Online Limousine / Shuttle Insurance Quote

Name*

Care of/DBA

Phone*

Email*

Mailing Address

Street Address City State ZIP Code

Garaging Address

Street Address City State ZIP Code

How many years in business?

Description of operations

Any PATIENTS transported?

If so, wheelchair use or lift?

School children transp.?

# Years with current policy

Radius

Source of Business

LIMITS

Liability

Uninsured motorist

General liability

Vehicles

Copies of registrations will be required at time of binding

List of vehicles

Year, Make & Model	# Passengers	Stated Value ($)	Deductible

If you have multiple vehicles, please click + to add more.

Drivers

Submit all MVR's to info@discoveryins.com for quote

List of Drives

Full Name	License #	Years driving a limo	DOB(mm/dd/yy)	Tickets Accidents	SSN

If you have multiple drives, please click + to add more.

FILINGS REQUIRED

PUC #

Airport Exposure %

Airports

Bay Area
LAX
OC
Other

PRIOR CARRIER & LOSS INFORMATION

Loss runs will be required within 30 days of binding

Claims in the past 3 years

Amount Paid

Current Insurance

Policy #

Expires on

Prior Insurance

Policy #

Effective date

Prior Insurance

Policy #

Effective date

NEW VENTURES ONLY

Previous Employer(s) for the last 3 years:

New Ventures Only

COMMENTS

Comments