Last Name: Street/PO Box: City: State: Zip: Telephone: Email: Fax: Best way to Reach: --- Select item --- Home Phone Business Phone Email Website:

General Business Information

Business Name: Business Entity: --- Select item --- Individual Partnership Corporation Join Venture Subchapter S-Corp Not for profit org LLC Street: City: State: Zip: Phone: Years in business: New business: Yes No Tax Id: Estimated Gross Revenue: Number of employees: Payroll: Brief Description of Business and items being hauled: Are all driver’s covered by the Workers Compensation insurance? Yes No Do you drive passengers for a fee? Yes No Number of vehicles to be insured Vehicle’s Model Vehicle’s Make Vehicle’s Year Body Type( i.e passenger car, truck, van) Full VIN Radius of operations --- Select item --- 1-50 miles 51-100 miles 101-200 miles Unlimited Vehicle’s Cost when purchased For all Vehicles other then passenger, enter Gross Vehicle Weight Number of drivers Driver’s First and Last Name Driver’s DL # DL State Number of accidents: Describe accidents:

Coverage Section

Medical Payments --- Select item --- No coverage 2,000 5,000 Uninsured/Underinsured Motorist Coverage --- Select item --- Match my Liability limits No coverage Physical Damage Collision Deductible --- Select item --- 250 500 1000 2500 Physical Damage Comprehensive Deductible --- Select item --- 250 500 1000 2500

Previous Insurance History

Current Insurance: Yes No If yes: Insurance Company Premium paid last year: I had claims: Yes No Number of Additional insured: I need coverage: --- Select item --- ASAP Next Week Next Month I am shopping Do you need General Liability Insurance? Yes No Do you need Workers Compensation Insurance? Yes No How did you hear about us?