WINNIN ROADS LOGISTICS Certificate of Insurance Request
If any questions, please contact our Certificate Department at WRLtrucking@mail.com
Policy Holder's Name and DBA
*
Name of Insured (YOUR business)
Your Policy Number
Your DOT#
Your MC#
Your MC#
Your DOB ##/##/####
WHERE ARE YOU LOCATED?
*
For “Various Locations” – privide city(s) or county(s)
ARE YOU OTR?
*
For “Various Locations” – privide city(s) or county(s)
ARE YOU LOCAL WITH YOUR ROUTES?
*
For “Various Locations” – privide city(s) or county(s)
DO YOU NEED A FRIEND FOR DISPATCHING YOUR LOADS (YES/NO)?
*
For “Various Locations” – privide city(s) or county(s)
ARE YOU OTR?
*
For “Various Locations” – privide city(s) or county(s)
DO YOU HAVE ZELLE OR CASH-APP LIST YOUR NAME
*
For “Various Locations” – privide city(s) or county(s)
Your E-mail Address
*
Phone Number
*
-
Area Code
Phone Number
Requested by (Your First/Last Names)
*
Your First and Last Names
Name and Address of Certificate Holder (Person or entity asking you for insurance)
*
Email or Fax of Certificate Holder
Does the Certificate Holder want to be named as Additional Insured?
*
Yes
No
Additional Insured Name(s)
Please list names of ALL Additional Insured(s); separate additional names with a comma or semi-colon.
IS THIS YOUR FIRST TIME GETTING YOUR TRUCK(S) INSURED?
*
Please Select
Yes
No
HOW MANY TRUCK DOO YOU HAVE(S) INSURED?
*
Please Select
1
2
3
4
5
6
7
8
9
10
CHECK HOW MANY TRUCKS YOU WANY ON YOUR POLICY
Detailed Job Description; describe the work the named insured will perform for the additional insured
*
Does the additional insured maintain their own insurance to cover their own exposures?.
*
Yes
No
COMMENTS (do you need special endorsements and/or INSURANCE?
Attach and Upload Documents
Upload a File
Copy of contracts, detailed insurance requirements, DOT, DRIVERS LICENSE OF CLEAR PICTURE FRONT AND BACK ALL DRIVERS), W9-FORM, TRUCK VIN#, PROOF OF OWNERSHIP OOF TRUCK,
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Deposit
$2,500.00
$
2,500.00
Insurance Deposit to Start/ first month is free so you start the first of the following month to make monthly payments of $1000 per following month for monthly coverage. CASHAPP AND ZELLE CAN BE USED AS A FORM OOF PAYMENT AS WELL TO START ALSO.
Quantity
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2
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4
5
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9
10
Item subtotal:
$0.00
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0.00
Total
$0.00
$
0.00
Thank you for the opportunity to assist you!
By clicking Submit, I understand that NO COVERAGE IS BOUND on insurance changes until confirmed IN WRITING BY OUR AGENCY. Endorsements and/or Special Wording may require additional processing time and/or fee. Correctly completed certificate requests will be processed within two business days. YOU AR RESPONSIBLE FOR YOUR ACCIDENTS IN PAYING FOR ALL REPAIRS AND DAMAGES IN FULL. ALL MONTHLY PAYMENTS ARE TO BEE MADE ON THE FIRST OF EACH MONTH AND CLIENT WILL HAVE 3 DAYS TO PAY. ANY DAYS LATE WITHIN THE 3 DAYS IITS AN ADDITIONAL $100 PER DAY AS A LATE FEE PER DAY UNTIL PAID.
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