Information Request Form

Trucking Simplified

Name of Company

DOT#

Years in Business

Owner

DOB

License #

Garaging Address

# of Trucks

# of Trailers

FED ID#/ EIN

Equipment Type(s):

Top 3 Types of Cargo

Please provide the following documentation.

Limits/Coverages Required
A current Acord insurance certificate showing limits for Truckers Auto Liability, General Liability, Cargo, Physical Damage, Trailer Interchange, etc.

Limits/Coverages Required

Equipment List
Include Unit Type, Year, Make, Complete VIN # and Value (If Physical Damage is Required for Tractors and Trailers).

Equipment List

Driver List
Include Full Name, Date of Birth, Date of Hire, License #, State and Years of Experience.

Driver List

Loss Runs
Current year, plus at least two full prior years for renewing coverages. Insurance carriers require loss runs to be valued within the last 90 days – however provide most current available for immediate.

Loss Runs

Mileage Reports
IRP-schedule B reports, mileage by state for the most recent four quarters.

Mileage Reports

Trucking Simplified

CoRporate Office

Mailing Address

Quick Links

Client Services