Coverwhale - Valley Trucking Insurance

Commercial Trucking Application

Complete the application below to get more accurate pricing. We will shop this with all of our markets once complete.

Insured Information

Entity type(Required)

Dot Number(Required)

The "DOT Number" issued by the Federal Motor Carrier Safety Administration

Legal Name(Required)

Legal name must match FMCSA/SAFER records for filings to be processed.

Doing Business As ("DBA")

Email Address

Owner's Name(Required)

First Last

Insurance Contact

Name(Required)

First Last

Phone(Required)

Email(Required)

Mailing Address

Street(Required)

Line 2

City(Required)

County(Required)

State(Required)

ZIP(Required)

Business Garaging Address

The address must match SAFER records

Street(Required)

Line 2

City(Required)

County(Required)

State(Required)

ZIP(Required)

Additional Insured

Name

Address

City

State

ZIP

Additional Insured

Retail Agent

Name(Required)

First Last

Agency Name(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email Address(Required)

Coverage

Select Coverages to Quote

Auto Liability (AL)

Automobile Physical Damage (APD)

Motor Truck Cargo (MTC)

Truckers General Liability (TGL)

Non-Trucking Liability (NTL)

Auto Liability - Personal Injury Protection (PIP)

Auto Liability - Uninsured Motorists

Policy Effective Date(Required)

Limits

Number of Trucks(Required)

Total Value of Trucks(Required)

What would the vehicles sell for today?

Number of Trailers(Required)

Total Value of Trailers(Required)

What would the trailers sell for today?

Towing, Labor and Storage Limit(Required)

Trailer Interchange Limit(Required)

Auto Liability Limit(Required)

Do you need Waiver of Subrogation?

Do you need Primary and Noncontributory for AL?

Do you need Primary and Noncontributory for TGL?

Operations

ELD Vendor Name

Your Electronic Logging Device (ELD) Vendor

Do You Require Federal Filings for Auto Liability?

Do You Require State Filings for Auto Liability?

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)?

Any bankruptcies (Chapter 11, 7 or 13) in the past 5 years?

Time operating in your name - Year(Required)

Time operating in your name - Month(Required)

Please enter a number from 0 to 11.

Best description of your operation

Choose any that apply:

Will there be any personal use of any vehicle(s)?

Does the insured conduct any of the following Ineligible Operations?

Ambulance; EMT; Mobile Blood Banks; Armored Cars; Arms, Ammunition, Fireworks; Boat Haulers; Automobile Dismantlers; Boom Trucks; Brokerage; Cannabis Haulers; Carnivals, Circus; Cement Mixers, Pumpers; Coal Haulers; Contractors, Contractor Equipment Mobile Equipment; Cotton Haulers; Courier Services, magazines, news delivery, parcel, film delivery; Drive Away, Transporter Plates; Driving Schools; Dump Trucks S&G; Egg Haulers; Fast food delivery, including restaurant take-out delivery; Final Delivery; Freight Brokerage; Garbage/Refuse; Hazmat, Nuclear, Biological; Household Good Movers; Livestock Transporters; Logging Operations; Milk Haulers; Mobile cranes, Vehicles with buckets; Mobile Home Toters; Mobile Home Toters, Building Movers; Municipal; Operating outside of US; Operations using double/triple trailers; Oversized/Overweight haulers requiring pilot cars; Owned Units, Rented or Leased to Others; Private Passenger Vehicles; Public Livery: Buses, taxis, black car, ride share, shuttle, day care, church; Rental Leasing, Demo Vehicles; Salvage, Scrap Metal; Steel Dealers; Tankers Hauling Flammable Liquids; Towing/Repossession,; Vendor Trucks;

Shipping Address for Dashcam

Street(Required)

Line 2

City(Required)

County(Required)

State(Required)

ZIP(Required)

Radius of Operation

Enter the percentage of hauls that make each distance band. The percentages must add up to 100.

Under 50 Miles(Required)

Please enter a number from 0 to 100.

% of Hauls up to 50 Miles

51-200 Miles(Required)

Please enter a number from 0 to 100.

% of Hauls 51-200 miles

201-500 Miles(Required)

Please enter a number from 0 to 100.

% of Hauls 201-500 miles

500+ Miles(Required)

Please enter a number from 0 to 100.

% of Hauls over 500 miles

Cargo

Motor Truck Cargo Limit

Commodities

Commodity type

Percentage

Commodities

Do you haul refrigerated goods?

Terminals

Address

City

State

Zip

County

Terminals

Vehicles

Vehicle Identification Number

Year

Make or Manufacturer

Model

Value

Body Type

Vehicles

Drivers

First Name

Last Name

Driver License State

Driver License Number

Date of Birth

Date of Hire

Years of Experience on Equipment

Driver Eligibility

Accidents (last 36 months)

Violations (last 36 months)

Suspensions (last 36 months)

Major Violations (last 60 months)

Drivers

Trailers

Vehicle Identification Number

Year

Make or Manufacturer

Model

Value

BodyType

Trailers

Losses

Loss Confirmed

AutoLiability: Loss Count

AutoLiability: Losses Paid, Open or Reserved

Physical Damage: Loss Count

Physical Damage: Losses Paid

Cargo: Loss Count

Cargo: Losses Paid

Truckers General Liability: Loss Count (Open or Closed)

Truckers General Liability: Losses Paid

Non-Trucking Liability: Loss Count

Non-Trucking Liability: Losses Paid

Losses