COGO Insurance - Trucking Liability

(937) 404-1040
Mon - Fri: 8:30am - 5:00pm EST

Please fill in the form below to Get Coverage.

If you are a trucking company, then please have ready your last 4 quarters of IFTAs, 5 years of loss runs, all CDLs and if you have MVRs. If you had accidents/tickets please explain them.

"*" indicates required fields

Applicant Information

Applicant/Company Name*

SSN or FEIN*

US DOT*

Doing Business As

MC #

Garage Address*

Street City State Zip Country

Website*

Same as Garage Address?

Yes

Mailing Address*

Street City State Zip Country

Owner's First Name*

Owner's Last Name*

Title in Business*

Telephone Number*

Applicants's Legal Structure

Individual/Sole Proprietor

Corporation

Partnership

Joint Venture

LLC

Date Applicant Started operations

Date of Birth

Year's owner has in Trucking Industry

Is this a New Venture?

Yes

Please provide previous company name and role for owner

Federal Filings Required (BMC 91X)?

Yes

Please list any state filings required on your behalf

Is a Uniform Intermodal Interchange and Facilities Access Agreement (UIIA) endorsement required?

Yes

Requested Insurance Coverage

Requested effective date of Coverage*

Requested Limits of Liability

Auto Liability

Other CSL

UM/UIM

Rejected

State Minimum

PIP

Rejected

State Minimum

Medical Payments

Rejected

State Minimum

Hired Auto

Yes

Non-Owned Auto

Yes

Deductible

$1,000

$2,500

$5,000

Motor Truck Cargo Limit

Add Custom amount*

Excess Cargo Needed?

Yes

Trailer Interchange?

Yes

Limit

Deductible

General Liability

Yes

Limit

Deductible

What is the total number of Trucks/Tractors the Applicant currently uses and is requesting coverage?

What is the total number of Drivers the Applicant currently uses and is requesting coverage?

Schedule of Autos

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Truck/Tractors

Truck/Tractor	VIN Number	Year	Make	Model	Gross Weight	Stated Value ($)	Type of Trailer	Actions

There are no Truck/Tractors.

Schedule of Drivers

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Drivers

First Name	Last Name	Owner or Employee	Date of Birth	License State	License Number	Years of Class A Experience	Date of Hire	Number of Accidents/ Violations	Actions

There are no Drivers.

Radius of Operations (%)

0-150 %

151-300 %

301-500 %

Over 501 %

Areas of Operation (%)

Northeast

South

Southwest

Pacific

Rocky Mountains

Midwest

Commodities Hauled (%)

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General Freight

Household Goods

Metal: sheets, coils, rolls

Motor Vehicles

Drive/Tow away

Logs, Poles, Beams, Lumber

Building Materials

Mobile Homes

Machinery, Large Objects

Fresh Produce

Liquids/Gases

Intermodal Cont.

Passengers

Oilfield Equipment

Livestock

Grain, Feed, Hay

Coal/Coke

Meat

Garbage/Refuse

US Mail

Chemicals

Commodities Dry Bulk

Refrigerated Food

Beverages

Paper Products

Utilities

Agricultural/Farm Supplies

Construction

Water Well

How many years of experience does the Applicant have hauling these types of commodities with similar equipment?

What is the Minimum age for a Driver?

What is the minimum years of experience for a Driver?

Does the Applicant have a Safety Program in place?

Yes

Does the Applicant have a Maintenance Program in place?

Yes

Does the Applicant use the FMCSA’s Pre-Employment Screening Program?

Yes

Are all vehicles Scheduled owned and registered to the Applicant?

Yes

Does the Applicant obtain MVRs at the time of Hire for all drivers?

Yes

Does the Applicant require Drivers to pass drug tests at time of hire?

Yes

Please provide details for all “No” answers

Does the Applicant haul any Hazardous, dangerous, caustic, radioactive or flammable Cargo?

Yes

Has there been any change in operations, ownership, or management in the past 3 years?

Yes

Has the Applicant been involved in any accidents in the past 3 years?

Yes

Has the Applicant been involved in a claim in the past 3 years?

Yes

Has insurance been cancelled, declined, or non-renewed in the past 3 years?

Yes

Has the applicant ever had their own insurance in the past under a different Authority?

Yes

Does the Applicant allow drivers to drive in “Teams, Slip Seat Driving, Shift Driving” or any shared driving format whereby multiple drivers operate the same truck during any one 24 hour period?

