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TRANSPORTATION
WORKERS’ COMPENSATION
PROPERTY & GENERAL LIABILITY
ALL SERVICES
LIFE INSURANCE QUOTE
FORMS
CERTIFICATE
TRUCKING QUICK QUOTE
CONTACT US
TRUCKING QUICK QUOTE
Type
Type
Quick Quote
Renewal
POLICY NUMBER
TODAY'S DATE
COVERAGE DATE
FIRST NAME
*
MIDDLE NAME
LAST NAME
*
TELE #
*
EMAIL
*
INSURED SECTION
FIRST NAME
*
MIDDLE NAME
LAST NAME
*
INSURED BUSINESS
TAX ID
INSURED DBA
GARAGING ADDRESS
STATE
STATE
ARIZONA
CALIFORNIA
NEVADA
OREGAN
TEXAS
ZIP
FILING
YES
NO
TYPE
AZ DOT
CA DOT
NV DOT
OR DOT
TX DOT
PROVIDE ALL FILING NUMBER(S)
DOT#
CA#
MCP#
PUC#
TCP#
NATURE OF BUSINESS
COMMODITIES HAULED
YEARS IN BUSINESS
NEW VENTURE
1 YEAR
2 YEAR
3 YEAR
4 YEAR
4+ YEAR
RADIUS OF OPERATION
1 – 100
101 – 500
500 +
VEHICLES SECTION
NUMBER OF TRUCKS & POWER UNIT #
NUMBER OF TRAILERS #
TRUCKS & POWER UNIT 1
VEHICLE YEAR
MAKE MODEL
BODY TYPE
VIN
GVW
0 – 26,000 lbs
26,001 – 40,000 lbs
40,001 – 80,000 lbs
Over 80,000 lbs
VALUE ($)
USD
DED
$1000
$1500
$2000
$2500
$3000
$3500
$4000
$4500
$5000
$5500
$6000
$6500
$7000
$7500
$10000
TRUCKS & POWER UNIT 2
VEHICLE YEAR
MAKE MODEL
BODY TYPE
VIN
GVW
0 – 26,000 lbs
26,001 – 40,000 lbs
40,001 – 80,000 lbs
Over 80,000 lbs
VALUE ($)
USD
DED
$1000
$1500
$2000
$2500
$3000
$3500
$4000
$4500
$5000
$5500
$6000
$6500
$7000
$7500
$10000
TRUCKS & POWER UNIT 3
VEHICLE YEAR
MAKE MODEL
BODY TYPE
VIN
GVW
0 – 26,000 lbs
26,001 – 40,000 lbs
40,001 – 80,000 lbs
Over 80,000 lbs
VALUE ($)
USD
DED
$1000
$1500
$2000
$2500
$3000
$3500
$4000
$4500
$5000
$5500
$6000
$6500
$7000
$7500
$10000
TRUCKS & POWER UNIT 4
VEHICLE YEAR
MAKE MODEL
BODY TYPE
VIN
GVW
0 – 26,000 lbs
26,001 – 40,000 lbs
40,001 – 80,000 lbs
Over 80,000 lbs
VALUE ($)
USD
DED
$1000
$1500
$2000
$2500
$3000
$3500
$4000
$4500
$5000
$5500
$6000
$6500
$7000
$7500
$10000
TRUCKS & POWER UNIT 5
VEHICLE YEAR
MAKE MODEL
BODY TYPE
VIN
GVW
0 – 26,000 lbs
26,001 – 40,000 lbs
40,001 – 80,000 lbs
Over 80,000 lbs
VALUE ($)
USD
DED
$1000
$1500
$2000
$2500
$3000
$3500
$4000
$4500
$5000
$5500
$6000
$6500
$7000
$7500
$10000
TRUCKS & POWER UNIT 6
VEHICLE YEAR
MAKE MODEL
BODY TYPE
VIN
GVW
0 – 26,000 lbs
26,001 – 40,000 lbs
40,001 – 80,000 lbs
Over 80,000 lbs
VALUE ($)
USD
DED
$1000
$1500
$2000
$2500
$3000
$3500
$4000
$4500
$5000
$5500
$6000
$6500
$7000
$7500
$10000
TRUCKS & POWER UNIT 7
VEHICLE YEAR
MAKE MODEL
BODY TYPE
VIN
GVW
0 – 26,000 lbs
26,001 – 40,000 lbs
40,001 – 80,000 lbs
Over 80,000 lbs
