New Business Application

You can start your application for insurance here.

"*" indicates required fields

1Client Information

2Contact & Business Information

3General Operations

4Auto

5General Liability

6Property

7Warehouse / Cargo

8Warehouse / Cargo (continued)

9Warehouse / Cargo (continued)

10Crime

11Worker

12Comments / Explanations

Please complete any relevant sections of this application.

Client Information

First Named Insured*

Address*

Street Address Address Line 2 City State ZIP Code

Website Address

FEIN*

Effective Date*

MM slash DD slash YYYY

Years In Business*

Please enter a number greater than or equal to 0.

Contact & Business Information

First Named Insured Owner's Names & Titles*

Name

Title

% Ownership

Contact Name & Title*

First Last Title

Phone #*

Van Line Affiliation

Additional Named Insureds

FEIN

Description of Operations

Owner's Names & Titles

% of Ownership

Radius of Operation

Please provide a percentage of authority for each operation radius below. Fields should show a value between 0 - 100 and the total field must not exceed 100.

Under 50 miles

Neighborhood Authority
Total (must equal 100%)

% Your Authority*

Please enter a number from 0 to 100.

% Van Line Authority*

Please enter a number from 0 to 100.

% Other Authority*

Please enter a number from 0 to 100.

50 to 100 miles

Local Authority
Total (must equal 100%)

% Your Authority*

Please enter a number from 0 to 100.

% Van Line Authority*

Please enter a number from 0 to 100.

% Other Authority*

Please enter a number from 0 to 100.

101 to 300 miles

Intermediate Authority
Total (must equal 100%)

% Your Authority*

Please enter a number from 0 to 100.

% Van Line Authority*

Please enter a number from 0 to 100.

% Other Authority*

Please enter a number from 0 to 100.

301 to 500 miles

Regional Long Haul Authority
Total (must equal 100%)

% Your Authority*

Please enter a number from 0 to 100.

% Van Line Authority*

Please enter a number from 0 to 100.

% Other Authority*

Please enter a number from 0 to 100.

Over 500 miles

Country-wide Long Haul
Total (must equal 100%)

% Your Authority*

Please enter a number from 0 to 100.

% Van Line Authority*

Please enter a number from 0 to 100.

% Other Authority*

Please enter a number from 0 to 100.

General Operations

Does your company act as a Freight Forwarder under your authority?*

Yes

N/A

Does your company conduct business other than Moving & Storage? (i.e. sell packing material, crating, manufacture boxes, self-storage, rigging, equipment rental, auto repair, PODS, shredding).*

Yes

N/A

Please provide a description of these operations and revenue of each.*

If you are a Van Line Agent, are you required to provide primary auto liability insurance while operating under van line authority?*

Yes

N/A

Are any special certificates required?*

Yes

N/A

To whom?*

Excluding Van Line, do you have any trailer interchange agreements with other moving companies?*

Yes

N/A

Do you have any 409 agreements (military contracts)?*

Yes

N/A

Please provide names of contracts.*

Do you have a formal written safety program?*

Yes

N/A

Any material changes in your operations in the past 5 years?*

Yes

N/A

Please provide details.*

Any expected or potential changes in the upcoming policy year?*

Yes

N/A

Please provide details.*

Percentage of Operations

% Residential*

Please enter a number from 0 to 100.

% Commercial*

Please enter a number from 0 to 100.

Types of Goods

Please specify percentage of types of goods handled, between 0 - 100.

Used Household Goods %*

Please enter a number from 0 to 100.

New Household Goods %*

Please enter a number from 0 to 100.

Military Household Goods %*

Please enter a number from 0 to 100.

Office Furnishings %*

Please enter a number from 0 to 100.

Electronics %*

Please enter a number from 0 to 100.

Information & Records %*

Please enter a number from 0 to 100.

Special Products %*

Please enter a number from 0 to 100.

Total %

Auto

Do you own any vehicles not scheduled on this policy?*

Yes

N/A

Please explain.

Does anyone other than your company own any scheduled vehicles?*

Yes

N/A

Please explain.*

Do you use contract drivers or Owner/Operators?*

Yes

N/A

Are contract drivers or Owner/Operators included on your Driver List?*

Yes

N/A

Do contract drivers or Owner/Operators haul exclusively for you?*

Yes

N/A

Do you rent/lease vehicles not scheduled on the auto policy?*

Yes

N/A

What is the average annual expense for this?*

Is there a written vehicle maintenance program?*

Yes

N/A

Does it include regular preventive maintenance?*

Yes

N/A

Does it include certified mechanics?*

Yes

N/A

Does it include safety & pre-trip inspections?*

Yes

N/A

Hiring Practices

Is there a formal applicant screening process?*

Yes

N/A

Do you receive an application on all new employees?*

Yes

N/A

Do you obtain and review MVRs prior to hiring?*

Yes

N/A

Do you review MVRs annually?*

Yes

N/A

Do you complete a criminal background check prior to hiring?*

Yes

N/A

Are there written job descriptions with minimum qualifications?*

Yes

N/A

Are experience, qualifications and references verified for each new hire?*

Yes

N/A

Do you require a pre-employment physical for all employee drivers?*

Yes

N/A

Do you require pre-employment drug testing of all drivers, packers and handlers?*

Yes

N/A

Do you conduct random drug testing of all drivers, packers and handlers?*

Yes

N/A

Do you lease employees from an employee leasing firm?*

Yes

N/A

Please provide a copy of your current Auto Policy so we can review your current limits and exposures to ensure you are quoted the same or similar coverages .

