Commercial Trucking Insurance Application

1

Policy Information

Policy Renewal / Start Date *

USDOT Number

Business Structure *

Year Business Started

2

Business Information

Name of Business *

Business Address *

Business Phone

Business Email

Business EIN (Employer Identification Number)

Your 9-digit federal tax ID issued by the IRS. Format: XX-XXXXXXX.

3

Business Owner Information

Owner Full Name *

Date of Birth *

Owner Address (Street, City, State, ZIP) *

Primary Phone

Driver License Number *

4

Vehicles & Trailers

1 vehicle

Complete one block per vehicle. Each vehicle includes its own trailer section — if your truck operates with a dedicated trailer, complete that section as well.

5

Driver Information

1 driver

6

Coverage Requested

Bodily Injury & Property Damage Liability

Uninsured Motorist Bodily Injury

Uninsured Motorist Property Damage

Requested Deductible

Medical Payments

Motor Truck Cargo — Commodity & Coverage Limit

Hired Auto Liability

General Liability

Yes No

Additional Coverages Needed

Rental Reimbursement Rental with Downtime Roadside Assistance Gap Coverage Fire & Theft / Combined Add'l Coverage Employer Non-Owner Auto Liability Trailer Interchange Non-Owned Trailer Physical Damage Garage Keepers

🔒 Garage Keepers — Locations Up to 3 locations

Garage Keepers covers customer vehicles in your care, custody, or control. Provide details for each storage or service location.

7

Filings & Compliance

State or Federal Filings Required?

Yes No

Includes Federal Filings, MCS-90, and State Filings. Does NOT include ELD compliance.

Filing Types Needed

Federal Liability MCS-90 State Filing

State Filing — State & Type (Liability / Cargo / Other)

ELD (Electronic Logging Device) Required?

Yes No

Customers with an ELD who share driving data may qualify for a SmartDrive discount.

8

Additional Insureds & Waivers of Subrogation

Number of Named Additional Insureds

Named AIs receive copies of all notices/cancellations. Do NOT include blanket endorsements here.

Number of Named Waivers of Subrogation

Eliminates the insurer's right to recover losses from the specified party.

Blanket Additional Insured Endorsement Needed by Contract?

Yes No

Blanket Waiver of Subrogation Endorsement Needed?

Yes No

9

Existing Insurance

Are You a Current Progressive Customer?

Yes No

Other Business Coverages

General Liability Business Owner Policy (BOP) None