VALUE ($)
USD
DED
$1000
$1500
$2000
$2500
$3000
$3500
$4000
$4500
$5000
$5500
$6000
$6500
$7000
$7500
$10000
TRUCKS & POWER UNIT 8
VEHICLE YEAR
MAKE MODEL
BODY TYPE
VIN
GVW
0 – 26,000 lbs
26,001 – 40,000 lbs
40,001 – 80,000 lbs
Over 80,000 lbs
VALUE ($)
USD
DED
$1000
$1500
$2000
$2500
$3000
$3500
$4000
$4500
$5000
$5500
$6000
$6500
$7000
$7500
$10000
TRUCKS & POWER UNIT 9
VEHICLE YEAR
MAKE MODEL
BODY TYPE
VIN
GVW
0 – 26,000 lbs
26,001 – 40,000 lbs
40,001 – 80,000 lbs
Over 80,000 lbs
VALUE ($)
USD
DED
$1000
$1500
$2000
$2500
$3000
$3500
$4000
$4500
$5000
$5500
$6000
$6500
$7000
$7500
$10000
TRAILER 1
VEHICLE YEAR
MAKE MODEL
VIN
VALUE ($)
USD
DED
$1000
$1500
$2000
$2500
$3000
$3500
$4000
$4500
$5000
$5500
$6000
$6500
$7000
$7500
$10000
TRAILER 2
VEHICLE YEAR
MAKE MODEL
VIN
VALUE ($)
USD
DED
$1000
$1500
$2000
$2500
$3000
$3500
$4000
$4500
$5000
$5500
$6000
$6500
$7000
$7500
$10000
TRAILER 3
VIN
MAKE MODEL
VEHICLE YEAR
VALUE ($)
USD
DED
$1000
$1500
$2000
$2500
$3000
$3500
$4000
$4500
$5000
$5500
$6000
$6500
$7000
$7500
$10000
TRAILER 4
VIN
MAKE MODEL
VEHICLE YEAR
VALUE ($)
USD
DED
$1000
$1500
$2000
$2500
$3000
$3500
$4000
$4500
$5000
$5500
$6000
$6500
$7000
$7500
$10000
TRAILER 5
VIN
MAKE MODEL
VEHICLE YEAR
VALUE ($)
USD
DED
$1000
$1500
$2000
$2500
$3000
$3500
$4000
$4500
$5000
$5500
$6000
$6500
$7000
$7500
$10000
TRAILER 6
VIN
MAKE MODEL
VEHICLE YEAR
VALUE ($)
USD
DED
$1000
$1500
$2000
$2500
$3000
$3500
$4000
$4500
$5000
$5500
$6000
$6500
$7000
$7500
$10000
TRAILER 7
VIN
MAKE MODEL
VEHICLE YEAR
VALUE ($)
USD
DED
$1000
$1500
$2000
$2500
$3000
$3500
$4000
$4500
$5000
$5500
$6000
$6500
$7000
$7500
$10000
TRAILER 8
VIN
MAKE MODEL
VEHICLE YEAR
VALUE ($)
USD
DED
$1000
$1500
$2000
$2500
$3000
$3500
$4000
$4500
$5000
$5500
$6000
$6500
$7000
$7500
$10000
TRAILER 9
VIN
MAKE MODEL
VEHICLE YEAR
VALUE ($)
USD
DED
$1000
$1500
$2000
$2500
$3000
$3500
$4000
$4500
$5000
$5500
$6000
$6500
$7000
$7500
$10000
Fill up the field and attach MVRs for all driver(s) and owner(s) no more than 30 days old
OWNER DRIVEN
YES
NO
NUMBER OF DRIVERS
DRIVER 1
FIRST NAME
LAST NAME
DATE OF BIRTH
DRIVING LICENSE
0 / 10
State/Province
CLASS
COMMERCIAL
REGULAR
EXTENDED
YEARS OF EXPERIENCE
DRIVER 2
FIRST NAME
LAST NAME
DATE OF BIRTH
DRIVING LICENSE
0 / 10
State/Province
CLASS
COMMERCIAL
REGULAR
EXTENDED
YEARS OF EXPERIENCE
DRIVER 3
FIRST NAME
LAST NAME
DATE OF BIRTH
DRIVING LICENSE
0 / 10
State/Province
CLASS
COMMERCIAL
REGULAR
EXTENDED
