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Trucking Quote
Trucking Quote Form
Exact Business Name
Years In Business
Mailing Address
Garaging Address
County
Type of Business
Please Select
Corporation
Sole Proprietor
L.L.C.
Partnership
Other
Phone
Fax
Members of corporation (name, title, percent of stock held)
USDOT Number
MC#
If ntu (bobtail) liability, need name, city & state of company leased to
Commodities hauled (Name, percent hauled, and value per load)
Cargo Coverage
Yes
No
Cargo Coverage Limit
Percentage of total yearly mileage in each category (categories are one way)
0-75____ 76-150____ In city limits ____ Out of city limits____ 151-300____ over 300____ Example: if 40% of trips are 100 miles one way, put 40% in 76-150 range.
Metro areas with regular pick-ups or deliveries
Deductible to be used
$1,000
$2,500
$5,000
Equipment list with current value/year/make/vin/model (need gvw for straight trucks, pickups, & vans)
Drivers list with: DOB/D.L./Date of Hire/ yrs driving experience
General liability?
Yes
No
Need mechanic's payroll, if any, for quoting the G/L
Average Revenue and mileage for three years
Revenue Mileage _______ _______ <--- Projected _______ _______ <--- Current _______ _______ <--- Previous
Number of power units
_______ <--- Projected _______ <--- Current _______ <--- Previous
Current insurance carriers
Truck liability: _____________________ Expiration Date: _______ Physical Damage:__________________ Expiration Date:____________________ Cargo: _____________________ Expiration Date: _________ General Liability:_____________________ Expiration Date: _________ Work comp: _____________________ Expiration Date:__________ Health Insurance:_____________________ Expiration Date: _________
Any insurance paid claims last three years?
Yes
No
For work comp quote, the following payrolls are needed
Payroll Number ______ ______ <---- Drivers ______ ______ <---- Clerical ______ ______ <---- Mechanics ______ ______ <---- Sales
Are drivers paid by
Hour
Percentage
Load
Mile
Driver guidelines you use
Minimum Age
Experience
Are safety meetings held?
Yes
No
If so, how often?
Any commercial property quoted?
Yes
No
Do you lease any commercial property?
Yes
No
Do you do warehousing?
Yes
No
Are you a freight broker?
Yes
No
Revenue from brokerage
Name of Brokerage
MC# for brokerage
Do you trip lease to other carriers?
Yes
No
Revenue from trip leasing
Do carriers trip lease to you?
Yes
No
Do you use Owner/Operators?
Yes
No
List equipment and drivers
Do you need an umbrella?
Yes
No
Umbrella Limit
If yes, list number of employees and payroll
If private passenger vehicles included on truckers policy, do you also have a "personal" auto policy?
Yes
No
Name of insurance company
Copy of current insurance certificate to verify current carriers, coverage, and expiration dates.
File Size:
10000KB Maximum
File Types:
.jpg .jpeg .gif .bmp .png .doc .pdf .txt
Copy of "annual" IFTA report or Schedule B
File Size:
1000KB Maximum
File Types:
.jpg .jpeg .jpe .gif .bmp .png .doc .pdf .txt
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Contact Us:
Local: (810) 732-5800
Toll Free: (800) 530-9225
Fax: (810) 732-4154
G-3526 Miller Road
P.O. Box 321070
Flint, MI 48532