NEON 2468 APPLICATION FOR QUOTE
UNDERWRITER: [email protected]
BROKER:
INSURED:
DATE OF
APPLICATION:
March 22, 2017
CC:
[email protected]
1.
Name of the Insured:
2.
Address of the Insured:
3.
Policy Period:
From: [Click to Select Date]
Leave blank if TBA
To:
Leave blank if TBA
[Click to Select Date]
Both days inclusive, local standard time at the Address of the Insured
4.
Details of Additional Information Attached:
5.
Press ‘Control’ & Click to obtain a quote for:
MTC
APD
Page 1 of 7
NEON 2468 APPLICATION FOR QUOTE
COMMERCIAL AUTOMOBILE PHYSICAL DAMAGE
1.
Form:
NEON FORM 2017/01
SELECT
If an alternative Policy Wording is to be used, provide details here:
2.
Loss Payees / Lienholders:
Loss payee(s) and/or mortgagee(s) and/or lienholder(s) are automatically included hereon as and where applicable without prior
notification to Underwriters, each as their individual interests may appear.
3.
Interest:
Trucks, prime movers, tractor units, automobiles, trailers and similar interests (hereinafter “automobiles”) as may be declared to
the Underwriters, all as in the Automobile Schedule.
4.
Total Insured Value:
USD
5.
Limits of Liability:
i)
ii)
iii)
Actual cash value not exceeding:
USD
any unit in the Automobile Schedule.
USD
any combination of units in the Automobile Schedule.
USD
arising out of any one occurrence.
6.
Deductible:
USD
but minimum USD 2,000 in respect of overturn during loading or unloading of end
dump automobile(s).
7.
Premium:
USD
Calculated at annual rate
% on Total Insured Values
Page 2 of 7
NEON 2468 APPLICATION FOR QUOTE
8.
Optional Endorsements:
1.
Occurrence Deductible Endorsement
SELECT
2.
Additional Insured Endorsement
SELECT
3.
Lease Gap Endorsement
SELECT
4.
Alaska Endorsement
SELECT
5.
Driver Inclusion Endorsement
SELECT
6.
Protection of Salvage – Increased Expense Endorsement:
SELECT
Amount of increased expenses
7.
Radius of Use Limitation Endorsement:
Radius:
8.
SELECT
Miles:
Combined Motor Truck Cargo and Commercial Automobile
Physical Damage Occurrence Single Deductible Endorsement:
Deductible
9.
USD
USD
Downtime Rental Expense Endorsement:
SELECT
10. Insurance for Newly Acquired Owned Automobile(s) Endorsement:
SELECT
11. Trailer Interchange Endorsement:
SELECT
Trailer Limit USD
Loss Limit USD
12. Trailer Interchange Including Whilst Unattached
at Named Terminals Endorsement:
Trailer Limit USD
SELECT
Loss Limit USD
13. Garbage / Refuse Endorsement:
SELECT
14. Temporary Replacement Automobile Endorsement:
SELECT
Limit
9.
SELECT
USD
any one automobile
Surplus Lines Wordings:
Choose an item.
(Select from Drop Downs & add comment as applicable)
Choose an item.
Choose an item.
Choose an item.
Choose an item.
Page 3 of 7
NEON 2468 APPLICATION FOR QUOTE
10.
Additional Wordings:
11.
Claims Information:
Loss History Narrative:
12.
Additional Information:
13.
Attachments:
14.
Press ‘Control’ & Click to obtain a quote for:
MTC
Page 4 of 7
NEON 2468 APPLICATION FOR QUOTE
MOTOR TRUCK CARGO (USA)
1.
Form:
NEON FORM 2017/01
SELECT
If an alternative Policy Wording is to be used, provide details here:
2.
Interest:
The Insured’s liability for all risks of physical loss or direct physical damage to lawful cargo from an external cause whilst in their
care, custody or control as more fully described in the Motor Truck Cargo Neon Form (2007/01) and as per Conditions below.
3.
4.
Limits of Liability & Deductible:
A)
Truck Limit:
USD
B)
Loss Limit:
USD
C)
Deductible:
USD
Premium:
USD
(calculated at USD per power unit)
5.
Optional Endorsements:
1.
In Full Premium Endorsement:
SELECT
2.
Refrigeration Breakdown Endorsement:
SELECT
Deductible USD
3.
Riggers Endorsement:
a) Limit USD
(plus USD 1,000 if equipment more than 10 years old)
SELECT
b) Deductible USD
4.
Contingent Transit Endorsement (Truck Brokering):
SELECT
5.
Debris Removal Endorsement:
a) Limit USD
SELECT
6.
Less Than Trailer Load Endorsement (72 Hours off Truck Cover):
SELECT
Page 5 of 7
NEON 2468 APPLICATION FOR QUOTE
7.
Trailer Interchange Endorsement:
a)
8.
b) Loss Limit USD
Trailer Interchange Including Whilst Unattached
at Named Terminal(s) Endorsement:
a)
9.
Trailer Limit USD
SELECT
Trailer Limit USD
SELECT
b) Loss Limit USD
Target Interest Inclusion Endorsement:
a) Interests included:
SELECT
b) Limit any one claim for theft of these interests
c) Deductible any one claim for theft of these interests
USD
USD
10. Driver Inclusion Endorsement:
SELECT
11. Alaska Endorsement:
SELECT
12. Additional Insured Endorsement:
SELECT
13. Container Endorsement:
a) Container Limit USD
SELECT
b) Loss Limit USD
14. Double/Triple Wide Mobile Home Endorsement:
Total Deductible USD
SELECT
15. On Hook Endorsement:
SELECT
16. Named Terminals Extension for On Hook Endorsement:
SELECT
17. Cargo in and/or on Trailers in Tandem Endorsement:
SELECT
18. Loading and Unloading of Autos Endorsement:
SELECT
19. Loading and Unloading of Autos
(including Unloaded Vacated Autos) Endorsement:
SELECT
20. New Auto Valuation Endorsement:
Deductible USD
Option A
Option B
SELECT
SELECT
21. Named Perils Endorsement:
SELECT
22. Combined Motor Truck Cargo and Commercial Automobile
Physical Damage Occurrence Single Deductible Endorsement:
SELECT
23. Mobile Home Raising, Lowering and Setting Down Endorsement:
SELECT
24. LMA 5218 U.S. Terrorism Insurance Act of 2002 as amended
New & Renewal Business Endorsement (12/01/15)
Not Included
Additional Premium USD
25. LMA 5219 U.S. Terrorism Insurance Act of 2002 as amended
Not Purchased Clause (12/01/15)
Included
Page 6 of 7
NEON 2468 APPLICATION FOR QUOTE
6.
Surplus Lines Wordings:
Choose an item.
(Select from Drop Downs & add comment as applicable)
Choose an item.
Choose an item.
Choose an item.
Choose an item.
7.
Additional Wordings:
8.
Claims Information:
Loss History Narrative:
9.
Additional Information:
10.
Attachments:
11.
Press ‘Control’ & Click to obtain a quote for:
APD
Page 7 of 7