Max. file size: 100 MB.

General Liability

Does your company perform on-site office installation/assembly?*

Yes

N/A

Please provide description of these operations and payroll.*

Does your company perform on-site appliance installation/assembly, connect washers or icemakers?*

Yes

N/A

Please provide description of these operations and payroll.*

Do you utilize sub-contractors for either of the above 2 questions?*

Yes

N/A

Do you provide self-storage services?*

Yes

N/A

Estimated Annual Sales*

Do you have any rigging equipment?*

Yes

N/A

Do you rent rigging equipment or cranes?*

Yes

N/A

Do you allow customers access to the warehouse?*

Yes

N/A

Are there any premises that are leased to others?*

Yes

N/A

Please provide names, description of their operations, square footage occupied.*

Do you secure and maintain GL certificates from all tenants/lessors showing limits equal to or greater than your policy limits and listing your company as Additional Insured?*

Yes

N/A

Is there a written agreement for all locations that are leased or rented?*

Yes

N/A

Please provide a copy of your current General Liability Policy so we can review your current limits and exposures to ensure you are quoted the same or similar coverages .

Max. file size: 100 MB.

Property

Address*

Street Address Address Line 2 City State ZIP Code

Building Limit*

Contents Limit*

BI / EE or Loss of Rents Limit*

Are you owner or tenant?*

Owner

Tenant

Owned or leased in what entity name?*

Total building Sq. Ft.*

Sq. Ft. occupied by you (warehouse)*

Sq. Ft. occupied by you (office)*

Do you lease space to others?

Yes

If yes, provide names and Sq. Ft. for each

Name

Sq. Ft.

Outdoor scales and/or signs?*

Yes

If yes, provide value.

Year Built*

Construction Type*

Updates to roof, wiring, plumbing, or heating? Please provide details and dates.

Upgrade

Details

Date

Building Sprinklered?*

Yes

Fire Alarm?*

Yes

Central Station?*

Yes

Installed / Monitored By?

Burglar Alarm?*

Yes

Central Station?*

Yes

Installed / Monitored By?

Please provide a copy of your current Property Policy so we can review your current limits and exposures to ensure you are quoted the same or similar coverages.

Max. file size: 100 MB.

Warehouse / Cargo

Does your company issue a bill of lading and a warehouse receipt on all moves?*

Yes

N/A

Are you subject to state regulation or to a Tariff?*

Yes

N/A

Do you provide labor for on-premises moves?*

Yes

N/A

Do you ever have off-site or temporary storage?*

Yes

N/A

Are there any climate controlled storage facilities?*

Yes

N/A

Do you own self-storage or mini-storage facilities?*

Yes

N/A

Do you store any goods of others in a self-storage or mini-storage facility not owned by you?*

Yes

N/A

Do you have containerized self-storage or PODS?*

Yes

N/A

Do you do any specialized crating?*

Yes

N/A

Do you hold storage auctions?*

Yes

N/A

Do you store boats or vehicles?*

Yes

N/A

Any Exhibition/Trade Shows?*

Yes

N/A

Requested Cargo Liability Limit

Bill of Lading*

Per Truck*

Per Disaster*

Moving Equipment Limit*

ACV or RCV?*

ACV (Actual Cash Value)

RCV (Replacement Cost)

Is any mobile equipment valued greater than $25,000?*

Yes

Warehouse / Cargo (continued)

Valuation of Property

Coverage

% Transported (Cargo)*

At Limited Liability ($0.60 / lb.)

Please enter a number from 0 to 100.

% Stored (Warehouse)*

At Limited Liability ($0.60 / lb.)

Please enter a number from 0 to 100.

% Transported (Cargo)*

At $3.00/lb. or lower

Please enter a number from 0 to 100.

% Stored (Warehouse)*

At $3.00/lb. or lower

Please enter a number from 0 to 100.

% Transported (Cargo)*

At more than $3.00/lb. or declared value

Please enter a number from 0 to 100.

% Stored (Warehouse)*

At more than $3.00/lb. or declared value

Please enter a number from 0 to 100.

% Transported Total

Should equal 100%

% Stored Total

Should equal 100%

Valuation

% Transported (Cargo)*

On an Actual Cash Value (ACV) Basis

Please enter a number from 0 to 100.

