APPLICANT PRIOR CARRIER AND LOSS INFORMATION

LIABILITY INFORMATION - CURRENT YEAR AND PREVIOUS 2 YEARS MUST BE SHOWN

PHYSICAL DAMAGE INFORMATION - CURRENT YEAR AND PREVIOUS 2 YEARS MUST BE SHOWN

CARGO INFORMATION - CURRENT YEAR AND PREVIOUS 2 YEARS MUST BE SHOWN

COVERAGES

Limits - Combined single limit (BI/PD)

Hired and Non/Owned coverage only available if contractually required.

Estimated # of days vehicle hired in 12 months

Combined Deductible

Physical Damage

Cargo

Refrigeration Breakdown

Temperature controlled units must be inspected at least monthly and inspection records must be maintained and retained for at least one year.

Extras Endorsement

Towing Coverage

Are all vehicles equipped with theft alarms?

Are all vehicles equipped with fire extinguishers?

Are there any overages, shortages or damage claims pending?

Are any vehicles left loaded overnight?

Are vehicles left unlocked when unattended?

Does named insured transport own goods?