Motor Carrier Insurance Application

Company Information

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Eligibility Requirements

• All Drivers Meet Eligibility Requirements
• Active Commercial Drivers License (CDL)
• Current Medical Certificate on file with DMV
• Two (2) or more years CDL in the United States
• No DUI, Reckless, Speed +20MPH, or Suspension in last 5 years
• No More than 2 At-Fault accidents in last 5 years
• No More than 1 At-Fault accident in last 3 years
• No More than 3 Speeding in last 5 years
• No More than 2 Speeding in last 3 years
• No HazMat Loads that require $5,000,000 Filing
• Application is for a Motor Carrier with MCS-150
• All Owned and/or Leased Equipment is Included in this Submission
• All Operations are Within the United States of America
• Motor Carrier on this Application listed on Bill of Lading for All Loads
• Other than Employee Drivers, No Other Truckers Operate under your DOT Filing

Commodities

Truck and Trailer Storage Locations

Equipment

Drivers

Experience

Radius of Operations

Type of Carrier and Operation

Pick-Up and Delivery Location Types

Metropolitan Areas Traveled To

Safety Features

Upload the following documents below:

• FEIN (W-9 Form)
• Truck and Trailer Details including VIN(s)
• Prior Insurance Information (if any)
• IFTAs with Mileage Breakdown by State (if Any)
• Driver License Details
• Top 5 Customers
• Previous Loss Experience for last 5 years
• Current Motor Vehicle Report for all Drivers