Trailer Rental Insurance | Insurance for Trailer Rental Businesses

Section 1 — A. General Information

Proposed effective date

When is the quote needed by

Are you working with an agent/broker?

YesNo

Producer name

Producer phone number

Producer email

Applicant’s name*

Applicant’s mailing address

City

State

Zip

Email*

Business telephone number*

Fax

Do you have more than one location?

YesNo

Physical address of business if different

City

State

Zip

Physical address

City

State

Zip

Detailed description of business activities (specifically, and by location [1]

Detailed description of business activities (specifically, and by location [2]

Detailed description of business activities (specifically, and by location [3]

Detailed description of business activities (specifically, and by location [4]

Is this a new business?

YesNo

Date business started

Years in business

Name_Row_1

Role_Row_1

Contact Number_Row_1

Email Address_Row_1

Name_Row_2

Role_Row_2

Contact Number_Row_2

Email Address_Row_2

Name_Row_3

Role_Row_3

Contact Number_Row_3

Email Address_Row_3

Annual payroll

Annual gross receipts

Does the insured have any contract requirements? (If yes, please attach a copy)

YesNo

Section 2 — B. Insurance History

Why is the insured seeking new coverage

What is the target premium

Is the current insurance carrier offering a renewal quote?

YesNo

If yes, please provide the premium offered

If no, explain

Company name

Coverage

Limits

Annual premium

Company name

Expiration date

Annual premium

$_Limits

$_Coverage type

Are any other markets offering coverage?

YesNo

If no, please explain [1]

If no, please explain [2]

If yes, please provide limits, coverage and premium

Has the applicant or any predecessor ever had a claim?

YesNo

Paid claims_/ /

Reserved claims_/ /

Total incurred claims_/ /

From To

Paid claims_/ /

Reserved claims_/ /

Total incurred claims_/ /

Fill 44(table cell near “From To”)

Fill 441(table cell near “From To”)

Paid claims_/ /

Reserved claims_/ /

Total incurred claims_/ /

Fill 45(table cell near “From To”)

Fill 451(table cell near “From To”)

Paid claims_/ /

Reserved claims_/ /

Total incurred claims_/ /

Fill 46(table cell near “From To”)

Fill 461(table cell near “From To”)

Paid claims_/ /

Reserved claims_/ /

Total incurred claims_/ /

Fill 47(table cell near “From To”)

Fill 471(table cell near “From To”)

Are you aware of any incident, event, or occurrence, loss that might reasonably be expected to lead to a claim

YesNo

If yes, please explain [1]

If yes, please explain [2]

