Every day delivery companies are exposed to catastrophic losses where the damages owed to victims
could easily exceed the $500,000 or $1 million liability limits of typical insurance policies.  Luckily the
insurance industry has developed catastrophic "Umbrella" Liability Insurance, which costs just a small
fraction of what you pay for your first ('primary') layer of protection.  Apply below and see for yourself!

Call KBS from 8:30 AM - 6:00 PM EST for assistance with any part of this application.  You will
receive an email confirming our receipt of your application and a quote should be available within
4 hours (sometimes even minutes!).  We will notify you of any delays or if additional information is
required to proceed.

Finally, in order to provide you with more definitive quotations and a proposal that helps you compare
your choices, please fax KBS the Declarations Pages (also sometimes called the "Information
Pages" or "Face Pages").of your current Umbrella Liability policy (if you have one), as well as your
Auto, General Liability, and Workers Compensation policies. The KBS Fax Number: 914-636-0802.

Please note that no insurance is bound pending insurance carrier approval.  

Proceed to Application        Return to  Applications Pg. or  Client Services

 

 

 

Umbrella Compensation Application

Named Insured: 

Phone:        Fax:  

Type of Organization:

Federal Employer ID Number:

Contact Person:  
Title:  

E-Mail:  

Year Established:     (If less than 3 years, describe experience)

States Where You Have Offices: 

Complete Addresses of all Locations: (if more than one, indicate HQ)

Describe Operations other than Same-Day, Local Delivery:   check if "none"

Name/Describe any other businesses you own or manage:

Describe hiring standards, guidelines, and procedures for Delivery Personnel:
For example, age and vehicle standards, MVR checks and standards, experience, training, etc.

Describe all safety programs, training, meetings, incentives: 
Attach copies of any written materials


Operational Information: (complete for all classes, regardless of coverage)

Classification

 Total Number Number  Part-Time Empl or IC? Annual 'Payroll'/1099 (optional)
Drivers of Your Vehicles $
Owner-Operators $
Bikers $
Walkers $
Outside Sales $
Executive Officers $
Administrative / Office $
Other: (specify below) $

Claims Information for Prior Three Years:
1.  Any auto claims in excess of $25,000?   Yes    No
2.  Any general or bicycle liability claims in excess of $25,000?    Yes    No
3.  Any workers compensation claims in excess of $25,000?    Yes    No
For any claims, please provide details  (date, amount, description of claim, etc.)

 Current Insurance Information:

Categories

  Auto Insurance General Liability Workers Compensation Other:

Insurance Co.
Liability Limit
Policy Number
Expiration Date
Premium $ $ $ $

Notes / Comments:

Thank you for turning to KBS.  You will hear from us shortly!

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914-636-0802 fax
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