EZ 2get Commercial Trucking Insurance Application Questions

1
Date
Date
Month
Day
Year
2
Type a question
3
Type a question
4
Type a question
5
Type a question
6
Type a question
7
Type a question
8
Type a question
9
Type a question
Type option 1
2
3
4
10
Type a question
11
Type a question
12
908-388-4913
13
Type a question
14
VVEGA@GARDENMUTUAL.COM
15
Type a question
YESNO
16
Type a question
YESNO
17
Type a question
YESNO
18
Type a question
YESNO
19
Type a question
YESNO
20
Type a question
YESNO
21
Type a question
YESNO
22
Type a question
YESNO
23
Type a question
YESNO
24
Type a question
YESNO
25
Type a question
YESNO
26
Type a question
YESNO
27
Type a question
YESNO
28
Type a question
YESNO
29
Type a question
YESNO
30
Type a question
YESNO
31
Type a question* This field is required.
YESNO
32
Type a question
33
Type a question
34
Type a question
35
Type a question
36
MC Number
37
$1,000,000* This field is required.
38
WHAT'S YOUR USDOT Number* This field is required.
39
WHAT'S YOUR MC Number* This field is required.
40
WHAT IS THE NAME OF YOUR COMPANY AS IT APPEARS ON YOUR CORPORATE DOCUMENTS ?* This field is required.
41
OWNER FULL NAME* This field is required.
42
OWNER PHONE NUMBER* This field is required.
43
OWNER EMAIL* This field is required.
44
OWNER DATE OF BIRTH* This field is required.
45
OWNER DRIVER'S LICENSE STATE OF ISSUANCE* This field is required.
46
OWNER DRIVER'S LICENSE NUMBER* This field is required.
47
USING FORMAT MM/DD/YYYY ON WHAT DATE DID YOU FIRST INCORPORATE YOUR COMPANY WITH THE STATE?* This field is required.WHEN DID YOU FILE YOUR CORPORATE PAPERS ?
48
PHYSICAL ADDRESS* This field is required.WHERE RECORDS ARE KEPT
Street Address
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
49
MAILING ADDRESS* This field is required.(SAME MAILING ADDRESS AS ONLINE WITH THE FMCSA)
Street Address
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
50
Terminal / Parking / Garage Address* This field is required.where do you park your trucks?
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
51
Entity Type* This field is required.select one
individual
corporation
LLC
Join Venture
Partnership
52
What is the FEIN number for your business?* This field is required.
53
Time Operating in Your Name (years and months)* This field is required.how long has your company been on SAFER?
54
Continuous Commercial Auto Insurance Coverage* This field is required.how long have you had continuous insurance for this business without gaps (years and months)
55
Which coverages do you want included in your quote* This field is required.you can pick more than one
Auto Liability
General Liability
Cargo
Auto Physical Damage
Trailer Interchange
Other
56
How many trucks will be on the policy?* This field is required.how many do you own and use for your business?
57
Number of Trailers Total Value* This field is required.put 0 if you don't own trailers
58
Limits for Trailer Interchange* This field is required.
Please Select
Please Select
exclude
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000
59
Operation Description* This field is required.pick the best option for your business operation
Please Select
Please Select
Local Trucker
Intermediate
Long Haul Trucker
Intermodal or Port
Hot Shot (NTL not available for Class 3 Vehicles)
Other DOES NOT APPLY
Dump Trucks (Other)
Dump Trucks (Sand and Gravel)
ELoggingnd Dumper Units
Refrigerated Trailer
Oversized or Overweight
Automobile Hauler (Excluded for Cargo and NTL)
Household Goods Mover
Tankers
Tow truck
60
Driver Full Name* This field is required.
61
Driver Date of Birth* This field is required.
62
Driver license number* This field is required.
63
Driver license state* This field is required.
64
Driver date of hire* This field is required.
65
Driver - years of professional driving experience* This field is required.
66
License type* This field is required.
Please Select
Please Select
CDL
NON CDL
67
Will another driver be on policy?* This field is required.
YESNO
68
Driver Full Name* This field is required.
69
Driver Date of Birth* This field is required.
70
Driver license number* This field is required.
71
Driver license state* This field is required.
72
Driver date of hire* This field is required.
73
Driver - years of professional driving experience* This field is required.
74
License type* This field is required.
Please Select
Please Select
CDL
NON CDL
75
Will another driver be on policy?* This field is required.
YESNO
76
Driver Full Name* This field is required.
77
Driver Date of Birth* This field is required.
78
Driver license number* This field is required.
