Insurance Commercial Auto Policies

COMMERCIAL AUTO POLICY APPLICATION AND DECLARATIONS

APPLICANT / INSURED INFORMATION

Insured Name:

Sole Proprietor Partnership Corporation LLC

Principal Place of Business:

POLICY DETAILS

Proposed Policy Number:

Liability (Bodily Injury & Property Damage) Combined Single Limit Uninsured/Underinsured Motorist Medical Payments

Collision (Physical Damage) Comprehensive Specified Causes of Loss Hired and Non-Owned Auto Liability

LIMITS, DEDUCTIBLES, AND PREMIUM

Liability Limit - Per Person: $ Liability Limit - Per Accident: $

Comprehensive Deductible: $ Collision Deductible: $

VEHICLE SCHEDULE (LIST ALL VEHICLES TO BE INSURED)

Vehicle 1 - Year: Make/Model: VIN:

Garaging Address:

Vehicle 2 - Year: Make/Model: VIN:

Garaging Address:

Additional vehicles may be listed on a separate schedule attached to the policy declaration page. If more vehicles are to be insured at inception, list vehicle details on additional pages and attach.

EXCLUSIONS, ENDORSEMENTS, AND SPECIAL CONDITIONS

Standard policy exclusions apply, including but not limited to willful or criminal acts by the insured, use of the insured vehicle for unauthorized public conveyance, and racing. Endorsements requested or issued will be listed on the declarations page.

LOSS PAYEE / BENEFICIARY / ADDITIONAL INSURED

Loss Payee / Lienholder Name:

Beneficiary / Additional Insured Name:

CLAIMS HISTORY / PRIOR LOSSES

DOCUMENTATION CHECKLIST

Provide copies of the following as applicable (check items attached):

Vehicle Registration(s) Drivers List with MVRs Prior Policy Declarations

Photographs of Equipment / Vehicles Loss History / Claims Reports Other Documentation (describe below)

DECLARATIONS, REPRESENTATIONS AND CERTIFICATION

The undersigned declares that the information supplied in this application is true and complete to the best of the applicant's knowledge. The insured understands that this application shall be the basis of the contract with the insurer and that any material misrepresentation, omission, concealment or incorrect statement may be grounds for denial of coverage or rescission of the policy in accordance with the terms and conditions of the policy.

By signing below the applicant authorizes the insurer to obtain motor vehicle records, claim history, credit and other underwriting information necessary to evaluate this application. The applicant further agrees to cooperate with the insurer in the investigation and defense of any claim, to report occurrences as required by the policy, and to comply with the policy terms and conditions.

The applicant acknowledges that premium, coverage availability and terms are subject to underwriting review and verification of information provided. Coverage becomes effective only when a policy is issued by the insurer and the first premium is paid, subject to any conditional or binder provisions agreed in writing.

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