Bus & Taxi Form

Please complete in as much detail as possible

Company Name Phone Email
Contact Person Fax Website
City  St Zip
What do you operate? Inter or intra state Number of vehicles
Current Ex Date Liability Current PD Ex
Current Liability Company Current PD Company
Expiring Liability Premium Expiring PD Premium
Is business inside city limits If yes name of city
No. of yrs in Business   New Venture  Business Entity
Limit of Liability Deductible if any UM & UIM Limit
First Party Benefit if any

General Information

Description of operations:   Taxi Limo   Other

Are your vehicles double shifted

Do you have driver a training program

Safety Program   Vehicle Maintenance Program

At which Airports if any do you pick up or deliver

What percentage of your income is derived from airport pick up or delivery

Radius of Operation 0-50%  51-200%  Over 200 %

Major Cities to or through which you operate

Prior Insurance Carriers & Loss Experience

Policy # Insurance Comp Premium Paid Total Claim Paid Policy Period
Month and Year

 Please provide any other information you might think helpful.

Home Up

Send mail to CUSTOMER\insurancestrateg with questions or 
comments about this web site.
Copyright © 1999 Insurance Strategies, LTD
Last modified: February 01, 2005