Commercial Lines - Owned Business Auto

Driver Information

How many drivers are there for your vehicle(s)?*

Driver 1 Information

Name*

First Last

Date of birth*

Marital Status*

Married/Domestic Partnership
Single
Divorced
Widowed

Driver's License Number & State of Issuance*

Driver 2 Information

Name*

First Last

Date of birth*

Marital Status*

Married/Domestic Partnership
Single
Divorced
Widowed

Driver's License Number & State of Issuance*

Driver 3 Information

Name*

First Last

Date of birth*

Marital Status*

Married/Domestic Partnership
Single
Divorced
Widowed

Driver's License Number & State of Issuance*

Driver 4 Information

Name*

First Last

Marital Status*

Married/Domestic Partnership
Single
Divorced
Widowed

Date of birth*

Driver's License Number & State of Issuance*

If there are more than 4 drivers, please advise the following information for each driver: Full Name, Date of Birth, Marital Status and Driver's License State of Issuance & Number*

For Example: John Doe - DOB 11/01/1990; Divorced; CA DL#B11111111

Hired & Non-Owned Auto Exposure

Do employees drive their own vehicles on behalf of company business?*

Yes
No

How many employees drive their own vehicles on behalf of company business?*

How often do employees drive their own vehicles on behalf of company business?*

Do you make sure that employees who drive their own vehicles on behalf of the company have their own, valid auto insurance?*

Yes
No

Does the business reimburse employees for miles driven?*

Yes
No

Does the business ever rent vehicles?*

Yes
No

Owned Vehicle Information

How many vehicles does the business own?*

These vehicles should be registered in the business' name.

Please advise the Year, Make, Model, VIN, Replacement Cost Value and Garaging Address of each vehicle*

For example: 2020 Honda Civic, BGT2584557XZ6522, $25,000, 123 Sesame St Fantasy, CA 90000

Have any of the vehicles been equipped with after-market upgrades or improvements?*

Yes
No

For Example: truck bed liners, upgrades to upholstery/stereo/navigation/paint/wheels/trim, etc.

Please advise the vehicles that have such improvements/upgrades, list the improvements, and assign a value to each improvement:*

What is the radius of the vehicles' operation (in miles)?*

Are any of the vehicles leased or financed?*

Yes
No, they're owned outright

Please advise the Name of the Lessor/Lender, their address, the loan or lease agreement number, and the vehicle to which the information corresponds:*

For Example: Honda Financial, 123 Sesame St Fantasy, CA 90000, Loan #5878954, 2020 Honda Civic

Are employees ever allowed to take the business vehicles home?*

Yes
No

Under what circumstances?*

Are vehicles used for:*

Business only
Business and personal
Personal only

Which vehicles are used for personal purposes?*

Please explain the breadth of personal use:*

Is there a regular maintenance/repair program in place?*

Yes
No

Please explain what kind of program is in place:*

Are there any safety devices in the vehicles or safety protocols drivers have to follow, in place?*

Yes
No

For Example: low-jack/tracking devices, speed monitoring devices, cell phone usage policies, good driver incentive programs, seat belt enforcement, etc.

Please list the safety devices and protocols employed:*

Commercial – Owned Business Auto

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Commercial - Owned Business Auto

Customer Information

Prior Insurance / Claims

Driver Information

Driver 1 Information

Driver 2 Information

Driver 3 Information

Driver 4 Information

Hired & Non-Owned Auto Exposure

Owned Vehicle Information