Limits & coverages Anticipated Inception Date: Cover Required: Broad Form 15 What policy limits do you require? Note any special exceptions or reasons for especially high limits: There is more space at the end of the form if you need Truck Limit $ Loss $ Deductible $ Note any special reasons for a variable deductible. Underwriters usually impose a deductible of at least $5000 for theft of target items (items A to H on previous page). Optional endorsement requested Please indicate which optional endorsements you would like to purchase and specify limit. ENDORSEMENT LIMIT $ Cargo on Trailers in Tandem Endorsement Please advise what percentage of – Yes No 1 the operation uses trailers in tandem: % Refrigerated Breakdown Endorsement. Min Deductible $2500.00 $ 2 NOTE: Ten year age limitation in this endorsement. Riggers Endorsement. $ 3 Contingent Transit Endorsement Brokering). $ 4 Unattended Truck Endorsement. $ 5 Earned Freight Endorsement Yes No 6 Debris Removal Endorsement $ 7 L.T.L. Endorsement (Off Truck Cover) $ Cover for cargo UNLOADED from trucks is required at the following terminals $ Address Limit $ A $ $ B 8 Terminal Protections: Fully Fenced / Gates 24 Hour Guards Building Alarmed Building Sprinklers A B In Full Premium Endorsement $ 9 Limits cover to named trucks only. We will need a list of VIN numbers. $ Any one trailer. Trailer Interchange Endorsement 10 Approx no. of trailer interchange day’s per annum? $ $ Any one loss. Target to be covered Deductible Target Interest Inclusion $ 11 Endorsement $ Note: All Policies are subject to a 25% minimum retained premium.
Limits & coverages Anticipated Inception Date: Cover Required: Broad Form 15 What policy limits do you require? Note any special exceptions or reasons for especially high limits: There is more space at the end of the form if you need Truck Limit $ Loss $ Deductible $ Note any special reasons for a variable deductible. Underwriters usually impose a deductible of at least $5000 for theft of target items (items A to H on previous page). Optional endorsement requested Please indicate which optional endorsements you would like to purchase and specify limit. ENDORSEMENT LIMIT $ 1 Cargo on Trailers in Tandem Endorsement – Please advise what percentage of the operation uses trailers in tandem: % Yes No 2 Refrigerated Breakdown Endorsement. Min Deductible $2500.00 NOTE: Ten year age limitation in this endorsement. $ 3 Riggers Endorsement. $ 4 Contingent Transit Endorsement Brokering). $ 5 Unattended Truck Endorsement. $ 6 Earned Freight Endorsement Yes No 7 Debris Removal Endorsement $ 8 L.T.L. Endorsement (Off Truck Cover) $ Cover for cargo UNLOADED from trucks is required at the following terminals $ Address Limit $ A $ B $ Terminal Protections: Fully Fenced / Gates 24 Hour Guards Building Alarmed Building Sprinklers A B 9 In Full Premium Endorsement Limits cover to named trucks only. We will need a list of VIN numbers. $ 10 Trailer Interchange Endorsement Approx no. of trailer interchange day’s per annum? $ Any one trailer. $ Any one loss. $ 11 Target Interest Inclusion Endorsement Target to be covered Deductible $ $ Note: All Policies are subject to a 25% minimum retained premium.