QUICK QUOTE REQUEST
BROKER
CONTACT NAME
AGENCY/DBA
PHONE NUMBER #
EMAIL ADDRESS
INSURED
INSURED TYPE:
Corporation
Individual
INSURED NAME
YEARS IN BUSINESS
DBA
LEGAL NAME
ADDRESS
STATE
ZIP
RADIUS OF OPERATION
FILINGS
NATURE OF BUSINESS
Long Haul - Reefer/Dry
Long Haul - Dry
State Only
5 State
10 State
Tanker - Non-HazMat
Tanker - With HazMat
Sand & Gravel
Car Carrier - Long Haul
Car Carrier - State Only
Household Goods Mover/s
Tow Truck
Mobile Homes
Flat bed
Live Stock
Container Hauler
Ice Cream Truck
Utility Vehicle/Services
Garbage and Debri Construction and Landscaping
Garbage, Debri and Refused Trash from House
Forest Logs, Beams and Lumber
Coal/Coke
Auto Hauler
COMMODITIES HAULED
Agriculture Waste
Alcohol
Alfalfa
Almonds
Animal Feed
Appliances
Asphalt
Auto Parts
Autos
Backhoe
Beams
Beans
Beer & Wine
Beverages
Boats
Bottled Water
Bricks
Building Materials
Candy
Canned Goods
Cans
Carpets/Rugs
Cement
Ceramic
Cereal
Cheese
Chilled Foods
Clean Dirt
Cleaning Products
Clothing
Clothing (non designer) Shoes, Slippers
Coils
Compost
Computer Accesories/Games
Concrete
Construction Debris
Construction Material
Containers
Copper Wire
Cotton
Cow Feed
Crushed Concrete
Dairy Products (Non Reefer)
Dairy Products (Reefer)
Debris
Department Store Merchandise
Dog Food
Draft
Drums Filled with Drilling Mud
Dry Asphalt
Dry Cement
Dry Concrete
Dry Groceries
Dry Wall
Eggs
Electronics
Empty Cans
Empty Cardboard/Wood Boxes
Explosives
Fertilizers
Fish
Fish (Packaged)
Fish Raw
Flour
Flowers
Food Products
Forest Lumber
Forklifts
Fracking Sand Non-Hazmat
Frozen Chicken
Frozen Produce
Fruit
Fruit (Non Reefer)
Furniture Old
Galvanized Metal Frames
Garbage
Grain
Granite
Gravel/Gravel Fill
Hardware Supplies
Hay/Hay Bales
Insulation
Intermodal Containers
Landscaping
Light Machinery
Liquors
Livestock
Logs (Home Depot)
Lumber
Machinery
Machinery Small Parts
Mattress
Meat
Metal Coils
Metal Drums
Metal Plates
Metal Sheets
Milk & Cream
Mobile Homes
Mulch and Soil
New And Used Cars
New Furniture
Non Brand Clothing
Nuts
Office Equipment
Office Supplies
Oilfield Equipment
Pallets
Paper
Petroleum
Pipe
Pipes/Fittings
Plastic Bottles/Plastic Items
Plastic Items
Plywood
Poultry
Produce
Produce (Non Reefer)
Recycled Materials
Reefer Goods
Roofing Shingles
Sand and Gravel
Scrap metal
Seafood
Seafood (Frozen)
Seafood Raw
Sheet Rock
Shellfish (Frozen)
Shingles
Small Tools
Small Tractors/Forklifts
Sodas
Soft Drinks
Steel
Steel Sheets, Pipes
Sugar
Textiles
Tires
Tires New
Tobacco
Toiletries
Toys
US Mail/Flowers
Used Furniture/Hausehold Movers
Vegetables
Vegetables (Non Reefer)
Water Tanker
Wood
Wood Chips, Pallets, Sheets
VEHICLES
TRACTORS
EXTRA TRAILERS
TRUCKS
TRACTORS
TRAILERS
TRUCKS
DRIVERS
NUMBER OF DRIVERS
DRIVERS INFO
FILES
SUPPORTED FILE TYPES: .xls, .xlsx
UPLOAD VEHICLE LIST
(YEAR | MAKE/MODEL | VIN | TYPE (TRACTOR, TRUCK, TRAILER, OTHER) | *PULLED BY VIN | **VALUE)
*ONLY APPLIES FOR TRAILER TYPE, ENTER TRACTOR'S VIN FOR TRACTOR-TRAILER RELATION.
**VALUE FIELD ONLY IF PD COVERAGE IS REQUIRED.
CHECK FILE
(FILE MUST NOT BE LARGER THAN 4 MB)
DOWNLOAD VEHICLE FORMAT EXAMPLE
UPLOAD DRIVER LIST
(FIRST NAME | MIDDLE NAME | LAST NAME | DATE OF BIRTH | CDL)
CHECK FILE
(FILE MUST NOT BE LARGER THAN 4 MB)
DOWNLOAD DRIVER FORMAT EXAMPLE
PLEASE USE THE PROVIDED FORMATS FOR SUBMISSION
BUSINESS SECTION
LIABILITY $
DED $
$1,000
$1,500
$2,000
$2,500
$3,000
$3,500
$4,000
$4,500
$5,000
$7,500
$10,000
UM
UIM
PIP
PIP LIMIT: $
PIP DED: $
PIP ONLY AVAILABLE WHERE MANDATORY
CARGO $
DEDUCTIBLE $
REEFER BREAKDOWN:
Yes
No
DEDUCTIBLE $
TOWING AND STORAGE LIMIT
TOWING AND STORAGE DEDUCTIBLE
ATTACH LOSS REPORT(S) FOR ALL ACCIDENT(S)
LOSSES 3 YEARS
LIA $
PD $
CARGO $
UPLOAD ATTACHMENTS
(VEHICLE REGISTRATIONS, MVR, LOSS RUNS, FILINGS, ETC.)
(FILES MUST NOT BE LARGER THAN 4 MB)
COMMENTS
Version 05252021
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