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FL Hauling and Trucking - Truck Trailer Hauler Transportation on Florida Highway

Home » Our Forms » Hauling & Trucking

Everyone’s insurance needs are different. Consider filling out our form and we’ll get back to you soon.

Get the hauling and trucking insurance coverage for your needs.

Please complete the form to your best ability. Fields marked with an * are required.

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General Business Information

Business Owner Full Name*

Business Owner Full Name

First Name* Last Name*

Phone Number*

Email*

Business Name*

Business Type*

If other, please specify.

Years in Business*

Federal Employer Identification Number (FEIN)*

USDOT Number (if applicable)

Business Address*

Street Address* Address Line 2 City* State* ZIP Code*

Are there any losses for the business in the last 5 years? Please list.*

Auto Insurance Details

Driver Information

Number of Drivers*

Add driver information for up to five drivers.

Driver 1

Name*

Date of Birth*

MM slash DD slash YYYY Date of Birth*

Drivers License #*

State of License*

Driver 2

Name

Date of Birth

MM slash DD slash YYYY Date of Birth

Drivers License #

State of License

Driver 3

Name

Date of Birth

MM slash DD slash YYYY Date of Birth

Drivers License #

State of License

Driver 4

Name

Date of Birth

MM slash DD slash YYYY Date of Birth

Drivers License #

State of License

Driver 5

Name

Date of Birth

MM slash DD slash YYYY Date of Birth

Drivers License #

State of License

Any tickets or claims in the past 5 years for any drivers?*

Yes

Vehicle Information

Number of Vehicles*

Add year, make/model, and VIN for up to five vehichles.

Vehicle 1

VIN*

Year*

Make*

Model*

Purchase Price or Current Value*

Vehicle 2

VIN

Year

Make

Model

Purchase Price or Current Value

Vehicle 3

VIN

Year

Make

Model

Purchase Price or Current Value

Vehicle 4

VIN

Year

Make

Model

Purchase Price or Current Value

Vehicle 5

VIN

Year

Make

Model

Purchase Price or Current Value

Lender or Lease Company (if applicable)

Insurance Requirements from Lender (if any)

Upload Insurance Requirement Documents from Lender

Drop files here or

Max. file size: 300 MB.

Job & Operational Details

Brief Description of Business Operations*

Is the business for-hire (operating on behalf of others)?*

Yes

What does the business haul?*

Does the business operate...*

Intrastate (within one state only)

Interstate (across state lines)

In what states does the business operate?*

Typical Travel Radius*

0–50 miles

51–100 miles

101–250 miles

251+ miles

What is the longest one-way trip you typically make for a job?*

Are you involved in any other operations NOT related to hauling, delivering or dumping?*

Yes

If yes, please describe.

Do you have contractor or employer insurance requirements?*

Yes

If yes, please describe.

Upload Insurance Requirement Documents for Contractor

Drop files here or

Max. file size: 300 MB.

Workers' Compensation Information

Number of Employees - Full-Time*

Number of Employees - Part-Time*

Estimated Annual Payroll*

Current Insurance Coverage

Do you currently have any active insurance policies?*

Commercial Auto

General Liability

Workers’ Compensation

Inland Marine / Equipment

Other

No Active Insurance

If other, please specify.

Please list carrier names and policy effective dates.

Upload a copy of any active policies.

Max. file size: 300 MB.

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800-638-9202

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Maury Donnelly & Parr, Inc. is a professional insurance agency that is devoted to keeping our insured protected and providing them with insurance solutions for their needs. MDP strives to offer personalized levels of service in our niche programs as well as a wide range of insurance knowledge to write most classes of business, regardless of their size. Our goal is to provide insurance of the highest quality so every client may obtain coverage levels that are right for their unique situation and to always value coverage over policy price.

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