C5 - Non-Trucking Liability
We have processed over 700 applicants and provide expedited proposals within 3 Business days (Depending Upon State), accurate every time, guaranteed. This is a FAST LANE, expedited service and requires an application fee, but puts you in the position to be on the road driving for C5.
Policy
Sender Name
Reply Email
example@example.com
Agency
Monday.com Title
Customer
First Name
*
Last Name
*
Full Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
Date
Mailing / Billing Address (This Is The Location Where You Garage The Vehicle)
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Driver's License #
*
Driver's License State (Abbreviation)
*
Please Select
AL
AK
AZ
AR
CA
CO
CT
DE
DC
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
Your Company Name (If Applicable) - Please Include LLC or Inc. If Applicable
Target Start Date
-
Month
-
Day
Year
Date
Has this driver had any accidents or violations in the past 5 years? *NOTE* THIS COULD AFFECT PREMIUM PRICING AT TIME OF POLICY ISSUANCE.
*
No
Yes
Approximate Date of Accident/Incident
*
-
Month
-
Day
Year
Date
Description of Incident/Accident
*
Are you storing/parking the vehicle in a location different than the mailing address above?
*
Yes
No
Address of vehicle when storing/parking.
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
DOT # (If Applicable), Leave Blank If Driving Under Someone Else's DOT Number.
FEIN # (If you are waiting on one, please type "Waiting")
*
Do you own or lease/rent the vehicle?
*
Own
Lease
I am leasing/renting from:
*
Enterprise
Kingbee (You are required to purchase physical damage insurance from MM Insurance)
Other
Vehicle Year (Vehicle Must Be 12 Years Or Newer To Qualify)
*
Vehicle Make & Model
*
Ex: Ford Transit
Vehicle VIN # (YOUR QUOTE WILL BE DELAYED UNTIL THE VIN IS PROVIDED FOR THE VEHICLE YOU OWN OR ARE RENTING)
*
As of today, do you currently have coverage in force for this vehicle? If you do, a discount is applied of 10%
*
Yes
No
Please provide a picture of your current insurance card. REQUIRED.
*
Browse Files
Drag and drop files here
Choose a file
Cancel
of
What carrier is the current coverage with?
*
Ex: Progressive
Company you will be driving for.
In addition to Non-Trucking Liability, please select one of the following.
*
I need Physical Damage Coverage
I am getting Physical Damage Coverage through the truck rental company
I do not require Physical Damage Coverge
Show Me A Video Explaining This In More Detail **DO NOT LEAVE THIS OPTION SELECTED WHEN SUBMITTING YOUR APPLICATION - AFTER YOU WATCH THE VIDEO PLEASE SELECT YOUR CORRECT OPTION ABOVE**
What deductible would you like? (Note: The higher the deductible, the lower the premium).
$1,000
$2,000
What Is Physical Damage Coverage?
I would like uninsured/underinsured motorist coverage. (Electing this coverage does yield additional premium. This coverage is important but not required by trucking companies).
Yes
No
Show Me A Video Explaining This In More Detail **DO NOT LEAVE THIS OPTION SELECTED WHEN SUBMITTING YOUR APPLICATION - AFTER YOU WATCH THE VIDEO PLEASE SELECT YOUR CORRECT OPTION ABOVE**
Uninsured/Underinsured Motorist
Longest Distance Traveled (Away From My Home Address)
*
Please Select
50 Miles
100 Miles
200 Miles
300 Miles
500 Miles
Over 500 Miles
Do You Need State Or Federal Filings (Please answer "Neither" if you are driving under another trucking company's authority):
*
Neither (I am driving under someone else's authority)
Both
State Only
Federal Only
What is your MC(Motor Carrier) Number or the MCS90 and Federal Filing
*
In order for your Federal Filing to be accepted by the FMCSA your address on the insurance policy must exactly match the address on file with FMCSA. (Ex. Suite Number/Unit, Spacing etc.). I confirm that the address listed above PRECISELY matches the FMCSA address. PLEASE DOUBLE CHECK.
*
Yes
No
Please include the telematics discount of 5-10% on my proposal. I AM interested in enrolling in the app that monitors my speed, safe driving habits. (ie - Progressive's Telematics program is called SmartHaul).
Yes
No
Non Trucking Liability coverage is not the same as full auto liability coverage. I will be driving under the authority of another company as a subcontractor. While I am driving under their authority (under load), I understand that their liability insurance is primary and responsible. If I am driving under my own authority, I need full auto liability coverage. Non Trucking liability coverage protects me (my vehicle) while I am driving not under load ONLY. Because the trucking company I drive for carries full auto liability while I am driving under load, I only need NTL coverage to cover the gap.
*
I Acknowledge
**Error - Please Fix**
One of the questions above has "Show Me A Video Explaining This In More Detail" selected. Please select an appropriate answer otherwise your form cannot be submitted
** Quote Turnaround & Approved States ** - If your home address (included in the application above) is listed in the following states you are in our expedited program and can expect a quote within 3 Business days for your quote: AL, AZ, CO, CT, DE, FL, GA, IN, KS, KY, MA, MD, MI, MN, MO, NV, NJ, NC, OH, PA, SC, TN, TX. If your address is not in these lists, we recommend that you contact a local agent.
*
I Acknowledge That My Address Is In An Approved State Listed Above
I Understand & Acknowledge That There Is A Non-Refundable $45 Application / Processing Fee
*
I Acknowledge
Non-Trucking Liability Application / Processing Fee
*
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Application / Processing Fee
$45.00
$
45.00
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