BASIC INFO
COVERAGE
EQUIPMENT
1/3
FMCSA TYPEMCDOTFF
TARGET EFFECTIVE DATE*
0%
COVERAGE Automotive LiabilityPhysical DamageMotor Truck CargoReefer BreakdownGeneral LiabilityGarage Keepers LiabilityOn-HookTrailer InterchangeNon Owned Physical DamageExcess/UmbrellaUM/UIMHired/Non-ownedNon-Trucking Liability/BobtailWorkers CompensationOccupational Accident
INSURANCE LIMIT
DEDUCTIBLE
[text* 0-50-MILES placeholder "0-50 MILES"]
[text* 51-200-MILES placeholder "51-200 MILES"]
COMMODITY General FreightHousehold GoodsMetal: Sheets, Coils, RollsMotor VehiclesDrive Away/TowawayLogs, Polls, Beams, LumberBuilding MaterialsMobile HomesMachinery, Large ObjectsFresh ProduceLiquids/GasesIntermodal ContainerPassengersOil Field EquipmentLivestockGrain, Feed, HayCoal/CokeMeatGarbage, Refuse, TrashU.S. MailChemicalsCommodities Dry BulkRefrigerated FoodBeveragesPaper ProductsUtilitiesAgricultural/Farm SuppliesConstructionWater WellOther:
HAULED
AVE LOAD VALUE
MAX LOAD VALUE
SHIPPER
50%
DRIVER Full NAME
LICENSE NUMBER
STATE
DATE OF BIRTH (MM/DD/YY)
YEARS OF EXPERIENCE
YEAR
MAKE
VIN
VALUE
LIENHOLDER
A Reliance Partner representative will be in contact with you to gather IFTA documents.
A Reliance Partner representative will be in contact with you to gather Loss Run documents.
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