Commercial Vehicle Insurance 

Commercial Auto Application

Commercial automobile exposures can be more complex than your personal auto insurance coverage, requiring specialty coverages to be considered based on the individual needs of your business.

Commercial automobile coverage can protect your company from any liability stemming from automobiles used in your business or any damage to the covered automobile. A Business Auto Policy (BAP) has the flexibility to provide coverage for business, personal, non-owned, or hired autos based on the coverage purchased and applied to each scheduled auto. Automobiles can be separately scheduled along with corresponding coverages. Coverage can differ by vehicle. The automobiles are classified by weight (light, medium, heavy, extra

heavy) and by type of use (private passenger, service, commercial).

Unlike personal auto policies that separate bodily injury and property damage limits (split limits), BAPs commonly utilize a Combined Single Limit (CSL) for the limit of insurance. This creates higher limits for the both coverages, including per occurrence limits.

 
1. General Information
Contractor License Number:
Insured/Contact
* Company Name
* Phone
Fax
E-mail Address
Policy Term Requested
Mailing Address
* Street Address
* City
* State
* Zip
 
Premise Address
Street Address
City
State
Zip
2. Describe business operations
3. Years in business?
Years
4.
Liability Uninsured Motorist Med Pay Physical Damage
UMPD:   Yes No           Hired Auto:   Yes No           Non-owned Auto:   Yes No
5. Business Auto Schedule
Veh
No.
Year Trade name
model and body
Serial Number Gross
vehicle
weight
Stated
Amount
Radius
1
2
3
4
5

Veh
No.
Principal
Operator
Marital
Status
Date of
Birth
License
Number
State Number
Violations
Number
Accidents
# of major
violations
1
2
3
4
5
6. Nature of business
Prior Carrier Information / Name & Policy Number
7. Have you had continuous auto coverage for the past 12 months?

If yes please provide carrier name(s), policy number(s), and expiration dates.
8. Comments


 

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LICENSE #: OD80851

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Last Updated Monday, September 8, 2008
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