UIIA Application

UIIA
**PROGRESSIVE INSURANCE COMPANY WILL NOT FILE THE REQUIRED INSURANCE FILINGS WITH UIIA!!**
CARRIER INFORMATION
Full Name: *

First NameLast Name
Legal Name *
Individual or Company Name ending in Inc,Ltd,LLC,etc.
DBA
Work Phone: *

Area CodePhone Number
Phone Other: *

Area CodePhone Number
Fax Number:

Area CodePhone Number
Email:*
example@example.com
Physical Address *
City*
State*
Postal Code *
Mailing Address*
City*
State*
Postal Code *
DOT#*
MC#*
EIN#*
FID=xx-1234567 or SSN=123-45-6789
DO YOU HAVE A SCAC?*

YesNo, I need one
Equipment Provider List

(Please select ALL shippers you would like to establish an account with)

(*)The companies below indicated with a single asterisk require that you make them additional insured on your General Liability Policy.

(**)The companies below indicated with a double asterisk require that you make them additional insured on your Cargo and/or Trailer Interchange Coverages.
Select Equipment Provider(s):

ACL Grimaldi Group/ Inarme (*)(**)American President Lines LLCANL Singapore Co. Pte. LtdBermuda Container Line, Limited (*)BNSF Railway Company (*)C U Lines LimitedCanadian National/ Illinois Central Railroad (*)Canadian Pacific Railway-US (SOO Line and D&H) (*)CCM-Consolidated Chassis Management LLC (NON-UIIA EP) (*)(**)CCM LLC and SACP LLC (NON-UIIA EP) (*)(**)CMA-CGM(America) LLCCOFC Logistics LLCCOSCO Shipping Lines Co., Ltd./COSCO Shipping Lines (North America), Inc.Crowley Liner Services (*)(**)CSX Intermodal Terminals, Inc. (*)(**Depotrans Clewiston LLC (formerly Odyssey FoodTrans LLC) (*)(**)Eimskip USA, Inc.Ellerman City Liners Ltd.Evergreen Shipping Agency (America) Corporation (*)(**)Flexi-Van Leasing, LLC (*)(**)Hamburg Sud North America, Inc. (formerly HSAC Logistics, Inc.) (*)Hapag-Lloyd (America) Inc. (*)(**)HMM Co. Ltd. (formerly Hyundai Merchant Marine, Inc.) (**)Innovative Terminal Services, Inc (*)Interpool, Inc. d/b/a TRAC Intermodal, its affiliates, subsidiaries and Chassis Lessors (NON-UIIA EP) (*)(**)Iowa Interstate Railroad LtdISO Tank Chassis Services LLCKalypso Compagnia di NavigazioneKansas City Southern Railway (KCS) (*Lihua Logistics Company LimitedMACS Maritime Carrier Shipping LLC (formerly: Galborg Pte) (*)(**)Maersk Line Limited (*)Maersk Line U.S.A. as agent for Maersk Line A/S dba Maersk Line/Safmarine/Maersk Domestic/Sealand (*)Matson Navigation Company (*)(**Matson Navigation Company of Alaska LLC (*)Mediterranean Shipping Co. SA (*)(**)Milestone Chassis Company LLC (*)(**)Milestone Equipment Company LLC (*)(**)National Shipping of America, LLC, c/o National Shipping Agencies (*)Neptune Pacific Direct Line Pte Ltd. (*)(**)Norfolk Southern Corporation (*)North Amercian Chassis Pool Cooperative LLC (*)(**)Ocean Network Express North America, Inc./Ocean Network Express PTE LTD (*)(**)Oceanus LineOOCL (USA), Inc as agent for Orient Overseas Container Line Limited .& OOCL (Europe) Limited (*)(**)Pasha Hawaii Holdings LLC (*)(**)Pasha InternationalPaul’s Transport, Inc.Sarjak Container Lines Pvt. LtdSchuyler Line Navigation Company LLCSeaboard Marine Ltd. (*)(**)Sea Lead Shipping Pte LtdShanghai JinJiang Shipping (Group) Co. Ltd.SM Lines Corporation (*)(**)Somers Isles Shipping Ltd. (*)Swire Shipping (formerly Indotrans, Inc. & Indotrans Pacific)The Genset Pool, LLC (*)(**)Tiger Cool Express LLC (*)Tote Maritime Puerto Rico LLC(formerlySea Star Lines, LLC) (*)(**)Transfar Shipping Pte Ltd.Turkon Container Transportation & Shipping, IncUnion Pacific Railroad Co. (**)Virginia International Terminals, Inc.(Virginia Inland Ports) (*)(**)Wan Hai Lines, Ltd. (*)X-Press Container Line Singapore Pte Ltd.XPO Stacktrain, LLC (*)(**)Yangming(c/o Yang Ming (America) Corp.) (*)(**)Yang Ming(Singapore) Pte Ltd. c/o Yang Ming (America) Corp. (*)(**)Yangming Marine Transport c/o Yang Ming (America) Corporation (*)(**)Zim American Integrated Shipping Service Co LLC (*)(**
Upload Owner's Driver's License*

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