YEARS OF EXPERIENCE
DRIVER 4
FIRST NAME
LAST NAME
DATE OF BIRTH
DRIVING LICENSE
0 / 10
State/Province
CLASS
COMMERCIAL
REGULAR
EXTENDED
YEARS OF EXPERIENCE
DRIVER 5
FIRST NAME
LAST NAME
DATE OF BIRTH
DRIVING LICENSE
0 / 10
State/Province
CLASS
COMMERCIAL
REGULAR
EXTENDED
YEARS OF EXPERIENCE
DRIVER 6
FIRST NAME
LAST NAME
DATE OF BIRTH
DRIVING LICENSE
0 / 10
State/Province
CLASS
COMMERCIAL
REGULAR
EXTENDED
YEARS OF EXPERIENCE
DRIVER 7
FIRST NAME
LAST NAME
DATE OF BIRTH
DRIVING LICENSE
0 / 10
State/Province
CLASS
COMMERCIAL
REGULAR
EXTENDED
YEARS OF EXPERIENCE
DRIVER 8
FIRST NAME
LAST NAME
DATE OF BIRTH
DRIVING LICENSE
0 / 10
State/Province
CLASS
COMMERCIAL
REGULAR
EXTENDED
YEARS OF EXPERIENCE
DRIVER 9
FIRST NAME
LAST NAME
DATE OF BIRTH
DRIVING LICENSE
0 / 10
State/Province
CLASS
COMMERCIAL
REGULAR
EXTENDED
YEARS OF EXPERIENCE
BUSINESS SECTION
LIABILITY
$750,000
$1,000,000
$1,500,000
$2,000,000
UM
30,000
60,000
500,000
750,000
1,000,000
CARGO ($)
USD
DED
$1000
$1500
$2000
$2500
$3000
$3500
$4000
$4500
$5000
$5500
$6000
$6500
$7000
$7500
$10000
REEFER BREAKDOWN
YES
NO
REEFER BREAKDOWN DED
$1000
$1500
$2000
$2500
$3000
$3500
$4000
$4500
$5000
$5500
$6000
$6500
$7000
$7500
$10000
Upload Attachments
1- Attach MVRs for all driver(s) and owner(s) no more than 30 days old. 2- Attach Loss Report(s) for all Accident(s)
Upload Attachments 1
Choose File
No file chosen
Delete uploaded file
(MVR, Vehicle registrations, loss runs, filings)
Upload Attachments 2
Choose File
No file chosen
Delete uploaded file
(MVR, Vehicle registrations, loss runs, filings)
Upload Attachments 3
Choose File
No file chosen
Delete uploaded file
(MVR, Vehicle registrations, loss runs, filings)
Upload Attachments 4
Choose File
No file chosen
Delete uploaded file
(MVR, Vehicle registrations, loss runs, filings)
Upload Attachments 5
Choose File
No file chosen
Delete uploaded file
(MVR, Vehicle registrations, loss runs, filings)
Upload Attachments 6
Choose File
No file chosen
Delete uploaded file
(MVR, Vehicle registrations, loss runs, filings)
Upload Attachments 7
Choose File
No file chosen
Delete uploaded file
(MVR, Vehicle registrations, loss runs, filings)
Upload Attachments 8
Choose File
No file chosen
Delete uploaded file
(MVR, Vehicle registrations, loss runs, filings)
Upload Attachments 9
Choose File
No file chosen
Delete uploaded file
(MVR, Vehicle registrations, loss runs, filings)
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