Obtain a truck insurance quote ONLINE

Intermodal Trucking Companies looking for an expert with the UIIA Intermodal Association.

Whether it be Trailer interchange, Primary Liability, or Cargo, we
haveagents available to take your call.

Ocean Marine

We offer a wide arrangement of Freight Broker and Freight Forwarder

Complete this Form and press submit button to send us your information.
(More complete submissions provide for faster results.)

*Required

*Date:

*Name:
*Address:
*City:
*State: Ye! *Zip:
*Phone#:
Fax #:
*E-mail:

Coverages

*Auto Liability (Please select one)

$750,000 CSL

$1,000,000 CSL

Motor Truck Cargo

$Coverage Limit
$Deductible
(Normal shipper requirements are $100,000)

Additional Coverages

Workers' Comp

Trailer Interchange

General Liability

Occ/Accident

Non-Truck Liability(Bobtail)
*For owner-operators only

$500,000 CSL

$750,000 CSL

$1,000,000 CSL

Truck Physical Damage(Damage to your vehicle)

$500 Deductible

$1,000 Deductible

$2,500 Deductible

Equipment

* For types, use...TT=Tractor, ST=Straight Truck, TR=Trailer, PASS=Passenger/Bus
	*Year	*Make	*Type	Full Serial-VIN (optional)	Value	*Radius of Operation
1)
2)
3)
4)
5)
Operations

ICC Docket Number: Years In Business:

For Hire: YesNo Filings Needed: YesNo

*Commodities Hauled (by % of time): (If "General Freight", please be as specific as possible.)

Reefer Breakdown Coverage?: YesNo (Standard Reefer Break-Down Deductible $2,500)

*Major Cities traveled to: (Please provide 3)

If in KY, is truck garaged in city limits? YesNo

If permanently leased:
Name of Lease Company:
Address:
Phone #: Fax #:

Drivers

Please note: Qualified drivers must have at least 2 years CDL A OTR experience.

*Driver Name	1)	2)
Date of Birth	1)	2)
Drivers Lic # /State Issued	1)	2)
Soc. Security #	1) (Optional)	2) (Optional)
Yrs Experience	1)	2)
Tickets/Accident	1) (Last 3 yrs)	2) (Last 3 yrs)
Covered by W/C	1) YesNo	2) YesNo

*Driver Name	3)	4)
Date of Birth	3)	4)
Drivers Lic # /State Issued	3)	4)
Soc. Security #	3) (Optional)	4) (Optional)
Yrs Experience	3)	4)
Tickets/Accident	3) (Last 3 yrs)	4) (Last 3 yrs)
Covered by W/C	3) YesNo	4) YesNo

*Driver Name	5)
Date of Birth	5)
Drivers Lic # /State Issued	5)
Soc. Security #	5) (Optional)
Yrs Experience	5)
Tickets/Accident	5) (Last 3 yrs)
Covered by W/C	5) YesNo
Thank you for your time in submitting this insurance quote form. A representative from our agency will contact you as soon as possible.