Century surety company
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| CENTURY SURETY COMPANY
HIRED and NON-OWNED AUTOMOBILE SUPPLEMENT 1. Applicant’s Name______________________________________________________ 2. Mailing Address_______________________________________________________ 3. Why is coverage being requested? ________________________________________ _____________________________________________________________________ 4. How will the vehicles be used? ___________________________________________ _____________________________________________________________________ 5. What will be transported by these vehicles: ___________________________________ ______________________________________________________________________ 6. What is maximum distance non-owned vehicle will be driven from insured premises: _____ 7. How often are non-owned vehicles used? ______ Total number of non-owed vehicles used? ______ Total number of employees: _________ Does applicant require employees to provide proof of auto liability coverage? Yes No If yes, for what minimum limit?_____________________________________________ What is estimated cost of hire? ___________ Type of vehicles hired: ____________________________ What is GVW? _________ What is average term? __________________________________ Does applicant have a Commercial Auto Liability Policy in force? Yes No Coverage Desired:
Applicants Signature: _____________________________Date:__________________________ Directory: wp-content -> uploads -> 2013 2013 -> International post doctoral research fellowship programme final report title of the research 2013 -> Seals Family History 1565 to 2004 2013 -> Rao bulletin 15 July 2013 html edition this bulletin contains the following articles 2013 -> R institute of technology school of foreign languages 2013 -> Provisional Programme – subject to change thursday 10th april 2013 -> June, 2013 National hiv testing Day Month Men’s Health Week Hurricane Safety Month 2013 -> In memory of the residents of the Parish Chesham Bois that served their country during wwii 2013 -> Federal contract awards in georgia april 2013 Download 13.79 Kb. Share with your friends:
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