Years Trucking Experience:
How many years prior insurance under the business name listed above?
Will applicant be hauling under authority of other trucking firm?
If yes, provide MC#:
(Less than 2 years in business)
Date Coverage Desired:
1. Is owner the only driver?
-- If no, question #11 must be fully completed
2. When did you first obtain your commercial class A license?
3. Have you ever had prior commercial insurance in you or your business name?
If yes,Insurance Carrier: Policy Term(s):
If yes, Details:
4. Have you been driving trucks / tractors commercially for at least 2 years?
Provide the following previous employer information where employed as a trucker for at least 2 years.
5. What radius were you traveling while employed?
6. What radius (farthest one way distance) do you anticipate traveling at least 80% of the time?
7. Will you be traveling out of California?
If yes,List states you may travel in: How often?
8. What type of commodities were you hauling while employed?
9. What commodities will you be hauling over the next 12 months?
10. Have you applied or will you be applying for the following authorities?
MCP - State Authority - CA#
ICC - Federal Authority - MC#
11. Are there additional drivers that may will be driving or operating vehicles? If yes, provide driver experience for past 2 years.