Form 80: Commercial Auto Insurance Application

COMPANY INFORMATION

Company Legal Name *

DBA Name (if applicable)

Federal Tax ID Number *

Years in Business *

Business Address *

City *

State *

ZIP Code *

Primary Contact Name *

Phone Number *

Email Address *

Type of Construction Business *

VEHICLE INFORMATION & FLEET MANAGEMENT

Total Number of Vehicles in Fleet *

Vehicles to be Added to Policy *

Vehicle #	Year	Make	Model	VIN	Vehicle Type	GVWR	Primary Use
1
2
3
4
5

Vehicle Types in Fleet *

Annual Mileage per Vehicle (Average)

Radius of Operations

DRIVER QUALIFICATION REQUIREMENTS

Total Number of Drivers *

Minimum Driver Age Requirement

Driver Name	License #	State	DOB	Hire Date	Years Experience	CDL Required

Driver Qualification Standards

MVR review required

Background checks performed

Drug/alcohol testing program

Safety training program

Ongoing driver monitoring

COVERAGE OPTIONS & REQUIREMENTS

Liability Coverage Limits *

Physical Damage Deductible

Additional Coverage Requested

Uninsured/Underinsured Motorist

Medical Payments

Rental Reimbursement

Towing & Labor

Equipment Coverage

Cargo Coverage

Certificate Holders Required

ALLIANCE INTEGRATION BENEFITS

As an Alliance for Contractors member, you qualify for exclusive commercial auto insurance benefits:

Fleet Management Discounts: Up to 15% premium reduction through Alliance insurance partnerships
Driver Safety Training Programs: Access to certified safety training with additional premium reductions up to 10%
Equipment Tracking Integration: GPS tracking system integration for theft protection and route optimization
Maintenance Scheduling: Automated maintenance reminders and service scheduling through Alliance partners
Claims Management: Dedicated Alliance claims advocate for faster claim resolution
Risk Management: Quarterly safety assessments and risk reduction consultations
Multi-Policy Discounts: Additional savings when combined with other Alliance insurance products

SIGNATURE & SUBMISSION

Applicant Acknowledgment: I hereby apply for commercial auto insurance coverage as described above. I certify that the information provided is true and complete to the best of my knowledge. I understand that any misrepresentation may void coverage.

Applicant Signature *

Date *

Print Name *

Title *

Submit Application

Alliance for Contractors Insurance Department
Phone: 1-800-ALLIANCE (1-800-255-4262)
Email: [email protected]
Fax: 1-855-ALLIANCE-FAX

Required Documents: Please attach copies of current vehicle registrations, driver licenses, MVRs, and any existing insurance policies.

Processing Time: Applications are typically processed within 24-48 hours. You will receive confirmation and policy documents via email and mail.

Date of Loss	Type of Loss	Amount Paid	Driver Name	Description