Yes

Does the Applicant allow passengers to accompany drivers?

Yes

Does the Applicant own any cargo being transported?

Yes

Does the Applicant Broker Loads out to others?

Yes

Are any owned vehicles not scheduled on this Application?

Yes

Please provide details for all “No” answers

Operation/Insurance History

Operation History (Current Year)

Number of Power Units*

Total Miles*

Gross Receipts*

Operation History (Previous Year)

Number of Power Units*

Total Miles*

Gross Receipts*

Operation History (Two Previous Years)

Number of Power Units*

Total Miles*

Gross Receipts*

Insurance History (list previous 5 years of insurance)

Policy Period

Carrier

# of Losses

Paid

Reserves

Total Incurred

1. Declaration Page or Certificate of insurance for previous 3 years 2. Current Valued Loss Runs for a minimum of the previous 4 years (within the last 30 days) 3. International Fuel Tax Agreement (IFTA) statements for a minimum of the previous 2 years 4. Signed, dated Application, Shareholders and Proxy Forms

Files

Drop files here or

Max. file size: 6 GB.

GENERAL FRAUD WARNING: Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents materially false information in an application for insurance may be guilty of a crime and may be subject to fines and confinement in prison. The undersigned, acting on behalf of all proposed Insureds, declare that the statements set forth herein are true and correct and that thorough efforts have been made to obtain sufficient information from each Insured proposed for this insurance to facilitate the proper and accurate completion of this Application. The undersigned agree that the particulars and statements contained in this application and any material submitted herewith are their representations and are the basis of the insurance contract. The undersigned further agree that this application and any material submitted herewith shall be considered attached to and a part of the Policy. Any material submitted with this application shall be maintained on file (either electronically or paper) with the Insurer and shall be deemed to be attached hereto as if physically attached. It is further agreed that: (1) if any significant change in the condition of the applicant is discovered between the date of this application and the Policy inception date, which would render this application inaccurate or incomplete, notice of such change will be reported in writing to the Insurer immediately and, upon receipt of such written notice, the Company has the right, at its sole discretion, to modify or withdraw any proposal for insurance; (2) any Policy, if issued, will be in reliance upon the truth of such representations and any misrepresentation by the Insured or the Insured's agent that is material to the acceptance of the risk will render the Policy null and void and relieve the Insurer from all liability herein; (3) this application has been completed as respects the entire Applicant; (4) the signing of this application does not bind the undersigned to purchase the insurance. I understand that the information submitted herein becomes a part of the Applicant’s Professional Liability Insurance Application and is subject to the same representations and conditions.

Signature*

Product Name

Price: $0.00

Best Custom Tailored Trucking Insurance

Contact Information

Office Hours

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INFORMATION DISCLAIMER: Insurance coverages may vary depending on location, policy, and individual business. Please talk to a licensed agent about coverages in your state. The definitions and material on cogoinsurance.com make no warranty as to state or federal law. Insurance policy coverage may vary depending on the specific terms, definitions, and individual policy exclusions. The product descriptions do not affect the provisions or coverages of any insurance policy or bond issued by Cogo, nor do they imply that coverage does or does not exist for any particular claim or loss under any such policy or bond. Coverages depend on the facts and circumstances involved in the claim or loss, all applicable policy or bond provisions, and any applicable law. Availability of coverage referenced in this document can depend on underwriting qualifications and state regulations. Discounts may vary by state and individual risk characteristics. Discounts are subject to eligibility, availability, do not apply to all coverages, and are not guaranteed.

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Please fill in the form below to Get Coverage. If you are a trucking company, then please have ready your last 4 quarters of IFTAs, 5 years of loss runs, all CDLs and if you have MVRs. If you had accidents/tickets please explain them.

Applicant Information

Requested Insurance Coverage

Requested Limits of Liability

Schedule of Autos

Schedule of Drivers

Radius of Operations (%)

Areas of Operation (%)

Commodities Hauled (%)

Operation/Insurance History

Operation History (Current Year)

Operation History (Previous Year)

Operation History (Two Previous Years)

Best Custom Tailored Trucking Insurance

Contact Information

Office Hours

Quick Links

Please fill in the form below to Get Coverage.

If you are a trucking company, then please have ready your last 4 quarters of IFTAs, 5 years of loss runs, all CDLs and if you have MVRs. If you had accidents/tickets please explain them.