% Stored (Warehouse)*

On an Actual Cash Value (ACV) Basis

Please enter a number from 0 to 100.

% Transported (Cargo)*

On a Replacement Cost (RCV) Basis

Please enter a number from 0 to 100.

% Stored (Warehouse)*

On a Replacement Cost (RCV) Basis

Please enter a number from 0 to 100.

Other

If you have another valuation basis, please specify here.

% Transported (Cargo)

Please enter a number from 0 to 100.

% Stored (Warehouse)

Please enter a number from 0 to 100.

% Transported Total

Should equal 100%

% Stored Total

Should equal 100%

Transportation

% Transported by Owned Vehicles*

Please enter a number from 0 to 100.

% Transported by Contractor Vehicles*

Please enter a number from 0 to 100.

Other

% Transported by Other Method

Please enter a number from 0 to 100.

% Total

Should equal 100%

Warehouse / Cargo (continued)

No Storage?*

No Storage (skip this section)

Have Storage

Storage

Address

Street Address Address Line 2 City State ZIP Code

WLL Limit Requested

Area of Warehouse

Non-Temp Military Limit (lbs. x $6.00)

% Unused

Please enter a number from 0 to 100.

% Racks

Please enter a number from 0 to 100.

% Loose

Please enter a number from 0 to 100.

% Vaults

Please enter a number from 0 to 100.

Vault Height

2-high

3-high

Other

Please provide a copy of your current Inland Marine Policy so we can review your current limits and exposures to ensure you are quoted the same or similar coverages.

Max. file size: 100 MB.

Crime

No Crime?*

No Crime (skip this section)

Crime Policy

Are regular audits performed?*

Yes

N/A

Audit frequency*

Annual

Semi-Annual

Quarterly

Audits performed by*

Staff

Public Accountant

CPA

Audit format*

Audit

Review

Compilation

Tax Return Only

Is audit made in accordance with generally accepted auditing standards and so certified?*

Yes

N/A

Does audit include inventory?*

Yes

N/A

Are all incoming checks stamped “For Deposit Only” as soon as they are received?*

Yes

N/A

Are all company accounts reconciled against a job/customer each month?*

Yes

N/A

Are drivers required to present receipts for fuel or other services daily with their bill of lading?*

Yes

N/A

Is the purchase of company supplies, packing materials, equipment, etc. handled through a purchase order process that requires not only an employee signature but also a general manager or controller signature?*

Yes

N/A

Is countersignature of checks required?*

Yes

N/A

Who signs controls?*

Will securities be subject to joint control of two or more responsible employees?*

Yes

N/A

Do you verify transfer instructions purportedly issued by you, an employee, or other management and staff, your vendors and customers?*

All instructions are verified.

Instructions are verified for all transfer instructions greater than a certain amount.

No requirement of transfer instructions is required

What amount?*

Do you accept credit card payments for moving or storage?*

Yes

N/A

Do you keep credit card numbers on file?*

Yes

N/A

Is there a written policy regarding EFTs?*

Yes

N/A

Should contractors or Owner/Operators be included for crime coverage?*

Yes

N/A

How many?*

Please provide a copy of your current Crime Policy so we can review your current limits and exposures to ensure you are quoted the same or similar coverages

Max. file size: 100 MB.

Worker's Compensation

No Worker's Compensation?*

No Worker's Compensation (skip this section)

Worker's Compensation Policy

Do you have a team safety incentive program?*

Yes

N/A

Do you have currently have a Drug Free Credit?*

Yes

N/A

Do Owner/Operators have their own worker’s compensation coverage?*

Yes

N/A

WIth whom?*

Do you have current certificates of insurance showing Owner/Operators own worker’s compensation coverage?*

Yes

N/A

Is group medical coverage offered to eligible employees?*

Yes

N/A

Percentage of employee participation*

Please enter a number less than or equal to 100.

Percentage paid for by the employer*

Please enter a number less than or equal to 100.

Paid sick leave?*

Yes

N/A

Paid vacation?*

Yes

N/A

Is there any retirement programs or life insurance offered for drivers?*

Yes

N/A

Do you have a modified/light duty Return to Work Program?*

Yes

N/A

Is casual labor used?*

Yes

N/A

Max number of employees in a vehicle at once?*

Please check each of the following safety devices/procedures utilized:

Lift Belts

Steel-Toe Boots

Dollies

Lift Gates

Formal Lift Training

Team Lifting

Team Lifting mandatory at? (in lbs.)*

Officers*

Officer Name

Title

Included / Excluded

Class Code

Payroll

Please provide a copy of your current Worker’s Compensation Policy so we can review your current limits and exposures to ensure you are quoted the same or similar coverages.

Max. file size: 100 MB.

Comments / Explanations

Please provide any comments or additional details for any questions here: