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Contact Information (Step 1 of 10)

Company Owner Information (Step 2 of 10)

Company Information (Step 3 of 10)

Operations Information (Step 4 of 10)

Commodities hauled: Please select all that apply.
Do you assemble furniture that is delivered?
If you install appliances, please provide percentages below




How many deliveries do you expect to complete each week?
Who is your Primary contracting Carrier?
Client you deliver for on behalf of your Primary Contracting Carrier
Are all vehicles registered and/or leased under your company name, or you as an individual?
Which rental/leasing company do you use? If Applicable
Passengers transported (other than helpers)?
If you do lease or rent equipment, what is your estimated total cost per year for the lease?
Do you hire helpers and/or drivers?
What is the expected payroll for your company this year?
Do you work, or plan to work for any other contracting carrier?
Do you need workers compensation coverage?

Insurance Information (Step 5 of 10)

Do you have current insurance coverage?
What is the effective date of your insurance coverage?
Is your current insurance compliant with guidelines?
Are you a new business/venture that is just getting started?
If you are a new business/venture where are you in the insurance buying process?
Have you ever been denied insurance coverage, or had coverage cancelled, during the past 3 years?
Loss History: I warrant that during the past five years no claims have been made against my insurance in the types checked below, nor am I aware of any situations that may result in a claim

Safety Information (Step 6 of 10)

Are drivers penalized for missing deadlines?
Are positive safety incentives (rewards, bonuses, etc.) offered?
Are safety meetings held regularly?
Do all employees complete mandatory safety training?
Any OSHA citations during past 12 months?
Do all vehicles display name/logo of your company?
Do you have a dedicated safety manager?
Is the company safety manual or procedures distributed to all employees upon hire?
If applicable, will you implement underwriter-recommended safety practices?

Driver Hiring Information (Step 7 of 10)

Written Application?
Formal Orientation?
Check Motor Vehicle Reports?
Interviewed in Person?
Written Test?
Drug and Alcohol Screening?
Background Check?
Physical Exam?
Check References?
Maintain Driver files?
Road Training?

Vehicle Information (Step 8 of 10)

Vehicle 1

Driver Information (Step 9 of 10)

Driver 1

Fleet Information (Step 10 of 11)

Personal use of vehicles permitted?
Vehicles used more than 12 hours per day?
Extra safety equipment/technology installed?
Vehicles 20 years old or older?
Pre/post trip vehicle inspections?How documented
Describe vehicle maintenance practices/schedule:

Upload Documents (Step 10 of 10)

Please provide the following documents related to the underwriting process:

  • Loss/Claim Reports (Loss Runs) from past 5 years (if applicable)
  • Company Owner Resume
  • MVRs for drivers (if available)
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