COURIER PROGRAM SUPPLEMENTAL APPLICATION
UTILIZATION OF X-HEAVY TRUCK TRACTORS
OWNED/SCHEDULED UNITS
This supplemental accompanies the completed Courier Program Application
Please complete this supplemental only if your business operations include the utilization of Owned/Scheduled Truck Tractors
(45k GVW or more)
Please note: We cannot consider trucking within our courier program. However, we can consider truck/tractors if they are utilized within the courier operations (e.g., picking up loads and dropping off at the courier location for distribution by courier vehicles).
Business Name:Owned/Scheduled Truck Tractors
Please provide the Number of Owned/Scheduled Truck Tractors:
Please explain how the owned/scheduled Tractors are being used within the courier business:
What types of commodities are being transported?
Approx how often are these units used on average per day & per week? / Per day: / Per week:
Is it scheduled/routed delivery? / Yes No
What is the average value of cargo per anyone vehicle?
What is the maximum value of cargo per anyone vehicle?
What is the approx. average and maximum Radius? / Average Radius: / Max. Radius:
What is the percentage of this operation is traveled over 200 miles, if any?
Please provide a detailed outline of the security measures put in place for the drivers of these types of deliveries:
APPLICANT SIGNATURE
Note: Certain States have statutes concerning fraudulent claims and/or deliberate misrepresentations to induce an insurer to provide coverage. If you wish to know the ramifications of such acts in your State, please consult with your insurance agent.
Note: The proposed insurance company reserves the right to inspect your operations, while it has no duty to do so. Should an inspection be conducted that generates recommendations to an insured, failure to comply may result in the cancellation of the policy.
I hereby certify that the foregoing information supplied on this application, along with any supplemental information provided in connection thereto, is true and accurate to the best of my knowledge. I further understand that any policy issued to me was done so upon reliance of the representation herein. I further understand and agree that any intentional material misrepresentations could compromise the insurance protection hereby afforded.
Printed Name of Applicant / Title
Signature of Applicant / Date
Courier Program Supplemental (Non-Owned Truck Tractors) 06/15 1 of 1