Section 3 — C. Desired Insurance

Section 4 — E. Employees

Section 5 — G. Equipment

Section 6 — Commercial Equipment Schedule

UNIT TYPE_Row_1

YEAR_Row_1

MAKE AND MODEL_Row_1

VIN # (12 DIGITS)_Row_1

*ACV VALUE_Row_1

UNIT TYPE_Row_2

YEAR_Row_2

MAKE AND MODEL_Row_2

VIN # (12 DIGITS)_Row_2

*ACV VALUE_Row_2

UNIT TYPE_Row_3

YEAR_Row_3

MAKE AND MODEL_Row_3

VIN # (12 DIGITS)_Row_3

*ACV VALUE_Row_3

UNIT TYPE_Row_4

YEAR_Row_4

MAKE AND MODEL_Row_4

VIN # (12 DIGITS)_Row_4

*ACV VALUE_Row_4

UNIT TYPE_Row_5

YEAR_Row_5

MAKE AND MODEL_Row_5

VIN # (12 DIGITS)_Row_5

*ACV VALUE_Row_5

UNIT TYPE_Row_6

YEAR_Row_6

MAKE AND MODEL_Row_6

VIN # (12 DIGITS)_Row_6

*ACV VALUE_Row_6

UNIT TYPE_Row_7

YEAR_Row_7

MAKE AND MODEL_Row_7

VIN # (12 DIGITS)_Row_7

*ACV VALUE_Row_7

UNIT TYPE_Row_8

YEAR_Row_8

MAKE AND MODEL_Row_8

VIN # (12 DIGITS)_Row_8

*ACV VALUE_Row_8

UNIT TYPE_Row_9

YEAR_Row_9

MAKE AND MODEL_Row_9

VIN # (12 DIGITS)_Row_9

*ACV VALUE_Row_9

UNIT TYPE_Row_10

YEAR_Row_10

MAKE AND MODEL_Row_10

VIN # (12 DIGITS)_Row_10

*ACV VALUE_Row_10

LENGTH (BOATS/PWC)_Row_1

ENGINE YEAR/MAKE (BOATS/PWC)_Row_1

ENGINE SERIAL # (BOATS/PWC)_Row_1

TOTAL HP (BOATS/PWC)_Row_1

MAX SPEED (BOATS/PWC)_Row_1

LENGTH (BOATS/PWC)_Row_2

ENGINE YEAR/MAKE (BOATS/PWC)_Row_2

ENGINE SERIAL # (BOATS/PWC)_Row_2

TOTAL HP (BOATS/PWC)_Row_2

MAX SPEED (BOATS/PWC)_Row_2

LENGTH (BOATS/PWC)_Row_3

ENGINE YEAR/MAKE (BOATS/PWC)_Row_3

ENGINE SERIAL # (BOATS/PWC)_Row_3

TOTAL HP (BOATS/PWC)_Row_3

MAX SPEED (BOATS/PWC)_Row_3

LENGTH (BOATS/PWC)_Row_4

ENGINE YEAR/MAKE (BOATS/PWC)_Row_4

ENGINE SERIAL # (BOATS/PWC)_Row_4

TOTAL HP (BOATS/PWC)_Row_4

MAX SPEED (BOATS/PWC)_Row_4

LENGTH (BOATS/PWC)_Row_5

ENGINE YEAR/MAKE (BOATS/PWC)_Row_5

ENGINE SERIAL # (BOATS/PWC)_Row_5

TOTAL HP (BOATS/PWC)_Row_5

MAX SPEED (BOATS/PWC)_Row_5

LENGTH (BOATS/PWC)_Row_6

ENGINE YEAR/MAKE (BOATS/PWC)_Row_6

ENGINE SERIAL # (BOATS/PWC)_Row_6

TOTAL HP (BOATS/PWC)_Row_6

MAX SPEED (BOATS/PWC)_Row_6

LENGTH (BOATS/PWC)_Row_7

ENGINE YEAR/MAKE (BOATS/PWC)_Row_7

ENGINE SERIAL # (BOATS/PWC)_Row_7

TOTAL HP (BOATS/PWC)_Row_7

MAX SPEED (BOATS/PWC)_Row_7

LENGTH (BOATS/PWC)_Row_8

ENGINE YEAR/MAKE (BOATS/PWC)_Row_8

ENGINE SERIAL # (BOATS/PWC)_Row_8

TOTAL HP (BOATS/PWC)_Row_8

MAX SPEED (BOATS/PWC)_Row_8

LENGTH (BOATS/PWC)_Row_9

ENGINE YEAR/MAKE (BOATS/PWC)_Row_9

ENGINE SERIAL # (BOATS/PWC)_Row_9

TOTAL HP (BOATS/PWC)_Row_9

MAX SPEED (BOATS/PWC)_Row_9

LENGTH (BOATS/PWC)_Row_10

ENGINE YEAR/MAKE (BOATS/PWC)_Row_10

ENGINE SERIAL # (BOATS/PWC)_Row_10

TOTAL HP (BOATS/PWC)_Row_10

MAX SPEED (BOATS/PWC)_Row_10

LIEN HOLDER NAME & ADDRESS_Row_1

UNITS OF INTEREST_Row_1

LIEN HOLDER NAME & ADDRESS_Row_2

UNITS OF INTEREST_Row_2

LIEN HOLDER NAME & ADDRESS_Row_3

UNITS OF INTEREST_Row_3

Section 7 — Representations And Warranties

Applicant

Agent/Broker

Signature

Print name

Rental Liability Application