79
Driver license state* This field is required.
80
Driver date of hire* This field is required.
81
Driver - years of professional driving experience* This field is required.
82
License type* This field is required.
Please Select
Please Select
CDL
NON CDL
83
Will another driver be on policy?* This field is required.
YESNO
84
Driver Full Name* This field is required.
85
Driver Date of Birth* This field is required.
86
Driver license number* This field is required.
87
Driver license state* This field is required.
88
Driver date of hire* This field is required.
89
Driver - years of professional driving experience* This field is required.
90
License type* This field is required.
Please Select
Please Select
CDL
NON CDL
91
Will another driver be on policy?* This field is required.
YESNO
92
Driver Full Name* This field is required.
93
Driver Date of Birth* This field is required.
94
Driver license number* This field is required.
95
Driver license state* This field is required.
96
Driver date of hire* This field is required.
97
Driver - years of professional driving experience* This field is required.
98
License type* This field is required.
Please Select
Please Select
CDL
NON CDL
99
Will another driver be on policy?* This field is required.
YESNO
100
Driver Full Name* This field is required.
101
Driver Date of Birth* This field is required.
102
Driver license number* This field is required.
103
Driver license state* This field is required.
104
Driver date of hire* This field is required.
105
Driver - years of professional driving experience* This field is required.
106
License type* This field is required.
Please Select
Please Select
CDL
NON CDL
107
Will another driver be on policy?* This field is required.
YESNO
108
Driver Full Name* This field is required.
109
Driver Date of Birth* This field is required.
110
Driver license number* This field is required.
111
Driver license state* This field is required.
112
Driver date of hire* This field is required.
113
Driver - years of professional driving experience* This field is required.
114
License type* This field is required.
Please Select
Please Select
CDL
NON CDL
115
Will another driver be on policy?* This field is required.
YESNO
116
Driver Full Name* This field is required.
117
Driver Date of Birth* This field is required.
118
Driver license number* This field is required.
119
Driver license state* This field is required.
120
Driver date of hire* This field is required.
121
Driver - years of professional driving experience* This field is required.
122
License type* This field is required.
Please Select
Please Select
CDL
NON CDL
123
Will another driver be on policy?* This field is required.
YESNO
124
Driver Full Name* This field is required.
125
Driver Date of Birth* This field is required.
126
Driver license number* This field is required.
127
Driver license state* This field is required.
128
Driver date of hire* This field is required.
129
Driver - years of professional driving experience* This field is required.
130
License type* This field is required.
Please Select
Please Select
CDL
NON CDL
131
Do you need Waiver of Subrogation?* This field is required.A Waiver of Subrogation prevents your insurer from seeking recovery from another party involved in a loss. Select "Yes" if this is required by your contract; otherwise, select "No".
YESNO
132
Do You Require Federal Filings for Auto Liability?* This field is required.Federal Filings are required if you operate across state lines or need proof of insurance for federal regulatory compliance. Select "Yes" if this applies to your operations; otherwise, select "No".
YESNO
133
Do You Require State Filings for Auto Liability?* This field is required.State Filings are required if your operations are regulated by state authorities or if proof of insurance is mandated by the state. Select "Yes" if this applies to your business; otherwise, select "No".
YESNO
134
Do You Require Primary and Noncontributory for Auto Liability?* This field is required.Primary and Noncontributory coverage ensures that your policy pays first in the event of a claim, without seeking contributions from other insurance policies. Select "Yes" if required by your contract; otherwise, select "No".
YESNO
135
Any Bankruptcies (Chapter 11, 7, or 13) in the past 5 years?* This field is required.
YESNO
136
Has your prior insurance ever been cancelled or non-renewed by any insurer in the past 3 years (for any reasons NOT related to payment of premium)?* This field is required.
YESNO
137
Enter the percentages of our hauls that you travel for each radius/range* This field is required.enter 0 if 0
under 50 miles
51-200 miles
201-500 miles
over 500 miles
138
Motor Truck Cargo Limit* This field is required.pick one
Please Select
Please Select
No, Excluded
$100,000.00
$125,000.00
$150,000.00
$175,000.00
$200,000.00
$250,000.00
139
Do you haul refrigerated goods?* This field is required.
YESNO
140
What type of commodities do you transport?* This field is required.Please select all the types of goods you typically haul. If you carry multiple types, click "Add Row" to select each one along with its approximate percentage.
141
What type of truck will you add on the policy?* This field is required.
Please Select
Please Select
Cargo/Sprinter Van
Hot shot
Box truck
Dump Truck
Wrecker
Flatbed Tow Truck
Tractor
142
class
Please Select
Please Select
3
6
8
143
gvwr
Please Select
Please Select
10,001
19,501
33,001
144
Please enter the Year of your equipment* This field is required.
145
Please enter the Maker of your equipment* This field is required.
146
Please enter the Model of your equipment* This field is required.
147
Please enter the stated value of your equipment* This field is required.
148
Please enter the VIN of your equipment* This field is required.
149
Will another truck be added to the policy now?* This field is required.
YESNO
150
What type of truck will you add on the policy?* This field is required.
Please Select
Please Select
Cargo/Sprinter Van
Hot shot
Box truck
Dump Truck
Wrecker
Flatbed Tow Truck
Tractor
151
class
Please Select
Please Select
3
6
8
152
gvwr
Please Select
Please Select
10,001
19,501
33,001
153
Please enter the Year of your equipment* This field is required.
154
Please enter the Maker of your equipment* This field is required.
155
Please enter the Model of your equipment* This field is required.
156
Please enter the stated value of your equipment* This field is required.
157
Please enter the VIN of your equipment* This field is required.
158
Will another truck be added to the policy now?* This field is required.
YESNO
159
What type of truck will you add on the policy?* This field is required.
Please Select
Please Select
Cargo/Sprinter Van
Hot shot
Box truck
Dump Truck
Wrecker
Flatbed Tow Truck
Tractor
160
class
Please Select
Please Select
3
6
8
161
gvwr
Please Select
Please Select
10,001
19,501
33,001
162
Please enter the Year of your equipment* This field is required.
163
Please enter the Maker of your equipment* This field is required.
164
Please enter the Model of your equipment* This field is required.
165
Please enter the state value of your equipment* This field is required.
166
Please enter the VIN of your equipment* This field is required.
167
Will another truck be added to the policy now?* This field is required.
YESNO
168
What type of truck will you add on the policy?* This field is required.
Please Select
Please Select
Cargo/Sprinter Van
Hot shot
Box truck
Dump Truck
Wrecker
Flatbed Tow Truck
Tractor
169
class
Please Select
Please Select
3
6
8
170
gvwr
Please Select
Please Select
10,001
19,501
33,001
171
Please enter the Year of your equipment* This field is required.
172
Please enter the Maker of your equipment* This field is required.
173
Please enter the Model of your equipment* This field is required.
174
Please enter the state value of your equipment* This field is required.
175
Please enter the VIN of your equipment* This field is required.
176
Will another truck be added to the policy now?* This field is required.
YESNO
177
What type of truck will you add on the policy?* This field is required.
Please Select
Please Select
Cargo/Sprinter Van
Hot shot
Box truck
Dump Truck
Wrecker
Flatbed Tow Truck
Tractor
178
class
Please Select
Please Select
3
6
8
179
gvwr
Please Select
Please Select
10,001
19,501
33,001
180
Please enter the Year of your equipment* This field is required.
181
Please enter the Maker of your equipment* This field is required.
182
Please enter the Model of your equipment* This field is required.
183
Please enter the state value of your equipment* This field is required.
184
Please enter the VIN of your equipment* This field is required.
185
Will another truck be added to the policy now?* This field is required.
YESNO
186
What type of truck will you add on the policy?* This field is required.
Please Select
Please Select
Cargo/Sprinter Van
Hot shot
Box truck
Dump Truck
Wrecker
Flatbed Tow Truck
Tractor
187
class
Please Select
Please Select
3
6
8
188
gvwr
Please Select
Please Select
10,001
19,501
33,001
189
Please enter the Year of your equipment* This field is required.
190
Please enter the Maker of your equipment* This field is required.
191
Please enter the Model of your equipment* This field is required.
192
Please enter the state value of your equipment* This field is required.
193
Please enter the VIN of your equipment* This field is required.
194
Will another truck be added to the policy now?* This field is required.
YESNO
195
What type of truck will you add on the policy?* This field is required.
Please Select
Please Select
Cargo/Sprinter Van
Hot shot
Box truck
Dump Truck
Wrecker
Flatbed Tow Truck
Tractor
196
class
Please Select
Please Select
3
6
8
197
gvwr
Please Select
Please Select
10,001
19,501
33,001
198
Please enter the Year of your equipment* This field is required.
199
Please enter the Maker of your equipment* This field is required.
200
Please enter the Model of your equipment* This field is required.
201
Please enter the state value of your equipment* This field is required.
202
Please enter the VIN of your equipment* This field is required.
203
Will another truck be added to the policy now?* This field is required.
YESNO
204
What type of truck will you add on the policy?* This field is required.
Please Select
Please Select
Cargo/Sprinter Van
Hot shot
Box truck
Dump Truck
Wrecker
Flatbed Tow Truck
Tractor
205
class
Please Select
Please Select
3
6
8
206
gvwr
Please Select
Please Select
10,001
19,501
33,001
207
Please enter the Year of your equipment* This field is required.
208
Please enter the Maker of your equipment* This field is required.
209
Please enter the Model of your equipment* This field is required.
210
Please enter the state value of your equipment* This field is required.
211
Please enter the VIN of your equipment* This field is required.
212
Will another truck be added to the policy now?* This field is required.
YESNO
213
What type of truck will you add on the policy?* This field is required.
Please Select
Please Select
Cargo/Sprinter Van
Hot shot
Box truck
Dump Truck
Wrecker
Flatbed Tow Truck
Tractor
214
class
Please Select
Please Select
3
6
8
215
gvwr
Please Select
Please Select
10,001
19,501
33,001
216
Please enter the Year of your equipment* This field is required.
217
Please enter the Maker of your equipment* This field is required.
218
Please enter the Model of your equipment* This field is required.
219
Please enter the state value of your equipment* This field is required.
220
Please enter the VIN of your equipment* This field is required.
221
Enter your owned vehicle information here* This field is required.add as many as you need, slide right to complete each vehicle entry
222
Estimated Annual Mileage total for all power units* This field is required.
223
Who is your Telematics providerif you don't have cameras then skip
224
Who is your ELD provider?* This field is required.
225
State Line Crossings* This field is required.abbreviate the list of the states you cross into from your home state
226
Will you add a trailer(s) to the policy?
YESNO
227
Please enter your trailer details below.Slide right to complete each entry. If you're not adding trailers, select (none ) and enter 0 in all of the boxes.
228
Please add details for each driver below.* This field is required.Slide right to complete each entry. Click "Add Row" to enter additional drivers as needed.
229
Attach 3 years of loss runs of all policies, 30 days old or newerEvery commercial insurer requires official loss runs — no exceptions. Even if you’ve never had a claim, we still need the report from your current or previous insurer. 👉 Ask your agent for them, or email info@gardenmutual.com — we’ll help you get them. You can skip for now if you dont have them. We will reach out to you promptly to advise you on how to obtain them.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Browse Files
Cancelof
230
Upload motor vehicle reports for each driver , 30 days old or newerEvery underwriter must see official MVRs. They come from your state DMV or a vendor like 4safedrivers.com (~$40 per driver). Or Zelle $19 per driver to info@gardenmutual.com — we’ll pull them for you. (Quotes will change if MVRs aren’t current — you can skip for now if you don't have them.)
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Browse Files
Cancelof
231
Attach recent 4 consecutive quarters of IFTA's if none then skip
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Browse Files
Cancelof
232
thank you✅ You’re almost done! If you didn’t upload your loss runs or MVRs, check your email — I’ll personally help you get them. (No documents = no final quote - informal only until all documents are received and processed. Thanks for you patience and assistance.)
233
CA DTSC
Yes
No
234
Oversize / Overweight / Over-dimensional Loads
Yes
No
235
Filing Needed
Yes
No
236
Filing Types
237
Requested Auto Liability Insurance Limit
238
TX Certificate Number
239
CA MC Number
240
Cargo Limit
241
Waiver of Subrogation
Yes
No
242
30 Day Notice of Cancellation
Yes
No
243
Primary and Noncontributory
Yes
No
244
Total Insured Value
245
Owner/operators used
Yes
No
246
Owner/operator usage changed
Yes
No
247
Owner/operators permanently leased
Yes
No
248
Owner/operator units included on the schedule
Yes
No
249
Proof of insurance required when not covered under this policy
Yes
No
250
Liability limits at least equal to this policy
Yes
No
251
Proof of non-trucking or trucking liability required
Yes
No
252
Truckers liability required or bobtail only
Yes
No
253
Trip lease operators used
Yes
No
254
Brokerage authority
Yes
No
255
Agent Email
example@example.com
256
Rent trucks or tractors without operators short term
