Contingent Auto Liability - Quick Quote | Proactive Financial Corp

Contingent Auto Liability – Quick Quote Request

Fill out the form below to get a fast, accurate CAL quote for your brokerage.

Date *

Applicant Name *

Brokerage Name *

Email *

Phone Number *

Legal Entity Name *

DBA (if any)

Mailing Address *

FEIN / Tax ID

Years in Business

Website (if any)

Description of Operations *

US DOT #

MC # *

Do you hire owner-operators or third-party carriers? *

Estimated vehicles hired annually *

Radius of Operations *

Local (<100 miles) Intermediate (100–300 miles) Long Haul (>300 miles)

Commodities Hauled (check all that apply)

General Freight Refrigerated Food Household Goods Autos Hazardous Materials

Other:

Single Combined Limit Required *

Requested Effective Date *

Current Carrier & Expiry (if any)

Any losses in last 3 years?

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