Tow Truck Operator Form

First Name

Last Name

Email Address

Contact Number

Company Name

Business Address

City

State

Zip / Postal Code

Do you have two years of hard copy loss runs available? Do you have two years of hard copy loss runs available? Yes No

Is there a lapse in coverage in the last two (2) years? Is there a lapse in coverage in the last two (2) years? Yes No

What is your radius of operation? What is your radius of operation? 0-100 miles 101-300 miles 301+miles

Do you own and use transporter tags? Do you own and use transporter tags? Yes No

How many transporter tags?

Use:

Have you executed any contracts with hold harmless or waiver of subrogation agreements? Have you executed any contracts with hold harmless or waiver of subrogation agreements? Yes No

To whom and why?

What is your US DOT number?

US DOT number issue date?

What fillings are required?

If fillings are required, does this insurance cover all owned, leased and operated vehicles? If fillings are required, does this insurance cover all owned, leased and operated vehicles? Yes No

Do you ever hire owner/operators? Do you ever hire owner/operators? Yes No

Are all owner/operators scheduled on this policy? Are all owner/operators scheduled on this policy? Yes No

Do you subcontract your towing work? Do you subcontract your towing work? Yes No

Do they operate under your filing? Do they operate under your filing? Yes No

What percentage of your towing is for Private Passenger Type Vehicle?

What percentage of your towing is for Light/Medium/Heavy Trucks Percentage?

What percentage of your towing is for Ex-Heavy Vehicles Percentage?

What percentage of your towing is for Watercraft Percentage?

If are other types, please describe and state percentage

What percentage of your towing is done for For Hire Wrecker (24-hour towing, police rotation, etc.)?

What percentage of your towing is done for Wrecker Repo (Any repossession operations at all)?

What percentage of your towing is done for Wrecker with Garage Dealer (towing owned vehicles for your dealer operations)?

What percentage of your towing is done for Wrecker with Service Operation (towing customer’s autos to your shop for service/repair)?

What percentage of your towing is done for Wrecker with Salvage Operation (used exclusively to tow junk cars for salvage ops)?

Do you monitor police scanners to obtain business? Do you monitor police scanners to obtain business? Yes No

Describe your accident reporting procedures

Describe lot security? Describe lot security? None Fence & Gate Post & Cable In Building Others

Please describe

Where are vehicle keys kept when the business is closed? Where are vehicle keys kept when the business is closed? Key Cabinet Taken Home In/On the Vehicle

Do you check MVR's on all drivers before hiring? Do you check MVR's on all drivers before hiring? Yes No N/A (No Employees)

Do you check MVR's annually thereafter? Do you check MVR's annually thereafter? Yes No N/A (No Employees)

Do you and all your drivers have a CDL license? Do you and all your drivers have a CDL license? Yes No

If "No", please explain:

Do you hire drivers under age twenty-one (21)? Do you hire drivers under age twenty-one (21)? Yes No N/A (No Employees)

Do you and all your drivers have at least two (2) years experience driving a Tow Truck? Do you and all your drivers have at least two (2) years experience driving a Tow Truck? Yes No

Do you have a preventive maintenance program for vehicles? Do you have a preventive maintenance program for vehicles? Yes No

If "Yes", who performs the maintenance? If "Yes", who performs the maintenance? Employees Other (describe)

Other (describe):

Any Scheduled autos over twenty (20) years old? Any Scheduled autos over twenty (20) years old? Yes No

Vehicle inspection is required. If physical damage coverage is provided you will need to submit photos of all four sides of the vehicle. Vehicle inspection is required. If physical damage coverage is provided you will need to submit photos of all four sides of the vehicle. I agree

Are all Tow trucks equipped with emergency flashing lights and adequate exterior lighting? Are all Tow trucks equipped with emergency flashing lights and adequate exterior lighting? Yes No