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California Farm Insurance
"Keeping the Farm in the Family"
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Water
MENU
MENU
Home
Farm & Ranch
Farm Insurance
Commercial Agriculture Insurance
CA Farms
Types of Farm Insurance
California Farms
Our Insurance lines
Agriculture
ranch insurance
Farm Insurance Quote
California Farm Insurance
Wineries
Equine
Equine General Liability
Equine Assisted Therapy
Events
Everything Agricultural
WhatsHappeningToday.com
Contact
FAQ
Water
Trucking 1-5 Units
Trucking & Transportation 1 to 5 Units
Trucking Quote(2)
Step
1
of
4
- Applicant Information
0%
Are you new to this site?
*
Please Select
Yes
No
We highly recomment registering for this site because it will save you time in the future in receiving quotes and it provides us with security information that we will require in order to assisty you with servicing.
Expiration Date of current Insurance
MM slash DD slash YYYY
Website
Email
*
Enter Email
Confirm Email
Business Name
*
Input DBA or if none, type "none" or your Name.
Phone Primary
*
Fax Number:
Name
*
First
Last
Mailing Address:
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Please indicate a mailing address by street or P.O. Box
Describe Operations
Description of Operations / Trucking
*
Please describe the kind of cargo transported
Just a brief statement or detailed if you wish.
Coverage limits requested
Liablity:
*
Please select
$750,000
$1,000,000
$2,000,000
Uninsured Motorists
*
Please Select
Reject
$100,000
$300,000
$1,000,000
Medical
*
Please select
Reject
$1,000
$2,000
$5,000
Unidentified Trailer limit
*
Please select
Reject
$5,000
$10,000
$20,000
$30,000
$40,000
$50,000
$60,000
$70,000
Cargo Coverage limit: (enter limit desired)
Truck / Tractor Units (Up to 5 units on this form)
How many Truck / Tractor Units to you have?
*
1 Trucks / Tractors
2 Trucks / Tractors
3 Trucks / Tractors
4 Trucks / Tractors
5 Trucks / Tractors
Truck / Tractor Unit 1
Truck-Tractor-1 Year, Make & Model
*
Truck Unit # 1 (GVW or GCW)
*
Truck-1 Radius
*
Comp.& Collision on Truck-1?
*
Please select
Reject
Yes
No
Truck 1 Stated Value
# 1 Deductible
Please select
$500
$1,000
$2,000
$2,500
$5,000
$10,000
Truck / Tractor Unit 2
Truck-Tractor 2: (Year, Make & Model)
Truck Unit # 2 (GVW or GCW)
Truck 2 - Radius
Comp. & Collision on Truck 2?
Please select
Yes
No
Reject
Truck 2 Statef Value
Truck 2 Deductible
Please select
$500
$1,000
$2,000
$2,500
$5,000
$10,000
Truck / Tractor Unit 3
Truck-Tractor 3: (Year, Make & Model)
Truck Unit # 3 (GVW or GCW)
Truck 3 - Radius
Comp. & Collision on Truck 3?
Please select
Yes
No
Reject
Truck 3 Stated Value
Truck 3 Deductible
Please select
$500
$1,000
$2,000
$2,500
$5,000
$10,000
Truck / Tractor Unit 4
Truck-Tractor 4: (Year, Make & Model)
Truck Unit # 4 (GVW or GCW)
Truck 4 - Radius
Comp.& Collision on Truck 4 ?
Please select
Yes
No
Reject
Truck 4 Stated Value
Truck 4 Deductible
Please select
$500
$1,000
$2,000
$2,500
$5,000
$10,000
Truck / Tractor Unit 5
Truck-Tractort 5: Year, Make & Model
Truck Unit # 5 (GVW or GCW)
Truck 5 - Radius
Comp.& Collision on Truck 5 ?
Please select
Yes
No
Reject
Truck 5 Stated Value
Truck 5 Deductible
Please select
$500
$1,000
$2,000
$2,500
$5,000
$10,000
Trailer Units (1 to 5)
How many Trailer Units do you have?
Please select
None
Trailers 1
Trailers 2
Trailers 3
Trailers 4
Trailers 5
Trailer 1
Trailer Unit 1 Year, Make & Model
Trailer 1 Radius
Comp.& Collision on Trailer 1?
