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9 Union St N, STE 400
Concord North Carolina 28025
704-773-9699
Client Support
Get a Quote Now
Coverages
Resources
CLIENT SERVICE
Get a Certificate
MVR Request
ADDITIONAL RESOURCES
YouTube Channel
Schedule a Call
Start Up Checklist
Owner Op Lease Agreement
Accident Release Form
Amazon Relay Intermodal and UIIA Loads
FAQs
TRUCKING LIBRARY
Recent
IRS VCSP – Voluntary Classification Settlement Program
March 13, 2024
How to Get Cheaper Truck Insurance Quotes
November 28, 2023
All Articles
Partners
Contact
About
Our Agency
About Us
Daniel Summers
YouTube Channel
Schedule a Call
Write a Google Review
Get in Touch
9 Union St N, STE 400
Concord North Carolina 28025
704-773-9699
Client Support
Get a Quote Now
OperFi Freight Broker Quote
OperFi Freight Broker Quote
Charles String
2024-08-22T01:32:06-04:00
We can offer the following:
Freight Broker Bonds
Contingent Cargo
Contingent Auto
General Liability
Complete this form for quote(s)
Step
1
of
8
12%
Hidden
Insurance Agency Name
Hidden
Agency Phone
MC Number
(Required)
Company Name
(Required)
Company Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Primary Owner's Name
(Required)
First
Last
Phone
(Required)
Email
(Required)
SELECT THE LINE(S) OF COVERAGE FOR WHICH YOU WISH TO OBTAIN A QUOTE:
(Required)
Surety Bond [Broker Bond]
Contingent Cargo
Contingent Auto
General Liability
Cyber Liability
Professional Liability E & O
Please provide Insured's transportation related experience.
(Required)
Estimated Gross Revenue for the next 12 months?
(Required)
Does the insured use other brokers to arrange movement of goods?
(Required)
Yes
No
Do OTHER truck brokers use the insured to arrange movement of goods?
(Required)
Yes
No
Have the insured ever been named in a lawsuit?
(Required)
Yes
No
Does applicant obtain current certificates from motor carriers?
(Required)
Yes
No
Is applicant listed as Additional Insured on subhauler certificates?
(Required)
Yes
No
Is someone responsible for obtaining current certs as they expire?
(Required)
Yes
No
Has Applicant ever had prior insurance Cancelled or Refused?
(Required)
Yes
No
Has Applicant ever had prior insurance coverage?
(Required)
Yes
No
In the past three(3) years, has the insured experienced any claims?
(Required)
Yes
No
Approximate number of truckers the Applicant deal with?
(Required)
List your top 4 commodities most frequently moved
(Required)
Commodity
Max Value
Add
Remove
CONTINGENT AUTO LIMITS
(Required)
$1,000,000 per Occurrence / $1,000,000 Annual Aggregate
$1,000,000 per Occurrence / $2,000,000 Annual Aggregate
$2,000,000 per Occurrence / $2,000,000 Annual Aggregate
$3,000,000 per Occurrence / $3,000,000 Annual Aggregate
DEDUCTIBLE OPTIONS
(Required)
$5,000
$10,000
Do you have a BROKER CARRIER AGREEMENT(BCA) that you would like to upload?
(Required)
Yes
No
BROKER CARRIER AGREEMENT(BCA) Upload
(Required)
Max. file size: 12 MB.
CONTINGENT CARGO LIMITS
(Required)
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
$400,000
$500,000
$750,000
$1,000,000
CARGO DEDUCTIBLE OPTIONS
(Required)
$1,000
$2,500
$5,000
$10,000
REEFER CARGO DEDUCTIBLE OPTIONS
(Required)
NOT NEEDED
$2,500
$5,000
$10,000
GENERAL LIABILITY LIMITS
(Required)
$1,000,000 per Occurrence / $1,000,000 Annual Aggregate
$1,000,000 per Occurrence / $2,000,000 Annual Aggregate
$2,000,000 per Occurrence / $2,000,000 Annual Aggregate
DEDUCTIBLE OPTIONS
(Required)
No Deduct - If Available
$1,000
$2,500
ARE FORKLISTS OR MOBILE USED?
(Required)
YES
NO
CLERICAL PAYROLL
(Required)
OFFICE SQUARE FT
(Required)
DO YOU NEED ANY OF THE FOLLOWING ENDORSEMENTS?
ADDITIONAL INSURED / BLANKET ADDITIONAL INSURED
WAIVER OF SUBROGATION
30 DAY NOTICE OF CANCELLATION
BUSINESS CONTENTS (BPP)
PRIMARY/NON-CONTRIBUTORY
BUSINESS CONTENTS LIMIT
(Required)
$25,000
$50,000
PROFESSIONAL LIABILITY E & O LIMITS
(Required)
100,000
250,000
500,000
1,000,000
Deductible
(Required)
1,000
2,500
Do you specialize in any specific commodities?
(Required)
Yes
No
Specific Commodities
(Required)
Commodity Type
Average Value Per Load
# of Shipments Annually
Add
Remove
If you belong to any professional organizations, please list them below.
Add
Remove
Tax ID / FEIN
(Required)
Company Established Date:
(Required)
MM slash DD slash YYYY
Primary Owner's Title
Primary Owner's SSN
(Required)
Primary Owner's Date of Birth
(Required)
MM slash DD slash YYYY
Primary Owner's Address
(Required)
Same as business address
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
This should match what is on your driver's license.
Does the Primary Owner Own Real Estate
(Required)
Yes
No
NUMBER OF ADDITIONAL OWNERS
(Required)
0
1
2
Second Owner's Name
(Required)
First
Last
Title
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
SSN
(Required)
Address
(Required)
Same as previous
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Does this Owner Own Real Estate
(Required)
Yes
No
Is this Owner a US Citizen?
(Required)
Yes
No
Third Owner's Name
(Required)
First
Last
Title
(Required)
Date of Birth
(Required)
MM slash DD slash YYYY
SSN
(Required)
Address
(Required)
Same as previous
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Does this Owner Own Real Estate
(Required)
Yes
No
Is this Owner a US Citizen?
(Required)
Yes
No
Consent to Credit Inquiry
(Required)
I agree to the terms and conditions.
In some cases, we may collect information for underwriting purposes. This information may include social security numbers, home addresses, dates of birth and driver's license numbers. In addition we may require personal and business financial statements. By providing personal or business information you agree and understand that As part of the underwriting process, we may review your personal and business credit history. To the extent required by law, we will, upon request, provide notice whether or not a consumer report has been requested by us or by an underwriting insurance or surety company, and if so, of the name and address of the consumer reporting agency furnishing the report.
Additional Notes
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