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Cargo & Logistics Application

Agency Information

Applicant Information

Insured has another DOT number?

Operations & Coverage

Type of Carrier

Type of Operation

Radius of Operations

Total Radius Allocation: 0%

Commodities Worksheet
No commodities entered yet.

Limits & Coverage

Optional Coverages

Terminals

Do you wish to list any terminals?

Coverage History

Cargo coverage cancelled or non-renewed in the past 3 years?

Bankruptcy within the past 3 years?

Authority under different name in past 3 years?

Loss History

Provide details for the past five years.

Policy Period # Claims Cause(s) of Loss Amount Paid Open Claim(s)?

Theft Exposure & Security

Outline how equipment is secured in transit and while parked.

1. Are vehicles ever left loaded and unattended?

2. Does applicant ever leave loaded trailers detached from power units?

3. What security is provided for loaded vehicles? (check all that apply)

At locations

In transit

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