Please select
Yes
No
Reject
Tailer 1 State Value
Trailer 1 Deductible
Please select
$500
$1,000
$2,000
$2,500
$5,000
$10,000
Trailer 2
Trailer Unit 2 Year, Make & Model
Trailer 2 Radius
Comp.& Collision on Trailer 2?
Please select
Yes
No
Reject
Tailer 2 State Value
Trailer 2 Deductible
Please select
$500
$1,000
$2,000
$2,500
$5,000
$10,000
Trailer 3
Trailer Unit 3 Year, Make & Model
Trailer 3 Radius
Comp.& Collision on Trailer 3?
Please select
Yes
No
Reject
Tailer 3 State Value
Trailer 3 Deductible
Please select
$500
$1,000
$2,000
$2,500
$5,000
$10,000
Trailer 4
Trailer Unit 4 Year, Make & Model
Trailer 4 Radius
Comp.& Collision on Trailer 4?
Please select
Yes
No
Reject
Tailer 4 State Value
Trailer 4 Deductible
Please select
$500
$1,000
$2,000
$2,500
$5,000
$10,000
Trailer 5
Trailer Unit 5 Year, Make & Model
Trailer 5 Radius
Comp.& Collision on Trailer 5?
Please select
Yes
No
Reject
Tailer 5 State Value
Trailer 5 Deductible
Please select
$500
$1,000
$2,000
$2,500
$5,000
$10,000
Driver Informaion
All drivers, temporary, seasonal, part-time or full-time must be listed. You can fax the MVR's to 209-223-3227 or Upload them thru this form. You can also have us order them at a cost of $10.00 each. Note: we cannot release the actual mvr to you as a privacy issue. An an alternative you can have your drivers go to DMV and get their own "individual" drivers license.If you have us order the MVR and the data You provided is incorrect you do not get a refund on the order as we do not get a refund. We highly suggest you get clear copies of the MVR's and provide accurate data as to 1.) First and Last name 'as they' appear on the license, Date of Birth, license number and State. If Foreign license number please provide foreign license number.
Driver 1
1. Driver First and Last Name
*
1. Date of Birth
*
1. License number:
*
1. State or Country if International
*
1.Years experience driving Class A
*
1. How many tickets/accidents 5yrs?
*
Driver 2
2. Driver First and Last Name
2. Date of Birth
2. License number:
2. State or Country if International
2.Years experience driving Class A
2. How many tickets/accidents 5yrs?
Driver 3
3. Driver First and Last Name
3. Date of Birth
3. License number:
3. State or Country if International
3.Years experience driving Class A
3. How many tickets/accidents 5yrs?
Driver 4
4. Driver First and Last Name
4. Date of Birth
4. License number:
4. State or Country if International
4.Years experience driving Class A
4. How many tickets/accidents 5yrs?
If more drivers or comments enter information here
Additional Underwriting Information
Do you use Sub-haulers?
*
Yes
No
Sub-hauler Gross Reciepts
What kinds of filings do you require?
*
Department of Motor Vehicle
ICC
Other
Explain "other"
Are you "New in this business?"
*
Please select
Yes
No
If new in business then you will not have had prior coverage of your own. If that is the case we need to know who your previous employer(s) were for the last five years.
Previous Employer 1
Previous Employer 2
Insurance Information
Name of Current Insurance Carrier
*
If non State "none"
Current policy expires on what Date?
MM slash DD slash YYYY
For how many years have you carried your own insurance?
*
Please select
One
Two
Three
New business
Prior Carrier Name 1
Policy Date 1
1. Claim payout $?
*
Any claims? if non type "none".
Prior Carrier Name 2
Policy Date 2
2. Claim payout $?
Prior Carrier Name 3
Policy Date 3
3. Claim payout $?
You may upload prior loss runs, motor vehicle reports
Drop files here or
Select files
Accepted file types: jpg, git, png, pdf, Max. file size: 100 MB, Max. files: 15.
Motor Vehicle Reports
Quantity
Price:
$10.00
Quantity
Total Price to be invoiced to you
$0.00
An invoice will be prepared and sent via email using Paypal from Athena Insurance and Financial Services