Yes
No
257
Canada or Mexico operations
Yes
No
258
Double or triple trailers
Yes
No
259
Safety program in place
Yes
No
260
Others operating under applicant authority
Yes
No
261
Vehicles used for personal use
Yes
No
262
Hazardous material transported
Yes
No
263
Hazmat liability limits greater than $1,000,000 required
Yes
No
264
Hazmat placards required
Yes
No
265
Refuse/waste/garbage/debris/scrap hauling
Yes
No
266
Logs or timber hauling
Yes
No
267
Timber details
Yes
No
268
Sand and gravel hauling
Yes
No
269
Residential moving and storage operations
Yes
No
270
Loaded trailers left unattended
Yes
No
271
Monitor motor vehicle reports for all drivers
Yes
No
272
All drivers properly licensed and DOT compliant
Yes
No
273
Owner operators subject to the same hiring practices
Yes
No
274
Insured keeps driver files on all owner operators
Yes
No
275
Pre/post trip inspections made regularly
Yes
No
276
Written vehicle maintenance program in effect
Yes
No
277
brokerage conducted under a different MC number
No
Yes
278
Records kept for each vehicle
Yes
No
279
team driving
No
Yes
280
MVR monitoring frequency
281
dead heading
No
Yes
282
MVR frequency after hire
283
bobtail
No
Yes
284
Drivers paid by
285
rent or lease trucks to others
No
Yes
286
Driver hiring practices
287
rent trucks or tractors without operators on a short-term basis
No
Yes
288
Newly hired driver training
289
operate or travel into Canada or Mexico
No
Yes
290
pull double or triple trailers
No
Yes
291
safety program in place
No
Yes
292
Vehicles used for personal use
YES
NO
293
Hazardous material transported
YES
NO
294
Hazmat liability limits greater than $1,000,000 required
YES
NO
295
Hazmat placards required
YES
NO
296
Refuse waste garbage debris or scrap hauling
YES
NO
297
Logs or timber hauling
YES
NO
298
Timber finished or raw
YES
NO
299
Driver responsible for timber securement loading and unloading
YES
NO
300
Moffet used for timber removal
YES
NO
301
Sand and gravel hauling
YES
NO
302
applicant allows others to operate under their authority
No
Yes
303
residential moving and storage operations
Yes
No
304
loaded trailers left unattended
Yes
No
305
driver award or bonus plan
Yes
No
306
accident review board
Yes
No
307
applicant has a driver's handbook
Yes
No
308
applicant has a written safety program
Yes
No
309
company allows personal use of company vehicles
Yes
No
310
applicant carries workers compensation coverage
Yes
No
311
safety devices currently in place
Yes
No
312
MVR reviewed prior to driver hire or lease
Yes
No
313
All drivers properly licensed and DOT compliant
Yes
No
314
Owner operators subject to the same hiring practices
Yes
No
315
Insured keeps driver files on all owner operators
Yes
No
316
Pre/post trip inspections made regularly
Yes
No
317
Written vehicle maintenance program in effect
Yes
No
318
Records kept for each vehicle
Yes
No
319
all listed safety devices currently in place
Yes
No
320
MVR monitoring frequency
321
MVR frequency after hire
322
drivers paid by
323
driver hiring practices
324
Newly hired driver training
325
Current Year
Optional
326
First Prior Year
Optional
327
Second Prior Year
Optional
328
Third Prior Year
Optional
329
Estimated Next Year
Optional
330
who reviews the MVRs
331
Notes for Historical Loss/Exposure Information
Optional
332
One80 operation classification
333
current DOT safety rating
334
DOT alerts
335
DOT alert count
336
DOT alert categories
337
authority lost or withdrawn
Yes
No
338
Major cities passed through on intermediate or long haul trips
339
Whether time guarantees are offered
Yes
No
340
Whether drivers are penalized for late deliveries
Yes
No
341
regulatory agency probation
Yes
No
342
Trailer interchange needed
Yes
No
343
Number of power units under agreement
344
Trailer days per power unit per year
345
Maximum trailer value
346
Trailer interchange deductible
347
Empty containers or sealed containers hauled
Empty containers
Sealed containers
Both
Neither
348
Percentage of loads for empty or sealed containers
349
UIIE required
Yes
No
350
IIA equipment provider list
351
Safety meeting frequency
352
Driver attendance policy for safety meetings
353
Preventive maintenance frequency
354
Is maintenance outsourced?
Yes
No
355
Who performs maintenance
356
Are tanker units used?
Yes
No
357
Is a dedicated food grade tanker used when food products are hauled?
Yes
No
358
Are all tankers equipped with proper baffling?
Yes
No
359
Do vehicles have specialized equipment or modifications?
Yes
No
360
Specialized equipment description
361
Does the insured service its own units?
Yes
No
362
One80 PDF URL
Should be Empty: