Logging and Log Hauling Auto Insurance Application

1
BUSINESS NAME:* This field is required.
2
DBA:
3
MAILING ADDRESS:* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
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Barbados
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Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
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Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
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Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
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The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
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Guinea-Bissau
Guyana
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Indonesia
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Iraq
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Israel
Italy
Jamaica
Japan
Jersey
Jordan
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Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
PHYSICAL ADDRESS:If different from mailing
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
5
WEBSITE:
6
FEIN#:
7
DOT#
8
ESTIMATED GROSS ANNUAL REVENUE:
9
MAIN CONTACT NAME AND TITLE:* This field is required.
10
MAIN CONTACT EMAIL ADDRESS:* This field is required.
11
DATE OF RENEWAL:* This field is required.
Date
Year
Month
Day
12
LIST COMMODITIES TRANSPORTED BY THE APPLICANT: (Show As Percentage, Total Should Equal 100%)* This field is required.
13
WHAT ARE THE TOWNS NEAREST THE MILLS TO WHICH THE APPLICANT EXPECTS TO DELIVER DURING THE COMING POLICY YEAR?* This field is required.
14
HOURS OF OPERATION:
15
WRITTEN APPLICATION:* This field is required.
Yes
No
16
PHYSICAL EXAM:* This field is required.
Yes
No
17
DRUG TESTING:* This field is required.
Yes
No
18
REFERENCE CHECKS:* This field is required.
Yes
No
19
MVR VERIFICATION:* This field is required.
Yes
No
20
ROAD TESTING:* This field is required.
Yes
No
21
REVIEW OF COMPANY RULES AND POLICIES:* This field is required.
Yes
No
22
EQUIPMENT FAMILIARIZATION:* This field is required.
Yes
No
23
ROUTE FAMILIARIZATION:* This field is required.
Yes
No
24
ACCIDENT REPORTING PROCEDURES:* This field is required.
Yes
No
25
MONITORING WITH GPS SYSTEMS:* This field is required.
Yes
No
26
MONITORING WITH DRIVE-CAM SYSTEM:* This field is required.
Yes
No
27
DAILY VEHICLE INSPECTION:* This field is required.
Yes
No
28
COMMODITY HANDLING TRAINING:* This field is required.
Yes
No
29
HOW ARE THE APPLICANT'S DRIVERS COMPENSATED? (e.g. Hourly, Tonnage, Mileage, Other)
30
PROVIDE THE NAME OF THE APPLICANT'S RANDOM DRUG TESTING CONSORTIUM:
31
DO ANY VEHICLES GO HOME AT NIGHT WITH DRIVERS OR OWNERS?* This field is required.
Yes
No
32
IS ANY PERSONAL USE OF VEHICLES ALLOWED?* This field is required.
Yes
No
33
IS THERE A WRITTEN POLICY PROHIBITING PERSONAL USE OF VEHICLES?* This field is required.
Yes
No
34
ARE ANY FAMILY MEMBERS OR NON-EMPLOYEES ALLOWED TO RIDE IN ANY VEHICLES?* This field is required.
Yes
No
35
DO YOU HAVE A VEHICLE PREVENTATIVE MAINTENANCE PROGRAM IN PLACE?* This field is required.
Yes
No
36
AT WHAT INTERVALS ARE VEHICLES MAINTAINED? (Time, Mileage, Hours, Other)
Please Select
Please Select
Time
Mileage
Hour
Other
37
EXPLAIN INTERVALS:
38
ARE MAINTENANCE RECORDS MAINTAINED FOR AT LEAST A MINIMUM OF 5 YEARS FOR ALL VEHICLES?* This field is required.
Yes
No
39
DO DRIVERS PERFORM PRE-TRIP INSPECTIONS BEFORE ALL TRIPS?* This field is required.
Yes
No
40
DESCRIBE THE KEY FEATURES OF YOUR PREVENTATIVE MAINTENANCE PROGRAM
41
WHAT VEHICLE INSPECTION/MAINTENANCE OPERATIONS ARE PERFORMED BY THE APPLICANT?
42
WHAT VEHICLE INSPECTION/MAINTENANCE OPERATIONS ARE PERFORMED FOR THE APPLICANT BY OTHERS? (List Providers and Operations Performed)
43
DESCRIBE YOUR VEHICLE SECURITY PROCEDURES:
44
DESCRIBE YOUR POLICY CONCERNING USE OF CELLULAR PHONES WHILE DRIVING:
45
HOW OFTEN ARE SAFETY MEETINGS HELD?
46
IS ATTENDANCE AT MEETINGS MANDATORY?* This field is required.
Yes
No
47
HOW ARE SAFETY MEETINGS DOCUMENTED?
48
DOES THE APPLICANT EMPLOY A FULL TIME SAFETY DIRECTOR?* This field is required.
Yes
No
49
IF "YES", LIST NAME:
50
WHAT IS THE MINIMUM NUMBER OF YEARS EXPERIENCE FOR DRIVERS?
51
WHAT IS YOUR DRIVER TURNOVER RATE?
52
DO YOU PERFORM ANY VEHICLE MAINTENANCE OR REPAIR FOR OTHERS?* This field is required.
Yes
No
53
DO YOU EVER BACKHAUL?* This field is required.
Yes
No
54
IF "YES", ADVISE PERCENTAGE OF TOTAL OPERATIONS AND COMMODITIES HAULED:
55
DO YOU HAUL LOGS FOR OTHERS?* This field is required.
Yes
No
56
IF "YES", ADVISE PERCENTAGE OF TOTAL OPERATIONS AND COMMODITIES HAULED:
Should be Empty: