Non-Owned Auto Coverage Supplement

 
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Supplemental Information
Name of Business:*
Business Contact:*
Contact Phone:*
Contact Email:*
Is Non-Ownership Liability Coverage being required by contract?*

Is Non-Ownership Liability Coverage being required by umbrella carrier?*

Is Non-Ownership Liability Coverage being required by other?*

If other, please explain:
Total number of employees:*
Total number of non-owned autos used in your business:*
Will non-owned autos other than private passenger types, pickups or vans be used?*

If yes, how often and why?
Are passengers transported?*

Are non-owned autos likely to be operated beyond 200 miles?*

If yes, how often and why?
If this is a social service operation, indicate the total number of volunteers furnishing autos for your operation:
Maximum number of volunteers at one time:
How often are non-owned autos used in your business?
Estimate the number of hours non-owned autos are used per month:
Do your employees lease autos on your behalf?*

If yes, under whose name are the autos leased?
Do you report employee mileage reimbursements for tax purposes?

If yes, how many miles were reported last year?
What is the estimated annual mileage for use of all non-owned autos (regardless of tax reimbursement status)
Do you require employees to have their own insurance?

If yes, what are the minimum limits required?
Do you require proof of insurance?

Will you use non-owned autos other than those owned by your employees?*

If yes, whose autos will you be using?

 
 
*Required fields:


Complete if Non-Owned Coverage is Requested

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