Business Auto Insurance Application – Tiger Insurance Group LLC

Business Auto Insurance Quote

Get your Business Auto Insurance application in today!

"*" indicates required fields

1BUSINESS AUTO INSURANCE QUOTE

2POLICY INFORMATION

3DRIVERS

4VEHICLES

5COVERAGES

6UNDERWRITING

Business Auto Insurance Quote

Save up to 20% on your insurance. Get a quote and get covered.

Business

Name DBA

Applicant Information*

First Last

Date of Birth*

MM slash DD slash YYYY

Mailing Address

Street Address Address Line 2 City State ZIP Code

Business Phone*

Business Website Address

Entity Type*

Years in Business:*

Is this a Non-Profit?*

Yes

When was business established?*

MM slash DD slash YYYY

Proposed Effective Date*

MM slash DD slash YYYY

Garaging Location*

Same as mailing address

Street Address Address Line 2 City State ZIP Code

Additional Location?

Additional Location

Row ID	Location Address	Actions

There are no Garage Locations.

Maximum number of garage locations reached.

Nature of the business:*

Classification*

Description Of Operations

Retail store or service operations % of total sales?

Additional Interest?*

Yes

Additional Interest

Name	Address	Actions

There are no Additional Interests.

Maximum number of additional interests reached.

Waiver of Subrogation Needs*

Is a Federal Filing Required?

Yes

Federal (BMC-91)*

Yes

How long has the insured's current federal operating authority been active?

How long has the insured had continious insurance with their current carrier?

Can the insured provide a claim free 3 year loss run?*

Yes

Federal Liability (MCS-90)*

Yes

Federal Cargo (BMC-32)*

Yes

State Filings

State Cargo Filings

Other

Does the insured have a DOT or MC number?*

NONE

DOT

DOT Number*

MC Number*

Import Drivers OR Add Below

Accepted file types: pdf, xlsx, Max. file size: 750 MB.

Add Driver

Driver License #	First	Last	Actions

There are no Drivers.

Maximum number of drivers reached.

Add Vehicle

VIN#	Actions

There are no Vehicles.

Maximum number of vehicles reached.

COVERAGES

Liability Limit (CSL EA)*

Medical Payments*

Liability Coverage Auto Symbol

Uninsured Motorists*

Yes

Liability Limit (CSL EA)*

Comprehensive Deductible*

Other Deductible*

Collision Requested*

Other Deductible*

Waiver of Collision*

Yes

Towing & Labor*

Other Reimbursement*

Transportation Expense/ Rental Reimbursement*

Underwriting

General Information

Is the applicant a subsidiary of another entity?*

Yes

Entity Name*

Parent Company Name Relationship Description

Number*

Please enter a number greater than or equal to 0.

% Owned

Does the applicant have any subsidiaries?*

Yes

Entity Name*

Parent Company Name Relationship Description

Number*

Please enter a number greater than or equal to 0.

% Owned

Is a formal safety program in operation?*

Yes

Untitled*

Safety Manual

Safety Position

Monthly Meetings

Osha

Other

Any exposure to flammables, explosives, chemicals?*

Yes

Exposure...*

Any policy or coverage declined, canceled or non-renewed during the prior three (3) years for any premises or operations?*

Yes

Untitled*

Non-Payment

Non-Renewal

Underwriting

Condition Corrected

Agent No Longer Represents Carrier

Any past losses or claims relating to sexual abuse or molestation allegations, discrimination or negligent hiring?*

Yes

untitiled*

During the last five years (TEN IN RI), has any applicant been indicted for or convicted of any degree of the crime of fraud, bribery, arson or any other arson-related crime in connection with this or any other property?*

Yes

untitiled*

Any uncorrected fire and/or safety code violations?*

Yes

Occur Date*

MM slash DD slash YYYY

Explanation*

Resolution*

Resolve Date*

MM slash DD slash YYYY

Occur Date*

MM slash DD slash YYYY

Explanation*

Resolution*

Resolve Date*

MM slash DD slash YYYY

Has applicant had a foreclosure, repossession, bankruptcy or filed for bankruptcy during the last five (5) years?*

Yes

Occur Date*

MM slash DD slash YYYY

Explanation*

Resolution*

Resolve Date*

MM slash DD slash YYYY

Occur Date*

MM slash DD slash YYYY

Explanation*

Resolution*

Resolve Date*

MM slash DD slash YYYY

Has applicant had a judgment or lien during the last five (5) years?*

Yes

Occur Date*

MM slash DD slash YYYY

Explanation*

Resolution*

Resolve Date*

MM slash DD slash YYYY

Occur Date*

MM slash DD slash YYYY

Explanation*

Resolution*

Resolve Date*

MM slash DD slash YYYY

Has business been placed in a trust?*

Yes

Untitled*

Any foreign operations, foreign products distributed in USA, or us products sold / distributed in foreign countries?*

Yes

Does applicant have other business ventures for which coverage is not requested?*

Yes

Untitled*

Does applicant own / lease / operate any drones?*

Yes

Untitled*

Does the applicant hire others to operate drones?*

Yes

Untitled*

With the exception of any encumbrances, are any vehicles for which insurance is requested not solely owned by and registered to the applicant?*

Yes

VIN#*

Owner Name*

VIN#*

Owner Name*

Do over 50% of the employees use their autos in the business?*

Yes

Untitled*

Is there a vehicle maintenace program in operation?*

Yes

Untitled*

Are any vehicles leased to others?*

Yes

Untitled*

Do operations involve transporting hazardous material*

Yes

Untitled*

Any vehicles used by family members*

Yes

Untitled*

Does the applicant obtain mvr verifications?*

Yes

Untitled*

Does the applicant have a specific driver recruiting method?*

Yes

Untitled*

Are any drivers not covered by workers compensation?*

Yes

Untitled*

Any vehicles owned but not scheduled on this application?*

Yes

Untitled*

Any drivers with convictions for moving violations?*

Yes

Provide Details (One Violation Per Line)*

Attachments (Any optional or pertinent information to include with this application)

Max. file size: 750 MB.

Consent*

*To provide you with an accurate quote, our carrier partners obtain information about you and other household members from consumer reporting agencies. This includes credit-based insurance score, driving and claim histories and other consumer reports. They use this information to underwrite and rate your policy. They may order additional reports to update or renew your insurance. Our carrier partners may use a third party to develop a credit-based insurance score. Not all reports are ordered in all states.

* I affirm that I have reviewed this information with the customer as required by law.

Insurance Quote

Get your insurance protection today!

Save up to 20% on your insurance. Get a quote and get covered.

What would you like to quote?(Required)

Commercial Lines

Personal Lines

Life Insurance

Select Personal Product(Required)

Commercial Product?(Required)

Would you like to submit an application yourself OR securely and quickly connect your existing policy for a Tiger agent to take over?(Required)

I want to submit myself.

I'd like a Tiger agent to help.

Do you have an existing policy?(Required)

Yes

CONNECT EXISTING POLICY

Name(Required)

First Last

Phone(Required)

Email(Required)

Enter Email Confirm Email

Upload documents here:

Drop files here or

Accepted file types: pdf, Max. file size: 750 MB, Max. files: 3.

We prefer you upload your policy declarations page. However, you may upload any documents you have.

[email protected]

702.518.1535

Business Auto Insurance Quote

Business Auto Insurance Quote

COVERAGES

Underwriting

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