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New Entrants to the motorcoach industry now have a unique opportunity to obtain quotes from the Nation's major insurers of motorcoaches. Fast and easy, operators should complete the short inquiry below to initiate a process the generally produces results, often in hours instead of the traditional few days.

UMA CoachSure Request
When would you like this coverage to be effective? (MM/YYYY)
Please provide some basic information about your company...
Company Name: DBA
Date Established:
Company Type: Individual Partnership Corporation Other
Business Phone: FAX:
Cell Phone: Home Phone:
Website: Email:
Mailing Address:
City: State:
Zip Code:
Where are you planning on garaging/parking your bus(es)?
Address:
City: State:
Zip Code:
Vehicle Information
YearMakeModel# of PAXVINValue
Are their any public transportation entity(ies) not covered under this application in which you or any of your officers, directors, partners, or stockholders have a direct or indirect ownership interest? If so, please provide their name, if none, please state none.
Who is the person in your company responsible for safety?
Name: Phone:
Operations Information
Please list the top 5 destinations your vehicle(s) will most frequently visit and the percentage of overall mileage attributed to each location:
 LocationPercentage
1.
2.
3.
4.
5.
Federal Employer Identification Number:
Do you have FMCSA Authority? NO YES - My MC# is:
If single state registration, please identify state:
Have you gotten intrastate operating authority? NO YES
Have you registered with the US Department of Transportation?
                      NO YES - My DOT# is:
Will your company service any casinos? NO YES - Please indicate % of trips:
Are you familiar with the Federal Motor Carrier Safety Regulations and will you comply with:
1. Driver Qualification Requirements:YES NO I NEED HELP
2. Maintenance Requirements:YES NO I NEED HELP
3. Drug/Alcohol Testing Requirements:YES NO I NEED HELP
4. Hours of Service Requirements:YES NO I NEED HELP
5. All Record Keeping Requirements:YES NO I NEED HELP
Driver Roster
Hire Date
MM/YYYY
NameDL#/StateSSNDOBFT/PT
FT PT
FT PT
FT PT
FT PT
FT PT
FT PT
Briefly describe your transportation work/business experience, background (driving, management, etc.):
Additional Comments:
 
      


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