Fillable Excess Transportation Supplemental Application (Hallmark Financial Services)

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Excess Transportation Supplemental Application (Hallmark Financial Services)

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The Excess Transportation Supplemental Application (Hallmark Financial Services) form is 1 page long and contains:

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Country of origin: US
File type: PDF

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Broker:
5420 Lyndon B. Johnson Freeway, Ste. 1100 Dallas, TX 75240
XSAutoSubmissions@hallmarkgrp.com P: 800-486-5616
Excess Transportation Supplemental Application
UL Coverages: Limits Requested: Target Pricing:
DOT
Numbers:
Projected:
Current:
1st Year:
2nd Year:
3rd Year:
4th Year:
Effective Date:
S
ubmission Includes:
Additional Exposures:
HNOA $:
Subhauler Cost of Hire $:
Truck Brokerage/ Freight
Forwarding Revenue $:
# of Teams:
# of Slip Seating:
# of Owner/Operators:
5 years currently
valued loss runs:
Radius of Operations (%):
0-50
51-200
>500
Y
ears in Business:
Vehicle Schedule:
Details on Losses
Greater Than $100k:
Company
Financials
(if available):
Acord Applications:
Trucking Supplemental:
(required):
Underlying Quotes:
Loss Summary:
IFTA’s
(if available):
Additional Notes:
Driver’s List:
Description of Operations/Commodities/Trailer Types:
Website:
Exposures:
# Rev Units: # Service Units: Revenue:
Mileage:
Physical Address:
City:
Name Insured:
ANI’s (if app.):
Mailing Address:
State:
Zip:
ANI
Description of
Ops (if app.):
201-500
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Excess Transportation Supplemental Application (Hallmark Financial Services)

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Completed 31 January 2021

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