Trucking Insurance Company Information Company Name Address City Province Postal Code Contact Person Email Address Phone Number Type of risk: Log HaulingWood Chip HaulingFinished LumberSand and GravelOther Years of experience: Present Insurer: Expiry Date: Claims History last 5 years: Conviction History last 5 years: Radius of operation: Province & average Distance Travelled: If any U.S. operations, please advise: Driver Information Name: Age: Experience: Vehicle Schedule Year: Make: Model: Limit price: List Price New/Actual Value: Coverages Liability Limit: $1,000,000$2,000,000 All Perils Deductible:
