Quotation for Taxi, Limousine or Bus

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Company Name Business Type: Indi Partner CorpLLC
Address City
State Zip Code
Insured FEIN OR SSN Proposed Eff Date
Description of Operation  
Phone   Fax
E-mail Address   Phone Optional
Contact Person   Title
Number of Years in the Business Number of Total Vehicles
Type of Operation Motor Coach School Bus Transit Bus Limousine Taxi Cab
Driver 1 Full Name DOB Driver Lic Violations Exp
Driver 2 Full Name DOB Driver Lic Violations Exp
Driver 3 Full Name DOB Driver Lic Violations Exp
Driver 4 Full Name DOB Driver Lic Violations Exp
Vehichle1 Year/Make/model V.I.N
Vehichle2 Year/Make/model V.I.N
Vehichle3 Year/Make/model V.I.N
Vehichle14 Year/Make/model V.I.N
Current Insurance Company Losses Expiration Date
Coverage: Liability Limit 2,000,000.001,000,000.00500,000.00300,000.00
Coverage: UM Limit Physical Damage Deductible
Comments  
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