Transcription of SUPPLEMENT TO TRUCK APPLICATION CARGO COVERAGE …
1 SUPPLEMENT TO TRUCK APPLICATIONCARGO COVERAGE APPLICATIONThis SUPPLEMENT is a part of the APPLICATION and willbe relied upon by the Company as an integral part ofthe APPLICANT'S NAME 2. Has any company ever cancelled or refused to issue CARGO insurance? G Yes G NoIf yes, explain 3. Have you purchased CARGO insurance in the past 3 years? G Yes G CARGO CARRIER AND LOSS EXPERIENCE (list for the past three years with most recent carrier first).Policy TermFromToCompany & Policy NumberPremiumNumber ofClaimsCause of LossAmount of CARGO % of HaulingMaximum ValueAverage desires to have CARGO premiums applied to each:G power unit, which includes any trailers, semi-trailers, or mobile homes, but only while attached to a described power unit, or.
2 G trailers or NEEDS Complete for desired coverages:G Named Perils or G Broad FormDeductible Amount $ Limit of Insurance $ OPTIONAL COVERAGES (Additional Premium):G Additional Insured Endorsement (Lessee)G Loading and Unloading CoverageG Earned Freight CoverageG Refrigeration Breakdown CoverageG Hired Car CARGO CoverageREDUCTION OF COVERAGE (Premium Credit): G Exclude Theft CoverageIf applicant hauls double wide mobile homes, Limit of Insurance must be equal to the value of both sides combined to satisfy of insurance on each TRUCK should equal maximum load carried, as policies contain 100% co-insurance FILING INFORMATION:List states for which insured requires CARGO FILINGS (check name on permits) Is filing required?
3 G Yes G Docket Number :M-4413a (12/2006)
