Submit this form through your insurance agent or directly to your insurance carrier. Ensure all fields are completed accurately and attach any required supporting documents. For physical submission, send the form to your carrier's address. Alternatively, you can submit the form via email or fax if these options are available. My advice is to review the form thoroughly before submission to avoid any errors or omissions.

Ensure to review and update your coverage limits annually. Policy renewals are typically due before the end of each calendar year.

This form serves to document the various coverages and limits for commercial auto insurance policies in California. It is crucial for business owners and commercial vehicle operators to accurately fill out this form to ensure they have appropriate insurance coverage. By providing detailed information on coverages such as liability, collision, and medical payments, the form helps mitigate risks and comply with state regulations. The purpose of this form is also to allow policyholders to make informed decisions about their insurance needs. It ensures they can select the appropriate coverage options and limits to protect their business assets and operations. Overall, completing this form accurately and comprehensively is vital for maintaining adequate insurance protection.

• 1. Agency Customer ID: Identifier for the agency customer.
• 2. Named Insured(s): Name(s) of the insured individual or entity.
• 3. Policy Number: Unique identifier for the insurance policy.
• 4. Effective Date: Date the policy becomes effective.
• 5. Carrier: Insurance carrier providing the coverage.
• 6. NAIC Code: National Association of Insurance Commissioners code for the carrier.
• 7. Coverages: Section to specify various coverages and limits.
• 8. Liability: Details about liability coverage and limits.
• 9. Collision: Details about collision coverage and deductibles.
• 10. Medical Payments: Information on medical payments coverage.
• 11. Uninsured Motorist: Details about uninsured motorist coverage options.
• 12. Waiver of Deductible: Option to select or reject deductible waiver for collision coverage.
• 13. Signature: Fields for applicant and producer signatures.
• 14. Additional Remarks: Section for additional comments or endorsements.

Failure to submit this form can result in inadequate insurance coverage and potential legal issues.

• Inadequate Coverage: Not submitting the form can lead to gaps in your insurance coverage.
• Legal Penalties: You may face penalties for non-compliance with state insurance regulations.
• Claim Denials: Incomplete insurance documentation can result in denied claims.

• 1. Policy Application: Complete this form when applying for a new commercial auto insurance policy.
• 2. Policy Renewal: Use this form to renew an existing commercial auto insurance policy.
• 3. Coverage Update: Submit this form to update your coverage limits and options.
• 4. Risk Assessment: Insurance underwriters use this form to assess risk and determine policy terms.
• 5. Compliance: Ensure compliance with California state insurance requirements.